Presenting Author: Isaac Parrish - Noorda College of Osteopathic Medicine

Purpose
Accurate blood pressure measurement is an important clinical skill for physicians to assess an important marker of patient's health. Despite this, training in blood pressure assessment is not standardized across medical schools. The current study seeks to assess the effectiveness of the American Medical Association (AMA) blood pressure module in providing training and longitudinal mastery of blood pressure assessment in first-year medical students.

Methods
Medical students at NoordaCOM completed the AMA blood pressure module which uses the latest evidence-based techniques for blood pressure measurement. Students were assessed at four time points (pre-test, post-test, longitudinal post-test, post-refresher test). The first assessment consists of a 10-item online AMA blood pressure module pre-test. Then, they completed the AMA blood pressure module. This was followed by an identical 10-item AMA blood pressure module post-test to assess mastery of the module. The same assessment was completed at the end of the first year in order to assess retention. At the end of the second year the students completed a refresher course and repeated the assessment.

Results
Data have been collected at four timepoints for the class of NoordaCOM 2025. Assessment scores were significantly different between timepoints F(2,37)= 30.23, p<.001), with higher post-test scores (M=8.01, SD=1.43) and higher longitudinal post-test scores (M=5.72, SD=1.45) indicating that the modules significantly improved students' understanding of blood pressure measurement. Although longitudinal scores indicate some lack of retention, they are significantly higher than pretest scores, indicating improvement from baseline scores. The refresher course post-test scores (M=7.50, SD=1.42) showed similar results to the initial post-test. The following cohort, NoordaCOM 2026, has completed the pre-test (M=4.58, SD=1.98) and the post-test (M=8.01, SD=1.43). There was no significant difference between the classes of 2025 and 2026.

Conclusion
The current study provides evidence that the AMA blood pressure module is an effective training tool for blood pressure assessment in first-year medical students. Despite decreased retention of AMA modules after 8 months, students still showed better understanding of the material compared to baseline. Including a refresher course has improved assessment scores as knowledge wanes over time. To further asses the effectiveness of the AMA blood pressure modules the class of 2027 will take assessments without ever completing the training modules. Data will be compared across cohorts to assess the retention of proper blood pressure measurement skills.

Categories:
Students: Learning Resources
Curriculum: Curricular Innovations

Presenting Author: Paula Smith - University of Edinburgh
Co-Authors: David Griffith - University of Edinburgh

Authentic assessment emphasises the evaluation of students' knowledge and skills in real-world contexts. Our MSc in Critical Care programme aims to measure students' abilities to apply their learning in the clinical workplace through in-course assessments involving a variety of tasks with real-world relevance and requiring skills in critical thinking, problem-solving, communication, and self-reflection. The online programme recruits students from healthcare professions involved in the management of critically ill patients, including doctors, nurses, and paramedics. Regarding this year's Virtual Forum theme, 'Changing Health Education for Changing Times', we have seen a shift in the demographic of students enrolling on the programme since its launch in 2019. We wanted to ascertain whether an authentic assessment approach disadvantages a particular group(s) of students, since different healthcare professionals will have varying levels of experience of the clinical scenarios posed.

We analysed the assessments for the six first year courses across academic years 2021/22 and 2022/23, and compared the marks awarded across the professions of enrolled students (n=91). In-course assessment, comprising a variety of tasks involving clinical scenarios and trial data (e.g. critical appraisal, infographic, oral structured patient handover, reflective essay, blog post), constitutes 100% of course marks. The influence of profession on end-of-year scores was assessed using the Cox proportional hazards regression model. Differences between group means were identified using one-way analysis of variance for multiple group comparisons.

Healthcare profession was not found to be a predictor of end-of-year scores (mean ± SD) (doctors: 63 ± 8 (n=37); nurses: 62 ± 8 (n=23); paramedics: 65 ± 5 (n=25); clinical pharmacists: 66 ± 18 (n=3); physiotherapists: 70 ± 11(n=3)(P=0.26). There was no significant difference in performance between five healthcare professions across each of the six core courses (P-values ranged between 0.15 to 0.95).

Demand for online qualifications has risen as a result of the pandemic, with greater recognition of their value by students and employers; by delivering core academic content online, in-the-workplace training can be augmented without the need to take time out to pursue a further qualification. The absence of a significant association between students' profession and academic performance on the online MSc in Critical Care programme suggests that the content of the programme stands alone, and is not necessarily dependent on previous clinical experience. Furthermore, each student within a particular profession can have a very different profile of skills and experience compared to others in the same profession. Thus, we shall retain our interprofessional, authentic assessment approach going forwards and can reassure students that everyone has the potential to perform well on-programme, irrespective of their professional background.

Categories: 
Students: Professionalism
Curriculum: Curricular Policies

Presenting Author: Abigail Hielscher - University of Vermont College of Medicine
Co-Authors: Sam Afshari - University of Vermont Larner College of Medicine
William Brown - University of Utah
Jacob Lythgoe - University of Vermont Larner College of Medicine
Ryan Walsh - University of Vermont Larner College of Medicine
Megan Zhou - University of Vermont Larner College of Medicine

Competency in imaging is essential for physicians to identify and manage diseases. At the Larner College of Medicine at the University of Vermont, first-year medical students enrolled in the Foundations of Clinical Sciences have traditionally learned imaging via asynchronous modules. Although these modules have been well-received, there is a need to expand the imaging curriculum to better prepare students for the expectations of the clinical environment. Toward this goal, we introduced first-year medical students to CT imaging in the gross anatomy lab. This environment was selected as we anticipated that students could better integrate the 3D anatomy of the cadaver-donor with the 2D anatomy of the images. To gain a better understanding of whether the source of imaging improved student learning outcomes, we separated students into groups: those who reviewed scans from cadaver-donors or from living individuals with no pathology. Students learned the cross-sectional imaging during the thorax and abdomen blocks, selected for their clinical relevance. Here, students accessed the images relevant to their study on iPads via Pacsbin, a web-based Digital Imaging and Communication in Medicine viewer. Radiology residents were available in each lab session to guide students with orientation and structure identification. Additional optional learning sessions were held by senior medical students who guided students on identification and labeling of structures in Pacsbin. Student performance was evaluated on laboratory practical examinations, CT image questions and spatial anatomical knowledge in the thorax and abdomen sections of gross anatomy. Results showed no statistically significant differences in practical examination scores, spatial anatomical knowledge, or identification of anatomical structures on CT image questions between students who learned from images on cadaver donors versus living individuals. In a questionnaire given at the end of the course, students in both the cadaver and living individual groups cited that the CT images improved their anatomical and imaging knowledge and that they felt better prepared to use imaging software and interpret diagnostic imaging results upon entering clerkships. The findings suggest that the source of scan does not impact student anatomical knowledge, information which may guide other educators considering the implementation of cadaveric imaging in their curricula. In general, the introduction of CT scans supported positive student perceptions of their anatomical and imaging knowledge and preparedness for use of imaging software in the future. Additionally, we were successful in integrating a strategy that not only enhanced the imaging curriculum, but did so using technology that students will encounter in the clinical environment. Overall, this work has informed future curricular decisions and has supported an interdisciplinary approach toward imaging education.

