Kaycee Fillmore    
Oakland University William Beaumont School of Medicine    

Purpose
Self-directed learning (SDL) is imperative to incorporate in the medical curriculum to develop lifelong learning skills. The Liaison Committee on Medical Education (LCME) defines four specific components of SDL that must be incorporated into medical education. Here, we created a SDL activity and evaluated whether this format of SDL aligns with the SDL components defined by the LCME using students' evaluations and reflections.

Methods
Participants were first-year medical students enrolled in the preclinical Respiratory course during the 2021/2022 winter semesters (N= 250). Using thematic analysis, we analyzed students' evaluations and SDL reflections to determine student satisfaction and whether SDL aligns with the SDL components defined by the LCME, respectively. We analyzed the effectiveness of SDL using SDL team peer evaluations and SDL presentations.

Results
The data has been acquired and is currently being analyzed. Our preliminary data shows mixed results from students when asked if SDL enhanced their learning. Using a 5-point Likert scale (1=strongly disagree and 5=strongly agree), students in the 2021/2022 classes (N=247) answered with a mean=3.2 (STD=1.35). Students' course evaluations (N=53) revealed positive and negative feedback, with 11 students reporting enjoyment, 11 finding it beneficial, 9 valuing teamwork, 11 indicating learning enhancement, 20 not finding SDL beneficial, 21 finding it time consuming, 17 feeling overwhelmed, and 16 feeling unmotivated. Our preliminary results in thematic analysis also observed several themes identified in previous publications (awareness, knowledge, appreciation, environment, and confidence).

Conclusions
We implemented an SDL activity within a preclinical Respiratory medical course. The students' perceptions about whether SDL effectively enhances their learning is variable. We are currently using thematic analysis to demonstrate if a given SDL activity aligns with the four SDL components defined by the LCME in addition to themes related to awareness, knowledge, appreciation, environment, and confidence.

Caroline Mueller    
Ohio University Heritage College of Osteopathic Medicine    

Purpose
Since many medical schools are moving towards an integrative curriculum, there is an overall need to incorporate more topics within the gross anatomy laboratory. Incorporating clinical cases and other basic science disciplines into anatomy education is an effective approach to teaching students.

Methods
At the Ohio University Heritage College of Osteopathic Medicine, the gross anatomy laboratory involves two distinct learning experiences: (1) cadaveric dissection by students and (2) station-based synthesis and integration (S&I). Station-based activities provide students a deeper understanding of musculoskeletal anatomy through both inter- and trans-disciplinary integration of basic and clinical sciences. This study examines the effect of the station-based S&I activity format on students' self-efficacy (SE) and performance on anatomy examination items compared to cadaveric dissection alone. Pre- and post-self-efficacy surveys were administered immediately prior to and following cadaveric dissections and station-based S&I activities.

Results
Preliminary results reveal that students had a statistically significant higher SE score after the dissection lab than before (Z = 3.785, p = 0.000). Similarly, there was a statistically significant increase in SE scores after the S&I experience than before the SI (Z = 3.807, p = 0.000). Examination of the post-survey scores demonstrated that there is no statistically significant difference between the dissection and S&I sessions (Z = -0.100, p = 0.920). Exam item performances have yet to be analyzed.

Conclusion
Students' SE was improved during both anatomy experiences; however, the lower SE in the station-based S&I experience may reflect the challenging nature of inter- and trans-disciplinary integration activities. Further analysis will yield if their SE correlated with exam performance.

Isabelle Robinson    
University of South Carolina School of Medicine    

Purpose
In March of 2020, education across the world transitioned to virtual delivery and medical education was not exempt. This work explores the efficacy of virtual medical education during the COVID-19 pandemic through comparison of the 2019 and 2020 iterations of a pre-clerkship immunology course offered at the University of South Carolina School of Medicine Greenville.

Methods
Course delivery methods and educational resources provided across the two years were assessed to develop a picture of the learning environment by year. Deidentified summative exam performance data from 204 students was analyzed across 61 matched exam questions that did not differ between 2019 and 2020. Overall course performance and performance by module-level objective were compared by year. Student performance by specific teaching session topic will be evaluated with respect to content delivery methods and resource materials provided.  Statistical significance was determined by unpaired t-test in GraphPad Prism.

