A Tool for Evaluating Session-Level Integration in Medical Education
AWARD NOMINEE
Amber Heck | Amanda Chase
TCU and UNTHSC School of Medicine | Nova Southeastern University College of Allopathic Medicine
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PURPOSE Integration in medical education is defined as the trans-disciplinary delivery of information between the basic and applied sciences. Examples of integrated curricula have increased in medical education yet creating an integrated curriculum does not necessarily establish cognitive integration. In addition, the degree of integration varies at a program, course, or session level. The purpose of this study was to evaluate medical educator use of the Session Integration Tool (SIT) to assess and improve the level of cross-discipline integration within individual educational sessions.

METHODS We developed the SIT based on Harden's integration ladder. The SIT is an analytic, developmental rubric that assesses session-level integration according to three criteria: development, delivery, and outcomes. To assess its use, we delivered faculty development sessions to two cohorts where participants used the SIT to analyze two case studies, which were examples of isolation and intermediate integration. In addition, they used the SIT to assess their own educational session. A survey was then administered, to assess satisfaction, usefulness and impact on practice. Statistical analyses were conducted using IBM SPSS.

RESULTS Pairwise independent samples ANOVA demonstrated a statistically significant difference between user scores of the example case studies for each set of criteria and for total scores (p < 0.000 for all pairs). Feedback was overwhelmingly positive, and the SIT was highly rated by users in terms of satisfaction, usefulness, and impact on practice, with average scores for each question ranging from strongly agree to agree.

CONCLUSION The SIT is an evidence-based, theory grounded, tool for evaluating session-level integration. The SIT has statistical validity in its ability to discriminate between isolation and intermediate levels of integration, defined according to Harden's ladder. Users found the SIT to be useful and impactful for medical education practice and believe it to support peer- and self-assessment of curricular integration.


Disrupting the Post-Clerkship Curriculum to actualize personalized undergraduate medical education
AWARD NOMINEE
Lourdes Estrada
Vanderbilt University School of Medicine
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PURPOSE There has been debate in the literature regarding the added educational value of the 4th-year of medical school as it is commonly unstructured and dominated by elective experiences challenging students to the transition from medical student to intern. In response to these challenges, we designed and implemented a two-year post-clerkship Immersion Phase, where learners follow an individualized path based upon personal aspirations and competency needs.

METHODS The Immersion Phase aims to build a broad selection of rigorous courses to promote effective workplace learning, review and advance foundational knowledge, and enable students to attain all required competencies in a meaningful and personalized way. Students select from a broad menu of courses organized by multiple course types (Integrative Science Courses, Advanced Clinical Experiences, Acting Internships, Advanced Electives) and participate in a mentored research experience and longitudinal elements including a focus on health system science, leadership, and ethics.

RESULTS In order to ensure that regardless of the individual pathway each student pursues and that all attain competencies expected on day one of residency, we articulated seven overarching Immersion Phase goals to guide the design of all courses. All courses use instructional design with multimodal assessments based on competencies that align with the primary goal of each course type. Students select their courses based on their interests and/or competency development. A responsive and rigorous quality improvement process is in place to evaluate the overall Phase objectives and outcomes.

CONCLUSION Extending the post-clerkship phase was motivated by the desire to address the common struggles during the transition from medical school to internship. Data from the 2019 AAMC Graduate Questionnaire and the Vanderbilt University's Annual Learning System Survey demonstrate that students feel prepared for the clinical responsibilities and professional duties of residency. Notably, 95.6% of students agreed/strongly agreed that the Phase individualized their learning opportunities.

Study of Live Lecture Attendance: Students Perceptions and Expectations
Johnathan M. Emahiser | John Nguyen | Cheryl Vanier | Amina Sadik  
Touro University Nevada
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PURPOSE Increasing numbers of preclinical medical students are missing class; instead, they are learning through the use of recorded lectures and commercially available board exam preparation resources. There are no studies focused on students' perceptions and reasons for not attending class. This study aimed to identify students' perspectives on attendance and potential attendance-improving measures.

METHODS A survey comprised of 23 questions was created and subjected to two- round validation by students, a focus group session, and final validation by educators before being deployed to 317 preclinical students at TUNCOM at the end of the 2018-2019 school year. Differences related to gender, cohort (first or second-year students), and desired specialty were related to lecture attendance using logistic regressions. Effect sizes were shown using odds ratios and 95% confidence intervals. Likert scales and rank variables were summarized by means and standard deviations, and comparisons among groups of interest were accomplished using t-tests or ANOVAs.

RESULTS Students skipped lectures mainly because of the increased efficiency of viewing lectures online (66%) and issues with professors' teaching style (59%). Improved cognitive integration between disciplines (70%) and professors pointing out "high-yield" material (65%) were the most popular options for improving class attendance. The use of directed study assignments with clinical relevance sessions (16%) or inclusion of case studies (26%) were the least popular.

CONCLUSION The results of this study corroborate other work that has identified preparation for Board Examinations as the primary purpose of learning in the first two years of medical education. Although other studies suggest that active learning might attract students to the classroom, the responses in this survey suggest otherwise. 

The Influence of Student Motivation and Learning Strategies on How They Perceive the Benefit of Active Learning Sessions    
Martha Faner | Seema Mehta | Amar Takrani | Casey Schukow | Ah Ra Cho | Raquel Ritchie | Carol Wilkins   
Michigan State University 
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PURPOSE: At Michigan State University College of Osteopathic Medicine, the biochemistry faculty have developed many active learning sessions throughout the pre-clerkship curriculum. This study aims to understand the characteristics, motivations and learning strategies of medical students that perceive active learning sessions to be beneficial and those of students that do not. This understanding may help us in modifying and designing these sessions to be more effective with a greater number of learners.

METHODS: A survey was administered to assess student's perception of an active learning session on hyperammonemia as well as the student's motivation for learning and their learning strategies in general. Survey items were based on the Motivated Strategies for Learning Questionnaire. A combination of Google Survey and scantron sheets were used for the anonymous administration of the survey to study subjects.  The survey was voluntarily completed by 131 students. From our collected dataset, survey items were validated using factor analysis. Pearson coefficient analyses were then employed to describe the correlation between student characteristics and how they perceive the benefit of active learning sessions.

RESULTS: We found that students who perceive active learning sessions to be beneficial have high task value, self-efficacy for learning and performance and control of learning beliefs.

CONCLUSIONS: As a community of medical educators, understanding student characteristics, motivations and learning strategies that result in students fully engaging in active learning sessions will help us in the development of more effective curricular material in the future.     
 

A Medicine Capstone Course Positioned at the Transition to Clerkships: Clinical Reasoning, Patient Care and Preparation for USMLE Step 1  
David Naylor    
University of Kansas Medical Center 
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Purpose The transition from the pre-clerkship curriculum to the clinical years can be a challenging period for medical students. We designed an eight-week "Capstone" course to consolidate and integrate content from pre-clerkship courses by having students address authentic clinical cases in an active, large-group setting. The dual goal was to prepare students for clinical duties and USMLE Step 1.  

Methods Based upon our pre-clerkship content and USMLE focus areas, a total of 96 clinical cases were developed. Eight-four clinicians and thirty-six scientists prepared and delivered content in the eight-week course.  Each day of the course was organized by a single patient presentation (e.g. "headache") and had three cases with disparate causes. Working in small groups (within the large classroom), students developed differential diagnoses, diagnostic and management plans. The process was facilitated by a clinician and included presentations of high-yield scientific content by science faculty. Our two regional campuses participated via interactive television. Daily formative assessment, based upon USMLE Rx (commercial question bank), was provided.  Summative assessment was via four 100 question exams built from the NBME CAS question bank.  

Results Overall, students reported a high degree of satisfaction with the course, with some perception that course demands competed with USMLE Step 1 preparation. The teaching partnerships between clinicians and scientists were a notable success, enriching the sessions and positively impacting collegiality. Results obtained by students on the course's NBME CAS exams correlated with scores achieved by the student cohort on USMLE Step 1.  

Conclusions We successfully delivered a course at the clerkship-transition period, which served the dual purpose of foundational content consolidation and practice in clinical reasoning.  While student focus during the period was squarely on USMLE Step 1 preparation, they reported satisfaction with the course's outcomes. Teaching partnerships between clinical and scientific faculty proved to be highly effective. 

Study of Live Lecture Attendance: Students Perceptions and Expectations
Johnathan M. Emahiser | John Nguyen | Cheryl Vanier | Amina Sadik  
Touro University Nevada
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PURPOSE Increasing numbers of preclinical medical students are missing class; instead, they are learning through the use of recorded lectures and commercially available board exam preparation resources. There are no studies focused on students' perceptions and reasons for not attending class. This study aimed to identify students' perspectives on attendance and potential attendance-improving measures.

METHODS A survey comprised of 23 questions was created and subjected to two- round validation by students, a focus group session, and final validation by educators before being deployed to 317 preclinical students at TUNCOM at the end of the 2018-2019 school year. Differences related to gender, cohort (first or second-year students), and desired specialty were related to lecture attendance using logistic regressions. Effect sizes were shown using odds ratios and 95% confidence intervals. Likert scales and rank variables were summarized by means and standard deviations, and comparisons among groups of interest were accomplished using t-tests or ANOVAs.

RESULTS Students skipped lectures mainly because of the increased efficiency of viewing lectures online (66%) and issues with professors' teaching style (59%). Improved cognitive integration between disciplines (70%) and professors pointing out "high-yield" material (65%) were the most popular options for improving class attendance. The use of directed study assignments with clinical relevance sessions (16%) or inclusion of case studies (26%) were the least popular.