IRB approval: STUDY00002139

Categories:
Curriculum: Curricular Innovations

Presenting Author: Hassler Stefan Macías Sánchez - Universidad de las Américas Puebla 

Biophysics has applications ranging from clinical proteomics to nuclear medicine for patient care. However, research in biophysics is mainly carried out by scientists from basic areas. Still, there's an opportunity to integrate it within the medical curriculum, in order to improve the understanding of these signatures. Course-Based Undergraduate Research Experiences (CUREs) represent the mechanisms by which professors engage students in conducting scientific research during college. CUREs are modules where students address research questions of great interest to them and to their teachers, it has proven an increase in student learning therefore, by contributing to the development of new ideas, aiming to have a more authentic research experience. Nowadays, it is necessary for medical students to know how to critically analyze papers because research skills are essential for medical education.5 Besides, improvements in computational algorithms have increased the accuracy of protein structure modeling, increasing biophysics' role in medicine and education. Finally, the importance of CURE has been reported in the literature as projects of learning in pharmacology and physiology where educators integrate biomolecular principles for the development of research projects led by students, while they also practice oral and written communication, reliability, and an emphasis on teamwork, without sacrificing academic information.

Categories:
Curriculum: Curricular Innovations

Presenting Author: Daniel Novak - University of California Riverside
Co-Authors: Ian V.J. Murray - Alice L. Walton School of Medicine
Caitlin Wardlaw - University of Arkansas Medical School

Medical education must adapt to challenging times, including robust assessments of clinical reasoning that is founded in the best available science. Script Concordance Testing (SCT) is a process that assesses clinical reasoning skills by probing the illness scripts of healthcare professionals by comparing novices' scores to that of a panel of experts. It also serves as a learning tool, as it prompts learners to reevaluate initial diagnostic hypotheses when challenged with new additional ambiguous clinical information. However, adoption of SCT remains limited, with barriers such as difficulty in creating high-quality scenarios based on illness scripts, a panel of 10-20 experts, and that 20% of questions are discarded post-exam test. In this study, we demonstrate the development of a modified SCT (mSCT) using the artificial intelligence (AI) program, in which Chat GPT generates Likert scores, estimated probabilities, and metacognitive written justifications.

ChatGPT was trained to generate modified SCTs (mSCT) and include 3 Likert scores, written justification, and an estimation of diagnosis probability. The AI was trained using progressively optimized prompts and a case previously developed by the author. The mSCT format contained a brief case scenario with an initial diagnosis, and to probe illness scripts, presented a related symptom or one from a differential diagnosis. The AI also provided a Likert score and written justification of the answer. We evaluated the generated mSCTs for 10 common diseases using the prompt "write a modified SCT for [insert disease]" focused on [insert discipline, or concept, or add differential disease here]. The mSCT medical information and estimated probability were compared to those generated by a different AI developed to aid medical students with answering USMLE questions (MedQBot https://poe.com/MedQBot).)

These pilot results demonstrate that Chat GPT, from a simple prompt, automatically created complex mSCT for the 10 diseases, providing clinical presentation, patient information, and history, as well as Likert scores and medical justifications. mSCT ambiguity, or intersections between different illness scripts, was achieved by specifying a differential diagnosis or a less likely (-1) Likert score in the prompt. MedQBot provided similar justification and estimated probabilities for the mSCT but struggled to diagnose questions with more ambiguity.

This pilot and novel application of AI lowers barriers to mSCT use, augmenting the creation of complex clinical mSCT with ambiguity and at the same time, providing Likert scoring and medical information justifying the diagnosis. While the AI cannot replace expert question review, it could augment score generation as the symptom-disease probability is known for many diseases. It is acknowledged that real-world mSCT validity and reliability testing more robust mSCT tests encompassing tests and treatment and more diseases and disciplines, are required.

Categories:
Curriculum: Curricular Transformation and Transition
Artificial Intelligence in Health Professions Education

Presenting Author: Allison Booher - Geisel School of Medicine at Dartmouth
Co-Authors: Chinmayee H. Balachandra - Geisel School of Medicine at Dartmouth
Sonia N. Chimienti - Geisel School of Medicine at Dartmouth
Lisa M. McBride - Geisel School of Medicine at Dartmouth
David W. Mullins - Geisel School of Medicine at Dartmouth
Roshini Pinto-Powell - Geisel School of Medicine at Dartmouth

Background
For decades, data have highlighted the adverse health outcomes related to structural violence, i.e., the racial, socioeconomic, and political forces that perpetuate harm against marginalized people. To address disparities and positively impact outcomes, many schools have deployed new curricula and designated lectures to enhance awareness of systems that perpetuate racial inequity. However, formal instruction in race and health equity differs widely across medical schools and often paints only a partial picture of health injustices in medicine.

Approach
To quantitatively and qualitatively evaluate content on race and health equity in an integrated pre-clinical curriculum, we examined >600 patient case presentations from the pre-clinical curriculum at the Geisel School of Medicine. We analyzed sessions across 8 courses for patient race, diagnosis, relevant context, and social determinants of health. Additionally, we tracked follow-up, or lack thereof, on these themes.

