Poster Abstracts: Curriculum 1

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David Chumba    
Moi University     

Purpose
Competence in breaking bad news is required in medical practice and medical education curriculum was designed to equip doctors in this important issue. The objectives of this study was to determine the adequacy of the medical training curriculum content and methodologies utilized in training doctors in breaking bad news tasks at MTRH. 

Methods
A mixed methods approach used to collect data. Qualitative data and focus group discussions and in-depth interviews; quantitative data; resident’s perception of the adequacy of the curriculum using a questionnaire. Study included postgraduate doctors, lecturers who were interviewed. Data was collected using questionnaires and in-depth interviews, quantitative data was cleaned and entered and analysed in SPSS version 22, descriptive statistics used to describe, and inferential statistics used in comparing data. Qualitative data was analysed and presented thematically.  A p-value of <_ 0.5 was set as significant for all tests.

Results
Curriculum content and structure; 33% utilized, teaching methodologies; 28.5% Residents perception of various aspects of curriculum: structure helical or spiral with competence levels; n=70 (87.5%) No, 12.5% (10)  yes, theoretical basis of communication skills covered n=46 (57.5%) No, 34 (42.5%) yes, breaking bad news training using task approach with task process n=51 (63.5%) No, 29 (36.25%) yes, Challenging situations in breaking bad news were addressed n=56 (70%) No, only 24 (30%) yes, Reflective approach in coping with the effects of breaking bad news 58 (72.5%) No, 22 (27.5%) yes.

Conclusions
Overall, this study found that curriculum content and methodologies in breaking bad news teaching and assessment is  inadequate to make resident doctors  competent in this important skills.

Himanshu Agrawal    
Minnesota Psychoanalytic Institute, Medical College of Wisconsin
    

Purpose
Sigmund Freud, often acknowledged as the father of psychoanalysis and psychiatry, is amongst the most famous personalities of the 20th century. His contributions have piqued the interest of thousands, as have his personality and personal life. Although psychoanalysis and psychodynamic psychotherapy continue to be taught in academic medicine, interest in this modality has been receding over recent years. There is growing evidence of bias and stigma against psychodynamic and psychoanalytic psychotherapy. We believe there is a gross misconception about Freud and his teachings, emanating from a failure to consider factors related to context and zeitgeist. We believe this misconception negatively affects openness to learning and practicing quality psychotherapy. 

Methods
In 2021, a 2-hour course was developed and delivered to PGY2 psychiatry residents at Medical College of Wisconsin, to discuss: The birth of psychoanalysis in late 19th century Europe, Sigmund Freud's role in developing psychoanalysis and his contributions to psychiatry, Facts and opinions that have been accurately and inaccurately attributed to Sigmund Freud and how this affects attitudes of contemporary mental health clinicians. Participants completed pre-course and post-course surveys. This survey assessed Word-associations with Sigmund Freud Attitude towards Sigmund Freud; and Attitude towards psychoanalysis and psychodynamic psychotherapy 

Results
Results of 40 pre-course surveys revealed a strong negative bias towards Sigmund Freud, and a weak negative bias towards Psychoanalysis in general. Results of 40 post-course surveys revealed a shift from negative bias to neutral attitude in relation to Sigmund Freud, and a shift from negative to positive attitude towards psychoanalysis in general. 

Conclusion
Results of these surveys indicate that not only is it important to teach courses (in this case, the history of psychodynamic psychotherapy), it is also important to consider the way the courses are taught. Delivering medical knowledge in the context of time and culture, and extrapolating principles and techniques to contemporary times may play an essential role in acceptance, adaptation and evolution of medical knowledge.

Yuriy Slyvka    
Ohio University Heritage College of Medicine    

Purpose
To alleviate the discrepancy between historically disadvantaged groups and access to medical education, a unique free-of-charge summer program was created at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM). Here we describe the program and its outcomes. 

Methods
The Summer Scholars program began 40 years ago and was revised in 2020 to mirror the current OU-HCOM flipped-classroom curricular environment. Participants must be economically, or educationally disadvantaged, or be an underrepresented minority in medicine. This 5-week program is designed to enhance opportunities for medical school admission by immersing participants in activities representing the first year at OU-HCOM. We analyzed outcome data from the last 5 years and surveyed our 2022 cohort. A special focus was placed on the teaching of basic sciences (anatomy, histology, physiology) as this is key knowledge for future medical students. 

Results
Over the last 5 years, 115 scholars completed the program, 89 were interviewed, and 47 were accepted to OU-HCOM. According to our survey of the 2022 cohort, many scholars did not have any previous experience in Histology (37.5%), Anatomy (12.5%), and Physiology (8.3%). At the end of the course, students reported increased confidence in Anatomy (95.8%), Histology (91.6%), and Physiology (83.3%). All participants stated a better understanding of OU-HCOM's curriculum and were satisfied with the overall level of teaching in the program. The level of integration between topics satisfied 95.8% of scholars.

