Kenneth Janda    
University of Houston

Purpose
To familiarize students with health insurance concepts and the challenges of accessing care depending on insurance type (or lack thereof), we developed an educational simulation as part of the Physicians, Patients, and Populations course. 

Methods
Designed for 1st-year medical students, the 120-minute simulation provides 10 personas for students to take on, with personas varying by age, gender, work status, income, immigration status, and other variables. In the first of 4 rounds, the personas seek health insurance given their demographic characteristics. The simulation offers multiple choices including the employer's HR Department, insurance agents/brokers, online government resources, and family/friends. At the end of this round, 1+ end up uninsured. In round 2, each persona reports an acute medical situation and seeks care using the insurance card obtained in round 1. The simulation offers multiple locations for each persona to try to receive care (e.g. doctor's office, emergency room, calling 911, or a community health center). In round 3, we model whether the acute condition improves following the receipt of care. In round 4, personas calculate the out-of-pocket cost of their care based on insurance type, where care was accessed, and outcomes. 

Results
Requests for and satisfaction with the program have grown each year. Overall, student feedback was positive (4.5/5). In a class of 30, 3 different people play using the same persona and often end up with different results. Scholars emphasized the different health and financial outcomes that arise from the process.

Conclusion
Simulations like these facilitate learning, allow for a practical application, and foster critical thinking on healthcare access.

Michael Dewsnap    
Texas A&M School of Medicine    

Purpose
The purpose of Texas A&M University School of Medicine's (TAMU-Medicine) learning environment program is to improve the learning environment for students and address related metrics within the AAMC Graduate Questionnaire (GQ). This comprehensive program is theoretically framed by conflict management principles and Appreciative Inquiry and launched at TAMU-Medicine in 2018 to over 4,500 faculty, staff, and students.

Methods
TAMU-Medicine reimagined nurturing the learning environment by: 1) focusing on all stakeholders (i.e., faculty, staff, and students); 2) implementing a peer-to-peer conflict management intervention modeled, with approval, after Vanderbilt's Center for Patient and Professional Advocacy (VCPPA) Cup of Coffee initiative; and 3) creating a transparent school-wide process (Environment Awareness System) for stakeholders to submit reports on negative, and positive, behaviors.

Results
Student data from the GQ showed four-year improvement of perceptions of the learning environment above the national mean. For example, in 2018 the learning environment scales from the TAMU-Medicine GQ survey were 10.1 (out of 15) for climate and 14.5 (out of 20) for student-faculty interaction compared to all United States medical schools at 9.5 and 14.3, respectively. In 2022, same scales for TAMU-Medicine measured 11.2 and 16.1 compared all medical schools at 9.6 and 14.2. Student responses to knowing where to report mistreatment increased from 86.1% in 2018 to 97% in 2022 (7% higher than the national average).

Conclusion
The year-after-year improvement in GQ metrics for TAMU-Medicine garnered nationwide attention with over 23 entities at TAMU as well as medical schools and health care organizations nationwide requesting over 30 presentations on TAMU-Medicine's learning environment program. In spring 2022, Texas A&M University approved scaling the program through its Office for Diversity to over 85,000 faculty, staff, and students. The initial focus is leveraging Appreciative Inquiry to a) promote positive behaviors; b) operationalize the University's core values; and c) enhancing the University's climate.

Denise Kay    
University of Central Florida College of Medicine    

Purpose
The Observed Structured Clinical Examination (OSCE) plays a critical role in assessing medical students' clinical skills. Scoring OSCE exams is resource intensive, especially the Patient Encounter Notes (PENs) often part of the student exam. Using artificial intelligence (AI) that can provide automatic, trustworthy PEN note scoring can free up faculty time, providing more opportunities for hands-on training with students. To alleviate the expensive process of requiring careful grading by faculty for each examination, we developed an AI model that is now increasingly accurate in automatically grade unseen examinations.