Outcome
We identified significant gaps in the curricular content, including: limited social and racial diversity in case presentations; lack of follow-up when race and social contexts were mentioned; racialization of certain disease processes; and persistence of harmful biases. The identified gaps represented opportunities to include health justice as an intrinsic part of medical education. We identified actionable opportunities to rapidly incorporate health justice as a longitudinal aspect of the curriculum. We are now working with curricular deans and course directors on methods and approaches to enhance and improve the presentation of content on race and health equity. Going forward, we will evaluate the efficacy of the curriculum interventions through assessment of student mastery and surveys of student satisfaction and confidence. As data are acquired, the curriculum will be reassessed through a process of continuous quality improvement.

Conclusion
Mapping of the curriculum, with a focus on race and health equity, can identify curricular gaps and opportunities that serve as a catalyst for change, allowing for extended discussions of health equity to better prepare trainees for future clinical practice.

Categories:
Curriculum: Curricular Transformation and Transition
Curriculum: Curricular Innovations

Presenting Author: Joseph Malaer - UNT Health Science Center
Co-Authors: Amber J. Heck - University of North Texas Health Science Center
Bern Perchalski - University of North Texas Health Science Center
Roxanne R. Zascavage - University of North Texas Health Science Center

Despite moves toward reform, designing self-directed learning (SDL) experiences continues to challenge health professions educators. Across disciplines and programs, there exists a well-established need for new instructional approaches that provide the structure and environment necessary for students to take responsibility for their own learning. New instructional approaches that better promote the development of higher-order skills have gradually been adopted. One prominent example is Problem-Based Learning (PBL), an active, inquiry-based instructional method in which a real-world problem, serves as the stimulus for SDL. PBL has demonstrated effectiveness in promoting student-to-student interaction and the development of problem solving and SDL skills but poses challenges due to the amount of planning and resources required. In online education, discussion boards are argued to be critical to provide and promote student-to-student communication. Like PBL, when students are required to respond to each other and instructor presence is minimized, student participation and responses occur more frequently. Educators who seek to use online asynchronous discussion boards to promote active learning face significant challenges, including students' reluctance to engage due to a perceived lack of benefit from discussion boards in previous courses. However, our problem-based online discussion (PBOD), a novel method based upon the PBL structure but redesigned for delivery via discussion board, is poised to promote student motivation by framing learning within authentic, relevant problems. PBOD has great potential to marry the benefits of technology-assisted learning methods, now ubiquitous to higher education, and established inquiry-based methods with lower instructor presence and proven SDL effectiveness. The PBOD approach facilitates all five steps of SDL by requiring students to take the initiative to identify their own learning needs, establish goals, identify resources, apply strategies, and evaluate their success in learning. As adult learners, health professions students are motivated to learn by a desire to solve problems that are relevant to their future careers. The PBOD instructional approach is high value, low cost, and an easy method to implement that will promote self-directedness without risk to student learning. 

Categories:
Curriculum: Curricular Transformation and Transition
Curriculum: Curricular Innovations

Presenting Author: Melissa Bui - Virginia Commonwealth University
Co-Authors: Jason Burton - Virginia Commonwealth University

Process groups have long been a mainstay of medical education and training. Such courses permit trainees to engage in regular group discussions to explore themes such as identity, professionalism, transference and countertransference, and conflict across multiple orders of scale within the healthcare system. The benefits of such groups are innumerable, including enhanced self-reflection, professional maturity, individuation and peer engagement. In order to permit free and open discussion, such courses are usually led by external facilitators who are not otherwise involved in the group's training or supervision. However, in our current era of considerable financial constraint, it can be challenging to secure adequate funding from the health system to pay facilitators for such a significant time commitment. It is also unreasonable to ask facilitators to donate such a substantial amount of time without reimbursement. As healthcare education transforms to reflect escalating financial pressures, process groups run the risk of widespread elimination. One solution to these many challenges is to incorporate themes of process groups into a Balint group style curriculum. Balint groups offer a number of parallels to process groups, including regularly scheduled sessions among a consistent cohort of trainees to explore themes of identity and professionalism encountered during clinical training. However, whereas process groups can encapsulate a wide range of individual and interpersonal themes, Balint groups emphasize a greater focus on patient encounters as a platform for deeper personal exploration. As such, Balint groups do not require such strict requirements for external facilitators, permitting internal faculty to serve as course leaders. This format still permits trainees to benefit from a semi-structured, longitudinal curriculum to explore issues which are critical to professional identity and development, and without the added cost incurred by hiring external facilitators. While Balint-groups may be formally implemented into trainees' medical education, the proprietary nature of these groups also comes with substantial financial and time commitments which may be unaffordable for many health systems. In this talk we will share our own development of a hybrid course for Psychiatry residents, termed a Peer Case Review Group. We will provide the audience with an overview about the importance of this process-themed curriculum as a component of medical training while also reviewing fiscally-sound implementation strategies. We will also present pre- and post-survey data from individuals who participated in the course, focusing on themes of empathy, clinician identity and group connectedness. Given our current climate of austerity, this hybrid approach represents the rare example of enhancing a program's humanistic approach to individuation and clinician identity with no added cost to the system, resulting in a truly win-win solution.

Categories:
Curriculum: Curricular Innovations

Presenting Author: Shawn D'Andrea - University of Botswana
Co-Authors: Fatima Abuzaid
Abrar Elaliem - Ahfad University for Women
Nada Fadul - University of Nebraska
Hadeel Mohamed - University of Khartoum

The ongoing conflict in Sudan has led to many civilian and combatant casualties while simultaneously disrupting the healthcare system. With over 600 people killed and an estimated 700,000 displaced Sudanese healthcare delivery and access have been severely disrupted. Due to the increase in trauma burden added to barriers to chronic care leading to acute medical emergencies, Sudan has faced a rapid need for healthcare workers (HCWs) to provide emergency care.