Conclusion
OU-HCOM established a unique summer program that provides an opportunity for participants from underrepresented populations to be better prepared for acceptance to, and performance in, medical school. The program provides scholars an opportunity to improve knowledge of basic sciences, become familiar with a medical school curriculum, and improve academic performance serving the ultimate goal of increased student retention.

Himanshu Agrawal    
Medical College of Wisconsin    

Purpose
Despite its known importance, interpersonal skills training is not prioritized in pre-clinical medical education. Addressing this gap through the use of active role-play, spaced learning and reflection has applicability for curriculum improvement in medical schools across the nation. Our program, Operation Conversation, allows pre-clinical students the opportunity to develop critical conversation skills outside of currently established medical curricula.

Methods
Students participate in three virtual workshops per semester. Students are assigned in pairs and grouped with the same physician facilitator who observes each role play. Each student role-plays as both the patient and physician. The role-playing physician's performance is then readily assessed via a validated communication checklist by all group members. This documented feedback is verbally relayed by each party to the role-playing student physician. Students complete a self-reflection survey following each workshop and a program evaluation after the final workshop. Data from the communication checklist, self-reflection, and program evaluation were used to determine the efficacy of the training process, offer qualitative evidence for program success, and improve workshop format. The communication checklist data were reviewed retrospectively, and a mixed methods approach was used to analyze findings.

Results
64 students successfully completed the program across two semesters. The communication checklist had 11 "communication proficiencies" for evaluators to mark as complete/incomplete to track student progress across workshops. The average number of "completed" communication proficiencies evaluated from a self-, peer-, and facilitator- perspective all showed statistically significant improvements from the initial workshop to the final workshop.

Conclusion
Operation Conversation is an effective extracurricular tool that positively supplements curriculum efforts related to interpersonal skills training. The program, with its reproducible workshop materials and virtual format, has established itself as a sustainable model with generalizability elsewhere. Communication skills are valued in all healthcare professions and prioritizing interpersonal training among aspiring physicians may undeniably improve patient care outcomes nationwide.

Tracey Taylor    
Oakland University William Beaumont School of Medicine    

Purpose
Following the commencement of the COVID-19 global pandemic and the murder of George Floyd, many medical schools received Call-To-Action (CTA) letters from students. These letters condemned manifestations of structural and systemic racism, and many school administrators responded with attempts to eradicate racial injustice. Curriculum committees were mobilized and curricular modifications included faculty training. Our aim was to investigate whether teaching related to diversity, equity and inclusion (DEI) topics has changed in the medical curriculum since the CTA. 

Methods
DEI-themed teaching materials were sought from the school's learning management system (LMS), searching for key DEI-related terms. Searching was for the academic year 2019-2020 (before the CTA) and the most current year. Other content (syllabi, committee reports, and student research project titles) were also analyzed for the same two timepoints. Results were compared for content changes over time. 

Results
At the level of session titles and objectives, few changes were observed between the two timepoints. All preclinical courses added DEI guidelines to their syllabi since the CTA. Teaching materials and content increased in the LMS for all DEI terms searched. DEI terms were extracted in 61 more courses/clerkships (424 vs 485) over time, and 3978 more times (5869 vs 9847). Individual differences, by DEI term, were also analyzed and the terms “race”, “equity”, and “LGBTQIA+” increased the most between the two timepoints. Student research project titles from the class of 2023 contained the most DEI terms, followed by the classes of 2021 and 2025, with the terms “gender”, “race”, and “ethnicity” observed most commonly.

Conclusion
DEI-themed content in teaching materials has increased since the CTA, both on a per-course basis and the number of courses; however, at the high level of learning objectives and session titles, there is no increase. Future studies will investigate longitudinal trends and faculty experiences.

Robin Ohkagawa    
University of Michigan; New England Donor Services    

Purpose
Competency frameworks guide educators to develop appropriate curricula and training programs. In areas where no standard framework exists, practice expectations are often developed idiosyncratically and can result in varied practice from institution to institution. This is the situation that many educators in the field of organ procurement faced when a national group of organ procurement educators decided to use a modified Delphi and backwards mapping process to create a standard competency framework to guide the development of relevant training programs.

Methods
24 educators from across the country were led through a backwards mapping curriculum design exercise for two days. Backwards mapping is based on three key steps: 1) knowing the desired results, 2) identifying assessment evidence, and 3) developing the curriculum or learning experiences to obtain those results. By use of a modified Delphi process, the experts were asked select questions in which they answered through both independent brainstorming and group work.

Results
Use of a modified Delphi process and backwards mapping exercise resulted in documentation of a standard framework for the procurement coordinator with universal competency domains, related standards and associated competencies. The processes permitted in-depth discussion, opinions, brainstorming and ultimate consensus on standards for a shared area of practice.

Conclusion
Backwards mapping is a simple yet effective process that can be used in all areas of health professions education to create standard curricula, content, and competencies where either none exist or are in need of revising. This method can be used when developing competencies for a specific practice, as done in this instance, for a core curriculum, a single part of a larger program, or to evaluate and update current competency goals. The stepped process provides a clear and straightforward action plan while the facilitation questions are an effective strategy for synergetic work during a meeting of experts.

