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BackgroundIndividuals with intellectual disabilities experience barriers to quality healthcare. To reduce this disparity, equipping medical trainees with the knowledge and skills required for treating this patient population is critical. Our aim is to describe the breadth of instructional interventions and identify gaps in intellectual disability medical education curricula.MethodUsing scoping review methods, the intellectual disability programmes described in 27 articles were evaluated and their coverage of the six core competencies on disability for health care education was examined.ResultsThe most frequently represented core competencies were disability conceptual frameworks, professionalism and communication, and clinical assessment, which were, in most programmes, fulfilled by activities involving individuals with intellectual disabilities. Uneven competency coverage warrants consideration.ConclusionsConsiderable variabilities exist in medical school curricula on intellectual disabilities. Using core competencies on disability for health care education for curricular design and evaluation would provide a coherent training experience in this important area.

As medical schools move to integrate the Core Entrustable Professional Activities for Entering Residency (EPAs) into curricula and address the transition from student to resident, residency preparatory courses have become more prevalent. The authors developed an experiential learning EPA-based capstone course for assessment to determine impact on learner self-assessed ratings of readiness for residency and acquisition of medical knowledge. All fourth-year students from the classes of 2018-2020 completed a required course in the spring for assessment of multiple EPAs, including managing core complaints, performing basic procedures, obtaining informed consent, and providing patient handoffs. Learners selected between three specialty-based parallel tracks - adult medicine, surgery, or pediatrics. Students completed a retrospective pre-post questionnaire to provide self-assessed ratings of residency preparedness and comfort in performing EPAs. Finally, the authors studied the impact of the course on knowledge acquisition by comparing student performance in the adult medicine track on multiple choice pre- and post-tests. Four hundred and eighty-one students were eligible for the study and 452 (94%) completed the questionnaire. For all three tracks, there was a statistically significant change in learner self-assessed ratings of preparedness for residency from pre- to post-course (moderately or very prepared: adult medicine 61.4% to 88.6% [p-value < 0.001]; surgery 56.8% to 81.1% [p-value < 0.001]; pediatrics 32.6% to 83.7% [p-value 0.02]). A similar change was noted in all tracks in learner self-assessed ratings of comfort from pre- to post-course for all studied EPAs. Of the 203 students who participated in the adult medicine track from 2019-2020, 200 (99%) completed both the pre- and post-test knowledge assessments. The mean performance improved from 65.0% to 77.5% (p-value < 0.001). An experiential capstone course for the assessment of EPAs can be effective to improve learner self-assessed ratings of readiness for residency training and acquisition of medical knowledge.

BACKGROUND: Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS: PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS: Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS: Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.

Distinct pedagogical approaches within medical curricula in France and in the U.S. reflect a growing recognition of the importance of nutrition to address major public health challenges. However, recent generations of medical students have expressed mixed opinions regarding nutrition education. What pedagogical approach may improve nutrition education? Despite different medical systems, students from both France and the U.S. share similar concerns and expectations, that nutrition knowledge must be embedded in the curriculum and must be engaging. Hands-on, system-based, epistemological, and multidisciplinary approaches need better articulation to forge a robust medical curriculum. In the rapidly changing contexts of medicine and public awareness, social science research may facilitate recommendations for improved nutrition education.

IntroductionThe enduring legacy of colonisation on global health education, research and practice is receiving increased attention and has led to calls for the 'decolonisation of global health'. There is little evidence on effective educational approaches to teach students to critically examine and dismantle structures that perpetuate colonial legacies and neocolonialist control that influence in global health.MethodsWe conducted a scoping review of the published literature to provide a synthesis of guidelines for, and evaluations of educational approaches focused on anticolonial education in global health. We searched five databases using terms generated to capture three concepts, 'global health', 'education' and 'colonialism'. Pairs of study team members conducted each step of the review, following Preferred Reporting Items for Systematic reviews and Meta-Analyse guidelines; any conflicts were resolved by a third reviewer.ResultsThis search retrieved 1153 unique references; 28 articles were included in the final analysis. The articles centred North American students; their training, their evaluations of educational experiences, their individual awareness and their experiential learning. Few references discussed pedagogical approaches or education theory in guidelines and descriptions of educational approaches. There was limited emphasis on alternative ways of knowing, prioritisation of partners' experiences, and affecting systemic change.ConclusionExplicit incorporation of anticolonial curricula in global health education, informed by antioppressive pedagogy and meaningful collaboration with Indigenous and low-income and middle-income country partners, is needed in both classroom and global health learning experiences.

ProblemMedical educators recognize that partnering actively with health system leaders closes significant health care experience, quality, and outcomes gaps. Medical schools have explored innovations training physicians to care for both individual patients and populations while improving systems of care. Yet, early medical student education fails to include systems improvement as foundational skills. When health systems science is taught, it is often separated from core clinical skills.ApproachThe Clinical Microsystems Clerkship at the University of California, San Francisco School of Medicine, launched in 2016, integrates clinical skills training with health systems improvement from the start of medical school. Guided by communities of practice and workplace learning principles, it embeds first-year and second-year students in longitudinal clinical microsystems with physician coaches and interprofessional clinicians one day per week. Students learn medical history, physical examination, patient communication, interprofessional teamwork, and health systems improvement. Assessments include standardized patient examinations and improvement project reports. Program outcome measures include student satisfaction and attitudes, clinical skills performance, and evidence of systems improvement learning, including dissemination and scholarship.OutcomesStudents reported high satisfaction (first-year, 4.10; second-year, 4.29, on a scale of 1-5) and value (4.14) in their development as physicians. Clinical skills assessment accuracy was high (70%-96%). Guided by interprofessional clinicians across 15 departments, students completed 258 improvement projects in 3 health systems (academic, safety net, Veterans Affairs). Sample projects reduced disparities in hypertension, improved opiate safety, and decreased readmissions. Graduating students reported both clinical skills and health systems knowledge as important to physician success, patient experience, and clinical outcomes (4.73). Most graduates discussed their projects in residency applications (85%) and disseminated related papers and presentations (54%).Next stepsIntegrating systems improvement, interprofessional teamwork, and clinical skills training can redefine early medical student education. Health system perspectives, long-term outcomes, and sustainability merit further exploration.