The community medical response team (CMRT) originated during the COVID-19 pandemic to provide resources to Sudanese patients, including COVID-19 vaccination, home healthcare visits, and education regarding the disease and vaccine benefits. One outcome of this initiative was a network of over 5000 Sudanese healthcare workers and students connected through the use of the Telegram Messenger app for synchronous learning. Immediately following the onset of the current conflict CMRT leaders, coordinating with Project ECHO leadership, developed and initiated a remote emergency care training program for healthcare workers on the CMRT network. The curriculum initially used the WHO basic emergency care course as a model for the curriculum. Using a multifaceted implementation strategy, the time from program inception to initiation was 4 days. Since initiating this program, the CMRT network has expanded to include over 12,000 HCWs with remote sessions held twice weekly to provide instruction and resource sharing about emergency care and related topics synchronously and asynchronously. In addition, the Telegram group has become a resource for participants for knowledge and resource exchange. The Sudan Emergency CMRT / ECHO program adds to a limited, but growing number of remotely deployed programs to rapidly provide basic and advanced emergency care training to healthcare workers, providing care during an active armed conflict.

Categories:
Curriculum: Curricular Innovations

Presenting Author: Avery Miller - University of Cincinnati College of Medicine
Co-Authors: Heather Christensen - University of Cincinnati College of Medicine
Chitra Kumar - University of Cincinnati College of Medicine
Aaron Marshall - University of Cincinnati College of Medicine

Background
National data demonstrates that on average, people are treated differently by doctors based on their gender. Unfortunately, this impacts the quality of care patients receive thereby altering health outcomes. This variation ranges from how seriously a patient's pain is perceived to whether "unusual" signs of a myocardial infarction are noted. Even though the origin of this problem is often subconscious rather than malicious, it is our duty as future healthcare providers to ameliorate implicit gender biases in order to provide patient centered, equitable care.

Methods
Two medical students under the guidance of two faculty members piloted a mandatory implicit gender bias curricular thread designed for preclinical years. The thread is composed of eight 15-minute sessions spanning the course of two years. The objective is to note if a sensitive topic such as implicit bias is better addressed in shorter, repetitive bursts by peers versus a hypothetical formal alternative led by faculty; and if a peer-led structure designed to remove power differentials and concerns over grades leads to more impactful education and growth. Session content ranges from real case studies within the medical school to bystander training aimed at preparing students to be allies during their clinical rotations. After each session, a survey is distributed to garner feedback and gauge the impact of the curriculum.

Results
Post-presentation survey data demonstrated that 87.6% of students (n=299) preferred to hear these presentations from peers alone, 0.13% preferred an option presented by both peers and faculty members, 8% had no preference, and 3% preferred an option taught by faculty members alone. Another survey question asked students to rank the statement "I gained something valuable from this presentation" on a scale of one to ten with one signifying "strongly disagree" and ten signifying "strongly agree." For the first presentation, the average rank for the session was 6.9, the median was 7 and the mode was 10. For the second presentation, the average rank for the session was 8.4, the median was 9, and the mode was 10.

Conclusion
Findings suggest that peer-to-peer teaching may be an effective model to ameliorate implicit bias in healthcare by leveraging the unique perspective that students develop throughout their pre-clinical and clinical experiences. This innovative approach can be further extended and tested throughout medical training for a wider reach.

Categories:
Curriculum: Curricular Innovations

Presenting Author: Siobhan Moyes - University of Plymouth, Peninsula Medical School

Anatomical education often provides a narrow view of what is perceived as 'normal,' visible through anatomical models, textbooks, language, virtual anatomy and curricular and session design. This excludes many groups of people and fails to recognize the importance of healthy variation.

Lacking diversity in anatomy research and education can result in poor healthcare treatment and outcomes for under-represented groups. For example, the recent MBRRACE-UK report identified that black mothers were 4 times more likely to die after childbirth in the UK than white mothers. While this will be multifactorial, poor understanding of healthy variation in pelvic anatomy is known to contribute to poor patient care.

Conversations around decolonisation have led to more overarching discussions around improving inclusivity and diversity in anatomy teaching. However, understanding diversity requires an understanding of peoples lived experience and how under-representation is manifested and perceived.

A mixed-method, online questionnaire was disseminated to anatomy staff and students internationally. Participants were asked to self-describe their demography and subsequent questions focused on understanding whether individuals felt represented by their anatomy curriculum, what inclusivity meant to them and whether they met any barriers to improving inclusivity. Text was analysed via a reflexive thematic approach to inform subsequent focus groups.

This research aims to
1) better understand what inclusivity means to diverse groups, and how we can best achieve it,
2) create a repository of rich, anonymised, data available for analysis by key stakeholders,
3) to provide a toolkit to support the development of more inclusive approaches to anatomy teaching.

To date 1319 staff and 122 students from 23 countries completed this survey. Improving inclusivity and representation in anatomy is a 'wicked problem', difficult to define and even more difficult to solve. Many barriers, from personal to environmental, prevent anatomists developing inclusive curricula. This talk will outline the research findings so far, and how we can all initiate changes, large and small, that will move us towards more representative and diverse anatomy curricula.

Categories:
Curriculum: Curricular Transformation and Transition

Presenting Author: Michelle Dong - Geisel School of Medicine at Dartmouth
Co-Authors: Sonia N. Chimienti - Geisel School of Medicine at Dartmouth
David W. Mullins - Geisel School of Medicine at Dartmouth

Background
Fluency in the conduct and ethics of basic, translational, and clinical research is of utmost importance to a successful career in medicine. Physicians who master these concepts are equipped to integrate research into practice and deliver cutting-edge innovations to patients, and the LCME mandates the inclusion of these topics in the medical curriculum. We sought to implement a comprehensive curriculum on the principles, practices, and ethical considerations of basic, translational, and clinical research, to better prepare our learners for clinical practice and meet LCME Standard 7.3 (Scientific Method/Clinical/Translational Research). Recognizing the value of integrated instruction, and respecting the ever-increasing time demands on medical students, we created a longitudinal approach that is largely incorporated into the existing curricular activities.

Approach
We mapped the integrated Geisel curriculum, focusing on scientific and ethical principles of research. Using these findings, a curricular working group (consisting of experts and stakeholders from across the medical curriculum) identified areas of weakness and opportunities for improvement, then applied backward design to create and codify the goals and expectations of the curriculum. Insertion and integration points for scientific method and ethical principles of research were identified. New instructional methods and innovations were incorporated, including: pre-matriculation implementation of the Collaborative Institutional Training Initiative (CITI Program) for incoming students; an introduction to the scientific method through a case-based Team-Based Learning activity in early pre-clerkship courses; an introduction to translational research design and ethics through targeted discussions of scientific literature; longitudinal presentation of scientific methods and research ethics in the context of journal article discussions and case-based learning; and peer-learning activities on translational and clinical research and ethics during clerkships. 