CONCLUSION The results of this study corroborate other work that has identified preparation for Board Examinations as the primary purpose of learning in the first two years of medical education. Although other studies suggest that active learning might attract students to the classroom, the responses in this survey suggest otherwise.   

The Influence of Student Motivation and Learning Strategies on How They Perceive the Benefit of Active Learning Sessions
Martha Faner| Seema Mehta | Amar Takrani | Casey Schukow | Ah Ra Cho | Raquel Ritchie | Carol Wilkins
Michigan State University
VIEW THE PRESENTATION     

PURPOSE: At Michigan State University College of Osteopathic Medicine, the biochemistry faculty have developed many active learning sessions throughout the pre-clerkship curriculum. This study aims to understand the characteristics, motivations and learning strategies of medical students that perceive active learning sessions to be beneficial and those of students that do not. This understanding may help us in modifying and designing these sessions to be more effective with a greater number of learners.

METHODS: A survey was administered to assess student's perception of an active learning session on hyperammonemia as well as the student's motivation for learning and their learning strategies in general. Survey items were based on the Motivated Strategies for Learning Questionnaire. A combination of Google Survey and scantron sheets were used for the anonymous administration of the survey to study subjects. The survey was voluntarily completed by 131 students. From our collected dataset, survey items were validated using factor analysis. Pearson coefficient analyses were then employed to describe the correlation between student characteristics and how they perceive the benefit of active learning sessions.

RESULTS: We found that students who perceive active learning sessions to be beneficial have high task value, self-efficacy for learning and performance and control of learning beliefs.

CONCLUSIONS: As a community of medical educators, understanding student characteristics, motivations and learning strategies that result in students fully engaging in active learning sessions will help us in the development of more effective curricular material in the future.

A Medicine Capstone Course Positioned at the Transition to Clerkships: Clinical Reasoning, Patient Care and Preparation for USMLE Step 1
David Naylor  
University of Kansas Medical Center  
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Purpose The transition from the pre-clerkship curriculum to the clinical years can be a challenging period for medical students. We designed an eight-week "Capstone" course to consolidate and integrate content from pre-clerkship courses by having students address authentic clinical cases in an active, large-group setting. The dual goal was to prepare students for clinical duties and USMLE Step 1.  

Methods Based upon our pre-clerkship content and USMLE focus areas, a total of 96 clinical cases were developed. Eight-four clinicians and thirty-six scientists prepared and delivered content in the eight-week course.  Each day of the course was organized by a single patient presentation (e.g. "headache") and had three cases with disparate causes. Working in small groups (within the large classroom), students developed differential diagnoses, diagnostic and management plans. The process was facilitated by a clinician and included presentations of high-yield scientific content by science faculty. Our two regional campuses participated via interactive television. Daily formative assessment, based upon USMLE Rx (commercial question bank), was provided.  Summative assessment was via four 100 question exams built from the NBME CAS question bank.  

Results Overall, students reported a high degree of satisfaction with the course, with some perception that course demands competed with USMLE Step 1 preparation. The teaching partnerships between clinicians and scientists were a notable success, enriching the sessions and positively impacting collegiality. Results obtained by students on the course's NBME CAS exams correlated with scores achieved by the student cohort on USMLE Step 1.  

Conclusions We successfully delivered a course at the clerkship-transition period, which served the dual purpose of foundational content consolidation and practice in clinical reasoning. While student focus during the period was squarely on USMLE Step 1 preparation, they reported satisfaction with the course's outcomes. Teaching partnerships between clinical and scientific faculty proved to be highly effective.    

Histology Retention in a Pre-Clinical Medical School Curriculum    
Alexa Hryniuk | Catherine Will | Anna Edmondson 
University of Manitoba
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PURPOSE: Poor retention of medical knowledge is a concern within medical education. Investigation of histology retention is increasing important as medical education moves towards integrated curricula. The purpose of this study was to evaluate histology retention during the pre-clinical integrated curriculum at the Medical College of Georgia.

METHODS: Academic performance data from histology and pathology was collected for first and second-year students from classes 2022 and 2023 (n=362). A histology comprehensive assessment was administered at the end of the first and second academic years to assess histology retention. Medical students were surveyed on histology experience and learning as well as study modalities during their pre-clinical training. A comparison of means was used to assess the relationship between histology retention compared to academic performance, histology exposure, and modality of study. Paired sample t-tests were used for analyses.

RESULTS: First-year medical students were found to retain 52.4% ±17.0% of histology content by the end of the academic year. Student retention dropped on from ~84% to 52% regardless of retention interval length (2, 3, 5, or 6 months). Histology retention was significantly increased in students with prior histology experience (58.5% ±15.3% vs. 51.2% ±17.2%; p=0.04). However, no significance in retention was seen when study modalities were compared. Data collected from second-year medical students will be analyzed at the end of the academic year and results will be available at time of presentation.

CONCLUSIONS: Students are retaining 50% of histology taught in the pre-clinical curriculum. The significant difference in histology retention found with prior histology exposure suggests that re-exposures during the pre-clinical curriculum could aid in histology retention. These results may be useful in guiding reform for better retention outcomes in pre-clinical curricula.    

Improved Care for People with Disabilities: A Pilot Study of Development and Initial Implementation in Medical School Training
Natalie Hamilton | Sarah Yonder | Jade Johnson | Jason Adam Wasserman | Neli Ragina  
Central Michigan University College of Medicine | Oakland University William Beaumont School of Medicine 
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PURPOSE Healthcare professionals often are unaware of the health inequity for people with disabilities. This is unsurprising since the topic is underrepresented in the medical curricula. Based on focus groups, diverse patient encounters (DPE), and integrated community experiences (ICE) we developed an opportunity for medical students to gain knowledge about barriers to healthcare faced by people with disabilities.

METHODS 300 medical students participated in either 1) conducting focus groups in the twelve surrounding counties in the Mid-Michigan area, 2) participating in DPEs in order to gain clinical skills in caring for patients with disabilities, and 3) volunteering in ICE programs developed in collaboration with Special Olympics that fostered peer-to-peer interaction with people with disabilities.

RESULTS In the focus groups where students were trained to interview people with disabilities, three major themes were identified: 1) lack of patient centeredness; 2) barriers in navigating the healthcare system; 3) inadequate communication. In the DPEs, students reported the lack of preparedness in addressing the needs of people with disabilities. Finally, data from ICE groups demonstrated the importance of and benefit to medical students working directly with this population.

CONCLUSION Problems of healthcare access for people with disabilities represents a unique set of challenges. Although improved technology makes healthcare more efficient, the majority of patients with disabilities still reported issues of access, and cited problems of "patient-centeredness" as an obstacle to quality care. Our results clearly demonstrate the need of incorporating educational interventions regarding disabilities into the medical school curriculum.    

Multivariable Analysis Shows Early Clinical Exposure Improves Preparedness for Clerkships
Aaron Atlas | Donna-Marie McMahon | Christine Hutak | Paula Ryo | Min-Kyung Jung | Alanna McTaggart | Thomas Chan
NY Institute of Technology College of Osteopathic Medicine
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PURPOSE Much literature qualitatively assesses preparedness for practice using questionnaires and interviews of recent medical graduates. These studies repeatedly report the positive impact of clinical shadowing. This study aims to quantify the effects of early clinical exposure (during medical school years 1 and 2) by defining a threshold of clinical experience which confers improved performance on standardized clinical evaluation and feelings of preparedness for clerkship rotations in year 3.

METHODS First- and second-year medical students were sent an initial online survey to list the number, type, and hours of clinical experience which they completed during their first two years of medical school. On a validated follow-up survey, students reported their own level of preparedness for clinical rotations across 6 indices: clinical skills, procedural skills, communication, teaching/learning, work environment, and teamwork. Multivariate regression assessed the effects of clinical experiences on Objective Structured Clinical Examinations (OSCE) and preparedness surveys.

RESULTS 76 students completed an average of 1.2 clinical experiences (31.9 hours) in the first 2-years of medical school. Doctor shadowing was the most common experience (28.9%). Students who completed at least 15 hours had significantly higher OSCE scores, improved preparedness for clerkships overall, and improved preparedness with clinical and procedural skills. First- and second-year students who participated in the Clinical Practicum program reported nearly 24% and 14% higher clinical skill preparedness, respectively. Amongst first-year students, each additional hour of clinical experience conferred a 0.2% increase in self-reported preparedness for clerkships. This class also reported a 7.3% increase in teaching and learning preparedness per each additional clinical experience.

CONCLUSION Improved performance on clinical exams and increased student feelings of preparedness for clerkships resulted from increased number and hours of clinical experience. These findings support encouragement of additional time shadowing physicians during the preclinical years of medical school in order to improve clinical readiness.

A Comprehensive Review of Mentorship in Medical School: 2014-2019
Emily Seltzer | Aaron Atlas | Bernadette Riley | Thomas Chan
NY Institute of Technology College of Osteopathic Medicine 
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PURPOSE Formal mentorship programs afford medical students more research involvement, career guidance, personal and professional development. To better understand the influences on mentor-mentee connections, this study examined the medical school mentorship landscape. The primary objective was to determine the most common goals and models of mentorship programs in the United States and abroad.

METHODS A systematic review of PubMed, Ovid, and Cochrane databases identified all studies of medical school mentorship published between 2014-2019. Studies were reviewed for program location, goal(s), program model (pairing strategy, meeting frequency, forum, etc.), benefits to mentors and mentees. Frequency analyses compared domestic and international programs.