Gabi N Waite    
Geisinger Commonwealth School of Medicine    

Purpose
Increasing use of integrated curricula across health professions education mandates unique leadership skills from faculty. Often, faculty development directed toward such leadership addresses skills for managing teams in general. However, as instruction moves out of silos of individual disciplines toward integrated teams, training tailored towards leaders overseeing vertically and horizontally integrated curricula is necessary. A recent DR-ED post regarding faculty development in leadership for health professions educators in integrated curricula showed interest in such programs. Accordingly, we created a steering group to frame the leadership development tools directed toward Leadership in Longitudinal Integrated Curricula, LILIC.

Methods
Faculty members from 3 institutions who responded to the DR-ED post met at a national medical education conference agreeing that there is a need for such tools. Each of us holds leadership roles in integrated curricula in our respective institutions and formed a steering group to frame specific leadership attributes and skills. We will analyze broad leadership attributes and skills and consider how those apply to LILIC based on the collective experiences of the steering group members. We will use the format of the "twelve tips" series in Medical Teacher as the framework. In addition to a description for each section, tools for faculty development will be described as well.

Results
Our initial framework for leadership skills falls broadly into 4 key areas including intrapersonal, interpersonal, organizational and systemic (Med Teacher 2012; 34: 312–319). We will develop attributes for each area and define faculty development tools which can be used by faculty as they transition into leadership positions.

Conclusion
We have identified a need for developing leadership skills for faculty in integrated curricula. Our model will provide a tool kit for institutions to develop faculty for leadership roles to effectively lead integrated curricula spanning the developmental stages of learners in health professions.

Sateesh Babu Arja    
Avalon University School of Medicine    

Purpose
Although all preceptors routinely teach in their role as clinicians; not all ACGME-accredited residency programs offer formal instruction in teaching. Relatively inadequate amount of formal training combined with the intrinsic time constraints faced by residents and increased work-hour restrictions, tactically incorporating formal medical education elective experiences into medical school curricula seem understandable. The aim of this study is to explore if medical education electives can enhance the interest of future physicians in teaching and research.

Methods
The Medical Education Elective at Avalon University School of Medicine (AUSOM) is a new four/six-week course developed to give interested medical students an experience in medical education to prepare future physicians for significant teaching roles. The modules are accreditation/regulation, curriculum development, learning theories, assessments, and research methodology. Students can choose any one of the modules. The medical education unit at AUSOM offered the medical education elective to twenty-five students in the year 2021. All of them gave feedback when they were asked open-ended questions at end of the elective. We did the data (feedback) analysis through framework analysis, familiarization, generating initial codes, searching for themes, reviewing themes, and defining and naming themes.

Results
Different themes emerged, enhancing the interest in academic medicine, understanding research methodologies, supporting learners, and aware of learning theories. Few of the quotes 'I truly learned a lot about research methodology during this Medical Education elective. Thank you for all the reading materials, assignments, and feedback you have provided me over the past few weeks. This medical education elective was a great experience.' 'One day, I hope to work in academic medicine, and this elective has helped me develop a perspective on the nature of medical education.

Conclusions
The medical education electives can enhance students' interest in teaching and research if an appropriate medical education curriculum is employed.

Margaret Herr    
Wright State University Boonshoft School of Medicine

Purpose
Medical schools use curricular objectives to assess the competency and preparedness of medical students, as future physicians. Markers of these objectives typically include academic performance, however, specific objectives such as professionalism and interpersonal/personal development cannot be quantified using examination scores. We have developed a novel strategy to allow for growth in these curricular objectives through nonacademic settings and assess medical students' confidence in these components. A pilot peer mentorship program for 2022-2023 has served as a way to measure student self-reported confidence in the educational competencies of professionalism and interpersonal/personal development.

Methods
Medical students at Wright State University (BSOM) were recruited to sign up to mentor premedical students in a pilot mentorship program for the 2022-2023 school year. During the mentorship program, an Orientation Session was held to teach mentors on best practices for a successful mentor-mentee relationship. Throughout the program, mentors have the opportunity to grow in the skills of professionalism and interpersonal/personal development by leading workshops and volunteering as guest speakers. Pre- and post-program surveys will be distributed to assess the confidence level of mentors in BSOM curricular objectives for professionalism and interpersonal/personal development.

Results
40 medical students signed up to partake in the pilot program as peer mentors for 120 premedical students. Each medical student has three premedical students to mentor throughout the program duration, from October 2022 to February 2023.

Conclusion
Medical students' self-reported confidence level will increase in objectives pertaining to professionalism and interpersonal/personal development, based on their attendance in the Orientation Session, participation in weekly checklists to manage discussion with mentees, and leadership role taken during the workshop and speaker sessions. Future survey data will show insight as to if medical students are more confident in competencies that do not directly coincide with academic knowledge.