Outcomes
In our recent evaluation, the LCME deemed the curriculum satisfactory to meet the requirements of Element 7.3. We will evaluate the efficacy of the curriculum through assessment of student mastery of foundational knowledge and their ability to communicate scientific research to peers and patients. Surveys of students from the legacy and revised curricula will assess changes in satisfaction and confidence in their understanding and ability to apply the concepts in clinical scenarios and practice. As data are acquired, the curriculum will be reassessed through a process of continuous quality improvement.

Conclusion
Our approach achieves the goal of LCME Element 7.3 and provides a comprehensive framework for understanding and applying the concepts of scientific method, research, and ethics into clinical practice, in a time-efficient longitudinal approach.

Categories:
Curriculum: Curricular Transformation and Transition
Curriculum: Curricular Innovations

Presenting Author: Szabolcs Felszeghy - University of Eastern Finland
Co-Authors: Outi Huhtela - University of Eastern Finland
Pirjo Kurki - University of Eastern Finland
Mikko Liukkonen - University of Eastern Finland
Liisa Suoninen - University of Eastern Finland

We hear music almost everywhere we go. Heath care professionals` office, shopping malls, elevators, restaurants... Even when we look around in our campus library, students have headsets on. Research on music in various environments has supported its positive effects on emotions and well-being. Evidence also suggests that background music can foster education and learning and has the potential to increase student satisfaction and productivity. However, data on whether background music has an influence on the anxiety levels of preclinical students during practice or alters their performance is scarce to non-existent. Although an appropriate level of stress is beneficial in stimulating learning and memorization in students, previous studies have shown mixed results. Students often experience a high level of stress due to excessive academic load, fear of failure due to manual skills examination, peer relations. For students wishing to improve their skills, the path to get there can be hard and intense. In order to master their craft, they need relaxed training scenario. That is when they can truly learn, practice, watch. In a recent study carried out at the University of Eastern Finland, researchers have investigated the effect of slow background music and belly breathing on students' preclinical dental training. They found these implementations can effectively reduce stress and improve motivation and performance. According to the researchers, this pilot study lends support to the use of background music in manual skill training as it appeared to have helpful effects on education and practice. This music intervention could also be extended to other stressful health care education environments.

Research article: Felszeghy, S, Liukkonen, M, Tornero, CS, et al. Influence of background music on stress reduction and impact on performances during students' simulation exercises. J Dent Educ. 2023; 1- 10. https://doi.org/10.1002/jdd.13235

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Curriculum: Curricular Innovations

Presenting Author: Elaine Winge - SUNY Downstate Health Sciences University
Co-Authors: Jacqueline DiSalvatore - SUNY Downstate Health Sciences University
Miar Elaskandrany - SUNY Downstate Health Sciences University
Shirley Eisner - SUNY Downstate Health Sciences University
Melanie Peters - SUNY Downstate Health Sciences University

Although incorporating ultrasound education into medical school curriculum has become commonplace, many institutions struggle to implement new curricula due to limited faculty and financial resources. Involving medical students in the process of curriculum development is a valuable way to assess the need for, develop, and implement such curriculum. SUNY Downstate medical students expressed a need for continuity of ultrasound education from the foundational years to clerkships. In particular, students identified the Obstetrics/Gynecology (OB/GYN) clerkship training as a high priority gap in ultrasound skills preparation. In response, three medical students worked with medical education and OB/GYN faculty to develop and implement a sustainable, standardized OB/GYN ultrasound session. Anticipating difficulty in securing sufficient faculty or residents to teach, our session relies on ten recruited fourth year medical students applying to ultrasound-dependent specialties, including OB/GYN. These students committed to teaching the curriculum every 6 weeks for each OB/GYN cohort throughout their last academic year. We are already preparing future session leaders for the next academic year through shadowing opportunities.

The 90-minute session operates under the supervision of one faculty member. During the session, MS3s rotate in small groups through three stations, each led by a fourth year medical student. There are case-based vignettes that include ultrasound interpretation to assess and diagnose abnormal uterine bleeding and confirm an intrauterine pregnancy. Students also practice their ultrasound skills on Ultrasound Phantom Models: one simulating a normal intrauterine pregnancy and one simulating an ectopic pregnancy. Student preparation for the session includes watching two relevant videos on basic transabdominal and transvaginal ultrasound scanning technique and images. Through students' pre- and post-test quizzes and post session surveys, we gauge the curriculum's efficacy in improving students' accuracy in ultrasound interpretation and students' confidence in their ultrasound skills.

This curriculum initiative is a model for delivering ultrasound education without having to rely on multiple faculty and resident teachers. Our case-based approach and use of simulation facilitates integration of clinical knowledge and improvement of students' ultrasound skills. Our goal is to inform and guide the development, implementation, and execution of novel ultrasound learning by medical students to enhance their clerkship experience. Furthermore, senior student-led sessions have the benefit of creating spaces in which junior students feel more comfortable engaging with the presented content and asking questions. Lastly, this model provides an excellent value-added medical education opportunity for medical students to train for future professional roles as medical educators in residency and beyond.

Categories:
Curriculum: Curricular Innovations
Teaching: Team Teaching

Presenting Author: Miklos Fogarasi - Frank H. Netter MD, School of Medicine, Quinnipiac University
Co-Authors: Rebecca Zucconi - Frank H. Netter MD, School of Medicine

Mock Tumor Board (MTB) is a mandatory, two-hour instructional event during the second-year foundational medical sciences course. It is attended by 90-100 students and is updated annually to current standards-of-care. It has been evaluated both in in-person and zoom-adapted formats. The panel includes representatives from Surgical, Medical and Radiation Oncology, Diagnostic Radiology, Genetics and Pathology who discuss a "mock" patient case in front of our entire 2nd year medical student class.

