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

Purpose
The COVID-19 pandemic forced medical students to quickly adapt to a remote learning format. Previous studies demonstrated medical students affected by the pandemic performed inferiorly on exams during their first trimester compared to pre-COVID cohorts. Our study ascertains if there were similar outcomes in medical student's preparedness for clerkship training.

Methods
In April 2022, third-year (COVID) and fourth-year (pre-COVID) medical students at the Kirk Kerkorian School of Medicine at UNLV completed a Qualtrics survey which reported their self-perceived preparedness prior to the start of clerkships (COVID) or from the perspective of when they were entering their clerkship training the year prior (pre-COVID). The surveys also measured student's confidence in taking patient histories, physical exams, and communication with medical staff. Students rated the importance of didactic lectures versus experiential learning for clerkship preparation. Shelf exams scores were also compared.

Results
The COVID cohort felt significantly disadvantaged when entering clerkships compared to the pre-COVID cohort (4.3/5 vs. 3.4/5). Furthermore, the COVID cohort rated didactic lectures to be less important than experiential learning (37.5% vs. 62.5%), while the pre-COVID cohort rated didactic lectures to be more important than experiential learning (53.2% vs. 46.8%). All other survey items, including shelf scores, did not differ significantly.

Conclusion
Online learning during the COVID pandemic does not affect self-perceived clerkship preparedness. Students who began medical school during the COVID-19 pandemic felt disadvantaged compared to pre-COVID students, however overall feelings of preparedness do not seem to be affected by COVID-19. Students may have perceived disadvantage secondary to a "grass is greener" phenomenon, which is the perception of a missed opportunity due to resources that were given to another group. For future direction, STEP 2 scores will be compared between cohorts.

Diego F. Niño    
Florida International University Herbert Wertheim College of Medicine    

Purpose
As medical education continues to transition from lecture-based to active learning strategies (e.g., flipped classrooms), maximizing academic performance and learner engagement remain a priority. The current study sought to identify student perceptions and preferences of instructional materials used to support the preparatory phase of active learning.

Methods
A survey of second- and third-year medical students was conducted to assess learners' perceptions on and preferences for flipped classroom preparatory resources and reported interest in learning additional information about the content using Likert scale questions (1 = strongly disagree to 5 = strongly agree).

Results
A Friedman's 2-way ANOVA by rank analysis of the survey data demonstrated that there was a significant effect of type of resource (chapter text, recorded lecture, YouTube video, instructor-made video, and interactive e-module) on self-reported completion of the preparatory material (p<0.01). A follow-up pairwise multiple comparisons test indicated that the score for text (mean rank = 2.09) was significantly lower than YouTube video (mean rank = 3.73, p?0.001) and instructor made video (mean rank = 3.26, p=0.016). There was no statistically significant association for the other preparatory resources.

Conclusions
The results of this survey suggest that medical students prefer audiovisual resources over text formats. YouTube videos and instructor-made videos are effective in generating student interest in the subject more so than text. We acknowledge that respondents have had limited exposure to interactive "e-module" resources. Ongoing research efforts consist of a cross-sectional study comparing academic performance of first-year medical students after using different types of preparatory resources. The results of this study will help to inform instructors when developing asynchronous preparatory resources to support active learning.

Satria Nur Syaban    
Swansea University    

Purpose 
The use of technology in both synchronous and asynchronous medical education has been long on the rise, with the COVID 19 pandemic providing an additional push for many. Numerous medical education platforms have begun making their way to both institutional and individual continuum of study in recent years. With this study we aim to analyze which usage behaviors in one such platform act as predictors of outcomes in a mock USMLE assessment.

Methods 
We collected anonymized data on student behaviors and usage from an online platform and compared it with results on the mock USMLE assessment. Examined data points included number of videos watched, duration of sessions, retrieval questions answered, including accuracy and self-reported confidence levels, performance on Q bank questions, and adherence to assigned materials. In a subsequent analysis, we will collect further data on study strategies and usage of e-learning tools, and compare with performance on the actual USMLE exam

Results 
Results from our first analysis show that increased platform usage is associated with better performance on the mock exam. High usage of spaced retrieval quizzes and Q-bank exercises were associated with higher performance. The higher performing students also had a significantly higher number of videos watched. Adherence to spaced retrieval questions did not correlate with better performance.

Conclusion 
Certain usage behaviors are statistically significant positive predictors of performance, supporting the use of e-learning platforms and retrieval-based learning to improve outcomes in an standardized exam. This may have implications for clinical practice and further studies are required to better delineate and exclude confounding variables. Acknowledging the numerous confounding factors at play, we will conduct subsequent research while triangulating the results with student surveys, and compare with outcomes of actual USMLE performance.

Nada A Fadul    
University of Nebraska Medical Center    

Purpose
Project ECHO has demonstrated success in improving health outcomes. While its has mainly focused on healthcare settings, it can be leveraged to create virtual global health programs. We describe our experience in training Sudanese inter-professional students on community engagement from a US-based ECHO hub.

Methods
We used a project life cycle of plan, implement, and evaluate. Between January-April 2021, we recruited a team of 20 students to perform situational analysis of community needs. We developed a curriculum and partnered with academic, governmental, and non-governmental organizations. Between May 2021-April 2022, we trained volunteers to implement outreach projects in underserved regions for COVID-19 prevention and management. Evaluation was done by analyzing post-session surveys and implementation reports submitted by the student volunteers.