Rebecca Andrews-Dickert    
Sam Houston State University College of Osteopathic Medicine   
 

Purpose
As point-of-care ultrasound (POCUS) is increasingly recognized as a valuable tool for physicians, many medical schools are incorporating ultrasound in undergraduate medical education (UME). The lack of knowledgeable faculty is a recognized barrier to including ultrasound in UME. The purpose of this study is to examine the effects of faculty participation in a POCUS professional development program on attendees’ perceptions regarding the use of ultrasound in UME.

Methods
Seven weekly 1-hour sessions were available for faculty and deans at Sam Houston State University College of Osteopathic Medicine. Sessions covered ultrasound physics, technical skills, and application of ultrasound in clinical decision-making. Sessions consisted of presentations and hands-on learning with ultrasound machines. An anonymous, post-program survey was conducted and analyzed using qualitative and quantitative measures. IRB exemption was granted for this project.

Results
Six of the 7 attendees completed the survey. On a five-point Likert scale, the mean rating of faculty members’ self-reported ultrasound knowledge increased from 2.17±1.07 to 3.17±1.34 prior to and after the event, respectively. Recognition of the importance of integrating ultrasound into UME also increased with a mean of 3.0±1.0 to 3.83±1.46. Respondents reported plans to increase incorporation of ultrasound into their teaching (from 50% of respondents incorporating ultrasound the previous academic year to 83% in the upcoming year). Survey responses indicated anatomy as the most useful discipline for ultrasound integration and identified limited room in the curriculum as the main barrier to incorporation. Overall, faculty reported satisfaction with this program.

Conclusion
Our data suggests that this pilot POCUS faculty development program has positive preliminary results. Future research directions include quality improvement of the faculty development program, assessment of the long-term effect of the program on ultrasound integration in UME by our faculty, and collaboration with our institute’s student ultrasound interest group to develop student-faculty partnerships.

Thomas Chan    
Western Michigan University Homer Styrker M.D. School of Medicine    

Purpose
Many medical schools and their accrediting bodies [such as the Liaison Committee on Medical Education (LCME)] require that students participate in service learning or community outreach. Most prior research has focused on the effectiveness of such programs in reaching the local communities. Less research has explored the impact of participating in service learning on the medical student volunteers, especially within the realm of educational outreach. As an option for students to meet this LCME requirement, we created Brain Explorers, a neuroscience outreach and service-learning program that tasks medical students to develop and deliver neuroscience lessons to children in underserved middle schools. The present study used qualitative methods to examine the impact of participation in Brain Explorers on medical student participants.

Methods
As part of their work with Brain Explorers, medical students designed and delivered neuroscience lessons to middle school students in a rural community within southwest Michigan. Following their involvement with the program, the medical student volunteers were invited to participate in a focus group, which was transcribed and qualitatively analyzed using applied thematic analysis.

Results
All participants expressed that the experience positively impacted their communication skills. Specifically, they emphasized the challenge of curricular design, the difficulty of distilling information to a level that children could understand, and the importance of improvising following "reads" on the audience. Making scientific content engaging, educational, and understandable for the target audience is difficult and requires preparation and adaptation. Participants recognized that these will be important skills for communicating complex medical information to lay audiences, including patients.

Conclusion
Educational service-learning programs that have health professions students create and deliver science lessons can improve self-reported scientific communication skills. These skills may be transferrable to clinic, highlighting an added benefit for health professions students to participate in educational service learning.

Shanna E. Williams    
University of South Carolina School of Medicine Greenville    

Purpose
Faculty are the bedrock of medical education. They are responsible for defining the competencies and objectives to be achieved by medical students and designing and implementing the components of medical curriculum to enable students to achieve these competencies. Yet, too often faculty experiences, knowledge, and opinions are ignored or not solicited during times of curricular reform. We describe a multitiered approach that promotes personal and programmatic interests to increase faculty engagement.

Methods
Amplifying faculty voice during curricular reform was initiated through working groups, surveys, and incentives. Three focus areas were identified: 1)active learning modalities, 2)assessment of medical students' progress, 3)faculty professional development. Strategic initiatives and goals were created around each focus area. Faculty were then invited to join and participate in working groups constructed around these focus areas to encourage their engagement. To further promote participation, monetary and timesaving incentives were offered to faculty participants.

Results
A crucial aspect of curricular reform is to encourage faculty to join initiatives and pursue common goals. This nonmandatory approach promoted faculty voice while simultaneously creating a beneficial coalescence of self-interest with organizational interest. When faculty were given the option to join a working group, 60% of faculty chose to participate. Groups met monthly and reported their findings at faculty meetings. Examples of successful outcomes include development of a menu of active learning techniques from which faculty could design their courses, targeted faculty development in active learning, and a faculty mentoring program based on solicited feedback from all faculty in the department.

Conclusions
Our shared model provides a foundational framework that can be used to promote faculty voice in different institutions. Implementing large-scale curricular reform is not a quick or easy endeavor, but gathering and honoring faculty voices is an essential first step.