Methods
The deep learning AI model was developed in two phases. In phase 1, we tested the model's performance based on training with 5, seen OSCE stations (trained on 80% of PEN notes and faculty scores and independently scoring the remaining 20%). Now, in phase 2, we tested the models' performance on 5, completely unseen stations presented with different grading criteria. This is a more challenging task for the model given that, without any prior knowledge about the new stations, the model's accuracy can be compromised.

Results
Without prior training on OSCE stations or the grading criteria, the model scored new, previously unseen PEN notes and/or scoring rubrics with 78.2% accuracy (phase 2), an accuracy level of only 4.42% less than when the model scored PEN notes and rubrics it was familiar with via training on 80% of the PEN notes and scoring the remaining unseen 20% (phase 1).

Conclusion
This study shows that our model is able to automatically grade unlabeled and unseen OSCE stations with different scoring criteria. In phase 3, we plan to compare the AI scoring of unseen OSCE stations with two or more human raters to establish trust in the AI model competence.

Addwoa Dansoa Aduonum    
Philadelphia College of Osteopathic Medicine    

Purpose
The emergence of the COVID-19 virus forced healthcare institutions and programs to pivot to virtual learning platforms. In this post COVID-19 era, many healthcare institutions have shifted to hybrid instructions. This abstract describes how we developed a virtual multi-institutional Interprofessional Education (IPE) simulation program with diverse healthcare disciplines across multiple geographic regions.

Methods
Location: Virtual Number of students: over 300 - Pre-Session: Facilitators Standardized Patients (SP) Programs Internal: Doctor of Osteopathic and Doctor of Pharmacy External: Respiratory Therapy, Master's of Social Work, Medical Interpretation and Language Arts, Licensed Practical Nurse, and Bachelor of Nursing. - During Session: Pre-briefing of facilitators and students Students will go into their pre-assigned rooms to meet with SP and facilitator for 25 minutes Clinical Faculty Debriefing - Post session/ Assessments: A rubric was designed and given to the facilitators to assess the participants professionalism, empathy, communication, teamwork, decision making, situation awareness, and treatment during the simulation encounter. A Post Simulation Peer Evaluation was collected from each participant.

Results
The overall group performance and confidence in the simulation activities improved over the course of the academic year beginning with the Fall term and end in the Spring year. Having access to multiple content experts in disciplines such as cultural and spiritual humility and social determinants of health encouraged student engagement.

Conclusions
The Virtual IPE Curriculum highlighted the following: (1) Improved DEI and collaboration among the healthcare workforce to ensure health equity. (2) Students understood the value of working together. (3) Small group discussions facilitated relationship building among students. (4) Not having travel time allowed for better coordination and student engagement in a timely fashion.These virtual IPE activities have given our trainees access to various healthcare disciples that they may otherwise not interact with until they are part of a workforce team.

Rasha Noureddine    
University of Central Florida 

Purpose
Evidence-based learning strategies such as Interleaving and Spaced retrieval have been clearly validated as highly effective ways of augmenting the acquisition of knowledge, yet they are rarely implemented as part of a curricular structure in a defined way. This is likely because courses are generally taught by different subject matter experts making spacing and interleaving of content often difficult to achieve and monitor. Internet-based learning platforms can help solve this problem by facilitating the use of these strategies and tracking compliance.

Methods
The use of an Internet-based learning platform was used to deliver didactic content to students at a government-chartered private medical school established to increase capacity in an underserved part of Jamaica. To optimize the learning potential of the students, many of whom lacked well developed study skills, the curricular content was delivered via an Internet-based learning platform which was designed to facilitate the use of evidence-based learning strategies. All didactic videos were followed by recall questions which, after being answered, were entered into an algorithm-driven spaced repetition deck. Pop-up summary notes encouraged free recall and customized assignments allowed for the interleaving of concepts. Compliance and performance could be tracked which allowed academic coaches assigned to each student to help them refine their study strategies, and teachers to adjust the focus of their teaching sessions.

