Moderated by Sateesh Arja

PRESENTATION 1 - LGBTQ+ Curriculum in Medical School: Vital First Steps    
Pratima Singh
Kansas City University

PURPOSE Medical school curriculum increasingly incorporates educational content that prepares graduates to address healthcare needs of the LGBTQ+ community. A necessary starting point for this curriculum is a cultural literacy session that provides medical students a uniform, fundamental education on definitions, language, and other verbal and non-verbal communication relevant to the LGBTQ+ community.

METHODS A novel one-hour session was delivered in the Fall 2021 College of Medicine orientation week to establish baseline LGBTQ+ cultural literacy for incoming students. Learning objectives incorporated: defining sexual orientation, gender, sex assigned at birth, gender identity, and gender expression; describing identities within the acronym LGBTQ+; listing inclusive vocabulary options; describing strategies to recognize and mitigate personal implicit biases about LGBTQ+ patients; listing preferred pronoun options; describing ways to initiate conversations about preferred pronouns; describing active and passive ways to provide allyship towards LGBTQ+ individuals during a clinical encounter, and listing LGBTQ+ resources for future patients and self-education. Didactic delivery alternated with actor scenarios, specifically scripted to demonstrate inappropriate and/or insensitive physician verbal and non-verbal communication with patients in the LGBTQ+ community, paired with a follow-up demonstration that allowed for a more positive and affirmative approach.

RESULTS Pre- and post-course Likert-style questions distributed to students allowed them to self-reflect on their knowledge of the content and comfort level in engaging in the interactions presented. Comparison of all paired question sets showed a statistically significant increase (p<0.001, t-test) in knowledge and comfort levels after the session.

CONCLUSION Medical school education is evolving to address the healthcare needs of the LGBTQ+ community. A cultural literacy program offers a vital first step in establishing baseline knowledge and communication skills essential for competent, affirmative patient interactions.
 

PRESENTATION 2 - Physician Perception of Genome Sciences Education and Use in Clinical Practice    
Joseph Fontes
University of Kansas School of Medicine

PURPOSE Medical practice has been impacted by genome sciences, affecting prevention, diagnosis and management of disease. We wanted to understand physician perceptions regarding the importance of and comfort with the use of genome sciences, as well as their expectations for medical trainees.

METHODS A retrospective survey was sent to physicians employed by a health system associated with a public medical school. The survey was based upon published reports that used a five-point Likert scale to assess the physicians' self-reported training in genome sciences as well as their comfort level with ordering and using specific types of genetic testing. Survey recipients were also asked about their expectations for training of medical students and incoming residents in genome sciences. All data were exported to Statistical Package for the Social Sciences (SPSS) v26 for analyses.

RESULTS Analysis of the responses revealed that despite most physicians having had formal genetics training in medical schools, clinicians reported discomfort in this content area. The majority also believed that the impact of genomic sciences on their practice will increase in the next five years. These same physicians expect a high level of competency in genome sciences for medical students and incoming residents. Compounding the sense of being unprepared for the use of genome sciences in clinical medicine, many in our survey also reported limited access to genetics expertise.

CONCLUSION While more work is needed to assess the specific use of genome sciences and the differences in application among medical specialties, our study revealed that practicing physicians feel the current curricula do not produce physicians with required competency. This is despite the perceived importance of this domain in medical practice. Physician discomfort with ordering genetic studies in the clinic points to a need for effective continuing medical education. Our findings suggest a potential need for expanded, thoughtful genomics education at all levels of training.


PRESENTATION 3 - Constructed Response Short Answer Questions on Medical Student Exams: Are They Feasible and Reliable?    
Doreen Olvet
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

PURPOSE CR-SAQs on summative exams carry benefits for medical students and educators. However, the perceived burden associated with CR-SAQs may impede their use in medical education. The objective of this study was to examine the feasibility of utilizing constructed response short-answer questions (CR-SAQs) from the perspectives of faculty and students across three institutions and to establish the inter-rater reliability of scoring CR-SAQs. 

METHODS Question writers (N=5) from three US medical schools met virtually to create a set of CR-SAQs to be used at each school on a summative exam in the first year of medical school. After the exams were administered, the study questions were scored by faculty content experts (N=7), faculty non-content experts (N=6), and fourth-year medical students (N=7). Cohen's weighted kappa (kw) was used to evaluate inter-rater reliability between the content expert and other scorers. Structured interviews were performed with question writers and an open-ended question survey was administered to scorers. Content analysis was performed on the qualitative data.

RESULTS Inter-rater reliability between the content expert and student scorers was fair/moderate (kw=0.34-0.53 holistic rubrics) or substantial (kw=0.67-0.76 analytic rubric), but lower between content and non-content experts (kw=0.18-0.29 holistic rubrics; kw=0.59-0.66 analytic rubric). All question writers participated in the interviews and twelve faculty and student scorers (N=12/20, 60%) completed the survey. Working with a team, getting feedback from others, and carefully wording the question were recommended for writing CR-SAQs. For scoring CR-SAQs, reading a sample of responses first, adjusting the rubric, creating notes, and setting aside sufficient time were recommended.

CONCLUSIONS CR-SAQs can be reliably scored using an analytic rubric by faculty or senior medical students who do not have content expertise, which may relieve the faculty burden associated with grading CR-SAQs. Our findings also show that it is feasible to include CR-SAQs in summative exams.


PRESENTATION 4 - More Than a Check Box: an Overview of Diversity, Equity, and Inclusion Efforts in Physician Assistant (PA) Education    
Daphne Mills
Physician Assistant Education Association

PURPOSE To equitably ensure the competence and success of all PA applicants, students, and graduates, physical assistant programs are poised to make changes in support of their students and faculty, especially those from underrepresented minority (URM) backgrounds.  The Physician Assistant Education Association (PAEA) developed the Diversity, Equity, and Inclusion (DEI) Toolkit and Best Practices to assist PA programs in examining their practices, climate, and cultures.  Programs were surveyed to gain an understanding of the current state of DEI efforts in PA education. METHODS In August 2021, program directors at all 277 PAEA member programs were surveyed on their DEI practices, including usage of the DEI toolkit, DEI efforts (e.g., the development, implementation, and support of goals) and engagement in best practices. In addition, programs also surveyed about whether strategies were in place to understand retention issues in instances where URM students, faculty, and staff were not retained.   Further, we investigated if there were differences in public and private PA programs' DEI engagement. RESULTS 162 programs provided data, a 58.4% response rate. Although 72.2% of programs indicated that they had DEI goals, only 35.2% reported measuring the effectiveness of strategies taken to address their goals. The results found differences in the engagement of public vs. private programs, with public programs reporting greater levels of toolkit usage and higher levels of engagement with DEI efforts. In addition, implementation of the 21 best practices outlined in the toolkit varied widely across programs, with some practices being implemented widely while others were virtually untouched. CONCLUSION Although PA education program are making strides towards diversity, there is still a great deal of work to be done.  Having DEI goals is not enough, programs must engage in efforts to attract, recruit, and retain students, faculty, and staff from URM backgrounds.