Joshua Levy    
Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas  
  

Purpose
The COVID-19 pandemic caused medical schools to adapt to an online setting, and it became imperative to change lecture formats quickly. New curricula were adapted, with some schools having greater success than others. Kirk Kerkorian School of Medicine's (KSOM) small-group interactive learning style had clear signs of struggle with a significant decrease in exam performance. Rocky Vista University's (RVUCOM) large-group didactic lecture style had greater success with its curriculum adaptation leading to minimal effect on their exam performance. We aim to define what aspects of medical school curricula are most resilient for online learning by comparing exam scores from KSOM and RVUCOM.

Methods
KSOM and RVUCOM students were grouped into "above average" and "below average" categories based on each institution's standardized exam performance metrics. Independent sampled t-tests were performed to compare groups. KSOM was classified as a small-group interactive curriculum through its heavy reliance on student-led Problem Based Learning (PBL), whereas RVUCOM was classified as a large-group didactic curriculum through its extensive proctor-led slideshow lectures.

Results
KSOM's online PBL transition led to fewer students scoring above the national average compared to previous cohorts on NBME exams (55% vs. 77%, respectively, N=47 & 78, (p<0.01)). RVUCOM's transition to online large-group lectures yielded no significant differences between students who performed "above average" and students who performed "below average" between their cohorts (63% vs. 65%, respectively, N=305 & 300, (p>0.05)).

Conclusions
KSOM's COVID cohort performed significantly worse than RVUCOM's COVID cohort during their medical school organ-system exams. We believe that the small-group learning at KSOM is less resilient for online curricula compared to the large-group didactics seen at RVUCOM. Understanding which didactic methods can transition to online learning more effectively than others is vital in guiding effective curriculum adjustments as online delivery becomes more prominent.

Bruce Giffin    
University of Cincinnati College of Medicine   
 

Purpose
The rapid growth and obsolescence of medical knowledge accentuate the necessity for life-long learning and self-directed learning (SDL). Here we present the results of implementing an assessment tool to monitor the development of SDL skills.

Methods
We integrated SDL activities into our preclinical curriculum and, using the Delphi Technique, created a SDL inventory (SDLI) tool to monitor the developing SDL skills and behaviors of the students longitudinally. The inventory is administered prior to matriculation and at the end of each year of the curriculum. The SDLI, which consists of 37 items, helps us assess seven self-directed learning constructs.

Results
Aggregate data were analyzed using a Wilcoxon Signed Rank Test for each of the items. In the results below, a "negative" shift refers to a shift towards larger counts of a "Disagree" response and vice versa for a "positive" shift. The following statistically significant trends were observed: Inventory responses expressed a negative shift from pre-matriculation throughout the M1 year. During the M2 year, inventory responses expressed a positive shift, especially in the topic areas of course material, incentive to learn, and usage of external material for learning. In the M3/M4 years, significant shifts were observed in the inventory under the topic areas of optional educational activities and using them to improve skills.

Conclusion
Utilizing the SDLI enabled longitudinal tracking of SDL skills and behaviors of individual students or the entire class in aggregate. Additionally, longitudinal results detected several developmental trends in SDL skills over a medical education curriculum. This Inventory can be used to improve medical education curricula by: Identifying aspects of the SDL process where students feel confident. Detecting areas where students struggle with the SDL process. Making strategic interventions to how SDL is presented in the curriculum.

Khiet Ngo    
Loma Linda University School of Medicine    

Purpose
To use a learning objective (LO) scoring rubric to evaluate the quality of LOs in an organ system curriculum.

Methods
This study modified a published framework for writing LOs.  The framework included 4 elements: 1)target audience; 2)behavior expected; 3)degree to which the behavior should be demonstrated; and 4)the setting the behavior should be demonstrated in. A focus group of students and faculty reviewed the published framework. Three themes emerged from the focus group. The first  was that the subject of the behavior to be performed is often unclear to students. For example, “Compare and contrast type I versus type II diabetes with respect to risk factors, pathogenesis, and clinical presentation,” versus “Compare and contrast type I and type II diabetes.” The former has specific criterion for the compare and contrast behavior. A second theme was  that teachers routinely excluded categories #1 and #3 because they assumed the audience would be students, and students are expected to be 100% accurate in their responses during exams.  We modified the scoring rubric to include 3 categories: 1)a measurable behavior; 2)the behavior should be followed by clear criteria for the subject of the action; 3)the setting in which students are expected to demonstrate the behavior. (eg. clinical presentation). LOs were scored in each of the 3 categories with a maximum possible of 3 points for a single LO.

Results
134 LOs were scored. The mean composite LO scores was 74.3% (stdv=8.4). The mean for the behavior, subject, and condition domains were 96.0%, 79.5%, and 46.7% respectively. There was a modest association between teaching experience and cumulative LO with a Pearson coefficient of 0.4.

Conclusions
A LO scoring rubric that includes behavior, subject, and condition domains can be used to score learning objectives, and identify specific areas for improvement.

Dan Webster    
Texas Tech University Health Sciences Center Lubbock   
 

Purpose
With the USMLE Step1 exam changing to Pass/Fail, the TTUHSC-SOM changed its curriculum to add Cell Biology and Histology (CB/Histo;~ 25 extra hours) to an Anatomy and Embryology block (~150 hours).  The institution also transitioned to a Pass/Fail grading system for its pre-clerkship curriculum. The first iteration of the new block showed decreased performance in CB/Histo, so we hypothesized that students would benefit from the development of additional resources to encourage success in this content-heavy block. Therefore, an integrated CB/Histo lab study guide and a substantial question set were constructed for the second iteration.