Results
Using a platform-based approach to implementing and tracking the use of evidence-based learning strategies helped overcome the hesitation to use these tools and thus leverage the benefits of using strategies associated with "desirable difficulty". 

Conclusion
Using Internet-based platforms to integrate and leverage the use of evidence-based learning strategies provided significant benefit to the students in this school and should be considered for use in a wide array of settings due to its ease of use. 

John Chilton   
University of Plymouth 

Purpose
Students have access to a wide range of anatomical models to enhance their understanding of the 3-D nature of the body's structures. Few comparable resources are available for them to visualise processes at the molecular scale. In the case of receptors, transporters, channels and enzymes this is crucial to a full understanding of biochemical mechanisms, pharmacological modulation and clinical application. We have created custom 3-D molecular models to enhance teaching of a range of medical science disciplines including biochemistry, pharmacology, immunology and microbiology. Our models are not static 3-D representations but tailor-made tools harnessing multiple learning modalities to promote learning and retention of molecular concepts. 

Methods
We commissioned custom-printed 3-D models of key proteins encountered in the undergraduate medical curriculum, each chosen to exemplify important concepts. Models were rendered in PyMol using data from rcsb.org. Protein domains were coloured to match corresponding publications, key functional residues were also highlighted. This approach synergises linkage of kinaesthetic experience with visual and written learning. Mini-magnets were embedded in models to dynamically attach components and demonstrate intramolecular binding of domains and intermolecular association with 3-D printed ligands.

Results
Student feedback was obtained through focus groups. Models were compared to 3-D graphical rendering by computer (current best technological option) and 2-D paper-based representation (traditional teaching method). We present here illustrative examples of models with intended learning outcomes and analysis of the accompanying student feedback in terms of their engagement and learning. We explore its application to ideas for future refinement of this educational approach.

Conclusion
3-D printing offers a cost-effective and bespoke means to enhance traditional teaching of cellular and molecular sciences in biomedical curricula. There is great potential to expand this to many clinically relevant macromolecules to help medical students make deeper conceptual links between molecular mechanisms and patient outcomes.

Sandra Haudek    
Baylor College of Medicine    

Purpose
With burnout on the rise among health professionals, academic leaders are searching for effective strategies to enhance well-being among their faculty and staff members. While accrediting organizations begun incorporating recommendations for wellness activities for learners (students, residents, and fellows), few guidelines and resources exist for faculty and their teams. The Wellness Initiative Supporting Health (WISH) Grant program aims to 1) Enhance well-being among faculty and staff members through innovative collaborations, and 2) Solicit creative proposals for wellness activities from across an academic medical department.

Methods
In 2018, the Department of Medicine at Baylor College of Medicine created the WISH Grant program. Applications (limited to 500 words) to fund small wellness projects of up to $500 are solicited annually. While the primary applicant must be a faculty or staff member in the department, participants may include trainees and family members. External reviewers using a specified scoring system scored applications. Grant recipients were sent a brief anonymous post-program evaluation survey.

Results
Over four cycles of grant solicitation between 2018-2022, 36 of 65 (55%) applications received funding. The most commonly proposed objectives included (1) individual wellness strategies, (2) team-building activities, and (3) networking events. 53% of awardees provided program feedback. The events had high participation rates, fostered inter-disciplinary, cross-institutional collaboration, and demonstrated positive outcomes. All awardees reported that the funded activity helped enhance wellness among participants and 82% felt that the program had an impact beyond direct participants. All strongly agreed with continuation of the WISH Grant initiative.

Conclusions
The robust response of innovative wellness proposals suggests a clear need to create new programs and enhance ongoing wellness opportunities within this Department of Medicine. With minimal funds, effective inter-disciplinary initiatives can be developed and/or supplemented to foster wellness among faculty and staff members within a large, diverse academic medical department.

