Moderated by James Swigart
Session Coordinator: Joshua Costin

Presentation 1 - Identifying Harmful Language in Preclinical Textbooks as an Early Intervention for Physicians in Training    
Brianne Lewis    
Oakland University William Beaumont School of Medicine    

Purpose
Physician use of harmful language impacting patient care has been well documented. Therefore, promoting appropriate language to describe patients should begin at the earliest stage of medical education. Early learning of appropriate language promotes consistent education leading to humanized care. Faculty should be aware that textbooks recommended to students in their training may unknowingly contain harmful language, providing an opportunity for early intervention. We completed an analysis on biochemistry textbooks for harmful language since medical students use these resources in preclinical training. 

Methods
A quantitative analysis for harmful language was completed on three clinical biochemistry textbooks most frequently used by medical schools in our region. Prior to analysis, a reference glossary of harmful terms was generated. Harmful terms were included if there was supporting literature to document how use of these terms results in suboptimal care. Three independent researchers separately reviewed the textbooks for evidence of harmful language considering the context of its use. Harmful language categories were generated and analysis included frequency of use across all textbooks using NVIVO software. 

Results
Our results show that clinical biochemistry textbooks used in medical training contain harmful language to describe patients or their conditions. We generated two primary themes of harmful language and documented its presence. The first primary theme, "Negative Clinical Language and Convention" (n=92), included the following sub-themes: difficult patient, general negative descriptive language, patient as failure and questioning patient credibility. The second primary theme, ""Labeling Bias or Condition Association"" (n=256) included the following: activity level, age, alcohol use, diabetes, drug use, fertility, obesity, occupation, weight and other disease or condition association. 

Conclusion
Our results highlight the presence of harmful language in foundational resources which can negatively reinforce the manner in which future medical professionals speak to and about their patients.

Presentation 2 - Changing Medical Education: Addressing Firearm Violence Prevention and Education (FVPE) in Undergraduate Medical Education (UME)    
Anna Lunderberg    
Michigan State University

Purpose
Firearm violence is an epidemic in the United States (US) with 45,222 deaths in 2020 - the most recorded since 1968.1 Medical schools should recognize diseases of increased prevalence and adjust curricula accordingly, however, few medical schools address firearm violence prevention and education (FVPE). 2 We evaluated changes in students' confidence, comfort, and perceived barriers to firearm safety counseling (FSC) through the implementation of a FVPE intervention.

Methods
This was a pre-and-post survey study among first-year medical students at a single US medical school. The FVPE intervention included a moderated discussion of physicians' roles in FSC and an educational video. Data included demographics, firearm experience, and 11-point Likert scales for key outcomes: comfort and confidence in FSC, and perceived barriers to FSC. Random intercept models were used to analyze the effect of FVPE on the key outcomes. All analyses were conducted with R 4.1.1.3

Results
There were 76 participants: 53% female, 44% male, and 3% non-binary. 43% were 24 years or younger and 21% reported previous firearm safety course completion (FSCC). Among participants with no previous FSCC, the estimated mean comfort and confidence improved by 1.4 (95% CI: 0.6,2.2) and 1.6 (95% CI: 1.9,2.3), respectively. No change was seen among participants with previous FSSC. 42% of participants identified "not knowing what to do if a patient at risk of a firearm injury has access to a firearm" as a barrier to FSC. However, the likelihood of barriers impeding FSC decreased post-intervention, with a mean composite score reduction by 10% overall (P<0.001).

Conclusions
The implementation of FVPE in a single medical school improved students' confidence and comfort and reduced perceived barriers to FSC. A standardized FVPE curriculum will best prepare future physicians to address the firearm epidemic.

Presentation 3 - Development and Evaluation of a Novel Quality Improvement and Patient Safety (QIPS) Training Program for Undergraduate Medical Students    
Ke Xin Lin    
University of Toronto, Temerty Faculty of Medicine

Purpose
Quality improvement and patient safety (QIPS) is a core competency in undergraduate medical education. Research has shown that combined didactic and experiential learning effectively enhances the application of foundational QIPS knowledge and skills to improve clinical outcomes and patient experience. While the core curriculum of the University of Toronto (UofT) MD Program involves didactic QIPS teaching, no formal opportunities exist to gain hands-on experience. This study aims to evaluate the effectiveness of Quality Improvement Experiential Student Training (QuEST), a longitudinal theoretical and project-based program, in equipping students with foundational QIPS knowledge and skills. 

Methods
QuEST consists of monthly didactic educational seminars, independent online modules developed by the Institute of Healthcare Improvement, participation in an experiential QIPS project, and completion of monthly capstone assignments related to their QIPS project. The study used pre-program and post-program Quality Improvement Knowledge Application Tool (QIKAT-R) and surveys to evaluate QIPS knowledge and skills, and self-reported QIPS attitudes and goals. QIPS project implementation and scholarly production were tracked. 

Results
QuEST enrolled 44 students across 16 projects. Using a 7-point Likert scale (1=not important/confident at all; 7=extremely important/confident), preliminary results from the pre-program survey demonstrated that participant self-reported QIPS attitudes were 6.28/7 (SD=0.23), QIPS knowledge was 3.47/7 (SD=0.57) and QIPS skills were 3.33/7 (SD=1.03). The most common participant program goals were to build competency in QIPS (74%), integrate QIPS into their future careers (43%), engage in research (33%), and make a difference in QIPS (24%). Post-program survey results will be available at the end of the academic year. 

Conclusion
Students feel moderately confident in their QIPS knowledge and skills, and are enthusiastic about the value of QIPS in healthcare. The next steps include following students longitudinally to determine whether QuEST participation led to sustained QIPS engagement in the clinical setting.

Presentation 4 - Clinician-Led Cultural Competency Workshops as Medical School Curricular Reform Positively Impact Medical Education    
Safa Salem    
Ohio State University College of Medicine

Purpose
There exists structural gaps in current medical education pertaining to issues of race, gender, sexuality, culture, and health equity. Social determinants of health are poorly integrated within preclinical medical curricula, emphasizing the need for culturally competent educational reform. At the Ohio State University College of Medicine, we developed and launched a novel student organization, Cultural Awareness, Representation, and Education (CARE), which seeks to enhance medical training by bolstering cultural competency among the next generation of physicians.

Methods
CARE is divided into a total of five subcommittees (Diversity in Medicine, LGBTQ+ Health, Stigmatized Health, Immigrant Health, and Accessibility and Health Equity), that advocate for health equity across the spectrum of the social determinants of health. Our current subcommittees span a diverse array of topics, and host clinician-led workshops ranging from identifying skin disorders on dark skin to increasing accessibility to mental healthcare among marginalized populations. We partnered with Ohio State's Clinical Skills Education and Assessment Center (CSEAC) to acquire and implement the College of Medicine's first set of melanated suture pads.

Results
We piloted four workshops to over 70 students and administered pre- and post surveys. Students exposed to our workshops reported a belief that exposure to diversity in medical training reduces disparities in medicine. Student evaluations unequivocally demonstrated that culturally competent curricular workshops positively impact medical education.

Conclusion
Our clinician-led workshops exposed students to matters of health equity pertaining to complex patient backgrounds and experiences, reflecting a critical need for medical schools to formally integrate cultural competency as a mandatory component of medical education. By hosting workshops in these clinical areas, we aspire to promote cultural competency and equip medical students with the knowledge required to adequately treat patients from all walks of life.