RESULTS 36 studies met inclusion criteria, of which 47.2% were US-based. Professional development was the most frequently identified goal of international mentorship (89.5%, p=0.002). Mentorship programs in the US more commonly indicated exposure to specific fields of medicine as a program goal (47.1%,p=0.004). More than 80% of mentorship programs paired students with faculty/physicians while about 15% assigned more senior students as mentors. Mentees were most often randomly assigned mentors, overall (56%). However, international programs preferred randomized pairing while US-programs more commonly used preference-based pairing strategies (p=0.008). One-on-one mentorship was significantly increased in US-programs, while international studies identified significantly more group mentorship (p=0.02). Studies in the US most often reported that mentee's valued mentors who demonstrated interest in their success (44.4%) while international studies most frequently identified value in strong interpersonal skills (33.3%). Career advice, professional development, and individualized support were the most commonly reported mentee benefits, while mentors most often perceived the opportunity to build relationships with students and provide support beneficial.

CONCLUSION Mentorship in the US has become geared to more specialized fields of medicine. Despite variance in program models, medical students in the US and worldwide prefer mentors who are invested and who they can connect with socially.

 

An asynchronous, online activity for small group case-based learning with multimedia elements: Bringing psychiatry to medical students at rural placements
Jessamina Blum  
University of Minnesota Medical School    
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PURPOSE The Rural Physician Associate Program (RPAP) at the University of Minnesota is a longitudinal integrated clerkship wherein medical students complete their third-year clinical curriculum at rural sites. During immersion in a rural community, students are often not exposed to the same diversity of psychiatric conditions as metro-area block clerkship students, and often report feelings of isolation and lack of peer-to-peer discussion during the nine-month program.

METHODS RPAP students completed a weeklong online case discussion that included interactive asynchronous and synchronous elements. In groups of 5-6, students posted a short video response to a case introduction, replied to each other's videos, and participated in an online written case discussion facilitated by a psychiatry resident. All students then attended an hourlong in-person or virtual case debrief with the facilitating resident and a faculty member.

RESULTS On average, students commented on each other's responses more frequently than required by the assignment, indicating a high level of engagement. Most cited clinical resources, including primary literature, to support their differential diagnoses and treatment plans. Through prompts from the facilitator and each other, and collaborative reasoning, common diagnostic errors were resolved. Several groups also raised broader psychosocial concerns.

CONCLUSION Online, case-based small group learning incorporating both video and written forums was successful in engaging learners in extensive discussion and active learning. Students will complete two more cases while at their rural sites. The second case will again be presented and facilitated by residents but the third will be presented and facilitated by a student volunteer from each small group based on a case experienced at their rural site. Further data collection will include student feedback about the activity structure, material, and the value of discussion in a small peer group versus with a preceptor alone. Feelings of isolation while at the rural site will also be measured and compared to baseline.    

Active Learning in Small Groups: What Do Medical Students Want, and Why?
AWARD NOMINEE
Jan-Willem Grijpma | Anne de la Croix | Anke Kleinveld | Martijn Meeter | Rashmi Kusurkar
Amsterdam University Medical Center, VUmc School of Medical Sciences | Vrije Universiteit Amsterdam | LEARN! Research institute for learning and education 
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PURPOSE Active learning strategies are an important component of medical curricula, because of their effectiveness in developing the knowledge, skills, and attributes of students. However, teachers frequently encounter resistance from students, when trying to engage them in a learning activity. This study aims to identify student preferences for active learning and determine the origins of these preferences, using the concepts of 'approaches to learning' and 'epistemic beliefs'. We have used funding from the IAMSE-ScholarRx Student Grant for this study.  

METHODS Q-methodology is a mixed-method research design used for the systematic study of subjectivity. First, we generated a set of 54 statements on active learning preferences from relevant literature and student evaluations. We used multi-source feedback and pilot testing to get a complete and unbiased set. Second, in individual interviews, first year medical students rank ordered these statements from 'most agree' to 'most disagree' and explained why. Last, the Q-sorts were analyzed using a by-person factor analysis. The factor solutions were evaluated, interpreted and finalized using methodological, statistical, and qualitative criteria through consensus.  

RESULTS A four-factor solution (i.e. profiles) was found to best fit the data collected from 52 students, and explained 52% of the variance. Students in profile 1 (N=15) can be summarized as 'understanding-oriented', students in factor 2 (N=8) as 'assessment-oriented', students in factor 3 (N=10) as 'group-oriented', students in factor 4 (N=14) as 'practice-oriented'.  

CONCLUSION Using Q-methodology, we were able to identify four student profiles describing distinct preferences for active learning. Underlying these preferences are differences in the students' approaches to learning (i.e. motives and strategies) and epistemic beliefs. Awareness of the profiles can help teachers when communicating with students about the active learning strategies used in their courses, and when engaging students in specific learning activities.

Using Human-Centered Design and Entreprenurial-Minded Learning Methodologies to Develop Innovation Ideas in Medical Education    Julia Schmitt  
Medical College of Wisconsin
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PURPOSE The practice of medicine is rapidly changing and will require innovative thinking to transform medical education. Developing innovators throughout medical colleges is important so that future physicians are prepared to help shape the transformation of medical care. Human-centered design (HCD) combined with entrepreneurial-minded learning (EML) are skills that can be taught to achieve that goal. They include using curiosity and empathy to discover the value learners need in their program.  The Transformational Ideas Initiative (TI2) program at the Medical College of Wisconsin (MCW) taught these skills to develop pilot programs.

METHODS Teams consisting of faculty, students and staff submit ideas on how to innovate medical education. These ideas are reviewed by a team of 5 using a standard scoring tool, with ten teams selected each year. Teams are coached through the HCD/EML approach during 2 workshops, 2 presentations and 2-3 coaching sessions over the course of 8 months. The Kern Institute funds each effort.

RESULTS 50 faculty, 25 students, and 11 staff at 3 academic sites have implemented an innovation idea through the TI2 program. 90% of participants rated their satisfaction with the program as "satisfied" or "extremely satisfied," 40% of participants have reported using HCD/EML strategies in other areas of their work. Confidence in using these skills increased after training by 80%.

CONCLUSION Team members liked using HCD/EML skill sets. They demonstrated confidence after training. Many reported using these skills in other areas of their career. Further study is underway to develop a validated rubric and to measure how the skills are translatable to other areas.

Faculty Lecturing at One Campus vs. Live-Streaming to the Other Campus and Its Influence on Student Performance and Student Evaluations of the Faculty    
Qing Zhong  
Rocky Vista University
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PURPOSE: Rocky Vista University has had two campuses since 2017, with one in Parker, Colorado and another in Ivins Utah. Our curriculum is organ-system based. The lecturing is presented in one campus and is live-streamed to another campus. All lectures are recorded and posed online. This study is to assess whether faculty lecturing in one campus affects performances of both-campuses' students and the student evaluation on the faculty.

METHODS: A pharmacology faculty was lecturing in CO campus for Second-year-RENAL II course. The same faculty was lecturing in UT campus for First-year-Cardiovascular I (CV1) course. We had second-year medical students of 153 in CO and of 122 in UT, and first-year medical students of 169 in CO and of 139 in UT. The performances of both campuses' students on this faculty's exam questions, and student evaluations on this faculty were collected. The data were analyzed by students' T test.

RESULTS: There was no significant difference in the performances on this faculty's RENAL II exam 1 questions ( 38 over total 50 questions) between two campuses' students ( CO 93.2 ± 8.1 % vs UT 94.2 ± 6.9%, P &gt; 0.05) when lecturing in CO campus. Similarly, the performance on the same faculty's questions in CV1 exam 2 (18 over total 65 questions) of CO campus' students was not significantly different from that of UT campus' students ( 94.6 ± 3.6 vs 93.3 ± 6.1, P &gt; 0.05) when lecturing in UT campus. Students of both campuses agreed and strong agreed that this faculty member effectively helped them to learn the course material (RENAL II: CO 96.77% vs UT 98%; CV1: CO 97.44% vs 88.9%, P &gt; 0.05).

CONCLUSIONS: Lecturing from different campus has no impact on both-campuses' students' academic performance, neither on student evaluation on the faculty.     

 
How Do Medical Trainees Learn To Manage Acutely Unwell Patients? A Uk-Based Qualitative Interview Study    
Dena Pitrola | Lynne Allery  
Wrexham Maelor Hospital | Cardiff University
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PURPOSE Medical trainees (MTs) manage a substantial proportion of acutely unwell patients. The UK MT curriculum1 broadly defines learning objectives for medical emergencies, however a busy working environment poses significant challenges. Furthermore, influential factors determining successful learning aren't always clear2. The aim was to explore factors influencing learning when managing acutely unwell patients using cases to form critical incidents when learning in acute care.

METHODS Ethical approval was obtained. Semi-structured interviews were conducted with MTs using the critical incident technique, after interview schedule piloting. Interviews explored trainees' perspectives on factors creating successful learning both when on call and during standard working days. MTs were asked to recollect positive and negative learning experiences and explore underlying reasons. Interviews were fully transcribed. Data was analysed using an inductive method, based upon grounded theory principles. Through an iterative process, data analysis guided further data collection to develop emerging themes until theoretical saturation occurred.

RESULTS Eight interviews were conducted. Data analysis demonstrated three interlinking themes. These were professional development, responding to challenges and the working environment. Trainees explained how supportive senior supervision enabled stimulation of a cycle of reflection based upon feedback and encouraged increased participation in complex tasks3. Difficulties were encountered when trainees perceived a lack of senior support including lack of feedback or discussion. Finally, senior leadership including emphasising learning was viewed as a positive solution when learning within a busy enviromnent4.

CONCLUSIONS This study provided insight into how supported supervision of MTs can stimulate a cycle of reflection through carefully timed feedback. This can facilitate trainees' development within professional roles to increase confidence in managing acutely unwell patients.    