IntroductionMany medical schools engage students in health system improvement (HSI) efforts. Evaluation of these efforts often focuses on students' learning outcomes and rarely considers the impact on health systems, despite the significant commitment health systems make to these efforts. Our study identified and evaluated system-level outcomes of pre-clerkship medical students' engagement in HSI efforts.MethodsWe used an instrumental case study approach to examine the effects of pre-clerkship medical students' engagement in HSI projects as part of a 15-month experiential curriculum. We extracted data from 53 project summaries and posters completed during the 2017-18 academic year and follow-up survey data collected in May 2019 from physician coaches and health system professionals who mentored students, contributed to these projects, and worked in the clinical microsystems where the projects occurred.ResultsWe identified three categories and ten indicators of health system outcomes relevant to medical student engagement in HSI. Using these indicators, our evaluation found multiple benefits to the microsystems in which projects occurred. These included achievement of project aims, perceived immediate and sustained project impact on the health system, and development and implementation of projects with aims that aligned with national and health system priorities.ConclusionEvaluation of HSI curricula needs to include effects on health systems so that program design can optimize the experience for all involved. Our study offers a framework others can use to evaluate system-level effects of project-based HSI curricula and shows several ways in which students' engagement can add value to health systems.

IntroductionThis study describes perceived knowledge gaps of third-year medical students after participating in a virtual surgical didactic rotation (EMLR) and shortened in-person surgery rotation during the COVID-19 Pandemic.MethodsOpen-ended and Likert questions were administered at the end of the virtual rotation and inperson-surgical rotation to medical students. Three blinded coders identified themes by semantic analysis.Results82 students (51% of all MS3s) participated in the EMLR. Semantic analysis revealed gaps in perioperative management (Post-EMLR:18.4%, Post-Inpatient:26.5%), anatomy (Post-EMLR:8.2%, PostInpatient:26.5%). and surgical skills (Post-EMLR: 43.0%, Post-Inpatient: 44.1%). Students also described gaps related to OR etiquette (Post-EMLR: 12.2%, Post-Inpatient: 8.8%) and team dynamics/the hidden curriculum (Post- Inpatient:26.6%). There was a significant improvement in perceived confidence to perform inpatient tasks after completing the inpatient clinical experience (p ≤ 0.01).ConclusionVirtual interactive didactics for cognitive skills development cannot replace a full clinical surgical experience for third-year medical students. Future curricula should address perceived gaps.

ObjectivesMedical educators may assess learners' professionalism through clinical scenarios eliciting value conflicts - situations in which an individual's values differ from others' perceived values. We examined the extent to which United States (US) medical students' discussion of abortion highlights their professionalism according to the 6 American Association of Medical Colleges (AAMC) professionalism competencies.Study designWe conducted anonymous, semistructured qualitative interviews with 74 US medical students applying to OB/GYN residency. Interviews explored attitudes toward abortion and abortion case vignettes. We analyzed interview transcripts using directed content analysis for alignment with the AAMC professionalism competencies: humanism, patient needs superseding self-interest, patient autonomy, physician accountability, sensitivity to diverse populations, and commitment to ethical principles.ResultsStudents' genders, races, religions, and geographic regions were diverse. Attitudes toward abortion varied, but all students commented on themes related to at least 1 AAMC professionalism competency when discussing abortion care. Statements demonstrating students' humanism, prioritization of patient autonomy, and sense of physician accountability were common. Most comments reflected positive professionalism practices, regardless of personal views on abortion or provision intentions; very few students made statements that were not aligned with the AAMC professionalism competencies.ConclusionsAll students in this study exhibited professionalism when discussing abortion, regardless of personal views on abortion or intention to provide this care. Case-based discussions involving abortion could be used to explore professionalism competencies among medical learners.ImplicationsDiscussing abortion has the potential to elicit values conflict, which enables learners to exhibit professionalism. Case-based abortion education should be included in medical school curricula to measure medical professionalism in future physicians, and to serve as a tool for teaching professionalism in medical school.

IntroductionReproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education.MethodsWe designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group.ResultsSixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases.DiscussionThis interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students' comfort and self-reported knowledge on several RJ topics.

IntroductionIn 2019, 4.6% of US-MD students self-identified as students with disabilities (SWD); many of these students will require accommodations on the USMLE Step-1 examination. Given the high-stakes nature of Step-1 for medical school advancement and residency match, SWD denied accommodations on Step-1 face considerable consequences. To date no study has investigated the rate of accommodation denial and its impact on medical school operations.MethodsTo investigate the rate of accommodation denial and evaluate whether Step-1 accommodation denial impacts medical school operations, a 10-question survey was sent to Student Affairs Deans and disability resource professionals at all fully-accredited US-MD granting programs. Two open-ended questions were analyzed using qualitative content analysis.ResultsSeventy-three of the 141 schools responded (52%). In the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 (52%) were denied. Of those denied, 74/144 (51%) were delayed entry into the next phase of curriculum and 110/144 (76%) took the Step-1 exam unaccommodated. Of the 110 who took Step-1 without accommodations, 35/110 (32%) failed the exam, and 4/110 (3%) withdrew or were dismissed following exam failure. Schools reported varied investments of time and financial support for students denied accommodations, with most schools investing less than 20 hours (67%) and less than $1,000.00 (69%). Open-responses revealed details regarding the impact of denial on schools and students including frustration with process; financial and human resources allocation; delay in student progression; lack of resourcing and expertise; and emotional and financial burdens on students.DiscussionStep-1 accommodation denial has non-trivial financial, operational, and career impacts on medical schools and students alike. The cause of accommodation denial in this population requires further exploration.

BackgroundThe COVID-19 pandemic disrupted the United States (US) medical education system with the necessary, yet unprecedented Association of American Medical Colleges (AAMC) national recommendation to pause all student clinical rotations with in-person patient care. This study is a quantitative analysis investigating the educational and psychological effects of the pandemic on US medical students and their reactions to the AAMC recommendation in order to inform medical education policy.MethodsThe authors sent a cross-sectional survey via email to medical students in their clinical training years at six medical schools during the initial peak phase of the COVID-19 pandemic. Survey questions aimed to evaluate students' perceptions of COVID-19's impact on medical education; ethical obligations during a pandemic; infection risk; anxiety and burnout; willingness and needed preparations to return to clinical rotations.ResultsSeven hundred forty-one (29.5%) students responded. Nearly all students (93.7%) were not involved in clinical rotations with in-person patient contact at the time the study was conducted. Reactions to being removed were mixed, with 75.8% feeling this was appropriate, 34.7% guilty, 33.5% disappointed, and 27.0% relieved. Most students (74.7%) agreed the pandemic had significantly disrupted their medical education, and believed they should continue with normal clinical rotations during this pandemic (61.3%). When asked if they would accept the risk of infection with COVID-19 if they returned to the clinical setting, 83.4% agreed. Students reported the pandemic had moderate effects on their stress and anxiety levels with 84.1% of respondents feeling at least somewhat anxious. Adequate personal protective equipment (PPE) (53.5%) was the most important factor to feel safe returning to clinical rotations, followed by adequate testing for infection (19.3%) and antibody testing (16.2%).ConclusionsThe COVID-19 pandemic disrupted the education of US medical students in their clinical training years. The majority of students wanted to return to clinical rotations and were willing to accept the risk of COVID-19 infection. Students were most concerned with having enough PPE if allowed to return to clinical activities.