Methods
The CB/Histo portion of the block was contained within the first Unit (3 weeks). Interactive laboratory manuals were designed to provide students with a more integrated view of didactic and lab materials. Students were able to add their own annotatable images to aid retention. Weekly quizzes were administered to assess student retention throughout the entire ten weeks of the block.

Results
Both resources were rated highly by the students.  For both the laboratory manuals and the weekly quizzes, at least 95% of students reported that the resources were helpful in preparing for examinations.  Narrative comments were largely positive.  However, student performance in the Histology portions of the three Unit exams did not change between two iterations in the new block, and were substantially lower than in the legacy curriculum.

Conclusion
Student feedback suggested that the two new resources were well-received by the students and  enhanced student learning.  The increased academic load, concurrent with the change to Pass/Fail, may have shifted student priorities and led to decreased student performance. Future iterations will attempt to further integrate CB/Histo concepts with Anatomy and Embryology material.

Christine Crumbley    
University of Texas Medical Branch   
 

Purpose
A first-year problem-based learning (PBL) course of an MD program was developed over 20 years ago and needed restructuring to narrow its focus and emphasize specific content. An assistant dean and senior medical educator organized five students who had previously taken the course for this effort: two beginning second year, two beginning third years, and one beginning PhD coursework for their MD-PhD. This presentation will discuss the student-centered approach to restructuring a course.

Methods
The group met weekly to discuss the course. Each student and dean reviewed one PBL case. Students wrote topic-specific learning objectives related to their case, mapped those objectives to the USMLE Step 1 content outline, and identified appropriate resources. Cases were reviewed for content appropriateness for the course, and to add or delete content as needed. One case was updated to remove implicit racial biases. The assistant dean and medical educator revised the course objectives which the students and course directors reviewed for alignment between the topic objectives and course content. The cases were handed off to the course directors who used the revised objectives and cases to rebuild the rest of the course content.

Results
A random sampling of first-year students participating in the course completed a weekly survey on the clarity of the topic objectives, alignment with the case and weekly quiz, and general feedback. Student feedback was reviewed weekly and course changes were implemented as needed. The course directors mapped each assignment, assessment question, and activity to the revised topic objectives.

Conclusions
Our approach put student feedback at the center of curriculum design. The students were able to provide insights from a learner perspective not usually addressed in course design. This allowed students a direct, hands-on approach to their own education and that of their peers.

Jessica Chacon    
Texas Tech University Health Sciences Center    

Purpose
Medical school educators face a challenge in determining what new and emerging topics to incorporate into the medical school curricula, and how to do so. A pilot study was conducted to gain a better understanding of the integration of emerging topics related to microbiology and immunology in the undergraduate medical curriculum (UME).

Methods
An anonymous survey was constructed using Qualtrics and emailed to faculty who teach Immunology and/or Microbiology at medical schools through DR-Ed listserv, the American Society for Microbiology (ASM) Connect listserv, and attendees of a workshop of Association of Medical School Microbiology and Immunology Chairs (AMSMIC). The survey asked participants about experiences, perceptions and the decision-making process regarding integrating emerging topics into UME.

Results
Our preliminary data find that the top emerging topics being added to the curriculum or considered adding in the last 10 years included COVID-19, Zika virus, mRNA vaccines, and monkey pox. Most respondents reported lectures and active learning (case-based learning, discussion, etc.) as the major methods to deliver these topics, with most faculty believing formative assessment is the best way to assess emerging topics. Content experts and course directors are the most cited individuals making these decisions. Top reasons for incorporating emerging topics into curriculum included preparing students for seeing cases in the clinic followed by demonstrating the importance of basic science and opportunities to integrate basic science into other disciplines. Challenges for incorporating emerging topics into the curriculum included making room in an already full course or curriculum followed by content overload for students.

Conclusions
Our study identifies the current main emerging topics related to microbiology and immunology being integrated in UME, as well as the main methods of integration and assessment. Future studies will include developing innovative learning modules that can overcome the barriers of integration.

Julie Swenson    
University of South Dakota Sanford School of Medicine    

Purpose
In the United States, 350,000 cardiac arrests a year occur outside of the hospital and 475,000 Americans die from a cardiac arrest annually. This demands providers to be competent in the management of cardiovascular emergencies. Despite the need, there is a lack of research regarding how to better provide training for medical students to address cardiopulmonary emergencies. The University of South Dakota Sanford School of Medicine (USD SSOM) has developed and implemented an ACLS Instructor (ACLS-I) course for medical students.

