Moderated by Tracy Fulton
Session Coordinator: Sateesh Babu Arja

Presentation 1 - Differences in Perceived Stress During Medical School Based on Demographic Group
Danielle Eames    
Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas

Purpose
Research supports the notion that medical school is inherently stressful and that addressing healthcare disparities in a diverse nation requires an equally diverse physician workforce. To accomplish the latter, medical schools must seek students historically underrepresented in medicine from diverse socioeconomic, educational, and occupational backgrounds. As “non-traditional” students, they may have unique perceptions of stress and varying social support from family and friends. The purpose of this study is to compare perceived stress during undergraduate medical education between four key demographic groups to help guide student support for constructive stress management to ultimately graduate a diverse student body. 

Methods
The Perceived Stress Scale (PSS) was administered to all cohorts up to four times: prior to matriculation, after the pre-clinical phase, after clerkship, and upon graduation. Using independent samples t-tests, mean PSS scores were compared among the following demographic groups: Under-Represented in Medicine (URM), Socioeconomic Status (SES), First-Generation medical student (Firstgen), and age 30 or older at matriculation (Over30). 

Results
Prior to matriculation and after the pre-clinical phase, URM, Firstgen, and Over30 groups reported lower stress. URM, Firstgen, and SES groups reported higher stress at the end of clerkship specialty rotations. At the end of their clerkship training, “Firstgen” students had significantly higher PSS scores than their non-first-generation peers (mean 7.69 vs. 6.49, p=0.026). 

Conclusions
A complex etiology of perceived stress exists throughout medical school, which may relate to demographic factors such as age, socioeconomic status, educational background, and historical underrepresentation in medicine. In our study, first-generation medical student stress peaked at the end of their clerkship training. With the established need for increased physician diversity comes the requisite for diversity among medical students. Demographic composition of medical student cohorts will fluctuate, and medical schools need to understand how demographics factor into students’ perceived stress so that they can provide suitable resources to support students navigating the challenges of medical education.

Presentation 2 - Feasibility and Acceptability of Meditative Practices Prior to Cadaveric Dissection
Aaron Marshall    
University of Cincinnati

Purpose
Cadaveric dissection has been a cornerstone of medical education. Given the hands-on nature, it is important to recognize the student experience will vary for many reasons. Some may enter the cadaver lab ill-prepared for the violent reality of human dissection. Students respond to discomfort in a multitude of ways: use of humor, desensitization, or avoidance. To mitigate the discomfort and promote student well-being, a team of faculty and students designed a series of meditative practices to offer preceding the cadaveric dissection. The purpose of this study was to assess (1) the feasibility of implementation for this practice and (2) the acceptability of this offering by medical students. 

Methods
Meditative reflections were structured similar to a surgical "timeout". Participating students gathered around a cadaver table, fifteen minutes prior to the scheduled dissection. Specific dissections were selected for this offering, using considerations for the sensitivity of the anatomy being studied or the amount of physical violence that occurred during the dissection. The practice was guided by a trained faculty member and consisted of, centering the mind of the breath, reflecting on the act of dissection, acknowledging any internal feelings, and offering gratitude toward the donor. 

Results
The methods described have proven feasible to implement, requiring the tacit permission of anatomy faculty. Following three reminders of this optional meditative activity, 83 students (46%) participated in the first offering. Future iterations will include brief, valid survey instruments (e.g. Perceived Stress Scale) to assess potential impact(s) on student.

Conclusions
We expect this curricular offering will allow students to intentionally contemplate the innate dignity of the human being they will dissect, as well as grapple with the nature of the dissection procedure itself. Bringing activities of well-being into the formal curriculum in such a manner is innovative, generalizable, and simple - but the impact is significant.

Presentation 3 - Lessons Learned to Optimize Medical Student Team Dynamics to Enhance Self-directed Learning in a Problem-Based Learning Environment: A Student Perspective
Vanessa Lozano    
Texas Christian University, Anne Burnett Marion School of Medicine

Purpose
Problem-Based Learning (PBL) is an active learning methodology used in medical education for students to critically examine complex clinical scenarios in a self-directed learning manner. However, there is minimal insight on how to form a functional team in the PBL process. We aim to provide medical students' perspective on how to optimize team dynamics in a PBL environment.

Methods
Our team (n=7) utilized Tuckman's 'forming, storming, norming, and performing' model of team dynamics over three months. We developed a tracking system where we recorded interpersonal challenges and solutions upon the conclusion of each weekly case and evaluated our progress during weekly debriefings. We identified the challenges we encountered, such as heavy workload, conflict, miscommunication, and low level of accountability. As solutions, we implemented setting clear responsibilities, expectations, and deadlines for team members. To monitor our progress, we performed self and peer evaluations against the targets listed in the tracking system.

Results
We found that by setting explicit expectations for each team member, we became actively engaged by effectively managing workload and conflict, leading to improved team dynamics. We improved our ability to respectfully listen to others' views and experiences. This alleviated any potential miscommunication and increased our accountability. Building upon our team dynamics, our communication skills, efficiency, and trust in each other were strengthened. Furthermore, our ability to deeply explore the weekly cases improved.

Conclusions
We transformed our communication and self-directed learning experience by intentionally identifying problems related to team dynamics and implementing thoughtful interventions. Through continuous self-reflection, our team evolved and developed psychological safety. Our framework for regular self-evaluation of team dynamics has the potential to expedite the formation of a "performing team." We plan to suggest this framework for future teams in a pre-clinical curriculum to strengthen intra-professional and inter-professional collaboration.