Luis Felipe Herrera    
Tecnológico de Monterrey    

Purpose
Generation Z (GenZ) students, also known as the iGeneration (iGen) are used to technological tools used for learning purposes. The basic foundation of learning based on repetition, understanding and recall does not necessarily require technology. Still students must internalize large volumes of knowledge. So the question is if traditional visual learning methods are known and used among them.

Methods
A pre- and post-mixed (multiple choice and open) online questionnaire regarding knowledge and use of visual learning strategies was asked to 16 medical bioscientist students enrolled in the 5-week block named Nervous and Endocrine Physiology.

Results
The results of the pre-test showed that 53.8% of students are used to writing summaries as a visual learning strategy, 23.1% highlight texts and 23.1% write notes, not as much diagrams and flowcharts. When asked to explain what is a flowchart, 38.4% of the students described it as a graphic depiction of a sequence of events, 30.7% as a visual simplification of a theme and 30.7% as a method of organizing information. From the post-test, 87.5% of the students agreed that the elaboration of flow charts is useful to understand the complex sequence of events in nervous and endocrine physiology. A pre and post flowchart was asked to identify the information depicted and after working with it the appropriate interpretation increased from 42.8% to 81.2%.

Conclusions
Traditional visual strategies like flowcharts are not commonly used among iGen students. Perhaps faculty should reflect upon repromoting the use of traditional methods that have proven to be useful to learn without the need of a high tech resource.

Joshua Costin    
Nova Southeastern University    

Purpose 
For beginning learners, it is difficult to connect fundamental science constructs in Microbiology and Immunology to clinical scenarios. These challenges can be overcome through thoughtful linkage of fundamental and clinical concepts, which is the basis for vertical integration of curriculum. While much research has been performed on vertical integration of other medical professions in Microbiology and Immunology, no studies have been published in the specialized area of Optometric education. By designing a curriculum highly focused on ocular Microbiology and Immunology, and utilizing an interprofessional education component that utilized optometric clinicians and case-based learning, learning outcomes as well as student interest in the course would increase. 

Methods 
We designed an interdisciplinary curriculum taught by microbiologists, immunologists, and clinical optometric faculty that included more of a focus on ocular manifestations of infections and immune responses by integrating clinical cases into the didactic lectures. The learning outcomes, as well as student interest, were evaluated using a mixed-methods design utilizing survey and summative assessment data. 

Results 
Students voluntarily returned the surveys in large numbers. Survey data showed a general increase in student perceptions of the relevance of the course to their future career as well as a reported increase in understanding of the course material due to the clinical lectures. There was a positive correlation between performance on clinically based exam questions and overall performance in the course.

Conclusions 
An interdisciplinary curriculum was designed that successfully increased learning outcomes as well as student interest in the subject matter. The positive relationship between clinical and foundational curriculum integration with increased enjoyment and success in a fundamentals microbiology and immunology course could serve as a model for other institutions. Future studies should be multi-institutional, longitudinal, and consider different clinically-based integrations, such as team-based learning, problem-based learning, and others.

Suma Thareja    
Medical College of Wisconsin    

Purpose
Interpersonal skills such as empathetic understanding and rapport building are fundamental for effective patient-provider communication. However, because of clinical time restraints, providers often cannot engage in informal or intimate conversations that strengthen confidence and trust. Veterans especially benefit from such practices as an understanding of their past experiences may uncover important information that influences their overall health profile. One way to have these conversations is through life story work (LSW). We established the voluntary "My Life, My Story" (MLMS) program at the Milwaukee VAMC to determine if this LSW program enhanced trainee interpersonal skills, fostered stronger patient-provider relationships, and contributed to effective patient-centered care. 

Methods 
We recruited Veterans from the Milwaukee VAMC and volunteers, mainly healthcare trainees, from the Medical College of Wisconsin. Volunteers interviewed Veterans while encouraging them to share any meaningful life experiences. Post-interview, trainees wrote a short first-person narrative in the voice of the Veteran, which, after the Veteran's approval, was added to the electronic medical record and made available to the patient's care team. We assessed feedback on the MLMS program through post-interview surveys. 

Results 
Between 2020-2021, we found that all three stakeholders benefited from MLMS implementation. All 28 Veteran respondents appreciated the opportunity to participate, all 24 volunteer respondents noted a meaningful impact, and all 13 provider respondents shared that they built stronger rapport and better understood their patients' perspectives after reading the narratives. Qualitative analysis of free-form stakeholder comments touched on the MLMS program being a rewarding experience, which holds both therapeutic and education value. 

Conclusions 
These life stories permit personalized care, enhance trainee interpersonal skills, and transform a VAMC into a community where Veterans feel accepted and understood. Narrative medicine initiatives like the MLMS program enable value-added education for healthcare trainees and harness the fields of arts and humanities into medical education.