Many challenges could occur that result in the need to handle an increase in the number of medical student clinical placements, such as curricular transformations or viral pandemics, such as COVID 19. Here, we describe four different institutions' approaches to addressing the impact of curricular transformation on clerkships using an implementation science lens. Specifically, we explore four different approaches to managing the 'bulge' as classes overlap in clerkships Curriculum leaders at four medical schools report on managing the bulge of core clinical placements resulting from reducing the duration of the foundational sciences curriculum and calendar shifts for the respective clerkship curriculum. These changes, which occurred between 2014 and 2018, led to more students being enrolled in core clinical rotations at the same time than occurred previously. Schools provided respective metrics used to evaluate the effectiveness of their bulge management technique. These data typically included number of students affected in each phase of their curricular transformation, performance on standardized examinations, and student and faculty feedback. Not all data were available from all schools, as some schools are still working through their 'bulge' or are affected by COVID-19. There is much to be learned about managing curricular transformations. Working on such endeavors in a learning collaborative such as the AMA Accelerating Change in Medical Education Initiative provided support and insights about how to survive, thrive and identifying lessons learned during curricular transformation.

IntroductionThe impact of COVID-19 on surgical education has been profound, and clinical learning experiences transitioned to virtual formats. This study investigated the impact of virtual experiences created to facilitate learning during the pandemic for medical students.MethodsWe performed a cohort study to determine the perceived clinical preparedness for medical students enrolled in the preclinical surgery pilot course, surgical Extended Mastery Learning Rotation (EMLR), and longitudinal surgical clerkship (LC). The preclinical surgery pilot course took place before COVID-19 disruptions, and the EMLR and LC experiences took place virtually. Specialty choice was examined in the EMLR and LC cohorts. Performance on the NBME surgical assessments was analyzed among students enrolled in the traditional clerkship and pandemic-disrupted courses and compared to national data using a two-sample t-test.ResultsCompared to preclinical students, EMLR and LC students demonstrated improvements in their perceived surgical clerkship readiness. After the 3-week EMLR course, in the setting of completing only one-third of the clerkship year, students had an average NBME Surgical Self-Assessment Exam score of 72 (SD 12), comparable to the national average of 71 (SD 9) p = 0.33. The average shelf exam score for students (N = 24) enrolled in the traditional clerkship (block 1), prior to COVID-19, disruptions was 66 (SD 9) compared to an average score of 69 (SD 9) for the longitudinal clerkship students (N = 20) that took the shelf exam later in the year (p = 0.36). COVID-19 disruptions did not affect specialty choice. All LC students have decided on a specialty; 50% nonsurgical and 50% surgical. From the EMLR cohort, 36% and 38% plan to pursue surgical and nonsurgical specialties, respectively, with 26% still undecided.ConclusionsCourses were well-liked and will be implemented in future clerkships. Surgical educators demonstrated flexibility and creativity in the development of the EMLR. Despite COVID-19 disruptions, medical students made progress in their clinical skills and foundational science knowledge. COVID-19 disruptions did not appear to impact specialty choice.

The application of continuous systems improvement in medical education can provide actionable information for curriculum development, improvement, and future planning (as reported by Bowe and Armstrong, Acad Med 92:585-92, 2017). After receiving a medical education grant, we developed a curriculum to teach medical students how to use quality improvement (QI) to address health disparities in vulnerable populations. During the process of developing and implementing this curriculum, we learned several lessons.One of the major surprises was that our proposed project work took much longer to complete than anticipated. This was mainly because we did not have the right team assembled from the beginning. Specifically, we were missing a team member with evaluation expertise, and therefore we did not devise a systematic process for evaluation and assessment. Without periodic checks or timely assessments built into our curriculum design, we received feedback from students after it was too late to implement changes. We realized that our initial research design had some methodological flaws, which we later rectified.We encountered additional technical challenges during the curriculum implementation. We struggled with various online learning platforms. Through this, we learned the importance of being knowledgeable upfront about the features of learning platforms and adaptable to changing educational technologies. We also learned our curriculum could and should evolve to meet the needs of our learners and faculty. Moving forward, we realize the benefit of applying a quality improvement process to our curriculum development and implementation, which will help us to continuously transform medical education for future health care needs.

IntroductionService learning can teach medical students about the social determinants of health and prepare them to better serve marginalized populations, while people in the sex trade can serve as effective educators for their peers and health professions trainees. However, service-learning projects involving medical students and people in the sex trade are currently rare.MethodsWe modified a curriculum from an author's prior institution to provide a unique service-learning experience for medical students and peer health education for women in the sex trade in a new city and new context. Medical students partnered with a local community organization to implement a 10-week course on physical and mental health for women in the sex trade. Coled by a medical student and a woman who had utilized the community partner's services, the course's instructional methods included in-class demonstrations, group discussion, games, and worksheets.ResultsTen women participated in the course, and six medical students facilitated its implementation. The participants demonstrated increased knowledge in physical and mental health topics and reported being more comfortable speaking with health care providers. The coleaders developed skills and confidence to pursue additional leadership opportunities. The medical student coleader gained a better understanding of addiction and was more prepared to work with patients with substance use disorders.DiscussionThis mutual learning experience was a valuable health education opportunity for a local underserved community and helped medical students understand the barriers women in the sex trade face when seeking health care and how physicians can better meet their needs.

IntroductionThe AAMC prioritizes promoting a diverse and culturally competent workforce which is thought to have a positive impact on the health of people living in the US. There is a lack of diversity in the current landscape of academic medicine and strategies are needed to effect change. This module introduced undergraduate and graduate medical trainees to leadership skills and opportunities in curriculum innovation and reform by learning about and interacting with the office of medical education (OME) at their institutions.MethodsWe implemented a workshop using small-group case discussions and didactics to help medical students and residents learn how to: (1) describe the structure and functions of an OME, (2) describe leadership competencies associated with various roles within the OME, and (3) identify opportunities for trainees to engage with the OME on curricular innovation and reform, especially advancing diversity and inclusion.ResultsAcross three sites, 45 learners completed partial or full workshop evaluations. Of learners, 22 (49%) were not knowledgeable and 13 (29%) were somewhat knowledgeable in identifying leadership opportunities for trainees to become engaged through the OME. There was a statistically significant increase in confidence after the workshop in "discussing an interdisciplinary approach to the creation of a medical education innovation," and, "assessing the need for curricula change." Over 90% of attendees agreed learning objectives were met.DiscussionThis workshop succeeded in promoting awareness of the structure and function of OMEs and confidence in seeking opportunities to become engaged in medical education, especially in advancing diversity and inclusion.