Although the narrative is scripted, its design allows for an interactive format. The case is first "performed" at real-life speed (over a few minutes), then repeated over the remainder of the 2-hour session at a pace appropriate for 2nd year students. It is a case of a patient with breast cancer, from screening through all diagnostic steps to staging, prognosis, selecting personalized treatment and follow-up. It utilizes national guidelines and introduces the role of accrediting agencies in health care. Interactive decision making is demonstrated by panel members and students are invited to ask questions from them and to collaborate in clinical decision-making.

Learning outcomes from this event include topics from surgical care, pathology, imaging studies, genetics, pharmacology, radiation therapy, as well as cancer survivorship and rehabilitation. This serves the purpose of horizontal integration across medical science disciplines and organ systems. Beyond delivering knowledge-based content, panelists model exemplary professional skills in medical communication, delivering bad news and shared-decision making. Through the MTB format, students witness "real-life" collaboration between representatives of multiple disciplines in a clinical setting and the practice of patient-centered care using evidence-based medicine.

Student feedback about MTB has been overwhelmingly positive since its implementation 5 years ago. In post-event surveys 84% agreed/strongly agreed that the content and structure contributed to their learning and 86% rated the quality of the session as good/very good or excellent. Qualitative comments from students included: "amazing, informative event"; "would like to see more classes like this"; "good insight into what a tumor board is"; "loved the opportunity to see a tumor board in action"; "a treat to hear from guest MDs and see their different areas of expertise"; "an interesting window into how real clinical setting runs"; "helpful from a holistic perspective". Anecdotally, our volunteer clinical faculty also views this instructional opportunity positively and have consistently offered to return to participate annually. We believe, that adding a social worker, clinical trial nurse or palliative care specialist to the panel or including a molecular tumor expert would all be feasible adaptations to transform the MTB from an interdisciplinary to an interprofessional event. In summary, MTB in our hands is a valuable tool of UME teaching.

Categories:
Curriculum: Curricular Innovations
Teaching: Active Learning

Presenting Author: Robert Hill - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Co-Authors: Brian E. Pinard - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
William P. Rennie - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Dissection has been a mainstay of medical education for centuries. Recently however, anatomy programs have faced reduction of teaching hours, elimination of dissection, and the shutdown of anatomy labs entirely. Some students view dissection as too time-consuming to be worthwhile. Two related questions arise: should dissection continue to be used in medical education, and (if so) can it be updated to remain relevant to the modern learner? We answer both of these questions in the affirmative, and describe several innovative uses for donor bodies in teaching and learning human anatomy.

At the Zucker School of Medicine (ZSOM), students participate in over 50 laboratory sessions during their two pre-clerkship years, and five more during their third year core clerkships. In place of a linear, regional dissection of the whole body, we integrate dissection mindfully throughout the curriculum, revisiting this time-honored method at intervals throughout the first three years of medical school.

ZSOM students participate in regional dissections selected for their clinical relevance and difficulty, including the limbs and the cavities of the thorax, abdomen, and pelvis. We frame certain other dissection sessions as surgeries or emergency procedures, including cricothyrotomy, thoracostomy, and thyroidectomy. In these sessions, step-by-step procedure manuals guide students in low-stakes simulations of lifesaving procedures. In three first-year courses we assign case studies to guide more detailed investigations, culminating in student presentations to peers and faculty. As part of these investigations, dissection groups may (and often do) elect to simulate a surgery as a means of demonstrating anatomical relationships important to their assigned case. Recent presentations have included simulations of renal transplant, coronary artery bypass grafting, sigmoidectomy, Billroth II gastric resection, and portocaval shunts. At suturing skills sessions, students use donor bodies to practice bowel anastomosis and the closure of surgical wounds and port sites. During their dissection experiences and other encounters with the donor body, students learn to identify and use authentic surgical instruments and use laparoscopic instruments with iPad visualization over an open abdominal cavity. Finally, students participating in our fourth-year medical education elective create prosections for use in near-peer demonstrations. These prosections emphasize unique and unconventional views of anatomical structure while also serving multiple purposes throughout our integrated, spiral curriculum. Students record all variations, discoveries, and procedural interactions with the donor body in a simulated medical record for the donor.

Our work over the past 15 years has shown that dissection remains a relevant activity for medical education. More importantly, dissection is versatile enough to be reimagined and integrated into a modern and dynamic student experience.

Categories:
Curriculum: Curricular Innovations
Teaching: Active Learning

Presenting Author: Hejin Jeong - Case Western Reserve University School of Medicine
Co-Authors: Ifeolorunbode Adebambo - MetroHealth Broadway Health Center

Background
While many U.S. medical schools have integrated social drivers of health (SDH) education as part of their pre-clinical curricula to provide students with theoretical knowledge about the impact of SDH on patients' health, there is a significant gap in preparing students to overcome the practical challenges that physicians currently face in identifying and addressing patients' social needs. Furthermore, research has shown that physicians often underutilize diagnostic codes to document identified social needs of patients, which may curtail the opportunity for other healthcare professionals to utilize the information to provide more holistic care and for public health organizations to develop population-level quality improvement initiatives. In order to address such gaps in current medical education, we aim to develop an interactive workshop focused on equipping pre-clinical medical students with practical skills to provide optimal quality of care to future patients with diverse social needs.

Methods
This 60-to-90-minute workshop will be offered to pre-clinical students as an optional learning opportunity. The workshop will consist of a didactic component that will introduce students to the main domains of SDH, how they can incorporate validated SDH screening tools to structure their patient interviews to overcome the time constraints of a typical encounter, what community-based and institutional resources are available for them to connect their patients to, and the benefits of using diagnostic codes to document their patients' social needs. Students will then engage in a patient encounter simulation, in which the facilitator acts as the patient while students take on the role of physicians. As a group, students will ask questions to identify the patient's medical and social concerns, and based on their knowledge from the didactic component, develop three potential management plans. Following the scenario, the facilitator will reveal a comprehensive narrative description of the patient's social context to allow students to compare it with their own understanding of the patient's perspective gained through the patient interview. Finally, the workshop will conclude with a discussion comparing the management plans generated by students with what was actually implemented.