Tracey Thurnes    
Elon University    

Purpose 
Students and aging adult community members face a host of systemic challenges and a lack of educational training for engaging in difficult conversations. Design thinking, as an interactive and collaborative process for generating and testing viable innovations to complex problems, can prepare students and community members for the crucial conversations they will face throughout life. 

Methods 
Design Thinking research incorporates five core elements, including frame, explore, generate, prototype, and cultivate. Design thinking requires students to move beyond routine or surface level service towards generating relevant and grounded projects in and with communities. This engaged learning educational session partnered students with community members to design a space supportive of holding difficult conversations. Session Learning Objectives Establish a supportive space for students and community volunteers to explore the crucial elements around having difficult conversations Utilize design thinking practices to help better prepare students and volunteers for crucial end-of-life conversations they will have as health care practitioners and patients Develop and foster humility, empathy, compassion and respect for the provider patient relationship Employ valuable learning tools and resources that better equip students and volunteers to have crucial conversations with their healthcare providers and their families 

Results 
Evaluations provided supporting data that the session appropriated mutual and reciprocal learning with both parties feeling empowered and better prepared for fluent communication under challenging circumstances. The results underscore the value of the conversations and the mechanisms employed to prepare future healthcare providers with skills to initiate and manage difficult end-of-life conversations. 

Conclusions 
Using Design Thinking principles in the classroom setting can translate into practice by preparing students and community members to have difficult and meaningful end-of-life conversations through prompting self- and other-awareness, encouraging empathetic listening, critical observation, and creative collaboration.

Analane Powell    
Noorda College of Osteopathic Medicine    

First year students struggle to climatize to the volume of medical information in Medical School. This is one of the causes for increased anxiety around exams which leads to student burnout. In an attempt to foster an environment of collegiality, cooperation, and wellness, the research curriculum involves and Academic Decathlon between students who compete not as individuals, but as a part of assigned research houses. This team-based approach harnesses each individuals' strengths while allowing them the opportunity to realize their weakness in a manner that mitigates feelings of inadequacy and highlights their strengths. 

Purpose
The Academic Decathlon is a team-based competition designed to boost students' confidence and overall preparation for final and board exams. 

Methods 
The Academic Decathlon is a four-hour competition between research houses. Students demonstrated their knowledge in eight different events including a Jeopardy style event, Clinical lab exercises, anatomy demonstrations, and a Kahoots game. Each event is worth a number of points. The research house with the most points at the end of the event wins the house trophy and "bragging rights" for a year. Following the decathlon, we sent out a survey asking the students to report their overall confidence and preparation for their exams and the extent to which the competition fostered collaboration instead of competition within the student body as a whole. 

Results 
Our research discovered the decathlon helped students identify content areas of strength and narrow areas of focus to review before the final exams. 38.2% identified knowledge gaps. It prompted students to look at content in new and different ways while assisting in building/improving relationships with other house members. 69.9% of the students reported the event increased their relationship with peers.

Conclusion
Team based competition helped boost students' confidence and relationships and identified areas in which students should focus study to preparation for their final exams.

Amber N Heard-Booth    
Michigan State University    

Purpose
Medical schools are increasingly adopting curricula that integrate basic sciences and clinical training during preclerkship years. While an integrated curriculum has benefits, a drawback is reduced instructional hours for basic sciences, notably laboratory-intensive courses such as anatomy. Therefore, faculty must develop creative ways to optimize content delivery. We present an instructional method modeled after medical rounds that maximizes content exposure in an anatomy elective.

Methods
Anatomy instruction at MSU-CHM includes required study of prosected donors during year one and optional participation in a four-week dissection-based elective at the end of year one or two. During the elective, students (N=6-8) independently prosect different anatomical regions. To gain exposure to content beyond their assigned region, students gather once weekly in the anatomy lab with peers and faculty to engage in rounds, where each student presents their project as if the donor was a patient. Students identify and relate structures to the donor's health history to integrate basic and clinical sciences. A question-and-answer period follows, then the group moves to the next student's project and the process repeats. As the elective progresses, students continuously expose structures that inform their weekly presentations, leading to rich discussions.

Results
The rounds model allows students to review anatomy of multiple body regions even though they prosect just one region. Student feedback regarding rounds is favorable, highlighting the opportunity to review and integrate concepts outside their own project.

Conclusions
The medical rounds model has the potential to maximize content exposure when instructional hours are limited, while simultaneously promoting basic and clinical science integration. Faculty have observed other benefits, including high student engagement in self-directed learning and peer-to-peer teaching, and regular opportunities for feedback. Future studies will investigate benefits, flaws, and student perception of using a medical rounds model in anatomy instruction.