Results
The community medical response team (CMRT) was the first ECHO in Sudan. The curriculum focused on interprofessional teamwork, community engagement, and the principles of COVID-19 prevention and management. A total of 538 students completed virtual volunteer on-boarding. Between May 2021-March 2022, 35 ECHO sessions were delivered by 24 faculty from the US, UK, the Gulf region, and Sudan. Out of 1943 attendees, 60% found the sessions relevant, 78% stated that they would use what they learned, and 71% would recommend the sessions to colleagues. The students conducted 150 community awareness campaigns, home-managed 65 patients with mild COVID-19, and delivered 20,413 doses of COVID-19 vaccine to underserved regions in 6 states in Sudan.

Conclusions
The ECHO model is promising for virtual global engagement with students in LMIC such as Sudan. We succeeded in creating an e-learning program for inter-professional students to work in community-engaged volunteer projects.

Nikolas Malize    
Texas Tech University Health Sciences Center El Paso    

Purpose
Pre-clerkship medical students increasingly use third-party resources (AMBOSS, Anki, Pathoma, Boards and Beyond, etc.) to supplement or replace traditional medical curricula learning resources: e.g., lectures, monographs, reading assignments. This increase reflects both the developing quality of these resources and the density of learning materials in a standard curriculum. However, student use of these resources has potential drawbacks: e.g., they can conflict with in-house learning materials leading to confusion and educators, who have no direct knowledge of the content within these resources, may fear that curriculum materials are ignored. Many institutions have begun integrating third-party resources directly into their curriculum to mitigate these pitfalls.

Methods
We will invite pre-clerkship medical students to complete an online survey including Likert-like items and open-ended questions to enquire about the frequency with which they use various learning resources and if these resources are formally adopted and aligned with the curriculum. Faculty will be asked about their perceptions of students using these resources, and if and how they use them to augment the formal curriculum.

Results
Students will rank the utility of different third-party resources, how much they use them, and their utility compared to the standard curriculum, and how their medical schools have adapted to the new learning landscape made available by these evolving resources.

Conclusion
The increasing use of third-party materials raises potential issues of poor alignment with medical school curricula; however, their use is likely to continue. Evaluating students' use and faculty perception of these resources will help inform appropriate integration into curricula.

Brianne Lewis    
Oakland University William Beaumont School of Medicine    

Purpose 
Medical students often find biochemistry a difficult topic with little sense of connection to clinical learning. Educators who teach metabolic pathways are challenged with developing competence in medical knowledge while emphasizing clinical significance to early learners. In order to address this challenge, we piloted an innovation in the metabolism block of our M1 year. This approach blended three elements (1-basic science, 2-laboratory testing and 3- clinical decision making) in each session to help students learn to diagnose metabolic disorders.

Methods
Sessions were delivered asynchronously through the LMS. Lectures included in this study were 50 mins with the following structure: Introduction to the case, didactic content in the form of mini modules, interactive case study (ICS) and reflection. The ICS presented a metabolic disorder case in an async virtual setting. Evaluation of the educational activity was assessed by a survey containing a 5 pt Likert scale, narrative feedback thematic analysis and viewership data.

Results
Our viewership data and student self-reporting demonstrated high participation with provided materials. Most students either agreed (46%) or strongly agreed (48%) that the format was useful for their learning. Students also agreed (49%) or strongly agreed (16%) that the interactive case study prepared them to diagnose the relevant metabolic disease. Major themes extracted from narrative feedback found that students felt that the case study contributed to their learning compared to the lecture content but would have liked additional formative assessment or specific content related information included.

Edward Klatt    
Mercer University School of Medicine    

Purpose
Medical students use diverse resources to prepare for clinical exams and rotations. This study aimed to identify the diversity of student resource usage for exam preparation and for clinical skills students find most challenging and the resources they used to help learn those skills. We also aimed to show the variance in which clinical skills students find the most challenging, and exhibit the diversity of resources they used to prepare. 

Methods
A retrospective IRB approved survey was sent to students at all campuses of Mercer University School of Medicine who had taken Step 2 CK. This survey was deployed using Amboss survey software. Descriptive statistics of de-identified self-reported score data and survey question responses were then analyzed.

Results
A total of 63 out of 120 eligible students provided responses. Students reported using UWorld, Anki, Amboss, and First Aid, the most. The most commonly used resource for Step 2 was UWorld. The most used resource for learning clinical skills and knowledge, was UpToDate. The 3 most difficult clinical skills to master were: proposing an assessment and treatment plan, answering preceptor questions about assessment and treatment plan, and proposing a differential diagnosis. Only 2 students used the school's curricular materials to learn these skills 69.4% of students never used the school's curricular material in clinical practice. 

Conclusions
This study shows that medical students break beyond the borders of their training program in pursuit of resources for exam and skills preparation via internet technology for access to diverse resources available online worldwide, bypassing physical borders. Online access 24/7 to resources developed in diverse locations is exemplified by Amboss, both a partner in this study, and a provider of learning resources for students at our school. Continued monitoring of student study resources may inform student and school acquisition of resources and materials.