Methods
The ACLS-I enrolls up to 15 MS2 students in good academic standing per year. ACLS certification is a required prerequisite for ACLS-I. After obtaining instructor status, the student-instructors have been involved in teaching ACLS classes. As educators, participants are repeatedly engaged in teaching ACLS under the supervision of experienced instructors which gives them deliberate practice. At the end of the longitudinal integrated clerkship (LIC) ACLS-I participants and non-participants are tested for their knowledge, skills, and confidence with providing care of in-hospital cardiac emergencies.

Results
ACLS-I course participants and non-participants are tested prior to beginning of the course to ensure absence of selection bias. Obtained results demonstrate no statistically significant difference between the cohorts. The entire class of 2024 will be tested in February 2023. The test will cover attitudes, knowledge, and skills regarding management of cardiovascular emergencies. The testing methodology will include the use of assurance indices. The results are expected to demonstrate ACLS-I cohort to have better knowledge, skills, and confidence than their non-participant peers.

Conclusion
ACLS-I course improves medical student competency to manage intra-hospital cardiovascular emergencies.

Mary Kate Worden    
University of Virginia    

Purpose
The University of Virginia School of Medicine educational program objectives are broadly articulated as "Twelve Competencies of the Contemporary Physician." In contrast, the learning objectives for the 18 month pre-clerkship phase of the UVA SoM curriculum number more than 10,000 and are highly specific statements detailing what learners should know/do having engaged in classroom activities.  Here we test the assumption that mastering this large set of pre-clerkship LOs is adequate for developing competency in all twelve of the UVA SoM educational program goals.

Methods
For each of 12 pre-clerkship courses, 15-25 course level objectives were drafted to state what learners should know or do as a result of engaging in all sessions of the course. These course level objectives form an intermediate layer of a curricular map that links specific learning objectives for each instructional session to one or more of the broader educational program goals (The Twelve Competencies of the Contemporary Physician).  The resulting curricular map was refined and evaluated by determining whether all the >10,000 learning objectives could be mapped to one or more of these new course objectives, and subsequently to all twelve of the educational program goals.

Results
As anticipated, the majority of pre-clerkship learning objectives mapped to Competency 2 "Apply the scientific basis of medicine to current clinical practice", however very few of our pre-clerkship learning objectives linked to Competency 11 "Formulate a prognosis...". This unexpected finding suggests that our students learn relatively little about forecasting the likely course of a disease or ailment throughout the pre-clerkship phase of their education. We are using the theory of change model to address this concerning curricular gap.

Conclusion
Creating and evaluating a curricular map is a useful strategy for identifying curricular gaps while facilitating the monitoring, review and revision of curricular objectives and educational program goals.

Palak Patel    
Wake Forest School of Medicine
    

Purpose
One in seven U.S. households struggle with medical debt. Cost conversations can strengthen the doctor-patient alliance and decrease financial toxicity, but many students and providers are uncomfortable initiating them. We devise a curriculum that trains medical students to present financial realities in an informational and empowering way. 

Methods
All first-year medical students will participate in an Anatomy of a Medical Bill workshop. Interested students can apply for our Cost-Conscious Care Certificate, which is a high-value care curriculum approved by our university. Participants attend six workshops in their first and second years of medical school. These workshops will lay the foundation for a capstone project, which students will complete before their third year. We will evaluate the success of this program at one year of implementation.

Results
We will judge the success of our certificate program by assessing how students grew in their knowledge of high-value care and healthcare waste using IRB-approved surveys. To assess improving literacy in cost-of-care conversations, we will ask students to participate in a simulated patient encounter and offer feedback. The capstone project will ask students to advance healthcare value in a specialty of their choice. These projects will be reviewed by our executive board both to offer guidance and to determine how students are progressing in their understanding and implementation of high-value care.

Conclusion
This program is a student-led, cost-effective, transferable strategy for addressing gaps in cost of care education. Strengths of our program include longitudinal teaching and assessment, involvement of faculty from diverse backgrounds and specialties, and strong institutional support. Limitations include creating an immersive curriculum while being mindful of the time-constraints of a busy medical student schedule.

Catherine Coe    
University of North Carolina
    

Purpose
Medical schools are innovating to address workforce needs through practice-based pathways and partnerships across the education continuum. We will describe two geographically dispersed efforts focused on recruiting, training, and retaining physicians to work in rural and low resource communities. 

Methods
The University of North Carolina's FIRST program is a 3-year MD program linked to rural GME programs in Family Medicine, Surgery, Pediatrics and Psychiatry and to subsequent practice in a health professions shortage areas. COMPADRE is a collaboration between the Oregon Health and Sciences University, the University of California, Davis, Kaiser Permanente plus nearly all residency programs and health centers in the region between the two schools and across the state border. Both efforts include cross-site educator development, UME-GME curriculum, and maximizing student connections with GME.

Results
These two efforts are linking mission driven students to mission-focused GME programs to enhance the likelihood that graduates will remain in place and practice in regions with dire physician shortages. Early data suggests good "stickiness" for students to remain in place. Between both programs, over 50 students have completed the accelerated pathway programs. 80% of graduates are practicing in rural or low resourced practice settings.