Terence Ma    
PlaceNets Consulting    

Purpose
Competency-based medical education (CBME) is an important approach used around the world. While most medical educators are familiar with writing learning objectives and using assessments to evaluate whether learners have achieved learning objectives, there is often confusion when writing objectives in competency-based educational programs. There is a difference between writing learning objectives and competency objectives.

Methods
We reviewed the literature on how learning objectives and learning goals are written. We compared them to the literature of how progressive learning occurs in competency-based educational systems.

Results
Learning objectives are specific statements of learning that an individual should achieve by the end of an educational experience. Learning objectives are written using specific verbs that demonstrate an expected level of learning at the end of the experience (session or course). These verbs align with Bloom's taxonomy and increase in levels of complexity. This lends itself to summative assessments and an ability to compare and rank learner achievement for that educational experience. Aggregation of learning objectives roll up to institutional learning goals. In contrast, competency objectives identify a pre-determined threshold that a learner must achieve and maintain. It does not matter the method by which the learner achieved that threshold. Learning in competency-based education depends on an individual's learning curve, which cannot be directly compared to other learners. Thus, this educational approach lends itself to frequent assessments to determine whether a learner has achieved and maintains the threshold of learning. Further, an institutional competency objective or goal can be parsed such that at different stages of the educational career of a learner, the threshold for the competence threshold differs. We compare the two types of objectives and how they differ.

Conclusions
Learning objectives are different from competency objectives. Learning objectives indicate the target of the learning whereas competency objectives indicate the threshold a learner must achieve.

Siobhan Moyes    
University of Plymouth    

Purpose
Throughout their training, students in health care professions are inundated with new terms that form the language of their chosen career. Mastering this vocabulary is a potential barrier to understanding new concepts. We have devised "Wordotomy", an active-learning approach to support learning technical terms, combining gameplay with visual cues to aid comprehension and retention of grammatical roots.

Methods
Wordotomy cards are formatted and made as standard playing cards. Each card has a root printed on one side, e.g. "pathy". On the reverse the root is repeated with its meaning, a visual representation of this definition and an example of the root used in a biomedical context, e.g. "neuropathy". Different gameplay approaches tailor the student experience. Global, semi-quantitative feedback was obtained from surveys completed by students after using the game in timetabled teaching sessions. Detailed qualitative feedback was gained from focus groups of medical undergraduates.

Results
Before playing Wordotomy, 27% of first year medical students had never previously considered understanding word roots as a means to understanding definitions. A further 24% were aware that terms could be broken down into roots but did not realise these had meaning. Together our data show that over half of the students surveyed were unable to make use of etymology in deciphering and using technical language. We present here student assessment of the relative comprehension of the roots used in Wordotomy demonstrating that the game provides a useful range of familiarity and novelty.

Conclusion
Wordotomy is a novel way of introducing etymology as a scaffold for self-directed learning. A strength of our approach is emphasising “visually and textually“ the meaning of morphemes rather than their linguistic derivation or using homonyms. This reduces reliance on memorisation, aids retention of knowledge and equips learners with the skills and confidence to understand and apply new vocabulary.

Jana Simmons    
Michigan State University

Purpose
Nutrition is a contributor to health including prevention and treatment of disease. Since 1985, Nutrition has been a recommended part of medical education and recently, the need for improvements has been recognized at a national level. Food access is an important component of public health and reducing health disparities, yet, its inclusion as a topic in medical nutrition education is rare and is almost completely absent from medical education literature. Here, I report on a food access project in an elective nutrition course for pre-clerkship medical students at MSU CHM.

Methods
This assignment is part of a month long medical nutrition elective course offered annually since 2017. Student small groups are assigned a food source and tasked with meal planning and conducting a shopping trip for a family of four. They must construct a written report and present it to their peers consisting of their proposed shopping list based on their meal plan, food available at their assigned source, nutritional analysis based on choosemyplate.gov, and a cost analysis including transportation.

Results
A total of 226 students have participated in this elective over 6 years with enrollments ranging from a low of 19 students in 2020 to a high of 70 students in 2019. Over the 5 years that evaluation data was collected on this class project specifically, 61 percent of respondents rated the activity as "very effective" or "extremely effective" (4 or 5 on a likert scale) with a 67% response rate. Expectedly, narrative feedback ranged from strongly positive to critical.

Conclusion
While topics like nutrition and food access are important in the education of future physicians and are recognized nationally as critical for the betterment of public health, they garner limited interest from students who often express a desire for content they perceive relevant for the NBME Step 1 exam.

Aditi Kesari    
The University of Tennessee Health Science Center    

Purpose
Flipped lectures are replacing traditional didactic lectures to promote active learning in the medical curriculum. The effectiveness of flipped lectures has been studied widely and most of these studies have shown favorable outcomes in terms of student opinions and their performance. However, the effectiveness of flipped lectures also depends on the educators, who conduct these sessions; hence, it is crucial to understand their viewpoints.