Hana Ahmad Taha,1– 3 Jawaher Khaled Al Saqer,2 Noora Rashed Al Harbi,2 Rand Nidal Younis,2 Fatma Al Dawoud,2 Mohammed Bassam Nawaiseh,4 Vanja Berggren3 1Department of Pharmacology, Public Health, and Clinical Skills, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan; 2Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan; 3Department of Neurobiology, Caring Science and Society, Karolinska Institutet, Huddinge, 141 52, Sweden; 4Jordanian Royal Medical Services, Amman, 11855, JordanCorrespondence: Hana Ahmad Taha, Department of Pharmacology, Public Health, and Clinical Skills, Faculty of Medicine, The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan, Tel +962-5-3903333, Email hanagh@yahoo.comBackground: Medical students’ involvement in patients’ care varies according to patient’s willingness, as some might consider it a privacy invasion. Thus, exploring patients’ perceptions and attitudes towards this interaction should be thoroughly investigated, to better understand it and to provide evidence-based data for improving the training of future doctors.Methods: A cross-sectional study was conducted at Jordan University Hospital. A questionnaire was answered by 420 patients from the out-patients’ clinics.Results: Of the patients interviewed, 94% were aware that they were in a teaching hospital, 92% approved the presence of medical students during their consultation and 80% accepted to be observed and examined by medical students in the presence of a senior doctor. However, this decreased to 30.5% if there was no senior doctor. Almost 83% of the patients believed that their consent should be obtained first. However, only 58% of them indicated that the student asked for consent prior to interacting with them. Patients who were more likely to approve the existence of medical students during consultation and allow students to perform procedures on them, respectively, were those who were asked for consent by students (P = 0.001 and P = 0.021), considered seeing medical students’ enjoyable (P < 0.001 and P < 0.001), thought that their privacy was not violated (P < 0.001 and P < 0.001), and were provided with useful information about their health problems (P < 0.001 and P < 0.001).Conclusion: Patients showed an overall positive stance towards the involvement of medical students in their healthcare. The majority were delighted to see medical students while some expressed concerns over their privacy due to the large number of students and because several students do not ask for their consent. It is essential to apply medical ethics practices together with patient-centered approach.Keywords: students, medical, education, undergraduate, curriculum, teaching hospital, patient perception

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated a sudden transition to remote learning in medical schools. We aimed to assess perceptions of remote learning among pre-clinical medical students and subsequently to identify pros and cons of remote learning, as well as uncover gaps to address in ongoing curricular development. METHODS: A survey was distributed to first- and second-year medical students at the University of California San Diego School of Medicine in March 2020. Frequencies of responses to structured multiple-choice questions were compared regarding impacts of remote learning on quality of instruction and ability to participate, value of various remote learning resources, living environment, and preparedness for subsequent stages of training. Responses to open-ended questions about strengths and weaknesses of the remote curriculum and overall reflections were coded for thematic content. RESULTS: Of 268 students enrolled, 104 responded (53.7% of first-year students and 23.9% of second-year students). Overall, students felt that remote learning had negatively affected the quality of instruction and their ability to participate. Most (64.1%) preferred the flexibility of learning material at their own pace. Only 25.5% of respondents still felt connected to the medical school or classmates, and feelings of anxiety and isolation were noted negatives of remote learning. Most second-year students (56.7%) felt their preparation for the United States Medical Licensing Examination Step 1 exam was negatively affected, and 43.3% felt unprepared to begin clerkships. In narrative responses, most students appreciated the increased flexibility of remote learning, but they also identified several deficits that still need to be addressed, including digital fatigue, decreased ability to participate, and lack of clinical skills, laboratory, and hands-on learning. CONCLUSIONS: Videocasted lectures uploaded in advance, electronic health record and telehealth training for students, and training for teaching faculty to increase technological fluency may be considered to optimize remote learning curricula.

BackgroundUnderinsured and uninsured surgical-oncology patients are at higher risk of perioperative morbidity and mortality. Curricular innovation is needed to train medical students to work with this vulnerable population. We describe the implementation of and early educational outcomes from a student-initiated pilot program aimed at improving medical student insight into health disparities in surgery.Materials/methodsFirst-year medical students participated in a dual didactic and perioperative-liaison experience over a 10-month period. Didactic sessions included surgical-skills training and faculty-led lectures on financial toxicity and management of surgical-oncology patients. Students were partnered with uninsured and Medicaid patients receiving surgical-oncology care and worked with these patients by providing appointment reminders, clarifying perioperative instructions, and accompanying patients to surgery and clinic appointments. Students' interest in surgery and self-reported comfort in 15 Association of American Medical Colleges core competencies were assessed with preparticipation and postparticipation surveys using a 5-point Likert scale.ResultsTwenty-four first-year students were paired with 14 surgical-oncology patients during the 2017-2018 academic year. Sixteen students (66.7%) completed both preprogram and postprogram surveys. Five students (31.3%) became "More Interested" in surgery, whereas 11 (68.8%) reported "Similar Interest or No Change." Half of the students (n = 8) felt more prepared for their surgery clerkship after participating. Median self-reported comfort improved in 7/15 competencies including Oral Communication and Ethical Responsibility. All students reported being "Somewhat" or "Extremely Satisfied" with the program.ConclusionsWe demonstrate that an innovative program to expose preclinical medical students to challenges faced by financially and socially vulnerable surgical-oncology patients is feasible and may increase students' clinical preparedness and interest in surgery.

