Presented By: Katie Hartnett, Geisel School of Medicine
Co-Authors: Khaqan Ahmad, Geisel School of Medicine
Daniella Azulai, Geisel School of Medicine
A. Konopasky, Geisel School of Medicine
L.C. Meyers, Geisel School of Medicine
Rajiv Potluri, Geisel School of Medicine

Purpose 
Alongside building complete knowledge bases, medical education should maintain student's mental health.  Academic origins of stress/anxiety in early medical school include new learning modalities and seeking 'work-life' balance. Exam scores bring immediacy to these concerns.  To promote a sustainable culture of learning in our school's first course, Foundations, we implemented an exam 'safety net' program (SNP) to allow students to improve a low score (<77.5%) through a minimal-stress open-book learning exercise.  Prior studies of remediation focused on low-scoring students; however, our study focused on the SNP's broader impact on the learning environment through class-wide exam performance, the student's perception of exams, and student wellness.   

Methods 
Foundations had two summative 'mid-term' exams, for which the SNP was offered, and a comprehensive final (no SNP).  To evaluate impact on exam scores we compared class-wide aggregated data from no intervention (2021) and intervention (2022 & 2023) classes.  Mixed-methods content analysis of narrative feedback from anonymous surveys and focus groups with students was used to determine impact on student perception of the learning environment.  

Results 
Non-adjusted scores on Foundations exams with the SNP as well as the final (no SNP) increased for classes with the SNP versus 'no intervention.'  Students who utilized the program increased their scores on subsequent exams more than the class as a whole.  Major SNP-associated themes in the narrative data included: mastery learning; study strategy experimentation; a low-anxiety introduction to the testing process; and collaborative learning.  

Conclusions  
The SNP led to favorable student perceptions of the learning environment without any negative impact on exam performance.  While faculty time for the program is challenging, with institutional buy-in and suitable exam structures, an SNP could be implemented elsewhere.