Methods
In this study, a scoping review of the literature was conducted to identify the perspectives of medical educators on flipped lectures. The scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis and documented via PRISMA-ScR guidelines.

Results
Based on the scoping review of the literature, the challenges faced by educators while flipping their lectures were identified. This study also provides evidence-based solutions and tips that educators and academic leaders can use to address these challenges.

Conclusion
This study identifies the challenges of flipped classrooms that medical educators face and offers strategies to address them. It also identifies the need for additional research to evaluate the perceptions of educators on flipped classrooms.

Shiva Kalidindi    
University of Central Florida College of Medicine    

Purpose
Medical students have reported the challenge of transitioning to clerkships, such as utilizing clinical skills and adjusting to the clinical space. There has been an effort made by a few medical schools to address this issue by adjusting their curricula to include transitional courses with simulation training. However, existing literature is lacking on the efficacy of orienting medical students to the hospital clinical setting.

Methods
Clinical simulation training was provided to the University of Central Florida College of Medicine Class of 2024 medical students before they began their clinical clerkship rotations at the start of their 3rd year of medical school. The students were asked to complete a pre-intervention survey to evaluate their confidence and proficiency in navigating the space and utilizing equipment within the hospital-based patient-care room setting. The students were subsequently provided an interventional simulation-based training that was intended to help familiarize them with a rudimentary hospital-based patient-care room setting. Following the simulation training, the students were asked to complete a post-intervention survey to evaluate their new level of confidence and proficiency.

Results
After the simulation training, it was found that the confidence from the pre-intervention survey participants (37.76% ± 13.74%) to the post-intervention survey participants (69.41% ± 14.36%) (t(160) = 13.97, <0.001) increased by 31.65% (95% CI, 27.16% to 36.13%). In addition, proficiency from the pre-intervention survey participants (32.31% ± 13.49%) to the post-intervention survey participants (62.12% ± 14/34%) (t(160) = 13.31, p<0.001) increased by 29.81% (95% CI, 25.38% to 34.24%).

Conclusion
Providing simulation training as a part of medical school curricula emboldens the medical student's confidence and proficiency level within the hospital-based patient-care clinical setting. Simulation training is a consistent and valuable educational tool for rising healthcare professionals.

James Grogan    
Oakland University William Beaumont School of Medicine    

Purpose
Improvement of lecture format and delivery has been a focus of medical educators to provide high-quality learning materials. Digital video lectures provide a useful format to investigate best practices for virtual instructor presence and the image principle. This research project explores cognitive load and student performance metrics associated with three modalities of video recordings in three preclinical content areas.

Methods
Medical educators at an allopathic medical school prepared videos of standard M1 lectures in anatomy, biochemistry, and physiology using best practices for multimedia presentations, and using available tools in the Panopto lecture-capture system. Several formative assessments were included at intervals within each presentation, as well as end-of-session feedback and cognitive load assessments of student participants.  Students chose from presentation formats (a. slides with audio, b. slides with audio and intermittent presence of the instructor, and, c. slides with audio and the continuous presence of the instructor), before completing assessments and surveys.

Results
Data has been collected for selected sessions during the fall and winter semesters during the Anatomical and Biomedical Foundations of Clinical Practice courses and the Cardiovascular Organ-system course, respectively. Results are expected to identify student format preferences, the impact of student format choice on learning performance, and associated cognitive load measures using standard survey instruments.

Conclusion
Recorded videos with different modalities of instructor presence have been prepared to investigate the image principle in multimedia presentations. In addition to student preferences for presentation formats, this study will collect student formative and summative performance data as well as an evaluation of student-reported cognitive load. It is anticipated that this study will result in an improved understanding of student preferences for content presentation in related multimedia modalities and whether or not student preference is aligned with optimal learning outcomes.

Eric Rupe    
University of South Dakota Sanford School of Medicine    

Purpose
Physicians are life-long learners and life-long educators. Through their entire careers, they educate patients, residents, medical students, and other health care professionals. Healthcare academia has recognized this need, which resulted in developing peer-assisted teaching and learning programs. USD SSOM has created a Medical Student As Simulation Educators (MSASE) program that teaches medical students the foundational concepts of adult education and how to effectively use them in simulation-based teaching. USD SSOM has demonstrated that learners' outcomes were similar whether they were taught by clinical faculty or by senior medical students. USD SSOM has also developed STACER (Simulation Teaching Academic Competency Evaluation Rubric) to assess MSASE-students' teaching competencies. 

Methods
MSASE program enrolls 12-18 medical students per year. They complete a set of asynchronous modules that cover history of healthcare simulation, educational theories, simulation modalities, feedback and debriefing, assessment, and high-fidelity simulation (HFS). After completing the didactic portion, MSASE students participate in teaching junior medical students under the supervision of clinical faculty. During teaching, they are evaluated with the use of STACER. STACER consists of the three parts: (1) learners evaluate student-educators, (2) student-educator's self-assessment, and (3) clinical faculty evaluate student-educators. STACER is a complex multi-domain instrument that assesses multiple aspects of delivering teaching. It allows for granular assessment and tracking of student-instructors' progress as educators. 