BackgroundThe use of the surgical robot has increased annually since its introduction, especially in general surgery. Despite the tremendous increase in utilization, there are currently no validated curricula to train residents in robotic surgery, and the effects of robotic surgery on general surgery residency training are not well defined. In this study, we aim to explore the perceptions of resident and attending surgeons toward robotic surgery education in general surgery residency training.MethodsWe performed a qualitative thematic analysis of in-person, one-on-one, semi-structured interviews with general surgery residents and attending surgeons at a large academic health system. Convenient and purposeful sampling was performed in order to ensure diverse demographics, experiences, and opinions were represented. Data were analyzed continuously, and interviews were conducted until thematic saturation was reached, which occurred after 20 residents and seven attendings.ResultsAll interviewees agreed that dual consoles are necessary to maximize the teaching potential of the robotic platform, and the importance of simulation and simulators in robotic surgery education is paramount. However, further work to ensure proper access to simulation resources for residents is necessary. While most recognize that bedside-assist skills are essential, most think its educational value plateaus quickly. Lastly, residents believe that earlier exposure to robotic surgery is necessary and that almost every case has a portion that is level-appropriate for residents to perform on the robot.ConclusionsAs robotic surgery transitions from novelty to ubiquity, the importance of effective general surgery robotic surgery training during residency is paramount. Through in-depth interviews, this study provides examples of effective educational tools and techniques, highlights the importance of simulation, and explores opinions regarding the role of the resident in robotic surgery education. We hope the insights gained from this study can be used to develop and/or refine robotic surgery curricula.

PurposeDespite increasing emphasis in medical school education on quality and systems improvement, many medical schools lack sufficient faculty with expertise to teach systems improvement. Using the pedagogical content knowledge framework, this study explores how faculty engage students in systems improvement work and faculty perceptions of the outcomes for the health system and students.MethodIn May-June 2017, the authors interviewed 12 of 13 invited faculty with experience in teaching and engaging first-year medical students in systems improvement work, the course of students' systems improvement work over time, the impact of students' projects on health systems, and students' learning and attitudes about systems improvement. The authors conducted qualitative analysis iteratively with data collection to sufficiency.ResultsSix emergent themes characterized faculty's approach to guiding students in systems improvement work: faculty-student relationship, faculty role, student role, faculty-student shared responsibility for projects, faculty and student content knowledge, and project outcomes. The faculty-student relationship was foundational for successful systems improvement work. Faculty roles included project selection, project management, and health systems interactions. Students engaged in systems improvement as their faculty leveraged their knowledge and skills and created meaningful student roles. Faculty and students shared responsibility and colearned systems improvement content knowledge. Faculty defined successful outcomes as students' learning about the systems improvement process and interprofessional collaboration.ConclusionsFindings highlight the critical importance of pedagogical content knowledge to engage early learners in systems improvement work, understand their learning interests and needs, and manage their projects longitudinally.

BackgroundIncreasingly, non-English speaking countries use English as the medium of instruction (EMI) to teach academic subjects. This study investigated the challenges and adaptation strategies of teachers and students in an EMI medical education program in China.MethodsData were collected on EMI and non-EMI students' test performances and student and teacher perceptions of the program. Test scores and survey results were analyzed using SPSS. Focus group transcripts and open-ended comments from surveys were examined using thematic coding.ResultsThere were no significant differences in admission and graduation test scores for EMI and non-EMI students. Four challenges with the EMI program were identified: (1) insufficient/inappropriate teaching materials, (2) unsatisfactory teaching, (3) inadequate class interactions, and (4) failure to teach medical humanities. To address these challenges, teachers and students used adaptive strategies, such as the use of alternative textbooks, self-learning skills and Chinese language.ConclusionsEMI programs are difficult to initiate, requiring faculty development and institutional support, and student self and peer group learning strategies to be successful. The adaptive strategies employed by both students and teachers offer insights into how other EMI programs might strengthen their implementation.

BackgroundPrior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact.MethodsIn 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum.ResultsIn the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician.DiscussionA required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training.

Delivering a cohesive oncology curriculum to medical students is challenging due to oncology's multidisciplinary nature, predominantly outpatient clinical setting, and lack of data describing effective approaches to teaching it. We sought to better characterize approaches to oncology education at US medical schools by surveying third and fourth year medical students who serve on their institution's curriculum committee. We received responses from students at 19 schools (15.2% response rate). Key findings included the following: (1) an under-emphasis of cancer in the curriculum relative to other common diseases; (2) imbalanced involvement of different clinical subspecialists as educators; (3) infrequent requirements for students to rotate through non-surgical oncologic clerkships; and (4) students are less confident in their knowledge of cancer treatment compared to basic science/natural history or workup/diagnosis. Based on these findings, we provide several recommendations to achieve robust multidisciplinary curriculum design and implementation that better balances the clinical and classroom aspects of oncology education.

Introduction: To help create a Bachelor of Medicine, Bachelor of Surgery (MBBS) curriculum centred around the student voice, the Imperial College School of Medicine (ICSM) recruited two medical students for a two-week student-staff collaboration in Summer 2019 for its wider curriculum review. This writeup discusses the background, processes, and outcomes of the collaboration and includes some student reflections.Methods: The team comprised a member of the faculty and two medical students (the authors). We met daily for two weeks and focussed on the Bioregulatory Systems (BRS) module of Year 1. There were three key areas of work: learning objectives, large-group sessions, and small-group sessions. Each aspect involved planning, implementation, and reflection. For example, learning objectives were recategorized and reorganised, students fed back on a new slide template for large-group sessions, and new small-group sessions were designed. Feedback from the staff was collected verbally, and the medical students submitted feedback in the form of a mid-project interview, a post-project report, andinformally.Results: We achieved such outcomes as reorganising and refining learning objectives, improving large-group teaching sessions, and refining and creating small-group teaching sessions. Following the collaboration, we had a debrief session.Conclusion: This collaboration was highly valuable for both students and faculty; the feedback revealed that the ideas,discussions, and outputs had a substantial impact. Overall, student-staff collaboration will become increasingly valuable as we emerge from COVID-19; we hope this write-up informs and inspires more ‘students as partners’ projects worldwide.

BackgroundThe 1995 Health Care Financing Administration (HCFA) guidelines stated that providers may only use the review of systems and past medical, family, social history in student documentation for billing purposes; therefore, many providers viewed the student documentation as an extraneous step and chose not to allow medical students to document patient visits. This workflow negatively affected medical student education in documentation skills. Although the negative impact on students' documentation skills is obvious, areas of deficits are unknown. Understanding the area of deficits will benefit future curriculums to prepare prospective resident physicians for proper documentation. We aimed to assess areas of deficits in documentation of fourth-year medical students according to HCFA billing guidelines.MethodsWe conducted a prospective study of fourth-year medical students' simulated chart documentations at a United States medical school from May 2014 to May 2015. We evaluated students' simulated charts from an online learning tool using simulated cases for completeness according to HCFA guidelines and analyzed data using descriptive statistics.ResultsWe found that 98.9% (n = 90) of the charts were downcoded. Of these charts, 33.0% (n = 30) had incomplete history of present illness, 90.1% (n = 82) had incomplete review of systems, 73.6% (n = 67) had incomplete past medical, family, social history and 88.8% (n = 80) had incomplete physical exams.ConclusionNew curriculum should include billing guideline information and emphasize the completeness of charts according to acuity.