Improving Student Performance with Case-Based Sessions in an Integrated Medical School Pre-Clerkship Curriculum  
James Fong | Dolgor Baatar | Cynthia Perry | Dale Quest | Diana Pettit
Texas Tech, El Paso TX | Kaiser Permanente School of Medicine
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PURPOSE Lecture-based dissemination of information is the traditional approach to presenting curricular materials. Recent studies suggest team or case-based learning sessions are more effective than didactic lectures. However, it remains unclear whether replacement of didactic lectures with case-based sessions would improve learning outcomes in medicals schools with integrated, clinical presentation-based curricula.

METHODS We converted the 2nd year Endocrine Unit (END), clinical presentation pre-clerkship curriculum from didactic lectures to monographs, voice-over Power Points or interactive modules, each with self-assessment quizzes, for use as asynchronous learning materials. At the end of each week students were required to attend integrated, case-based sessions beginning with an Individual Readiness Assurance Test (IRAT) on the material covered that week. IRAT scores comprised 12% of the Unit grade. At the end of the unit, students were ranked based on year one performance. Performance in the END unit for 2018, and 2019 pilot groups were compared to the 2017 control group.

RESULTS Summative exam performance for 2018 and 2019 was significantly higher than that of the 2017 control group (81.1%, 83.2% vs 76.6%, respectively, p<0.01). When we looked at individual longitudinal performance, there was no significant improvement in outcomes for the top 2/3 of the class across all years (p&gt;0.05). However, students ranked in the bottom 1/3 of 2018 and 2019 performed better than expected (p<0.01), while the bottom 1/3 of 2017 showed no significant difference in performance. This improvement resulted in a reduction in failure rate from 11% (2017) to 1% (2018), to 0% in 2019.

CONCLUSION The improvement in student outcomes suggests that students benefit from the addition of weekly case-based integrated sessions. Weekly graded quizzes insure that students stay current and come prepared for integrated sessions, which likely contributes to improved student outcomes. These results provide a rationale for replacement of lectures with interactive sessions as part of pre-clerkship curricula.    

Inclusion of People with Intellectual Disabilities and Developmental Disorder as Standard Patients to Teach Clinical Skills
Douglas Wells | Tonoya Sengupta | Michelle Cornacchia | James Caggiano | Francis Dawgert | Youngjin Cho  
Geisinger Commonwealth School of Medicine
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PURPOSE As a part of curriculum enhancement projects to better train medical students to provide care for people with intellectual disabilities and/or developmental disorder (IDD), we developed and assessed the effectiveness of a clinical skill session with people with IDD as standard patients (SP) in enhancing students' confidence in interacting with patients with IDD.

METHODS In our need assessment, our students identified discomfort due to lack of exposure as a significant barrier and ranked a simulated patient encounter as the preferred way to learn about people with IDD. We on-boarded 13 people with moderate to mild IDD to registered SPs pool. Within the Art of Practicing Medicine, a required clinical skill course for our MD2, we created a simulation module that is sensitive to the needs of people with IDD. The module consists of a didactic and an SP session; the students were introduced to the functional definition of IDD in the didactic session and practiced a general survey and the vital sign on people with IDD as SPs. The students' attitude toward patients with IDD was measured with 31 item surveys administered before and after the session.

RESULTS Around 40% of the M2 class completed both pre and post surveys. Statistically significant improvement in attitudes was detected in multiple areas, such as attitude toward problem behaviors and perceived difficulty in obtaining a medical history. Students' comfort in speaking with a person with IDD and feelings of goodness also increased. Qualitative comments captured in the students and facilitators post-survey supported the positive learning outcomes.

CONCLUSION The session was effective in aiding medical students to feel competent in recognizing a person with IDD, speaking with them, and focusing on the initial approach to care with ease, while establishing a sustainable platform for the inclusion of people with IDD into the curriculum.  

Platform-Based Delivery of Evidence-Based Learning Strategies Can Make Medical Education More Effective and Available  
Peter Horneffer
All American Institute of Medical Sciences
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PURPOSE There has been a marked under-utilization of evidence-based learning strategies in medical education, despite the clear efficacy of these strategies and the exponential rise in new content medical students are expected to learn. Furthermore, as new medical schools are established to help address the global shortage of physicians, many students in these programs require new approaches to learning in order to acquire the requisite knowledge base needed to be a physician.

METHODS Certain evidence-based learning strategies are known to make learning more effective but can be challenging to apply. This presentation describes the use of a specialized medical education platform to enable effective delivery of these learning tools in a new medical school situated in a rural, underserved community in an underdeveloped country. This innovative approach to helping students from resource-poor backgrounds perform at a high academic level, offers insights as to how to provide more effective ways to teach in all settings.

RESULTS Despite the significant cultural shift required to implement a flipped classroom approach, the use of a "smart platform" allowed for increased in-class interactivity afforded by the "flipped" approach, as well as the use of validated learning strategies such as "interleaving" and "spaced retrieval" which had been difficult to implement in a conventional teaching model. Both faculty and students recognized the benefits and adopted this new approach. The data tracking capabilities offered by this approach allowed for the unique opportunity to intervene early when students were struggling.

CONCLUSIONS Applying here-to-fore underutilized evidence-based learning strategies has been logistically challenging using conventional teachings methods. Specifically designed educational platforms can greatly facilitate this process. Medical students world-wide have a comfort level and desire to utilize technology to augment their learning processes. It is imperative that faculty take a pro-active role in facilitating this process to ensure that students use these new resources most effectively.   

Evaluating the Use of Augmented Reality to Teach Respiratory Anatomy    
Benjamin Robinson, Terence Mitchell, and Bonnie Brenseke 
Campbell University School of Osteopathic Medicine
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PURPOSE To determine the feasibility and applicability of using augmented reality (AR) technology in anatomy instruction at Campbell University School of Osteopathic Medicine (CUSOM).

METHODS A group of first-year medical students were randomized into experimental (n=5) and control (n=5) groups. The control group participated in a faculty-led learning activity on respiratory anatomy and histology using human cadavers, glass slides, and light microscopes. The experimental group used Microsoft HoloLens technology, with the anatomy platform HoloHuman and digitized photomicrographs, to participate in a faculty-led learning activity covering the same content. Multiple-choice anatomy knowledge assessments and perceived anatomy understanding ranking-scales were administered to students before and after the learning activity. Student perceptions of each learning method were recorded using 5-point Likert scales and written feedback.

RESULTS Both the control and experimental groups scored higher on the post-activity assessment of anatomy knowledge compared to their pre-activity assessment. There was no significant difference in post-activity assessment averages between the groups. The control group's mean score on the post-activity knowledge assessment was 85.0% (SD=10.9). The experimental group's mean score on the post-activity knowledge assessment was 85.0% (SD=12.4).  Compared to the control group, the experimental group had a higher mean post-activity perceived histology understanding, 4.0 compared to 3.2, and consistently rated the learning method higher on the 5-point Likert scale.

CONCLUSION This study suggests AR technology offers a novel approach to teaching gross and microscopic anatomy that is comparable to traditional methods, promotes student engagement, and has potential to increase perceived understanding of anatomical knowledge. Prior to making changes in the CUSOM curriculum, we need to further evaluate the technology and develop a strategy for its optimal use.   
 

Burnout, Depression, and Alcohol Use in Chiropractic Students
Sean Herrin | Christine Major | Leslie Takaki   
University of Western States    
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Purpose Psychological stress can have a significant impact on the well-being of medical students and can lead to burnout. Burnout is less well documented amongst chiropractic students. We believe that chiropractic and medical students suffer from the same stresses and, thus, would exhibit various forms of distress associated with burnout and alcohol abuse similarly. Additionally, perception of stress mitigation through participation in a mindfulness course was expected.

Methods All chiropractic students enrolled in the spring of 2010 and 2019 were surveyed anonymously using validated instruments to assess burnout, depression, and alcohol use. The survey included questions about demographic information, GPA, and occurrence of personal life events in the previous 12 months. In 2019, questions were also included about participation in a mindfulness elective.

Results The response rate in 2010 was 56% and 63% in 2019. 66% of students were €˜at risk for' burnout or had burnout in both cohorts. More students in 2019 scored in the highest burnout category than in 2010 (21% vs. 8%). In both cohorts, year-in-training was associated with increased burnout as were various life events. An increase in depression was observed from 62% in 2010 to 70.9% in 2019. Binge drinking was reported by 64% in both cohorts. 86% of the 2019 cohort who had taken a mindfulness training course felt it aided in stress management.

Conclusion Prevalence of burnout, depression, and binge-drinking amongst chiropractic students was similar to the prevalence previously reported in the literature amongst medical students. An association between year-in training and burnout was observed highlighting the increase in burnout as students matriculated through the program. Of interest, the majority of students who participated in a mindfulness course perceived it to be beneficial for stress management. Further exploration of mindfulness training may lead to the development of effective interventions for student burnout.    

Developing Professional Attributes and Well-Being Skills During the Initial 6-months of Medical School via Multiple Reflective Practice/Self-Assessment Cycles in Anatomy Coursework    
Jeff Fritz | Teresa Patitucci  
Medical College of Wisconsin 
No presentation provided

PURPOSE: Medical school is filled with transitions as first-year learners adjust to its academic pressures and issues of professional identity. This study's purpose was to determine if multiple reflective assignments/self-assessments integrated in an anatomy course would promote student development in areas of emotional intelligence, team-work or well-being without negatively impacting academic performance.

METHODS: Three separate cohorts of first-year medical students (n=65) wrote one reflection and one self-assessment for each of four blocks in anatomy coursework. Reflections were evaluated using qualitative analysis on the themes of emotional intelligence, teamwork, and wellness/wellbeing. Self-assessments were similarly evaluated. Learner satisfaction was evaluated with a follow-up survey. Aggregate exam scores were compared with peers not involved in the study group using unpaired t-test. This project has Institutional Review Board approval (PRO00032535).