Expected Outcomes
To evaluate the impact of this intervention, we will administer pre- and post-workshop surveys to participating students. We anticipate that the post-workshop survey will demonstrate improved knowledge and confidence among students in screening, managing, and documenting patients' SDH, a more positive attitude toward incorporating SDH discussions into their daily patient encounters, and that the workshop offered unique educational value beyond what is currently covered in the core curriculum. Based on the findings of this study and student interest, our ultimate goal is to integrate the contents of this workshop into the core preclinical curriculum.

Categories:
Curriculum: Curricular Transformation and Transition
Curriculum: Curricular Innovations

Presenting Author: Nicole Ackerman - SUNY Downstate College of Medicine
Co-Authors: Rachel Corona - SUNY Downstate College of Medicine
Shirley Eisner - SUNY Downstate College of Medicine

Introduction
In January 2022 the USMLE Step 1 exam changed from a three-digit score to a pass/fail report. Reasons given were that the graded score led to: diminished wellness; a parallel curriculum focused on exam preparation; distraction from other critical competencies; and misapplication in residency applications. There is little data on the effect this will have on the traditional dedicated study period (DSP) for Step 1 and for medical school curricula. Girard et al. report that students who completed a scored exam speculate that they would dedicate less time studying than for a numerical exam (72.7%) and more time preparing for Step 2 (70.5%). We aimed to analyze how the new pass/fail report impacted the first cohort's study behaviors and attitudes. Since literature suggests that residency programs will place greater emphasis on Step 2, we hypothesized students would suggest less study time for Step 1 and prefer more time allocated for Step 2 and/or curriculum modifications.

Methods
An electronic survey approved for IRB exemption was sent in November 2022 to 233 Class of 2024 students. It consisted of multiple choice and short answer quantitative and qualitative questions. Responses were de-identified and confidential. Descriptive statistics were used to analyze the data.

Results
Preliminary data consists of 52 respondents. Most felt that six weeks (same as with the scored exam) was "just right" (55.8%) or "too short" (38.5%) and a majority of students took the exam during (44.2%) or after (13.4%) the last week of the DSP. While most made use of the entire DSP, only 46.2% of students felt adequately prepared and 44.2% felt underprepared. The most reported preference was to maintain the DSP (69.2%). 56.8% of students stated they would recommend future students study as if taking it for a grade to ensure a pass, and because the material is essential for clerkships (39.4%).

Discussion
Our study is the first to show that students who completed a pass/fail Step 1 exam prefer to keep the DSP the same length and still believe that Step 1 requires substantial preparation. Potential explanations include ensuring a passing score, and in preparation for clerkships and shelf exams. Our hypothesis that students would prefer to reallocate Step 1 study time elsewhere was not supported by this study. However, if the DSP were shortened, adding time to the Step 2 DSP was a common preference, supporting our hypothesis that Step 2 preparation will rise in priority. Significance: Schools may consider restructuring their DSPs because of the change to pass/fail. This study may inform administrative decisions about DSP scheduling. Subsequent studies with the Class of 2025 may include survey variables that measure the impact on student well-being, study strategies, performance, and evaluate whether the aims that motivated the shift to pass/fail are being achieved. Finally, the impact on Step 2 can be studied by following the current cohort longitudinally.

Categories:
Students: Distinctiveness for Residency With Pass/Fail Boards
Curriculum: Curricular Transformation and Transition

Presenting Author: Ritcha Saxena - University of Minnesota

In the era of AI, the landscape of medical education is undergoing digital transformation, necessitating the adaptation and redefinition of roles for medical educators. Digital Twin (DT) is emerging as a linchpin in healthcare, with applications in studying a patient's genome, physiology, and lifestyle, and contributing to the development of safe and cost-effective interventions. In medical education, DTs serve as virtual replicas. For instance, in pathology education, DT technology can enhance clinical case scenarios by showcasing different pathophysiological mechanisms occurring in various organs. Integration of AI and DT technology in medical education can significantly enhance the learning experience for medical students and better prepare them for real-world scenarios in diagnostics and disease management.

In healthcare, AI has proven capabilities in automating tasks, analyzing large amounts of data, and making predictions based on patterns, revolutionizing patient-centered medicine. Utilizing AI's power in medical education is the obvious next step. AI can generate virtual diagnostic challenges, where students can analyze DT representations of diseases, honing their diagnostic accuracy and critical thinking skills. Also, AI algorithms can suggest differential diagnoses and relevant laboratory investigations in case-based learning (CBL) scenarios based on features seen in DT organ samples. Integrating AI and DT technology in virtual classrooms can also open doors to effortless presentation of complex biomedical data in a comprehensive manner during CBL.

Digital pathology (DP), through high-resolution scanning and image analysis, digitizes pathology slides for interactive learning. When combined with AI and DT technology, DP enhances medical education. For example, rad-path correlation can be made easy by developing AI models to analyze imaging, such as X-rays or MRI scans, and correlate them with morphologies in different disease entities. This not only provides students with a thorough understanding of disease process but also cultivates their acumen for making correlations.

To provide medical students with hands-on experience in AI applications and their potential impact on healthcare, collaborative projects with data scientists and AI experts can be initiated, with an extra benefit in fostering interdisciplinary learning. Medical schools can also support students in utilizing DT by introducing data science and informatics training, and emphasizing evidence-based practice. This ensures a broad grasp of DT's virtual simulation, AI's data analysis and personalized learning, and DP's role in enhanced diagnosis and remote learning.

The convergence of DT, AI, and DP in medical education is revolutionary. Early adoption of these technologies is crucial, as they enhance knowledge retention, critical thinking and diagnostic skills, enabling the physicians of tomorrow to provide exceptional patient care in their future careers.