BackgroundDespite an increase in psychiatry trainees' interest in global mental health (GMH), there is a lack of relevant training competencies developed using educational frameworks that incorporate viewpoints from high- and low-income countries. Objective: The aim of this study was to determine competencies for a two-year post-graduate GMH fellowship for psychiatrists utilizing Kern's six-step process as a theoretical framework for curriculum development. Methods: We conducted a targeted needs assessment via key informant interviews with a purposive sample of stakeholders (n = 19), including psychiatry trainees, generalist clinicians, medical directors, psychiatrists, researchers, and GMH educators from high- and low-resource settings in the United States and abroad. We analyzed data using a template method of thematic analysis. Findings: We tabulated learning objectives across 20 domains. Broadly, clinical objectives focused on providing supervision for short-term, evidence-based psychotherapies and on identifying red flags and avoiding harmful medication use among vulnerable populations such as children and the elderly. Non-clinical objectives focused on social determinants of health, education, and clinical supervision as part of capacity-building for non-specialists, engagement in a systems-wide project to improve care, and ethical and equitable partnerships that involve reciprocal and bidirectional education. Several competencies were also relevant for global health work in general. Conclusions: A theory-informed framework for curriculum development and a diverse set of key informants can provide educational objectives that meet the priorities of the trainees and the clinical sites in both low- and high-income settings. Limitations of this study include a small sample size and a focus on clinical needs of specific sites, both of which may affect generalizability. Given the focus on training specialists (psychiatrists), the low-resource sites highlighted the importance of educating and supervising their permanent, generalist clinicians, rather than providing direct, independent patient care.

ObjectiveTo gain insight into first year medical students' experiences of practicing empathic communication and how patients that train students perceive such communication, in order to inform early communication skills training.MethodsOur study consisted of four focus groups, two of year one students who completed a first semester clinical skills course, one of standardized patients, and one of volunteer outpatients. Focus group transcripts were independently coded and iteratively reviewed to identify major themes. Course evaluation data was collected and analyzed.ResultsThemes from student focus groups described significant challenges in striving to convey empathy: coping with anxiety due to multitasking, "buying-in" to learning empathy, and managing vulnerability when engaging emotionally. Patients appreciated students' expression of vulnerability and nonverbal communication.ConclusionFirst year medical students encounter challenges in learning empathic communication, and patients may perceive empathy from students in ways other than verbal responses. Early communications curricula should focus on assisting students with anxiety of multi-tasking, sense of vulnerability, buy-in to communications training, and the importance of non-verbal communication.Practice implicationsA deliberate focus on empathetic responsiveness, especially non-verbal, might lessen anxiety, improve attentional switching, and build confidence in managing vulnerability for early medical students learning communication skills.

PURPOSE:Integrated interventional radiology (IR) residencies recently underwent their second year in the match, the first year of which involved only a limited number of programs. Now that students can choose to enter IR directly, student perceptions of IR vs diagnostic radiology (DR) are of paramount importance. METHODS:We surveyed first- through fourth-year medical students and radiology residents regarding interest in IR vs DR. RESULTS:Students considering a radiological career expressed more interest in IR than DR. Conversely, residents expressed more interest in DR. CONCLUSIONS:Medical student advisors and IR programs should continue to anticipate a high number of applications for integrated IR positions.

Medical students must gain proficiency with the complex skill of case presentations, yet current approaches to instruction are fragmented and often informal, resulting in suboptimal transfer of this skill into clinical practice. Whole task approaches to learning have been proposed to teach complex skill development. The authors describe a longitudinal case presentation curriculum developed using a whole task approach known as four-component instructional design (4-C/ID). 4‑C/ID is based on cognitive psychology theory, and carefully attends to titrating a learner's cognitive load, aiming to always keep students in their zone of proximal development. A multi-institutional group of medical educators convened to develop expert consensus regarding case presentation instruction using the 4‑C/ID model. A curriculum consisting of 1) learning tasks, 2) supportive information, 3) just-in-time information, and 4) part-task practice was developed. Domains were identified that make the task of delivering a case presentation complex. A simplifying conditions approach was applied to each domain to develop sequential task class descriptions. Examples of the four components are given to facilitate understanding of the 4‑C/ID model, making it more accessible to medical educators. Applying 4‑C/ID to curriculum development for the complex skill of case presentation delivery may optimize instruction. The provision of the complete curricular outline may facilitate transfer and implementation of this case presentation curriculum, as well as foster the application of 4‑C/ID to other complex skill development in medical education.

Strategies to build a larger workforce of physicians dedicated to research on aging are needed. One method to address this shortage of physician scientists in geriatrics is short-term training in aging research for early-stage medical students. The authors examined the effects of two summer research training programs, funded by the National Institutes of Health, on medical students' attitudes toward aging, using the Carolina Opinions on Care of Older Adults (COCOA). The programs combined mentored research, didactics, and some clinical exposure. In a sample of 134 participants, COCOA scores improved significantly after completion of the research training program. There was a significant interaction of gender, such that female students had higher baseline scores than males, but this gender difference in COCOA scores was attenuated following the program. Four of the six COCOA subscales showed significant improvement from baseline: early interest in geriatrics, empathy/compassion, attitudes toward geriatrics careers, and ageism.

In addition to online questionnaires, many medical schools use supplemental evaluation tools such as focus groups to evaluate their courses. Although some benefits of using focus groups in program evaluation have been described, it is unknown whether these in-person data collection methods provide sufficient additional information beyond online evaluations to justify them. In this study we analyze recommendations gathered from student evaluation team (SET) focus group meetings and analyzed whether these items were captured in open-ended comments within the online evaluations. Our results indicate that online evaluations captured only 49% of the recommendations identified via SETs. Surveys to course directors identified that 74% of the recommendations exclusively identified via the SETs were implemented within their courses. Our results indicate that SET meetings can provide information not easily captured in online evaluations and that these recommendations result in actual course changes.