Results
In addition to changes in content delivery towards virtual and asynchronous sessions, the total number of integrated clinical cases decreased while formative, repeatable, on-line quizzes replaced in-person practice question sessions. There was no significant difference in student performance between the two years on matched exam questions. In-depth topic-level performance as a factor of delivery method and resources may reveal the best-fit learning environment for each subject.

Conclusion
The switch to virtual education did not have a significant effect on overall student performance on the Immunology summative exam relative to the prior year. We hypothesize that although the switch to virtual learning offered fewer synchronous sessions for student-faculty interactions, modifications to course materials counteracted any potential learning loss. Overall, this study suggests that virtual medical immunology education with adequate resources can be as effective as in-person delivery, which has implications for undergraduate medical immunology instruction and for medical education as a whole. 

David Harris    
University of Central Florida College of Medicine

Purpose
Evidence shows effective integration of pathophysiology and pharmacology using small-group case-based learning (CBL) in medical school first (M1) and second year (M2) modules, but CBL designs maybe be linear without empathizing critical interrelationships or longitudinal foundational clinical and integration. To innovative collaborative learning processes, small concept mapping assignments used in M1 were adapted for M2 systems. This pilot study compared outcomes using a rubric to provide formative feedback and assess summative performance.

Methods
Twenty groups (6-7 per group) in the fall Endocrine-Reproductive module (E-R) and the spring Brain-Behavior (B-B) module were assigned 2 collaborative concept mapping projects (Cmaps) on complex disease topics per module incorporating the categories of epidemiology, pathophysiology, clinical presentation/symptoms, pharmacology/management, and social determinants of health. A rubric (1-4 points per criteria; anchor 4=outstanding; 3=meets expectations; 2=developing/needs improvement; 1=insufficient) scored performance on the following criteria: Category presentation; Concept understanding; Interrelationship complexity; Organization. The E-R Cmaps were done before formative feedback while the B-B Cmaps were completed after formative feedback.

Results
Comparison of total mean rubric scores for E-R vs B-B (3.3 vs 3.4) showed cohorts met M2 expectations; Cmaps were most likely to be deficient in the social determinants category. Significant differences existed in interrelationships complexity for E-R vs. B-B (E-R:2.8 vs. B-B:3.3, determined by Student's t-test, p<0.01). Interrelationships complexity scores were lowest in both cohorts but performance in other categories was similar.

Conclusions
Results support that Cmaps can be executed effectively as a collaborative process to integrate complex foundational and clinical concepts. Students most commonly struggled with integrating social determinants into M2 content and demonstrating complex interrelationships essential to clinical development. The later finding was consistent with data from an M1 anatomy-physiology course. Formative coaching in M2 improved ability to demonstrate interrelationships so effective feedback was essential to mastering this complex but essential task.

Carol Restini  
Michigan State University    

Purpose
We designed an innovative model of alcoholic liver disease emphasizing the importance of self-directed learning through pre-class preparation and communication through student teaching during in-class sessions.

Methods
Medical students learn large amounts of information at the expense of comprehension and application. We developed a novel model involving pre-class preparation and in-class learning to address these issues. For pre-class preparation, concepts from core courses were integrated into modules for the healthy liver and clinical patterns of alcoholic liver disease: steatosis, hepatitis, and cirrhosis, designated as A, B, and C. Students were stratified into these Groups according and required to complete the assigned module. During the in-class session students in Group A teach Alcoholic Steatosis to students in Groups B and C; students in Group B teach Alcoholic Hepatitis to students in Groups A and C; and students in Group C teach Alcoholic Cirrhosis to students in Groups A and B with topic-specific quizzes in between.

Results
Modules are 8 to 10 pages long and include readiness quizzes and case-based questions. All materials have been reviewed by physicians and clerkship students. Focus groups with first year students have suggested increasing the depth and breadth of the pharmacology content. Qualitative analyses used to identify common themes, a questionnaire addressing timing and relevance of module information, and multiple-choice questions on unit exams are used to gauge retention.

Conclusions
The innovative design of this model goes beyond blended and flipped classroom formats and enables students to serve as teachers and learners in a single alcoholic liver disease learning event. All materials will be made available.