Blaine Traylor    
Southern Illinois University School of Medicine

Purpose
To develop a novel basic science medical teaching platform using video gamification. Our platform facilitates medical students' ability to connect cellular mechanisms and patient outcomes within the context of disease progression of bacterial sepsis. Students were provided real-time feedback on their game answer choices while playing the game allowing students to assess their competency in basic science pathways. Our hypothesis is that this new teaching platform will provide real-time, low-risk feedback to medical students in connecting cellular pathways to disease progression and clinical outcomes.

Methods
An interactive, branch-point decision-making platform was developed by a team of medical students, hospitalists and medical science faculty members. Second-year medical students (72) were eligible to voluntarily participate in the sepsis teaching program online. Each medical student's decision in the video game was scored by its potential to alter clinical variables of length and cost of hospital stay and risk of patient mortality. Each decision point measured a key conceptual step in immunological cascades involved in sepsis. A "correct" answer lowered each clinical outcome value whereas "incorrect" answers increased the values. Students could monitor results of each decision via a real-time clinical value bar on the screen.

Results
In total, there were 30 unique completions of the clinical scenario with a wide range of results for the three clinical data inputs. The "best" clinical values by a player were 4.9 days hospitalized, $48,510 cost of stay and 12% mortality rate. Multiple wrong answers yielded worse case clinical values of 15.8 days hospitalized, $157,689 cost of stay and 118% mortality rate.

Conclusions
This learning modality demonstrated 1) real-time assessment of medical students' knowledge of cellular basis of sepsis; 2) the game provided a low-stakes, rewards-based learning assessment; and 3) enables learning competency to be measured before a high-stakes examination.

Katherine Colón Reyes 
University of Colorado Anschutz Medical Campus

Purpose
Classically, anatomical variations are cataloged in various two-dimensional mediums, such as print, illustrations, or photographs. While technology has significantly progressed, anatomic records have not followed suit. Digital preservation of anatomy through three-dimensional (3D) surface scanning technology provides an opportunity to not only improve record keeping but disseminate true to life cadaveric resources. In this project, we demonstrate a streamlined approach to modern anatomy preservation.

Methods
A 34-year-old female cadaveric donor from the Colorado State Anatomical Board was dissected into organ blocs for medical education. This donor presented a unique opportunity to study a premenopausal uterus. The uterus was digitally preserved using an Artec Space Spider in two separate presentations, within the body cavity (in-situ) and removed from the body cavity (ex-situ). The surface scans were processed in Artec Studio 15 using automatic and manual tools. The resultant meshes have an average geometric resolution of 0.15mm and a 4K texture resolution. The 3D models were annotated using Maya, the textures were refined using Substance Painter, and deployed using Unreal Engine 5.

Results
The 34-year-old uterus was successfully scanned and processed to create two novel 3D models. These models are now available in the Graduate School's anatomical variation catalog. Through digital cadaver preservation, this unique uterus has both physical and virtual versatility in student education as it is capable of being 3D printed and interacted with in an application developed using Unreal Engine 5.

Conclusions
Learning from a premenopausal uterus is a rare circumstance not many students are fortunate enough to encounter. Modernizing how unique presentations of anatomy are cataloged in partnership with projects such as the Modern Human Anatomy Open Educational Resource (OER) Hub will facilitate greater access and equity of cadaveric resources. Virtual models can also better preserve anatomical detail far beyond the average lifetime of a cadaver or plastination.

Meredith Ratliff    
University of Central Florida College of Medicine    

Purpose
The integration of cases can help students build clinical decision-making and reasoning skills. However, integrating cases with coursework effectively can be challenging. Branching scenarios have shown promise in delivering introductory clinical experiences and by using evidence-based approaches, branching scenarios can allow for learning experiences that are effective and engaging.

Methods
Four branching scenarios were developed for a pediatric nursing course at a university in the United States. These were developed by a team of instructional designers using the Agile eVidence-based Instructional Design Model (AVIDesign Model) in collaboration with the course instructors. Based on desired course outcomes, identified needs, and available related evidence, two branching scenarios were developed to be piloted in summer 2022. From the results of the first two cases, two more cases were developed, with all four cases implemented in fall of 2022. The cases were developed using H5P which allowed for interactive elements as well as branching questions.