Results
The first set of data has been obtained in June - October 2022 during HFS for MS2 students. Preliminary results show strong correlation between self-assessment and evaluation by faculty. Learners' feedback has been overinflated. Additional data will be collected in February - March 2023 during the MS3 HFS course. 

Conclusion
STACER is an effective instrument to measure students' teaching competency.

Heather Christensen    
University of Cincinnati    

Purpose
Medical educators continually seek active ways to engage learners in the classroom through a variety of pedagogical methods. One evidence-based method is the "flipped classroom" (FC), which challenges students to assimilate first-pass information independently, reserving classroom time for facilitated, second-pass application of the material, often through case- and question-based learning. Despite the success of this practice, faculty struggle with how to effectively implement FC, particularly for "foundational material" in a time-compressed curriculum. As such, there is a paucity of data specifically in the utilization of FC for nephrology teaching, which has been identified in the literature as a particularly difficult subject matter for students. To this end, we designed a FC for renal physiology (and associated pathophysiology) to improve student learning and confidence in the clinical application of this content.

Methods
Two cohorts of second-year medical students (2021+2022) were assigned short, renal physiology videos created in-house (replacing two weeks of didactics). In-class, non-mandatory, active-application sessions were designed and implemented. For each, students completed a paper survey to assess their understanding of and confidence with the material before and after each session (10-point-scale; paired; anonymous), and their motivations for attending. Qualitative data was collected to assess learner perceptions of the activities.

Results
45-100 students attended the non-mandatory application sessions; the number of survey respondents varied from 23-80. Paired surveys demonstrated the application session resulted in an increase in student confidence, ability to connect foundational knowledge to a clinical context, and ability to think critically in that area. Students had an overall preference toward the FC learning style (versus traditional didactic lectures), and stress was not increased with this learning modality.

Conclusions
FC was feasible to implement in a pre-clerkship medical curriculum, and favorably received by students for content historically reported as difficult to learn. This work is a model for other foundational science content areas.

Noah Siegel    
Boston University Chobanian & Avedisian School of Medicine    

Purpose
Effective communication is a crucial component of patient-centered care, and clinical illustrations created by healthcare professionals have the potential to play a vital role in a patient's understanding of complicated and unfamiliar diagnoses. Physicians routinely draw in clinical practice, though the quality of these drawings is unstudied. Until now, no tool has existed to study the link between drawings created by physicians in a patient care setting and patient understanding.

Methods
Images depicting the pathological conditions of appendicitis, intervertebral disk herniation, endometriosis, and pathological cancer were drawn in collaboration with a Boston University fine arts student and Boston University Chobanian & Avedisian School of Medicine students. These illustrations were then assigned aesthetic scores by five artist raters who were trained to use a rubric that we developed and validated. A Likert scale survey was distributed to non-clinical subjects who rated how well each image helped them understand intended clinical concepts. We fit a random effects linear and logistic panel model to test the association of image aesthetic scores and communication effectiveness. 

Results
There was a significant correlation between assigned aesthetic score and communication effectiveness for all images. Likert scores improved with aesthetic scores, as did image preference rankings.

Conclusion
Drawing for patients may improve their understanding of a complex disease process, and an aesthetic scale may be a predictor of understanding. The addition of other forms of communication used in clinical practice, in concert with the images, may also improve understanding. A physician course aimed at simple improvements to their drawings could produce drastic changes for patients' health literacy.

Robert B. Mackin    
AU/UGA Medical Partnership    

Purpose
Image interpretation is a necessary skill for physicians. As novices, medical students often attempt to memorize whole images so that they can later recognize either the same or a similar image during assessment. To guide students away from memorization and towards image interpretation, we tested whether techniques used for analyzing art could help students learn how to analyze medical images. 

Methods
Three faculty members involved in teaching histology and an expert in art education developed a three-hour session to cross-teach skills involved in interpreting both artistic and medical images. After completing two histology sessions in the regular curriculum, students participated in the new session at the university's art museum. They then completed an additional 11 histology sessions over 15 weeks, and were asked to fill out a survey to measure their perception of the utility of their experience at the museum. 

Results
From a class of 60 first-year medical students, 33 completed an end-of-semester survey. The survey asked students to indicate the usefulness of the art museum session on interpreting different types of medical images using a 5-point sliding scale (1=Not Helpful, 3=Neutral; 5=Very Helpful). The types of images and the responses were: histology images: 3.18; anatomical illustrations: 3.12; and radiologic images: 3.24. Using the same scale, students also rated the usefulness of various elements of the art museum program as follows: interactive tour of the galleries: 3.48; small group worksheets within the galleries: 3.06; a concluding histology slide presentation in the museum auditorium: 4.06. Of interest, written comments regarding the experience were very positive. 