Gitanjali Bhushan    
Penn State College of Medicine    

Purpose
Despite strong efforts to instill health systems science (HSS) principles in medical students through institutional curricula, barriers to engaging with systems science include the vast amounts of new terminology medical students encounter as they enter medical school and the limited time they have to devote to HSS. Medical students at the Penn State College of Medicine (PSCOM) created and implemented a HSS reference guide which was provided to first and second-year medical students during their preclinical HSS course.

Methods
The reference guide followed the flow of the PSCOM HSS curricula and contained eight domains such as health care structures and processes; social determinants of health; population and public health; clinical informatics and health information technology; healthcare economics; evidence-based medicine; value-based care; and health care policy and advocacy. Information was presented in various formats which included definitions, tables, and conceptual diagrams. To align with the concepts of adult learning theory, individual guides were uploaded to Canvas after class, allowing students to critically think about the material before being presented with answers.

Results
The reference guide has been successfully implemented in two medical student classes with the goal of providing easily accessible and digestible information that supplements classroom learning. It is designed to be used 1) after class to better understand that day's learning objectives, 2) while working on class posters and projects and 3) by clerkships students, allowing them to identify health systems issues in the wards and helping them create solutions in real-time.

Conclusion
This quick reference guide increases accessibility to new HSS concepts and mitigates the "time burden" students feel when taking HSS courses in addition to basic and clinical sciences courses. Removing these barriers promotes engagement with HSS and therefore understanding of these critical concepts, providing a foundation for creating HSS-conscious physicians to ultimately improve healthcare quality and cost.

Delores Amorelli    
Kaiser Permanente Bernard J. Tyson School of Medicine

Purpose
Explicit instruction and coaching on professionalism and professional identity formation (PIF) have been increasing in importance in medical education, as we have learned that these aspects of medical students' careers require an intentional focus and cannot be assumed to be developed by the student, alone, in the apprenticeship model. Developing effective methods for facilitating conversations between students and faculty on these difficult topics is critical, especially in today's challenging times where students lack certainty about their roles and are struggling with feelings of isolation. We have implemented a novel instructional method in which faculty partner with a team of writers and actors to develop skits to facilitate conversations about professionalism and PIF.

Methods
To teach professionalism and PIF in an authentic and impactful way, faculty partnered with a team of writers and actors, conducting interviews, observations, and reviewing the school's professionalism attributes. The writers developed scenes portraying realistic situations faced by medical students and future physicians, using snappy dialogue and humor. Skits were vetted with faculty for accuracy and appropriateness. During the session, actors rotated among small groups of students, using performances to facilitate critical conversations. A survey from the continuing medical education team that provided the CareActors was adapted to evaluate this session.

Results
49 students participated in this learning activity. Evaluation data indicates that it was effective for student learning on this topic and 84% of students agreed that the activity was engaging. 70% of students would like to see this novel instructional method implemented in future sessions; qualitative feedback suggests that students felt it was an effective change of pace and provoked discussions.

Conclusion
The use of context-specific skits proved to be a powerful tool schools can use to facilitate learning on professionalism and PIF for medical students. This innovative instructional method could easily be applied to other difficult topics in the undergraduate medical school curriculum.

Marcine Pickron-Davis    
Philadelphia College of Osteopathic Medicine    

Purpose
In the US, people who identify as Black, Indigenous, and People of Color (BIPOC) along with Latinx/Hispanic are disproportionately affected with COVID-19 at a higher rate although they represent less than one third of the population. Recognizing the mistrust of healthcare that contributes to vaccine hesitancy, our interprofessional team utilized a grass-roots strategy through engagement with local churches. The primary aim of this research was to provide education, advocacy, and COVID vaccination. We present our strategy to establish mutually beneficial partnerships and best practices which can be used to augment and sustain COVID-19 vaccination efforts within the BIPOC community. 

Methods
The research included pre and post surveys to assess community knowledge, attitudes, behaviors, interviews, vaccine education, and an intervention strategy. Students representing osteopathic medicine, pharmacy, and biomedical sciences provided resources to educate the community about the importance of the COVID-19 vaccine in partnership with nonprofit organizations. The team partnered with local churches and the nonprofit community through outreach events such as health fairs. Additionally, they created an informational brochure to debunk some of the common myths about the vaccine. 