RESULTS: Reflections and self-assessments completed early in the term observed that students focused on teamwork skills and anatomical competencies. As the course continued, students tended to focus on self-discovery, team accountability and conflict resolution. Learners also expressed social and physical challenges (lack of time for support network, exercise, or prepare healthy meals). At the conclusion of the course, students continued to focus on self-discovery, and discussed insights on future specialty. Learners also expressed the most valuable things they learned from working with a human body donor were empathy, occupational satisfaction, and self-awareness. Follow-up survey results showed most respondents recommend continued use of the reflective practice/self-assessment process and application in future coursework. No significant difference in final grades between study participants and non-participants was observed.

CONCLUSION: Leaners found reflective writing coupled with self-assessment beneficial during their first six months of medical school with minimal impact on reaching course objectives. Learners demonstrated the most growth in areas of self-awareness and teamwork, but were challenged in finding time for relationships, physical and social wellbeing.    

Exploring Medical Students' Beliefs about Teaching and the Enactment of Those Beliefs in Practice
Deborah Barry | Selina Noramly  
University of Virginia School of Medicine
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PURPOSE Medical education teaching electives are increasingly popular across the United States, with the majority of medical schools now offering Students as Teachers programs (Matron, McCullough & Ranbanam 2015; Soriano, et al 2010). This project will provide insight into the practice of teaching for medical students, as well as how that practice is linked to student beliefs, if at all.

METHODS This study explores how participating in a two-week medical education preparatory course influences medical students' beliefs about teaching and the enactment of those beliefs. Students are required to complete a reflective teaching statement that asks them to articulate their ideas about teaching as well as their vision of how they see themselves as a teacher, as well as record a video of themselves teaching. These two assignments are qualitatively coded to first, create a rubric of each individual students' actionable beliefs about teaching, and then their videos are coded to look for those specific beliefs in action. These students also act as teaching assistants for first- and second-year courses. These teaching opportunities are also video recorded and coded using the student-specific rubrics.

RESULTS A total of eight fourth year medical students participated in the 2019 medical education preparatory course. Analysis of the reflective teaching statements revealed several action-based ideals of teaching for each student. For example, one student reported their intention to teach by "asking leading questions", while another wrote about implementing "case based interactive discussions".

CONCLUSION Several actionable themes emerged from students' reflective teaching statements. Analysis of microteaching and teaching assistantship data is still in process. At the completion of this project, we hope to evaluate the success of the course goals and construct a model that will elucidate best practices in training medical students as medical educators.    

Graduate Education Trends In the Anatomical Sciences: Are Anatomy Phds Nearing Extinction or Adapting To Change 
William S. Brooks | Niroop Kaza | Darius J. Singpurwalla | Adam B. Wilson  
University of Alabama at Birmingham | National Science Foundation
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PURPOSE Human anatomy is the cornerstone of health sciences education, yet literature over the past 50 years has demonstrated a continued shortage of anatomy educators. This study assessed trends in doctorates awarded in anatomy and related fields within the U.S. over the past 48 years and evaluated modern graduate education in the anatomical sciences.  

METHODS Retrospective data were compiled from the National Science Foundation Survey of Earned Doctorates. The number of doctorates in anatomy and related fields and the total number of doctorates by sex and race/ethnicity were plotted for trend analysis. The number of currently active PhD anatomy training programs within U.S. allopathic and osteopathic medical schools were assessed. Curricula and major characteristics of each active program where evaluated through website searches and phone interviews with program directors. The IRB at UAB did not qualify this study as human subjects research.  

RESULTS Since 1969, the number of PhDs awarded in Anatomy has declined, on average, by 3.3 graduates per year (Max = 163, 1982; Min = 9, 2017). Conversely, doctorates in Cell Biology, Developmental Biology, and Neuroscience have observed marked growth. Males have historically dominated the anatomical fields, but more females received doctorates than males from 2009-2016. The proportion of PhDs in the anatomical sciences awarded to underrepresented minorities (URMs) has steadily increased with an all-time high of 11.1% in 2015. Currently, 21 active doctoral programs in anatomy were identified from among 187 institutions affiliated with a medical school. PhD programs were categorized as either Anatomy Education (N=8), Classic Anatomy (N=8), or Anthropology/Evolutionary Anatomy (N=5) programs based on coursework and education/teaching-based curricula.  

CONCLUSIONS Declining numbers of PhD graduates and misalignment between training and job market needs has contributed significantly to the shortage of anatomists. A concerted effort is necessary to ensure the future of anatomy within health professions education.    

Professional Development and Continuous Quality Improvement through Mentoring     
Rohini Karunakaran | Srikumar P S   
AIMST University
No presentation provided

PURPOSE Mentoring is a dynamic process and enhances professional development for the mentors and the mentees. Lecturers in medical schools need to enhance their professional development skills to reform our educational system and to promote continuous quality improvement in educators. The mentoring process is a sign of a productive mentoring relationship between the mentors and mentees, which is underpinned by the mentor-mentee personal and professional qualities.

METHODS Mixed-Method research was conducted among the mentors. This mixed-method study includes surveying mentors (n = 75) on a five-part Likert scale and interviews with experienced mentors (n = 25) to analyse the professional development for mentors as a result of the mentoring process. Quantitative data was evaluated through a pedagogical knowledge framework.

RESULTS The research data revealed that mentoring process enhances professional development to the mentors, promotes continual quality improvement and led towards enhancing communication skills, developing leadership roles, critical thinking and problem-solving skills and promotes lifelong learning and entrepreneurial skills. Providing professional development to lecturers on mentoring can help to build capacity by quality mentoring of lecturers through explicit mentoring practices and reflecting and deconstructing teaching practices for mentors' pedagogical advancements.

CONCLUSION Mentoring enhances the mentors to sharpen their instructional skills, reflect on their instructional skills and critically evaluate their teaching strategies and thus promotes continuous professional development.    

A Comprehensive Review of Mentorship in Medical School: 2014-2019
AWARD NOMINEE
Emily Seltzer, BS | Aaron Atlas, BS | Bernadette Riley, DO | Thomas Chan, DO
NY Institute of Technology College of Osteopathic Medicine
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PURPOSE Formal mentorship programs afford medical students more research involvement, career guidance, personal and professional development. To better understand the influences on mentor-mentee connections, this study examined the medical school mentorship landscape. The primary objective was to determine the most common goals and models of mentorship programs in the United States and abroad.

METHODS A systematic review of PubMed, Ovid, and Cochrane databases identified all studies of medical school mentorship published between 2014-2019. Studies were reviewed for program location, goal(s), program model (pairing strategy, meeting frequency, forum, etc.), benefits to mentors and mentees. Frequency analyses compared domestic and international programs.

RESULTS 36 studies met inclusion criteria, of which 47.2% were US-based. Professional development was the most frequently identified goal of international mentorship (89.5%, p=0.002). Mentorship programs in the US more commonly indicated exposure to specific fields of medicine as a program goal (47.1%,p=0.004). More than 80% of mentorship programs paired students with faculty/physicians while about 15% assigned more senior students as mentors. Mentees were most often randomly assigned mentors, overall (56%). However, international programs preferred randomized pairing while US-programs more commonly used preference-based pairing strategies (p=0.008). One-on-one mentorship was significantly increased in US-programs, while international studies identified significantly more group mentorship (p=0.02). Studies in the US most often reported that mentee's valued mentors who demonstrated interest in their success (44.4%) while international studies most frequently identified value in strong interpersonal skills (33.3%). Career advice, professional development, and individualized support were the most commonly reported mentee benefits, while mentors most often perceived the opportunity to build relationships with students and provide support beneficial.

CONCLUSION Mentorship in the US has become geared to more specialized fields of medicine. Despite variance in program models, medical students in the US and worldwide prefer mentors who are invested and who they can connect with socially.



Influence of dedicated preparation for USMLE Step 1 and COMLEX Level 1 on student well-being
AWARD NOMINEE
Maniraj Jeyaraju | Jesse Moore | Mark Grichanik | Alice Hudder | Yoon Soo Park | Sandra Yingling | Sean Tackett
University of Maryland School of Medicine | Larner College of Medicine at the University of Vermont | Rush Medical College | Lake Erie College of Osteopathic Medicine | University of Illinois College of Medicine | Johns Hopkins Bayview Medical Center
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PURPOSE USMLE Step 1 and COMLEX Level 1 are the first in their respective series of national licensure exams in the U.S. and the most important factor post-graduate training programs use when deciding whom to interview. Preparing for such high-stakes exams is believed to cause stress for students, but no study has characterized students' well-being during dedicated exam preparation.

METHODS All students engaging in dedicated preparation for Step 1 or COMLEX 1 at three U.S. medical schools were surveyed online shortly after taking their exams and before most had received their scores. Surveys had Likert-type items asking about the influence of the dedicated preparation period on professional and personal aspects of their lives, their behaviors, and how often they experienced burnout or depression.

RESULTS A total of 353/921 (38%) students provided complete surveys. Students spent a median 62 hours per week (IQR 50-75) over 7 weeks (IQR 6-9) for dedicated exam preparation. While 95% of students felt their medical knowledge base improved, majorities reported worse quality of life (73%) and anxiety (80%). Regarding healthy behaviors compared to usual, some reported less sleep (44%) and most reported less exercise (66%), time away from academic responsibilities (75%), time with family (85%) and time with friends (93%). These rates did not vary significantly by school. Across the cohort, during dedicated preparation, 74% reported feeling burned out, and 53% depressed, weekly or more often.