Conclusions
Regional UME, GME, health center and health system collaborations create ecosystems that are responsive to the physician workforce needs. Lessons learned through these pathways include navigating regulatory bodies (Liaison Committee on Medical Education, National Residency Matching Program, Accreditation Council for Graduate Medical Education), providing learner support and tailored curricular experiences to optimize outcomes.

Christopher Vinyard    
Ohio University Heritage College of Medicine    

Purpose
Keywords are integral to mapping content in a curriculum by identifying coverage of key concepts and highlighting gaps and redundancies.  Despite their fundamental role in curriculum mapping, we have seen little congruence of keywords and their application across medical schools.  Here we document the development of a keyword list for an osteopathic medical school with a highly integrated curriculum.

Methods
Ohio University Heritage College of Osteopathic Medicine requires students complete the Pathways to Health and Wellness Curriculum (PHWC) to earn their D.O. degree. The first two years of PHWC is an integrated, case-based curriculum that applies weekly patient-centered cases using active learning to master essential components of the basic science, social, economic, clinical and professional practice of medicine. A group of faculty, staff and students met weekly for six months to develop a keyword list for curriculum mapping. Content experts were included as necessary, and a draft list was sent to all faculty for comments. The keyword effort was launched using the AAMC-CI Keywords and considered terms from the NBOME, AACOM, AAMC and ACGME.

Results
We developed 133 keywords describing the PHWC. We included 80 keywords from the AAMC-CI Keywords using 81% of their terms with 60% overlap. We split keywords into five groups: science disciplines; organ systems; clinical specialties; socioeconomic and patient/professional experiences; and professional practice. Grouping facilitates mapping and combining terms from different groups to build additional resolution in describing curricular events. Finally, this nested structure enables future generation of taxonomies or ontologies and linking terms to the NBOME Master Blueprint.

Conclusions
We created a keyword list to provide high-level coverage of the PHWC for the AAMC Curriculum Inventory aiming for a scalable infrastructure for future needs including increased resolution of curricular content mapping.

Kian Habashi    
Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas    

Purpose
Our purpose is to demonstrate the need for incorporating the training of teaching competencies into the pre-clerkship curriculum. We also seek to link medical student perspectives on necessary teaching skills with our institution's Problem-based Learning (PBL) Learning Issues (LI) rubric and the Residents as Teachers (RATs) curricular objectives[1]. The ability to teach is a skill long recognized by the medical community as necessary for providing quality patient care [2]. During clerkships, students are expected to prepare and present short teaching topics in which they will be evaluated on[3]. However, this skill training and performance is less emphasized during the pre-clerkship phase of medical school.

Methods
A qualitative needs assessment was sent to first through fourth-year medical students at Kirk Kerkorian School of Medicine to establish the current attitudes toward the importance of teaching skills in medical training. Student statements were coded and analyzed using qualitative data analysis methods. These statements were then cross-matched with our institution's PBL LI rubric teaching strategy measures and RATs curricular objectives.

Results
Student statements were codified into 27 unique teaching skills. Students expressed needs that matched 4 out of the 9 featured in our LI rubric, which were Complexity (105), Feedback (14), Engagement (12), and Utility (10). These skills also represent 4  of 10 RATs objectives.

Conclusion
Our analysis showed congruity between what medical students believe are important teaching skills to learn, our LI rubric measure items, and the RATs curricular objectives. Future directions of this project could also explore the attitudes of residents on essential teaching skills. Other institutions can use the codified teaching skills to inform the development of a preclinical teaching skills curriculum because they align with what competencies medical students report are important to them as well as the expected resident teaching tasks.

Kosha Gala
International Federation of Medical Students' Associations

Purpose
Medical Education Systems are responsible for the training of future health professionals. However, there are significant gaps in how medical education is delivered within and between countries and regions. Indeed, disparities and inequities are a substantial problem when we want to produce globally recognized competent doctors who can meet our society's present and future health needs. The International Federation of Medical Students' Assosciations believes medical students are critical stakeholders in advocating for and addressing disparities within the systems. 

Methods
In 2018, we conducted a Medical Education System Survey to outline how medical education is formulated globally and to understand the variations between schools, countries, and regions. This year, IFMSA will conduct a Global survey with a focus on 9 Areas of excellence in education: Student Assessment, Student Engagement, Social Accountability, Faculty Development, Simulation, Curriculum Development, Technology Enhanced Learning, International Collaboration in Health Professions Education and impact of the pandemic on the systems.

Results
The first survey in 2018 had 371 responses covering medical schools from 83 countries covering all five regions globally. We observed that traditional teaching dominates the teaching methodologies (77.1%). Integrated Systems Courses (36.7%) and Problem Based Learning (33.4%) were also used as supportive methodologies. With the recent advent of competency-based medical education alongside the introduction of revised WFME Basic Medical Education Standards in 2020, we aim to re-analyze the current medical education systems with a modified version of the previous survey. We plan to compare both survey results and prepare a report to be presented at the IAMSE 2023 conference.

Conclusion
There is an urgent need for new evidence on global medical education systems. Unfortunately, many medical students study in resource-limiting settings, thus reducing their chances of becoming agents of change in their communities.