Results
A key outcome of community-based research is to facilitate collaboration between community partners and the academic institution and for medical and pharmacy students to develop skills relevant to the practice of culturally-responsive medicine. 

Conclusions
This poster presentation highlights the Community-Based Research Faculty Fellowship launched by the Offices of Diversity and Community Relations and Institutional Advancement in January 2021 to provide applied research opportunities for graduate students interested in examining health equity. The Fellowship is designed for faculty who are interested in engaging community-based organizations and PCOM students in collaborative research studies. Faculty Fellows serve as mentors guiding the research study, planning, design, implementation, and evaluation.

Deniz Goodman    
Boston University Chobanian & Avedisian School of Medicine    

Purpose
Prior to 2022, the Boston University Chobanian & Avedisian School of Medicine preclinical curriculum consisted of a two-step regionally based approach of basic sciences followed by pathological sciences, which left sparse time for clinical application. Our new curriculum consists of a systems-based approach in which students learn basic science and pathology simultaneously. Consequently, students' education of point-of-care ultrasound (POCUS) through the Ultrasound is for Everyone (USIFE) elective evolved in parallel with curriculum changes.

Methods
In its second cycle, the USIFE elective evolved to increase accessibility for off-campus students. Each elective session guide was adapted into digital, interactive, free cases made available through https://www.shafferseminars.com (developed by K.S.). During half-hour recorded Zoom sessions, students were led through annotated, Socratic-style, case-based discussions with opportunities to attend subsequent in-person small-groups and office hours. We performed a narrative inquiry of student comments throughout the evolution of USIFE over the past two years.

Results
Prior to Fall 2022, students stated that while the elective was useful for learning ultrasound concepts, it was often inaccessible due to scheduling conflicts. Other challenges included difficulty with knobology, inconsistent pacing, and confusing prework. In the modified elective, the new Zoom sessions increased confidence and preparedness for the subsequent hands-on sessions, particularly with the new knobology session and primer. Students also appreciated the small group setting of the hands-on sessions as the most useful component of the elective. Challenges with the new elective included learning the types of probes, image orientations, and machine settings.

Conclusions
Since fall 2022, we have increased the accessibility of the USIFE elective for off-campus students, addressed logistical challenges, and replaced independent, challenging pre-work with guided case-based Zoom sessions. To improve the availability of POCUS instruction outside of elective sessions, we will be instituting a Butterfly iQ probe loan program for students to use the content we have produced independently.

Valerie Cadet
Philadelphia College of Osteopathic Medicine Georgia

Purpose
Social determinants of health (SDOH) impact health outcomes and health professionals must identify and appreciate the role they play in patients' health. The overall goal of this study was to evaluate an activity designed to enhance awareness of SDOH and how they extend privilege regarding health in various ways.

Methods
First-year students enrolled in the osteopathic medicine program at the Georgia campus of the Philadelphia College of Osteopathic Medicine were selected to participate. The activity was conducted in two sessions with students randomly assigned to one of the sessions. During each session, the movement activity was conducted over 45 minutes with a 30-minute discussion following. Participants stood in a circle around the perimeter of the room and took a step towards the center of the room, backward or remained motionless in response to a series of statements or questions (n=21) presented by the facilitator. The statements pertained to a variety of sociodemographic factors. A group discussion followed where students shared their observations regarding positioning, the statements and how these may relate to health status. Students were asked to submit an individual reflection on the experience utilizing a 6-point questionnaire provided by the facilitators. Thematic analysis was conducted.

Results
132 students participated while 97% (n=128) submitted the post-reflection questionnaire. Upon thematic analysis of the submissions, multiple themes emerged highlighting the positive effect of the activity on raising student awareness of what constitutes a SDOH; unearned privilege exists in some manner for most students; differentiating equality versus equity and how patient "non-compliance" could likely be due to structural barriers, among other themes.

Conclusion
This activity served to increase students learning about SDOH. Per many students, this was an extremely impactful way to recognize their role in mitigating the lack of inclusivity in access to healthcare.