IntroductionClinical reasoning is a complex cognitive process that involves multiple steps. Diagnosing and remediating clinical reasoning difficulties requires faculty to have an understanding of the cognitive theory behind clinical reasoning, familiarity with terminology, and a framework to identify different domains of struggle in their learners. Published resources on faculty development to diagnose and remediate clinical reasoning difficulties are limited. We created and implemented a workshop to assist faculty in developing these skills based on the five-domain framework described by Audétat, Laurin, and Sanche. This workshop provides all the materials needed to replicate this training with faculty at other institutions.MethodsThe workshop consists of a didactic component and case-based active learning in small groups. Each case focuses on different domains of clinical reasoning difficulties and targets different learner levels (preclinical medical students through residents). The workshop was given in multiple venues in 2016 and 2017.ResultsParticipants reported the session was valuable (4.71/5.0), the facilitators were effective (4.5/5.0), and the objectives were met (4.28/5.0). They highlighted the strengths of the interactive format, the framework to diagnose and remediate clinical reasoning difficulties, and the excellent take-home resources. They suggested more time for the workshop, revision of cases to better highlight difficulties, and refinement of instructions to approach the cases. These suggestions were incorporated into the current iteration of the workshop.DiscussionWe successfully implemented a workshop for diagnosing and remediating clinical reasoning difficulties in multiple venues. The sessions were diverse in terms of faculty participants and learner groups addressed.

BackgroundThe University of California, San Diego, School of Medicine implemented a curriculum change that included reduction of lectures, incorporation of problem-based learning and other small group activities. Six academic communities were introduced for teaching longitudinal curricular content and organizing extracurricular activities.MethodsSurveys were collected from 904 first- and second-year medical students over 6 years. Student satisfaction data with their sense of connectedness and community support were collected before and after the implementation of the new curriculum. In a follow-up survey, medical students rated factors that contributed to their sense of connectedness with faculty and students (n = 134).ResultsStudents' perception of connectedness to faculty significantly increased following implementation of a curriculum change that included academic communities. Students ranked small group clinical skills activities within academic communities significantly higher than other activities concerning their sense of connectedness with faculty. Students' perception of connectedness among each other was high at baseline and did not significantly change. Small group activities scored higher than extracurricular activities regarding students' connectedness among themselves.ConclusionsThe implementation of a new curriculum with more small group educational activities including academic communities enhanced connectedness between students and faculty and resulted in an increased sense of community.

Effective strategies are needed to address the health behaviors of older patients with diabetes. One approach is health coaching, the practice of health education and health promotion through a structured partnership designed to enhance well-being and facilitate the achievement of individuals' health-related goals. The aim of this study was to describe the development of a pilot health coaching curriculum, investigate its effects on geriatric patient outcomes, and examine qualitative feedback by older patients and medical students to the curriculum. This mixed-methods study involved 29 first-year medical students randomly paired with 29 older adults with uncontrolled Type 2 diabetes. Health-related quality of life (HRQoL), stage of change movement, diabetes knowledge, locus of control, Body Mass Index (BMI), and glycosylated hemoglobin (HbA1c) were assessed. Focus groups were used to evaluate patients' and medical students' experiences. Results showed significant increases in patients' HRQoL and stage of change for exercise improved significantly over time. There were no significant changes in stage of change for healthy diet and medication, diabetes knowledge, BMI, and HbA1c from baseline to end of study. Focus group data indicated positive responses by older patients and the medical students. A health coaching curriculum may improve patient outcomes and can provide medical students the skills needed to provide compassionate care for geriatric patients.

The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

BackgroundMedical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships.InterventionOur four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally 'non-teaching' service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills.OutcomeIn the elective's first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students' self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans.ConclusionsStudents found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students' perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource - the hospital medicine 'non-teaching' service - and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation.AbbreviationsA&P: Assessment and plan; H&P: History and physical; ILP: Individual learning plan.

Background and Aim: Establishing good communication with patients is an essential component of good doctor–patient relationships and has a positive impact on health outcomes. A vital component of communication is nonverbal communication (NVC). NVC may reinforce or contradict our verbal comments, thereby altering the meaning of a message and its outcomes. Hence, it is imperative that medical students are made aware of NVC. The present study was undertaken to develop and implement a module for NVC skills and assess the perception of students and faculty. Materials and Methods: The study was conducted with students of 2nd professional MBBS. Participation was voluntary and approval was taken from the institutional ethical committee. All the contents of the module were jointly developed by the core faculty members. The module was conducted across three sessions and included role plays, exposure to simulated patients, an interactive lecture, and a focused small-group discussion. Feedback was obtained from students and faculty facilitators after conclusion of the third session. Results: Fifty-two students and seven faculty facilitators participated in the study. Fifty students (96%) agreed that the module was helpful in improving their NVC skills. All 52 students (100%) agreed that they felt more confident interacting with patients after attending the sessions. Forty-four students (84.6%) strongly agreed that they would attend such sessions in future also. The suitability of the module as a whole for inclusion in the curriculum was endorsed by all participants (100%). The faculty members felt that the most encouraging aspects of the module were its implementation in a nonthreatening environment, maintaining privacy during interactions with simulated patients, and self-assessment of the interaction. Conclusion: With regard to the feasibility and acceptability of the module, 100% of the participants and faculty facilitators agreed that the module should be included in the undergraduate curriculum.

Despite increasing numbers of cancer survivors, non-oncology physicians report discomfort and little training regarding oncologic and survivorship care. This pilot study assesses medical student comfort with medical oncology, surgical oncology, radiation oncology, hospice/palliative medicine, and survivorship care. A survey was developed with input from specialists in various fields of oncologic care at a National Cancer Institute-designated comprehensive cancer center. The survey included respondent demographics, reports of experience with oncology, comfort ratings with oncologic care, and five clinical vignettes. Responses were yes/no, multiple choice, Likert scale, or free response. The survey was distributed via email to medical students (MS1-4) at two US medical schools. The 105 respondents were 34 MS1s (32 %), 15 MS2s and MD/PhDs (14 %), 26 MS3s (25 %), and 30 MS4s (29 %). Medical oncology, surgical oncology, and hospice/palliative medicine demonstrated a significant trend for increased comfort from MS1 to MS4, but radiation oncology and survivorship care did not. MS3s and MS4s reported the least experience with survivorship care and radiation oncology. In the clinical vignettes, students performed the worst on the long-term chemotherapy toxicity and hospice/palliative medicine questions. Medical students report learning about components of oncologic care, but lack overall comfort with oncologic care. Medical students also fail to develop an increased self-assessed level of comfort with radiation oncology and survivorship care. These pilot results support development of a formalized multidisciplinary medical school oncology curriculum at these two institutions. An expanded national survey is being developed to confirm these preliminary findings.

PurposeIt aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA.MethodsMedical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases.Results354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%).ConclusionA FC/TBL format for ACLS marginally improved written test results.