Conclusion
This study indicates that our student's perceived ability to analyze images is enhanced by participating in the session conducted at the art museum. We are discussing possible improvements to this project, including timing and content of the session, and methods for analyzing the session's benefits.

Cassandra Lee    
Boston University Chobanian & Avedisian School of Medicine    

Purpose
The provision of effective communication is an essential element of patient-centered care, and clinical illustrations created by healthcare professionals can play an invaluable role in helping patients understand complicated and unfamiliar diagnoses. Clinical practitioners routinely draw in their practice, but the quality of these illustrations has not been studied. No tool has yet been developed to study the link between drawings created by physicians and patient understanding.

Methods
In collaboration with Boston University Chobanian & Avedisian School of Medicine students and a Boston University fine arts student, multiple images depicting the concepts of appendicitis, herniated disc, metastatic cancer, and endometriosis were drawn. A visual aesthetic scale was used by five trained artists to rate these illustrations. A virtual quiz was distributed to participants in which they answered a set of questions relating to the image concepts both before and after viewing a randomly assigned illustration that was previously scored. We statistically measured the association between image quality and differences in quiz scores.

Results
Post image change in quiz score increased as the image aesthetic score increased. For some concepts, the differences in quiz scores were large enough to be significantly correlated to the illustration quality. A significant association was also found between concept and change in quiz score, presenting a confounding factor. Quiz scores also always improved after seeing an image, regardless of its quality.

Conclusion
A drawing may assist patients in understanding a complex disease process, and a higher-quality image may be more beneficial to patients than a lower-quality image. Additional forms of communication may also enhance understanding when combined with images. The simple improvement of physicians' drawings could have a dramatic impact on the health literacy of their patients.

Sean Kumar    
Eastern Virginia Medical School    

Purpose
Shadowing a physician in a clinical setting is pivotal in a medical student's career. It is often formative learning experiences that influence the students into the career of their choice. However, shadowing provides little exposure about medical profession. For these reasons, students need to take an active approach to the shadowing experience. In addition, the literature is limited to purposeful or innovative ways to transform clinical shadowing into a dynamic learning process.

Methods
Based on our medical experience and literature review, we recognize the following elements for effective "clinical shadowing." Before anticipation of clinical cases, tasks students need to be informed about future cases. Physicians should ask the student a structured series of questions to assess and clarify any misconceptions. The physician should introduce the patient to the shadow during the patient's presentation. The physician leads and invites the students through the history-taking process and physical examination with patient consent. After debriefing the clinical case, students should try their best to formulate differential diagnoses and treatment paths.

Results
This new proposed form of shadowing will allow students to anticipate the art of practicing medicine via observation, inquiry process, bibliography review, and mirroring. Students could have the opportunity to create their educational clinical journals. Engaging learners through active shadowing methods should give them a new perspective to understand a physician's work. However, a question lingers: what are the boundaries within which a student can participate during the active shadowing experience?

Conclusion
Defining a novel shadowing approach could revolutionize the medical student's learning experience. The proposed methodology of shadowing is feasible and easily followed, which is helpful. A study of proposed methods needs to be practiced for future evaluation so that it can be incorporated as a typical medical student exercise.

Erika Williams    
Michigan State University-College of Human Medicine    

Purpose
The onset of the COVID-19 pandemic sparked many changes in higher education, some which have lasted several years. One such change occurred in the Integrative Biomedical Lab (IBL) at MSU-CHM. This lab focuses on histology, pathology, genetics, microbiology, and physiology concepts that are relevant to the current clinical theme being covered in the curriculum. Pre-pandemic, weekly IBL class time was unstructured; students worked through lab objectives independently. To adapt this course for virtual learning, we introduced a structured learning environment. This involved guiding students through lab objectives, posing questions for small group discussion, and asking multiple choice questions with immediate feedback. These changes were maintained after virtual learning ceased. This study aims to determine whether implementing this structured learning environment improved student exam performance.

Methods
This study will evaluate first year medical student academic performance by analyzing average class scores on regularly scheduled lab assessments. Comparisons will be made between the average performance of students enrolled in the course from 2019-2020 and from 2021-2023 (approximately 200 students per academic year).

Results
This project is ongoing. It is expected that the results of this investigation will provide insight that can be used to guide the future development of the IBL course and other similar courses to improve assessment outcomes. The results of the impact of the structured learning environment on student performance will be presented at the conference.

Conclusion
Evaluation of these innovative structural changes is in an early stage. Lessons learned will be used to direct future curricular revisions with the goal of maximizing student learning.

