Presentation 1 - WHAT ABOUT US? THE IMPACT OF CURRICULUM REVISION ON STUDENTS IN THE LEGACY CURRICULUM
Giulia Bonaminio
University of Kansas School of Medicine-Kansas City
 

PURPOSE Little is known about issues for students continuing in the traditional (€œlegacy€) curriculum during curriculum reform. We sought the views of legacy students on the new curriculum, its impact on their education, and their interactions with first-year students (MS1) in the new curriculum. METHODS We conducted focus groups of legacy students 8-9 months after initiating the new curriculum. Groups had the same facilitator and format. The video-recorded sessions were independently reviewed by two researchers to identify themes and illustrative quotes. Major themes were developed by consensus and reviewed by the research team. Issues were resolved by discussion and session review. Major themes were summarized and differences between classes/campuses explored. Internal validity was determined through inter-rater reliability checks. The themes identified were used to create a framework of categories to be analyzed for constancy and applicability. Groups were conducted until saturation of responses.  Chi Square or Fisher's exact test were used to identify associations among specific themes and class and/or campus. Cluster analysis was used to determine association among individual themes. RESULTS Legacy students were generally well-informed and supportive of the new curriculum. Groups identified consistent areas of strength, weakness, and challenges. They did not perceive any major impact from the new curriculum on the quality of their education, reporting examples of both faculty disengagement and efforts to make outstanding final presentations of legacy content.  They reported significant loss of their ability to mentor incoming students and some resistance from MS1s to the traditional senior peer support. Students also identified lack of engagement by MS1s in student-run clinics and specialty interest groups. CONCLUSION Legacy students did not perceive themselves at educational disadvantage and provided valuable insights on curricular reform. They were frustrated by loss of their mentoring role and concerned about decreased participation by first years in peri-curricular activities.

 

Presentation 2 - Connecting the Dots: Evidence of Successful Cognitive Integration among Preclinical Medical Students during a Simulated Viral Pandemic
Jennifer Jackson

Wake Forest School of Medicine
 

PURPOSE:  Previous studies suggest novices' cognitive integration of basic science and clinical concepts leads to improved diagnostic performance. Although curricular integration efforts are increasingly more common among medical schools, studies show curricular integration doesn't guarantee learners' cognitive integration; and because cognitive integration is not directly observable, demonstrating evidence of successful cognitive integration remains a challenge.  We developed a novel problem-solving activity for preclinical medical students and performed qualitative analysis to assess for evidence of cognitive integration. METHODS: During a 2-hour simulated viral pandemic, 140 1st-year medical students worked in teams to analyze epidemiological, clinical, and histological data and to formulate justified differential diagnoses for the pandemic's etiology, infection containment recommendations, and treatment recommendations.  Assigned tasks required application of previously encountered learning content from basic science, clinical skills, ethics, and biostatistics courses, in addition to self-directed learning of new health systems content. Qualitative analysis of students' reports was performed to characterize cognitive integration tasks using both inductive and deductive coding, and themes and sub-themes were generated.  Distribution and frequency of integration tasks occurring among students' reports were calculated using descriptive statistics. RESULTS:  Sixteen cognitive integration tasks were identified among students' reports; tasks were clustered in themes of basic science content, clinical content, virus epidemiology content, biostatistics content, and ethics content.  Identifying presenting symptom similarities between the case and known diseases was the most common clinical content integration task performed (100%). Identifying cellular structure similarities and justifying treatments based on the differential diagnosis were the most common basic science integration tasks performed (95% and 95%). Biostatistics content-related tasks were less commonly observed than other content types (15% - 45%). CONCLUSIONS:  Evidence of learners' cognitive integration can be made explicit through learners' narrative justification of problem solving tasks.  Patterns of learners' integration task performance can provide insights into their problem-solving approaches and development.

 

Presentation 3 - ASSESSING SELF-DIRECTED LEARNING IN THE MEDICAL CURRICULUM
Leslie A. Hoffman

Indiana University School of Medicine

 

PURPOSE Medicine is a dynamic field, with an ever-expanding body of scientific knowledge and constantly evolving clinical applications of that knowledge. This ever-changing landscape of medicine requires that physicians continue to learn throughout their practice, therefore it is critical that medical students learn the skills and habits of self-directed learning (SDL) during medical school. The purpose of this study is to assess medical students' development of SDL skills during undergraduate medical education. METHODS A validated assessment tool, the Self-Directed Learning Instrument (SDLI) was selected for the study based on the domains of SDL measured and psychometric characteristics. The SDLI was administered to medical students at three timepoints: at the beginning of the first year (T0), after the first semester of medical school (T1), and at the beginning of the second year (T2). Changes in SDLI scores were assessed using ANOVA. RESULTS There was a significant increase in total SDLI score between T0 and T2 (T0 = 81.05, T2 = 83.33, p = 0.012). Post-hoc tests showed that the greatest gains were seen during the first semester (between T0 and T1). Further analysis indicated increases in total SDLI scores between T0 and T2 were driven by gains in the planning and implementing domain (p < 0.001) and the self-monitoring domain (p = 0.025). CONCLUSION The results of this study suggest that students improve their SDL skills relatively quickly after entering medical school. In particular, students report that they are better able to set goals, select appropriate learning strategies and resources, monitor their time, and evaluate their progress.

 

Presentation 4 - Pharmacology as a continuum: a curricular model for spaced repetition, vertical and horizontal integration
Best Oral Presentation Award Nominee

Jennifer Cleveland

Virginia Tech Carilion School of Medicine

 

PURPOSE:   The pharmacology content at Virginia Tech Carilion School of Medicine is horizontally integrated across several curricular elements.  Historically, large group sessions focused on organ-based pharmacology, whereas Problem-based Learning (PBL) included all pharmacology presented in the featured case.  This approach rapidly exposed students to numerous pharmacological agents, but the student-led PBL forum proved to be diffuse and frustrating as cases often included incidental drugs, not directly related to the pathological focus.  Despite efforts to reinforce content in several curricular locations, data from the AAMC graduate questionnaire and student performance on end of block NBME exams indicated a need to reevaluate the delivery. METHODS: We implemented a new curricular strategy to better coordinate pharmacology delivery across Basic Science and PBL.  In each PBL case, we identified the drugs related to the content being presented in large group sessions and wrote specific objectives to highlight key aspects of the drug.    Additionally, as students' progress through the M1 and M2 years, drugs that had been addressed in previous cases were highlighted as a reminder to the students to review the content. RESULTS: Student performance on pharmacology content on Block NBME exams has improved dramatically.  (Block I up 5 points, Block II up 11 points and Block III 5 points when compared to exam performance metrics AY 16 -17). CONCLUSIONS:  The restructure of pharmacology across curricular elements allowed both students and faculty to focus on important aspects of a specific drug, reducing the stress and often extraneous nature of exploring all drugs in a PBL case.  This modification has positively increased student performance and perception of pharmacology delivery.  Integrated curricular design requires elegant coordination across elements and in this case, we have been successful in focusing the student learning on relevant content and enhanced overall performance. &nbsp;