Diffusion is critical to physiological processes ranging from gas exchange across alveoli to transport within individual cells. In the classroom, however, it can be challenging to convey the concept of diffusion on the microscopic scale. In this article, we present a series of three exercises that use food and cooking to illustrate diffusion theory and Fick's first law. These exercises are part of a 10-wk undergraduate course that uses food and cooking to teach fundamental concepts in physiology and biophysics to students, including nonscience majors. Consistent demonstration of practical applications in a classroom setting has the potential to fundamentally change how students view the role of science in their lives (15).

BackgroundUltrasound has become a major diagnostic tool in many parts of the world, with broad clinical applications. Ultrasound provides a noninvasive, painless mode of diagnostics that produces instant results. Disseminating ultrasound skills to remote and rural communities has become a challenge for many medical schools, particularly those where distances are great and the density of population is low.Materials and methodsThe University of California, Irvine School of Medicine and the University of New England School of Rural Medicine in Australia piloted the use of dual video feeds in two scenarios: (1) to display the instructor's ultrasound feed and the instructor's transducer placement to provide guidance for remote students; and (2) to display side-by-side views of the instructor's and the remote student's ultrasound feeds to allow the instructor to guide the remote student in his or her transducer placement.Results and conclusionsUsing high-speed broadband connections, the two schools demonstrated the feasibility of remote, synchronous, practical, and hands-on ultrasound training and instruction over international distances. This opens up a broad range of possibilities for future remote ultrasound education.

BackgroundBurnout among veterinary students can result from known stressors in the absence of a support system. The objectives of this study were to evaluate use of the Maslach Burnout Inventory-Educator Survey (MBI-ES) to assess burnout in veterinary students and evaluate the factors that predict the MBI-ES scores.MethodsThe MBI-ES was administered to first (Class of 2016) and second year (Class of 2015) veterinary medical students during the 2012-2013 academic year in the fall and spring semesters. Factor analysis and test reliability for the survey were determined. Mean scores for the subscales determining burnout namely emotional exhaustion (EE), depersonalization (DP) and lack of personal accomplishment (PA) were calculated for both classes in the 2 semesters. Multiple regression analysis was performed to evaluate other factors that predict the MBI-ES scores.ResultsA non-probability sampling method was implemented consisting of a voluntary sample of 170 and 123 students in the fall and spring semesters, respectively. Scores for EE, DP and PA were not different between the 2 classes within the same semester. Mean ± SD scores for EE, DP and PA for the fall semester were 22.9 ± 9.6, 5.0 ± 4.8 and 32.3 ± 6.7, respectively. Mean ± SD scores for EE, DP and PA the spring semester were 27.8 ± 10.7, 6.5 ± 6.1and 31.7 ± 6.8, respectively. The EE score was higher in spring compared to fall while DP and PA scores were not different between the 2 semesters. Living arrangements specifically as to whether or not a student lived with another veterinary medical students was the only variable significantly associated with the MBI-ES scores. Students in this study had moderate levels of burnout based on the MBI-ES scores.ConclusionsThe MBI-ES was an acceptable instrument for assessing burnout in veterinary medical students. The EE scores were higher in the spring semester as compared to the fall semester. Thus students in the first and second years of veterinary school under the current curriculum experience the greatest levels of emotional exhaustion during the spring semester. This has administrative implications for the school, when considering the allocation and use of resources for student support systems during each semester.

The ACR Task Force on Medical Student Education in Radiology, in partnership with the Alliance of Medical Student Educators in Radiology, investigated the current status of how and to what extent medical imaging was being taught in medical schools. The task force executed a 3-part survey of medical school deans, radiology department chairs, and intern physicians. The results provided an updated understanding of the status of radiology education in medical schools in the United States. This summary includes recommendations about how individual radiology departments and ACR members can assist in advancing the specialty of diagnostic radiology through medical student education.

INTRODUCTION: The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training. METHODS: Medical students with ranging levels of ultrasound training received a 25-minute presentation on our USEFUL followed by a 30-minute hands-on session. Following the hands-on session, the students were asked to perform a timed USEFUL on 2-3 standardized subjects. All images were documented as normal or abnormal with the understanding that an official detailed exam would be performed if an abnormality were to be found. All images were read and deemed adequate by board eligible emergency medicine ultrasound fellows. RESULTS: Twenty-six exams were performed by 9 students. The average time spent by all students per USEFUL was 11 minutes and 19 seconds. Students who had received the University of California, Irvine School of Medicines integrated ultrasound curriculum performed the USEFUL significantly faster (p< 0.0025). The time it took to complete the USEFUL ranged from 6 minutes and 32 seconds to 17 minutes, and improvement was seen with each USEFUL performed. The average time to complete the USEFUL on the first standardized patient was 13 minutes and 20 seconds, while 11 minutes and 2 seconds, and 9 minutes and 20 seconds were spent performing the exam on the second and third patient, respectively. CONCLUSION: Students were able to effectively complete all scans required by the USEFUL in a timely manner. Students who have been a part of the integrated ultrasound in medicine curriculum performed the USEFUL significantly faster than students who had not. Students were able to significantly improve upon the time it took them to complete the USEFUL with successive attempts. Future endpoints are aimed at assessing the feasibility and outcomes of an ultrasound-assisted physical exam in a primary care setting and the exams effect on doctor-patient satisfaction. [West J Emerg Med. 2014;15(3):260-266.].

BackgroundTo encourage medical students' use of patient-centered skills in core clerkships, we implemented and evaluated a Telephone Follow-up Curriculum focusing on three communication behaviors: tailoring education to patients' level of understanding, promoting adherence by anticipating obstacles, and ensuring comprehension by having patients repeat the plans.MethodsThe intervention group consisted of two different cohorts of third-year medical students in longitudinal clerkships (n=41); traditional clerkship students comprised the comparison group (n = 185). Intervention students telephoned one to four patients 1 week after seeing them in outpatient clinics or inpatient care to follow up on recommendations. We used surveys, focus groups, and clinical performance examinations to assess student perception, knowledge and skills, and behavior change.ResultsStudents found that the curriculum had a positive impact on patient care, although some found the number of calls excessive. Students and faculty reported improvement in students' understanding of patients' health behaviors, knowledge of patient education, and attitudes toward telephone follow-up. Few students changed patient education behaviors or called additional patients. Intervention students scored higher in some communication skills on objective assessments.ConclusionA patient-centered communication curriculum can improve student knowledge and skills. While some intervention students perceived that they made too many calls, our data suggest that more calls, an increased sense of patient ownership, and role modeling by clerkship faculty may ensure incorporation and application of skills.