CONCLUSIONS Students work hard, isolate themselves, decrease healthy behaviors, and suffer during dedicated preparation for their first level exams. Finding ways to mitigate against this is imperative to improve well-being. Future studies should investigate if and when students recover from exam-related stress, whether dedicated exam preparation contributes meaningfully to poor overall student well-being, and how preparation-related stress influences exam scores.
 

Two First Year Undergraduate Courses in Anatomy and Physiology Delivered In Intensive Mixed Mode Successfully Enhance Student Engagement and Academic Recovery    
Leanne Kenway  
Griffith University
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PURPOSE In line with Griffith University's Academic Plan 2017-2020 to provide an excellent educational experience to attract and retain students and the move to a University-wide trimester model, two undergraduate Anatomy and Physiology (A&P) courses were designed to offer increased flexibility for first-year students, incorporating online curriculum coupled with an active learning environment on-campus.

METHODS These courses support students commencing studies in trimester 2 (6 week intensive) and those seeking academic recovery from trimester 1 (12 weeks traditional delivery). Students view pre-recorded minilectures online prior to attending compulsory tutorials and laboratory sessions on campus. Face-to-face interactive tutorials and a custom-designed tutorial workbook were designed to engage and support at-risk students. Repeated testing was used to maintain student attention and build confidence and independence with learning -- imperative for a cohort with a large proportion of repeat students. Instructor story-telling and imagery was used to bring case-study examples to life, providing real world relevance during students critical initial exposure to Anatomy and Physiology.

RESULTS Students have embraced the immersive nature of the intensive mixed mode A&P course during their foundation year. They found the guidance and challenge provided by the teaching team during interactive in-person tutorials and the structured tutorial workbook most useful, with consolidation of content occurring during laboratory sessions. These offerings have afforded the success of students undergoing academic recovery in particular. Over the 4 years since their institution, 74%, 70%, 50% and 71% of repeating students passed Anatomy and Physiology Systems 1 on their second attempt.

CONCLUSION Two undergraduate Australian Anatomy and Physiology courses offered in mixed mode intensively have successfully enhanced student engagement, satisfaction and retention into second year. 

Blended Pre-Matriculation Course on anatomy and physiology to support incoming medical students
Lee Cheng Jie Irene  
Duke-NUS Medical School    
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PURPOSE: The transition from undergraduate programme to a graduate medical curriculum represents a significant challenge for some students. Research indicated that self-efficacy has strong links to students' ability to cope in medical school, hence reflected in their academic performance. One of "self-efficacy" constructs is "mastery experience" defined as prior success at having accomplished something similar to the new behaviour. Therefore, we developed Pre-Matriculation Course (PMC) with its pedagogy bearing resemblance to that of our school. PMC mainly focuses on the learning of introductory anatomy and physiology. This abstract describes the course and its outcome.

METHODS: PMC is a blended course consists of flexible, online lectures and in-class team-based learning sessions. Without reinventing the content, relevant online resources and a learning roadmap with key learning objectives were assigned to incoming medical students before matriculation. Two senior medical students were involved in the development of team-based learning resources. To evaluate the effectiveness of PMC in preparing incoming medical students, we analysed students' reaction and learning gain. We collected Pre-PMC survey and Post-PMC survey to analyse students' self-perceived confidence  in learning relevant subjects and overall course ratings on a 5-point Likert scale.

RESULTS: PMC was implemented as a supplementary course in AY2019/2020. Out of 82 accepted students, 79 students accessed the online materials, 50 students attended in-class sessions. End-of-course feedback indicated favorable responses on the  overall course organization, online course materials and quality of in-class sessions. Students' self-reported confidence in applying current knowledge of body functions to major organ system also increased from 2.57 (SD 0.93) in Pre-PMC survey to 3.3 (SD 0.86) in Post-PMC survey. More data is being collected to further evaluate students' academic performance in an ongoing preclinical course.

CONCLUSION: A flexible, blended course is feasible and generalizable across medical schools to equip medical students with early head-start, coping with the rigor of medical curriculum.     

Extinguishing Burnout at Its Source: Addressing Wellness Course Efficacy for Medical Students     
Valerie Gerriets | Jason Kuan | Cindy Ma | Melanie Yoshihara | Austin Thompson | Jose Puglisi  
California Northstate University
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PURPOSE Attending medical school is considered highly stressful and many studies suggest medical students may be at increased risk of psychological issues, anxiety, burnout, and decreased life satisfaction. Importantly, stress experienced during medical school predicts postgraduate mental health issues and studies have shown up to one third of physicians have experienced burnout. To combat this trend, wellness courses are being implemented for medical professionals at many institutions. While mindfulness-based stress reduction (MBSR) and other wellness courses have been studied for physicians, their efficacy for medical students remains unknown. Our research assesses medical student wellbeing, and evaluates whether taking a compassion or mindfulness-based elective course alleviates or minimizes the psychological stress of attending medical school.

METHODS We invited CNUCOM medical students to complete an optional online survey based on the Oldenburg Burnout Scale (OLBI) once per semester. We compared the mean OLBI scores of students who took a wellness elective course, either MBSR or Healer's Art, over the past six months to students who have not taken either course. We analyzed the results using independent samples t-test through the SPSS program. RESULTS Our results show that taking a wellness course may alter burnout scores for subsets of students. Importantly, after completing a wellness elective, students identifying as male showed significantly reduced burnout scores compared to those who did not (p=0.023).

CONCLUSIONS Given that CNUCOM wellness elective courses appear to reduce burnout in male students, ongoing studies will continue exploring gender disparities. Furthermore, analyzing pre-/postcourse longitudinal data will improve understanding of medical student needs and identify programs that alleviate distress, to ultimately reduce burnout among physicians.    

Understanding Student Perceptions of Their Learning Process   
Cortny Williams, Chris Browne, and Brent Marshall 
University of Western States
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PURPOSE Learners with well-developed metacognition engage in learning experiences to hone their self-regulated learning process. However, many learners will not uphold the metacognitive cycle, citing time constraints and lack of understanding or efficiency when implementing a new strategy. The purpose of this study is to understand how students in a professional program adapt both their study strategies and their approach to planning, monitoring, and evaluation of study strategies in response to a task-specific learning experience. As a result of this study, educators will have a better understanding of student perceptions of their learning process that will guide design of high impact learning experiences.

METHODS This study has a pragmatic approach employing quantitative and qualitative methods to assess the distribution of study strategies and how they change with exposure to learning experiences. Qualitative analysis is triangulated with quantitative analysis to understand why the learning experience influences a change in study strategies and a change in approach to the self-regulated learning process.

RESULTS The majority of learners select low-impact strategies and extrinsic motivation when prompted to select items from a list, which would suggest underdeveloped metacognition. However, most learners demonstrate a higher level of metacognition in explaining how they use their selected strategies and how the learning experience shapes their learning. Nearly twenty percent of learners do not uphold the metacognitive cycle by explaining a lack of understanding a need for change or how to change their approach.

CONCLUSIONS While most learners demonstrate development of metacognitive skills from engaging in a variety of learning experiences, educators can support the metacognitive cycle by designing positive experiences that specifically model both how and why high impact learning strategies enhance clinical reasoning skills.    

Promoting the Success of First Generation College Graduates in Medical School: An Online Toolkit of Resources
Toshiko Uchida | Vicki T. Sapp | Mytien Nguyen | Hyacinth R. C. Mason | Lisa Coplit | Alejandra Casillas | April Buchanan | Jacob Altholz
Northwestern University Feinberg School of Medicine | Geisinger Commonwealth School of Medicine | Yale School of Medicine | Albany Medical College | Frank H. Netter MD School of Medicine at Quinnipiac University | David Geffen School of Medicine at UCLA | University of South Carolina School of Medicine, Greenville | Uniformed Services University of the Health Sciences    
VIEW THE PRESENTATION (submitted poster)

PURPOSE:  In the US, entrance to medical school typically requires an undergraduate degree from a four-year college or university. Medical students who were the first in their families to earn a four-year undergraduate degree bring unique strengths with them to medical school.1 However, first generation college graduates (FGCG), and others who come from backgrounds with limited exposure to medicine, may also have unique needs and face challenges.2,3 For example, cultural capital and social capital4 may be in short supply for FGCG students, leaving them encumbered by what researchers have shown to be invisible, yet very real, barriers.5 The goal of this project is to create an online Toolkit of resources for medical schools to support and celebrate FGCG students.  

METHODS: In 2019, the Undergraduate Medical Education Section of the Group on Educational Affairs within the Association of American Medical Colleges (AAMC) convened a working group to develop an online Toolkit of resources for use by medical schools to support FGCG students.  A broad search was conducted through standard literature review and web searching, and resources were solicited widely through medical education listservs, conferences and personal contacts.  

RESULTS:  The Toolkit is organized into six categories:  1) Academic support, 2) Learning environment, 3) Professional development and career mentoring, 4) Emotional support, 5) Financial support, 6) Family resources.  Each section includes a brief personal narrative from a FGCG student or faculty member, a list of resources and references.  A group of 15 Project Reviewers recruited from the wider US medical education community will be asked to give specific feedback on the content and structure of the Toolkit.  

CONCLUSIONS:  The Toolkit will be made publicly available on the AAMC website. Once published, the Toolkit will be maintained and updated as new resources become available for medical schools to support FGCG students.    