Carlos Brown    
Carle Illinois College of Medicine    

Purpose
A notable shift in medical education has occurred following the integration of experiential medical learning through problem-, case-, team-, and simulation-based learning methods. Medical simulation further reinforces learning through both experiential and reflective modalities and emphasizes basic neuroscience concepts while introducing medical students to clinical and critical thinking.

Methods
Clinical and basic science professors developed a simulation for ischemic stroke with conversion to intracerebral hemorrhage. Elements of basic neuroscience, social determinants of health, and clinical judgment were incorporated. Students practiced verbalizing orders, conducting medical interventions, and interpreting labs/imaging. They provided acute care for a high-fidelity simulation mannequin presenting with slurred speech and facial droop in an acute rural emergency department scenario. Pre- and post- simulation surveys were conducted anonymously. Five-point Likert scales were utilized for student self-assessment of understanding acute neurological conditions. Post surveys also provided space for qualitative feedback.

Results
33 first-year medical students participated. Understanding of acute neurological conditions and physiological mechanisms significantly increased following the simulation (p < 0.01). Students were more confident in the decision making process for treating neurological conditions (p < 0.01). Overall, students agreed that the simulation should be a required course activity (4.85(0.44)). 

Conclusions
Through this simulation, students were expected to apply classroom content to treat the patient's stroke symptoms. Results showed that students' understanding and comfort with neurological conditions increased as a result of the simulation. Utilizing SIM Mannequins created a safe and realistic scenario for students. Ultimately, success relies on active participation from students and guidance from clinical facilitators and the cases can easily be changed to be broadly implemented in the preclinical curriculum. Limitations of the study include sample size and population, as this unique group consisted of engineering medical students who may be more inclined to hands-on learning.

Carlos Brown     
Carle Illinois College of Medicine    

Purpose 
How is concept mastery success in simulation (SIM)-based learning activities measured and how do these measurements correlate to acquisition of basic medical school knowledge? As medical education evolves to include SIM modalities as a choice of learning framework, a lack of consensus on how to best use SIM as a valid tool in improving medical education and how to measure its effectiveness is apparent[1][2][3].

Methods
Fifty-nine first-year medical students participated in an acute-care SIM with components of a pre-briefing, Emergency Medicine Physician facilitators, and a debriefing. Pre- and post-surveys provided data designed for assessment of didactic learning and experiential satisfaction using board style questions and 5-point-likert scales. 

Results
Student answers to the pre- and post-surveys were analyzed for percent difference changes. Participants as a whole did not demonstrate statistically significant improvement in understanding of basic science concepts after SIM participation via Student T-Test (p=0.912). Additionally, student confidence in managing acute care incidents and experiential satisfaction with the SIM showed marked increases (+36.1% p=0.002 and +37.7% p=<9 x 10-11 respectively) over pre-survey values after participation.

Conclusions 
Experiential learning of a SIM may not correlate directly with improvement of didactic basic science knowledge. However, non-didactic areas of student learning, namely confidence and satisfaction, demonstrated growth. These data suggest that SIM could be used as an adjunct to traditional instruction methods and that metrics for SIM success should be adjusted to quantify more experiential components.

Rupak Mukherjee    
Medical University of South Carolina    

Purpose
COVID-19 pandemic mandated disruptions of in-class sessions for the preclerkship medical students at our institution required live webcast delivery of didactic material in addition to the traditionally provided asynchronous recordings.  This study was designed to compare student performance concomitantly with student satisfaction with the courses between classes that were COVID-19 impacted and a matched cohort from the year prior.

Methods
Student performance in summative exams and student satisfaction in end-of-course Likert scale surveys were compared between cohorts that were provided live webcasts and asynchronous recordings of the sessions (Hybrid) and those that were able to attend in-class sessions, but also provided with asynchronous session recordings (Pre-COVID).  Eleven matched courses over the entire preclerkship curriculum were included. 

Results
Average MCAT scores between the two cohorts were comparable.  Matched exam performance for the class (exam difficulty, class score, top/bottom quartile performance) were statistically similar between the two groups.  Similarly, student satisfaction was similar between the two cohorts.  The relationship between perceived student satisfaction and course performance was statistically significant for the Pre-COVID group (y= 4.99x – 367.17; r2: 0.47, p=0.012), but failed to attain statistical significance for the Hybrid group (y= 4.31x – 304.16; r2: 0.30, p=0.058).  There was, however, no difference in this relationship between the Pre-COVID and Hybrid groups (t-statistic: -0.27, p=0.790).

Conclusion
At our institution, student exam performance and student satisfaction with didactic material were not significantly affected by the change in the method of delivery during the COVID-19 pandemic.  This result suggests that the availability of asynchronous recordings may play a significant role in student learning regardless of the method of initial delivery of the sessions.  These findings may also suggest that our curricular offerings are robust enough to absorb transitions to virtual platform(s) mandated by sudden closures of the institution due to future pandemics or natural disasters.