Results
Preliminary results were extremely positive. Students found the cases more engaging than "paper" presentations. Students found the feedback and rationale for each set of questions (both branching and interactive elements) to be beneficial. The branches were given as a formative assessment, allowing students to redo each case until they passed an acceptable score. Initial results show improvements in test scores on related questions (this data is still in progress but will be completed by the conference).

Conclusion
Simulations can be time consuming and expensive to develop, but as technology progresses, simulations such as branching scenarios show promise in being an effective way to reproduce clinical experiences, saving both time and resources over traditional simulations. Using an evidence-based approach and systematic design helps ensure the experience is effective and engaging.

Deborah Dalmeida    
American University of Antigua College of Medicine   

Purpose
Scaffolding is essential for building metacognitive skills and providing an optimal balance of challenge and support. For complex topics where reasoning is difficult, the impact of software tools in scaffolding by providing additional structure to the task and enabling productive problem solving encounters needs to be explored. We determined, "Does inclusion of interactive modules as a form of instructional scaffolding achieve improved examination scores?"

Methods
Three modules in renal pathology for year two undergraduate medical students were deployed. Effect on academic performance in the end-of-course MCQ-based NBME summative examination, for topics covered within the modules in Fall 2022 was compared with the Fall 2021 cohort that did not receive these modules, using an unpaired t test and calculation of effect size. Learner perception was assessed using a five-point (Agree-Disagree) Likert scale survey and focus group.

Results
50 students completed all three modules. An overall 10 point difference between both cohorts (P value<0.0001) and an effect size of 0.6 was found in the end-of-course MCQ-based NBME summative examination. For two of three modules, a 20 and 23 point difference (P value<0.0001) with effect sizes of 0.8 and 0.7 respectively was detected. Survey and focus group analysis revealed that a significant majority of the learners found the modules easy to navigate, it stimulated prior recall and closed gaps in foundational knowledge, clarified complex concepts, helped organize their learning, found the variety of exercises memorable, and the open ended questions challenged them to apply content knowledge to new situations.

Conclusions
Interactive modules that check for understanding, provide feedback, and allow for retrieval fosters development of strong foundational knowledge of core concepts and provides learners multiple ways to reach a learning goal.

Meredith Ratliff    
University of Central Florida College of Medicine

Purpose
To develop a technology-based professional development program for medical education faculty in a resource-scarce country facilitated by platform-based learning.

Methods
A needs assessment was conducted to determine institutional, faculty, and student needs and to suggest potential solutions. The school has placed an institutional priority on technology and student-centered learning while using platform-based technology to deliver high quality content to students efficiently and economically. The faculty ranged in experience from being very new to teaching to decades of experience, and while some were tech savvy, some tended to avoid tech. Optimal skills, knowledge, and dispositions were identified using the IAMSE Educator portfolio and principles from the science of learning.

Results
The professional development (PD) plan developed has taken multiple facets including one-on-one on-site support, the continuation of on-site PD offerings, the development of self-paced technical skills modules, and the addition of platform-based lessons and workshops with educational specialists. One-on-one support helps faculty target individual technical skills while the self-paced modules target context-specific platform integration. The platform-based lessons are self-paced while the workshops are delivered synchronously and remotely. Both platform-based offerings have been developed by educational specialists to target pedagogical needs and platform integration. The continuation of on-site PD offerings helps faculty build pedagogical skills while fostering a sense of collaboration and scholarly pursuit.

Conclusion
PD can be complex and a single solution is unlikely to meet all needs. Utilizing technology and self-paced lessons allows for cost-effective training that targets the learners' needs while allowing for flexibility in busy schedules. Offering live training on-site and as remote workshops allows for project-based, hands-on, collaborative experiences that have been shown effective for PD in medical education.