Physician-Innovators and the Innovator Role in Problem-Based Learning Sessions    
Shonit Nair Sharma | Olivia C. Coiado  
University of Illinois at Urbana-Champaign
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PURPOSE The Carle Illinois College of Medicine is the first college in the nation designed at the intersection of engineering and medicine with the goal to develop a new generation of physician-innovators. We are exploring integrating engineering and innovation into the curriculum and enhancing students' ability to generate ideas. To encourage students' ideation, we added the innovator role in our Problem-Based Learning (PBL) sessions. The objective of this study is to describe the innovator role with a few examples generated during the PBL discussion and the rationale used to generate these ideas.  

METHODS Each PBL session is comprised of eight students and one facilitator who meet three times per week (6 hours). Each week one student plays the innovator role. The innovator conducts a literature search on the topics presented during the PBL sessions to address a clinical need. To systematically design the innovation, the student may utilize a "waterfall design process" entailing: 1) identifying user needs, 2) design input that fulfils the user needs, 3) design process - brainstorming or sketches, and 4) design output - presentation of the innovative idea.

RESULTS Some of the innovations include: an at-home medication dispensing and packaging device, a strain gauge for detecting jugular venous distention, a cost-effective compression device for prophylaxis of deep venous thrombosis, and an incentive spirometer made from paper for recovery after pneumonia. Most of the student innovations are medical devices, however improved techniques or tests can also be proposed.  

CONCLUSION The addition of the innovator role provided students the opportunity to research and explore their curiosity. We foresee with the incorporation of the innovator role a mindset that will perpetuate into the clerkship years and their entire career. Other schools which seek to prepare their students to impact health through innovation can adopt this role in PBL discussions.    

3d Digital Cadavers to Supplement Laboratory Learning    
Leanne Kenway | Abdullah Karaksha    
Griffith University 
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PURPOSE Limited availability of online anatomical resources utilising prosected human material, the constraint of laboratory space and increasing student enrolments necessitated the design and implementation of this digital resource. Structures of the Nervous System have traditionally proven more challenging than other human body systems studied within a first-year anatomy and physiology course at an Australian University, so developing a resource to assist students with revision of brain structure and function was given priority.

METHODS An Etool (electronic learning package) was developed using 2D high resolution images of cadaveric specimens which were further processed to create 3D rotating brains. The 2D images were also used to create a set of formative quizzes designed in Adobe® Captivate® with three levels of difficulty to challenge students during revision of laboratory content. This Etool package was uploaded to the Blackboard® Learning Management System (LMS), enabling ubiquitous access at no cost to students enrolled in a foundation Anatomy and Physiology Systems course. A paper survey assessed student engagement and perception of satisfaction with the Etool, and course analytics tracked student engagement within the LMS.

RESULTS The Etool provided a flexible, sustainable and cost-effective resource, that assisted in developing student confidence with self-directed revision. The majority of students who accessed the Etool found it useful for their learning (69% and 81% across two cohorts), particularly as laboratory specimens, the online revision tools and summative assessment were constructively aligned.

CONCLUSION Technical difficulties were a key factor in reducing student engagement with the Etool, and students needed regular reminders to access the tool online. Overwhelmingly, students found the Etool a useful supplement to their laboratory learning but did not wish to replace their face-to-face laboratory experience with digital learning.

Technology Assisted Faculty Development: Just in Time Teaching Tips (JITTTs)    
Alice Fornari | Janet Corral  
Zucker SOM at Hofstra/Northwell | University of Colorado SOM
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PURPOSE It is essential that clinical trainees develop teaching skills, as 1/3 of medical student teaching in clinical learning environments comes from trainees.  Methods of implementing resident as teacher is still not a well-defined concept. JITTTs provide a mechanism to send timely evidence-based teaching tips to busy trainees and clinicians.

METHODS Just in Time Teaching Tips (JITTTs), a new electronic based faculty development program was developed to increase the visibility of knowledge and skills required by busy trainees and clinicians to successfully interact with learners and ultimately improve the learning environment. A pilot study was conducted across 6 core clerkships, which followed with a full implementation.  A clinician educator and a trainee champion worked with the centralized office overseeing faculty/trainee development. JITTTs sheets, designed as infographics, reached all who interact with learners. Distribution used an email platform and content is automatically re-sized for mobile viewing to increase access.

RESULTS Pilot distribution reached 264 residents and 70% opened the TIPs sheets, with no significant difference between clerkships; Responses were received from 46 (26%) trainees. 46% rated the overall effectiveness highly and 94% rated delivery method and accessibility highly. 89% said the content was concise and visual. 100% of faculty ("champions") reported JITT TIPs sheets provided residents with support for their clinical teaching. Data on implementation will be available as well.

CONCLUSIONS Lessons learned: Electronic faculty development is a complement to other efforts to be considered in busy clinical environments where teaching needs to be prioritized. Limitations included a challenge to identify the exact day of the week and time to deliver the TIPs infographics. Continued research to assess the durability and long-term implications of utilizing TIPs infographics for trainees and faculty is needed. We intend to make all TIPs infographics readily available as shared documents, as well as include a brief podcast with each TIPs infographics.    

Using Virtual Reality to Change Medical Students Attitudes toward Caring For the Dying Patient: A Pilot Study   
Angela Wagner | Sarah Zahl | Benjamin Kopecky | Meaghan Mobley | Daniel Kinsey   
Marian University College of Osteopathic Medicine
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PURPOSE A literature review revealed that medical students may feel unprepared to care for the terminally ill, have anxiety about patient death, and lack context in care for terminally ill patient. An end-of-life virtual reality (VR) module (Embodied Labs) was utilized to address these issues.

METHODS Students experienced a first-person point of view VR module of a terminally ill patient. Study consisted of Two cohorts of OMS II students just prior to clerkships: VR Cohort (n=25) who experienced the VR module while wearing the headset themselves and 2D Cohort  (n=41) who observed another student experience the module projected on a screen. Both cohorts completed a pre and post survey using questions adapted from the Frommelt Attitudes Towards Care of Dying (FATCOD), short answer questions, and a faculty led debrief session.

RESULTS: Quantitative analysis showed no statistical change in total FATCOD score in either cohort.  Qualitative Analysis of the short answer responses revealed increased insight into caring for a dying patient, knowledge of the hospice team, and feeling more prepared to handle death of a patient.

CONCLUSIONS The qualitative data and debrief discussions indicated that this was a transformational experience for many students. The relevance of the FATCOD questions to the research question needs evaluation. The participating students had a positive disposition towards care of dying already given high pre scores on the FATCOD and a change in comfort level and attitude may be measured more specifically with another scale or more specific customized questions. In future iterations of this exercise adding a control group completing a non-VR exercise would be ideal.   

X-Ray Simulation using Pairwise Image Capture, Multi-Camera Alignment, and a Generative Image-to-Image Neural Network
Ellie Miller | Qing Hui | Eric Psota | Jay Carlson  
University of Nebraska Medical Center | University of Nebraska-Lincoln
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PURPOSE In radiography education, patient positioning skills are simulated in laboratory setting. No exposure is made in practice settings due to radiography's use of ionizing radiation; therefore, student radiographers cannot see the manifestation of poor patient positioning until exposing real-life patients to radiation during clinical rotations. This results in unacceptable images that necessitate repeated exposure to obtain a diagnostic image. Our aim is to develop a simulation technique to enhance radiographic training. Specifically, we propose a computer vision method to accurately simulate the results of patient positioning by generating a convincing x-ray output without exposing the patient to ionizing radiation.

METHODS A Microsoft Azure Kinect was attached to the radiographic tube's collimator housing, so the device can capture color, depth, infrared, and x-ray images simultaneously. For a test subject, we used a radiographic phantom. First, a custom calibration target with a copper checkerboard printed circuit board (PCB) was used to calibrate and align the Kinect and the x-ray. Multi-camera calibration allowed us to re-project the color and depth images into the same perspective of the x-ray. After calibration, the test subject was repositioned and imaged 80 times to create a varied multi-modal dataset.

RESULTS Preliminary results demonstrate that image-to-image generative adversarial networks (GANs) can be used to convert color/depth/infrared images to convincing x-ray outputs. We demonstrate that image augmentation and additional public datasets can be used to overcome the limitations of a relatively small dataset.

CONCLUSION We demonstrate the potential of computer vision and deep neural networks to improve the training experience of radiography students and potentially decrease repeated clinical patient exposures due to student error. With a larger and more varied dataset containing images of real human subjects, we anticipate that this method could be used to simulate x-ray image capture for generalized populations of subjects, radiographers, and equipment.

A Monopoly inspired board game to teach the metastatic cascade to medical students
Carrie Elzie | Kayla Creech    
Eastern Virginia Medical School
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PURPOSE Game-based learning is an effective tool for learning in medical education.  However, most research has focused on computer or virtual games, with under-utilization of board games.  Most educational board games were developed as reviews, rather than primary teaching material. Given this deficit in research, we designed a board game, Metsopoly, based on Monopoly to teach students the metastatic cascade.

METHODS 149 first-year medical students were divided into two groups. Both groups were given a pre-test to assess baseline knowledge. Group 1 played the board game first, took a mid-test to assess knowledge learned, attended a lecture on the subject, and then completed a post-test. Group 2 attended the lecture first, took a mid-test, played the board game and completed a post-test. Both groups were given a survey to gather feedback.  Test scores of each of the tests were analyzed, as well as, summative exam question scores from this class compared to a lecture-only course.

RESULTS Both groups had similar scores on the pre-test.  However, the group who played the game had a significantly higher score (92%) on the mid-test compared to the lecture only students (86.5%) (p<0.001). The knowledge gap diminished by the post-test.  When comparing identical exam questions of the game-based learning class to a lecture-only class, performance on content-specific questions was also increased (92% vs. 86.5%).  The overall class rated the game as highly enjoyable and an effective way to learn difficult material.  The majority of students wanted similar teaching methods for future curricula.