Dzhuliyan Vasilev    
Mayo Clinic Alix School of Medicine    

Purpose
More medical students in the U.S. are relying on third-party resources for learning rather than attending in-person classes, some even rating them more effective than lectures. Student use of third-party resources has changed following the shift to virtual learning during the COVID-19 pandemic and after the transition to a pass-fail grading for the Step 1 exam. Our study seeks to understand student perspectives on third-party resources during the preclinical years while using Q-methodology, an innovative analysis method.

Methods
A survey using Q-methodology was delivered to all students at an allopathic medical school. First, we held 8 focus groups with current students where participants were asked a series of questions about their use of third-party resources, and recorded statements were reviewed to make a representative Q-sample of 25 statements. All students were then asked to rank-sort the statements in order of agreement or disagreement.

Results
Data analysis will be performed by both participant and factor. Each statement in a participant's response receives a numerical score corresponding to how that statement was rank-sorted. Statements placed in the middle of the distribution receive a score of 0, statements students most agree with receive a score of +4, and statements students most disagree with receive a score of -4. A numerical array is created for each participant with statements organized by score. Similar arrays are grouped together into factors, representing commonly held opinions. Correlation coefficients are then calculated showing how closely a participant's response correlates with each factor. Data analysis will be completed by April 2023.

Conclusion
Our research is driven by and will contribute to a fundamental shift in undergraduate medical education where students face a dizzying array of third-party resources. Understanding how students use these resources will allow faculty to design courses that better align with student learning styles and preferences.

Mohsin Syed    
University of Arkansas For Medical Science    

Purpose
Medical students frequently observe variations in anatomy lab during cadaver dissection. The purpose of this study is to describe how unexpected findings during dissection open opportunities for experiential learning. Whereby, educators can actively direct students to investigate embryological events that determine variations and reflect on their potential clinical significance. However, there are some practical considerations and challenges that accompany the educational benefits of this instructional strategy.

Methods
This report is initiated by the observations of five freshman medical students. During their careful dissection of the posterior abdominal wall of a male cadaver, they discovered an unusual vascular pattern where the left common iliac vein crossed the aorta anteriorly and joined the right common iliac vein to form the inferior vena cava (IVC) at the level of L1 vertebra.

Results
The complex embryological development of IVC results in the potential for multiple congenital variations. Typically, IVC is formed by the confluence of the right and left common iliac veins at the level of L5 vertebra. By contrast, students observed that IVC is formed at the level of L1 vertebra, and the left common iliac vein crossed the anterior aspect of the aorta to join the right common iliac vein. These surprising findings prompted instructors to guide students toward exploration of previous studies concerning similar venous variations, and to discuss the potential medical or surgical implications. One of the challenges of this strategy is provision of similar experiences to all members of a large class and continued monitoring of student investment during a rapid paced course.

Conclusion
Cadaver dissection facilitates opportunities for experiential learning that provokes deeper and independent learning. Reported here is one example of such an opportunity related to a rare variation of formation of the inferior vena cava. The advantages and difficulties associated with this strategy are highlighted.

Anastasia Filimonov    
Boston University Chobanian & Avedisian School of Medicine    

Purpose
Grounded-Theory Thematic Meta-Analysis (GTTMA) is a novel method that extends the research techniques of grounded theory and thematic analysis to meta-analysis of papers in the literature. In summary, papers are considered as individual "voices" for narrative inquiry. This technique can be widely used in all fields of scientific and clinical research to connect qualitative and quantitative analyses to answer rigorous research questions. GTTMA is robust yet inexpensive, and can be done in a hybrid format, enabling diverse and interdisciplinary researchers to collaborate from any location. This method teaches students the importance of mixed methods analysis. We report the first applications of GTTMA to answer questions involving LGBTQIA+ policy and education issues.

Methods
GTTMA was used to identify health disparities amongst pelvic cancer patients; respond to Nature's recently published sex and gender guidelines by introducing methods to inform policy making; and analyze sex and gender evidence within the field of athletics. Coding levels were derived from concurrent terminologies within each discipline of research, which all served as PubMed boolean search terms. After narrowing the papers to analyze between 30-100 for each study, we applied GTTMA, considering each paper as an interview. 

Results
Our narrative inquiry resulted in coded data that elucidated the extent of knowledge on each topic. We found GTTMA to be a diverse tool, and suggest this methodology could be implemented to enrich students' academic interests and research experiences. This method is affordable, encourages collaboration, and can precede or combine qualitative with quantitative methods of analysis.

Conclusions
GTTMA is a novel research methodology that encourages intersectional work between scientists, clinicians and policy-makers, and provides students with rigorous laboratory experiences. We encourage future research to include the GTTMA method to find ways to address intersections in science, medicine, education, and policy-making.