CONCLUSIONS Our data show that a well-designed board game can surpass learning from lectures of difficult concepts in medical education.  Board games are an effective way of facilitating student-led teaching in small groups through active learning and a healthy spirit of competition. 

Call Me: Physician Assistant and Pharmacy Students Engage Via Phone Simulation    
Christine M Hall, Michael Biddle, Barb Mason
Idaho State University
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PURPOSE Despite the need to work collaboratively in practice, medical and pharmacy training is often unilateral. We designed an interprofessional education (IPE) activity that mimics a phone encounter between paired Physician Assistant (PA) and Pharmacy students. Drawing upon their respective training, students apply their professional perspectives to arrive at a safe therapeutic plan for a patient in a case-based scenario. This educational activity encourages respectful discourse between the PA and Pharmacy students, increasing their understanding of one another's roles on the healthcare team.  

METHODS For cohorts in 2018 and 2019, first-year PA and pharmacy students completed pre-activity surveys assessing their prior experiences and attitudes regarding IPE and collaboration. PA students individually completed an online case, arriving at the diagnosis of peptic ulcer disease from H. pylori, and arrived on a treatment plan. In pairs, the PA student ordered and pharmacy student received prescriptions for care over their cell phones at a pre-arranged time. A special consideration only ˜visible' within the pharmacy students' database required that the pharmacy student call the PA student back to inform them. They then strategized safe alternatives together. Students completed post-activity surveys, and faculty led debriefings reviewing treatment options and gaining additional student feedback.  

RESULTS 326 students have participated in this activity after use with two cohorts. Pre- and post- activity surveys using Likert scales showed increased self-assessed skills gained, awareness/knowledge of other team members' area of expertise, and favorable attitudes toward interprofessional collaboration. Students' qualitative comments were also positive.  
CONCLUSIONS To develop interprofessional communication skills early on in PA and Pharmacy students' training, this activity pairs students to solve a patient case scenario over the phone. Students found this IPE exchange realistic, valued sharing their expertise, and gained communication skills and some insight into how professional knowledge sharing can optimize patient care.  

Curriculum Mapping by Artificial Intelligence Using Audio Transcripts of Lectures    
Leonard J. Cleary | Brian T. Sutch | Dolph D. Ellefson | Timothy K. Gallaher | Ian S. Haworth   
The University of Texas Health Science Center | Sarcix Inc | University of Southern California
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PURPOSE Curriculum mapping is used to align curricular learning objectives, instruction, and assessment to ensure coverage of required student competencies. However, this is a time- and labor-intensive process and outcomes can be somewhat subjective. Here, we present an artificial intelligence (AI) approach to curriculum mapping using audio transcripts of lectures for an entire curriculum. We compare the results with a similar AI approach using teaching material (PowerPoint documents, etc.) from the same lectures.

METHODS Audio files representing nearly 1,000 lectures were transcribed using Google automated transcription algorithms. The resulting transcripts (.txt format) were separated into directories corresponding to curricular events and analyzed using Mapradish AI software (transcript map). These files were not edited before analysis. A similar directory structure containing documents from each event was used for AI analysis (document map). Each mapping was performed against USMLE content areas.

RESULTS Mapradish returns a score of 0 to 1 for each event vs. outcome comparison, where 0 and 1 indicate that the event has no and strong coverage of the outcome, respectively. Practically, we find that a score &gt;0.6 strongly links an outcome to an event. Comparison of these scores showed much higher resolution in the transcript map compared to the document map. For example, for an event entitled "Female Reproductive Physiology", the transcript map clearly distinguished between "normal" (stronger coverage) and "abnormal" (weaker coverage) USMLE content areas. In contrast, on the document map, this event was linked only generally to reproduction content areas.

CONCLUSIONS Advantages of using AI for curriculum mapping include time-saving and objectivity. Using audio transcripts for this approach gives a higher resolution compared to document mapping. Mapping using audio files is also advantageous since these files are likely to be stored by the IT department in a directory structure similar to that needed for the mapping analysis.    

Determining and Improving Performance Rubrics to Evaluate Medical Science Educators -- A Ground up Approach
Shuh Shing Lee | Inthrani Raja Indran | Celestial Yap | Dujeepa Samarasekera | Zhi Xiong Chen  
National University of Singapore
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PURPOSE Currently, evaluation of medical science teachers is largely determined by quantitative and qualitative feedback from students and peer reviews. While important, these parameters do not always accurately or sufficiently assess or reflect the teacher's educational intentions, capabilities and repertoire of pedagogical innovations.

METHODS In order to address this, we seek to determine the criteria, methods and approaches that are needed for a more holistic, comprehensive evaluation, reflective of the teacher's true effectiveness. To do so, we conducted 12 semi-structured interviews on medical science teachers and polled 4 questions using Poll Everywhere on medical students from Year 1 and 2, to obtain their views and perspectives. Each question received 71-129 responses from Year 1 and 13-14 responses from Year 2. Thematic analysis was carried out to analyze the data collected.

RESULTS From the thematic analysis, 4 themes emerged. They are feedback system design, feedback process, operations of feedback collection and post-feedback initiatives. For feedback system design, the main areas of concern are the scope, specificity, relevance and volume of questions, and the mode of collection. For feedback process, the main areas of concern are the selection and standardization process, and subjectivity of peer evaluation, the quality of student feedback and the ability to obtain insights from the feedback. For operations of feedback collection, the main areas of concern are the frequency and timings of feedback collection, the incentives to give and act on feedback, the manpower issues and the misuse of feedback. Finally, for post-feedback initiatives, the main suggestions are centered on enhancements to the evaluation scheme and pedagogical improvements.

CONCLUSION We hope our study will lead to more effective ways of evaluating teachers that may improve personal motivation, career advancement and quality assurance in teaching and learning.    

Flipped Out: Positive Learning Outcomes and Learner Dissatisfaction in Response to Flipped-Classroom Medical Embryology Course  
Troy K Kincaid | Janet Corral | Rachel Tan | Lisa MJ Lee  
University of Colorado School of Medicine | University of Arizona Tucson College of Medicine
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PURPOSE With the evolution of medical education from traditional, subject-specific didactic lectures to more integrated and self-directed curriculum, medical schools are beginning to customize digital content for their learners. We have implemented and evaluated a flipped- and assessment-based embryology curriculum in an integrated anatomy course for first year medical students.

METHODS This mixed-methods, retrospective study was IRB approved and implemented in Fall 2019. The intervention was comprised of a series of eleven 8-16 minute customized pre-work videos and corresponding pre-session quizzes that students were required to complete before each embryology lecture. Classroom time, which was used to deliver didactic lectures in previous years, was customized based on pre-lecture quiz performance and an in-class poll to self-identify knowledge gaps. The 2018 cohort received nearly identical embryology educational materials, including the same number of embryology lectures (n=11), learning objectives, review sessions, and assessments, but lectures were delivered in didactic presentations. The same embryology instructor delivered all lectures in 2018 and 2019. Exam data were analyzed using Item Response Theory (IRT), controlling from item difficulty differences. An optional end-of-course survey and lecturer evaluations were used to assess student experience.

RESULTS The flipped-classroom cohort (n=184) had higher embryology exam performances in all 4 exams than the 2018, didactic cohort (n=184). The 2019 cohort performed significantly higher than the 2018 counterparts on embryology in the 2nd exam and the comprehensive final. Interestingly, students perceived the pre-work videos positively, yet disliked the flipped-classroom experience on optional surveys that had high participation rates (n=175). Students found the instructor likable, yet cited that lectures felt disorganized and pre-work videos would be better suited as supplemental resources.

CONCLUSIONS As more schools continue to move toward implementation of novel teaching methodologies, emphasis should be placed on providing effective introduction to and rational for change to the new curricula.  

How Do We Make Difficult Concepts Intuitive? A Series of Simulation Experiences
Nicole Rockich Winston | Barbara Russell | Matthew Tews | A.J. Kleinheksel  
Medical College of Georgia at Augusta University
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PURPOSE We created a series of hands-on simulations to apply concepts that have been historically difficult for second year medical students.

METHODS Clinical and basic science faculty were recruited to create and implement a series of simulation cases for systems-based modules. Two days of simulation activities were incorporated into the cardiopulmonary module, one emphasizing arrhythmias and the other highlighting pulmonary conditions. The renal module simulations focused on propylene glycol poisoning and renal sepsis. The final comprehensive case simulated a COPD patient with pneumonia, atrial fibrillation, and sepsis. In total, 190 students completed four days of simulation activities, creating a differential diagnosis; ordering labs, diagnostics, and treatments; and observing physiological responses to treatment in real-time. Students were debriefed after each simulation experience. Following the session, students were asked to complete an online survey instrument to reflect on their experiences. Quantitative results were summarized using ANOVAs with post-hoc Scheffe analyses for Likert-type scale responses. Glaser's constant comparative method was used to analyze data collected through open-ended prompts.

RESULTS Of the four simulation days, the comprehensive case scored highest on a four-point scale for overall experience (3.70), level of instruction (3.84), value (3.59), and most (N = 105) students thought it should be integrated into the curriculum. Scheffe analyses demonstrated that the comprehensive case scored significantly higher for all Likert-scale questions as compared to the arrhythmia cases and the renal cases (p<0.01). Across the simulations, qualitative analysis revealed students valued application of knowledge (n=90), experiencing a real-life scenario (n=57), facilitator knowledge and assistance (n=22), and teamwork (n=21).

CONCLUSION These results demonstrate that medical students perceived extensive value in the simulation activities, with the most value perceived in the more complex comprehensive case. This study demonstrated the operational logistics required in the application of early-stage simulations with large medical school classes.