Categories:
Curriculum: Curricular Transformation and Transition
Artificial Intelligence in Health Professions Education

Presenting Author: Valerie DeGregorio - Baylor College of Medicine
Co-Authors: Peter Boedeker - Baylor College of Medicine
Elizabeth Elliott - Baylor College of Medicine
Brianna Etoria - Baylor College of Medicine
Charlotte Wilson - Baylor College of Medicine

Many physician assistant (PA) learners experience academic difficulties while completing their didactic curriculum as they enter a fast-paced learning environment. The literature indicates that learners who lack certain self-regulation skills (e.g., concentration, time management, etc.) experience lower academic performance. Also, self directed learning theory has continued to grow as a foundation of building curriculum for health professions students. As we engage our learners in more active experiences such as case based and team problem based learning we have noted a need to reinforce self- regulated learning skills to support learner success. In recent years, our PA program has experienced an increase in overall attrition. Learners have described academic challenges, personal challenges, and lack of connection to classmates and the program as reasons for their attrition. In response, our program has partnered with our college Academic Success Center to develop and integrate a learning frameworks course into the didactic curriculum with a focus on improving student learning and study strategies while supporting a collaborative atmosphere among learners.

This program was piloted in the matriculating 2022 cohort, all learners were required to participate in Physician Assistant Academic Success Series (PA2SS).

This program was composed of modules that engaged students in discussion and application of learning and study skills including: time management, creating a study schedule and time blocking; learning styles, study strategies, group learning strategies; and how to foster well-being and resiliency. The impact on student self regulated learning abilities was measured via a comparative analysis of the pre- and post-administration of the Learning and Study Strategies Inventory (LASSI), where students report how strongly they identify with 60-items related to 10 categories of learning and study strategies. Post-session course evaluations allowed the researchers to gather quantitative and qualitative data on student perceptions of the curriculum's impact and efficacy. 

This curricular enhancement has the potential to serve as a proactive intervention for incoming health professions students that may have otherwise struggled with adjusting to the self-directed nature of professional school. In our pilot program analysis of pre- and post-administration data of the LASSI, data demonstrated self perceived improvement in the ability to select main ideas and manage anxiety.

According to individual module survey data, learners found most sessions relevant to their academic success and realistic to apply to their study routine. Learners were most satisfied with the session focused on developing and applying engaging study strategies.

Categories:
Students: Learning Resources
Curriculum: Curricular Innovations

Presenting Author: Muhammad Nabeel Ghayur - University of Pikeville
Co-Authors: Ayesha Ghayur - University of Pikeville
Jasmine Hedayati - University of Pikeville

At the Kentucky College of Osteopathic Medicine (KYCOM), students are taught pharmacology yearlong in the 2nd year. These Doctor of Osteopathic Medicine (DO) students in Pharmacology were assigned board-style questions for board-prep practice available from different Commercial Off-The-Shelf (COTS) question resources. Our primary goal was to see if this activity would be beneficial for the students and also to see if assigning marks to this would help motivate more students to attempt and complete these questions during the year. During the Fall semester, there were no marks given for completing these COTS-based board-style questions (from UWorld© and TrueLearn©). In comparison, during the Spring semester, Bonus Marks were given to anyone completing these questions. Data was gathered from these question banks looking for completion data. Additionally, a survey was also sent out at the end of the year to assess the overall response of students for this additional learning activity. Results showed that for both UWorld© (77.4% vs. 47.2%) and TrueLearn© Q-banks (78.3% vs. 36.3%), there were significantly more students who completed the practice question during the Spring semester when marks were assigned to this activity. There was also an increase in the average class score (UWorld 65.3% vs. 63%; TrueLearn 70.5% vs. 53.6%) during the Spring semester. For the survey administered to the class, there was a response rate of 30.2%. For all the questions in the survey (questions related to these practice questions providing help, motivation, Board prep, confidence, overall learning, etc.), there was a statistically significant positive response ('strongly agree' and 'agree' responses). The data shows the benefit of assigning these COTS resources to medical pharmacology students. It also shows that assigning marks motivated more students to complete these practice questions.

Categories:
Students: Learning Resources
Curriculum: Curricular Innovations

Presenting Author: Jeannine Nonaillada - New York University Long Island School of Medicine

Background
Whether or not medical students receive training as educators, most are expected to teach. Since curricular time is limited, a compressed, one week elective was developed introducing foundations of teaching and learning offered from 2017-2022 at two institutions with a maximum of four students per cohort for a total of five sessions.

Aims
The elective objectives prepared medical students for roles as dynamic educators in inpatient, ambulatory, and classroom settings with emphasis on bridging the core entrustable professional activities for entering residency[1]. Teaching skills emphasized: learner-centered instructional theory, curriculum development, clinical teaching, and giving and receiving feedback. To culminate their experience, students created and taught a lesson for review by the course director, and evaluated one current teaching and learning method being performed at either institution where the student was enrolled.

Method
Prior to attending sessions, students were expected to complete pre-readings. The first four sessions were formatted with content in one designated teaching and learning topic from the objectives. These were presented with live, synchronous classes using PowerPoint containing main concepts and video clips of publicly available resources, and prompts to facilitate group discussion. Students had to individually complete a required reaction paper for each session, consisting of open-ended questions and statements prompting personal inquiry about intended session objectives. The fifth and final session was for each student to teach a lesson on a chosen topic, with the only requirement to display accumulated knowledge and application of concepts from prior sessions of what constitutes valuable educational delivery[2]. As such, the students delivered original, interactive, and memorable lessons with hands-on, participatory activities including: tap dancing, dreidel spinning, sewing, drawing mehndi, making paper origami fish, intersecting art and medicine, magic tricks, and exploring data mapping tools. Students' evaluations of observed teaching and learning methods performed at their institution were also submitted at the completion of all five sessions. Examples of observations included Grand Rounds, course lectures, and noontime teaching sessions that students attended during that elective week.

Results and Discussion
Subjective feedback was overall positive. Students stated having the option to choose an elective on teaching and learning in medical school was "an exceptional, rare occurrence", and one "that they would remember above other courses". Students commented how reviewing theoretical underpinnings of educational techniques was impactful. With the overwhelming volume within medical school curricula, providing a creative outlet for students to tap into hobbies and interests was invaluable to 'teach the professor'. *This elective is easily be adaptable for any health professions program.

Categories:
Curriculum: Curricular Innovations
Teaching: Active Learning

Presenting Author: Ryan Boyland - University of Nebraska Medical Center
Co-Authors: Yasmeen Bora - University of Nebraska Medical Center
Shirley Delair - University of Nebraska Medical Center; Children's Hospital Omaha

Background
Small group work is crucial to preclinical medical education. Strong interpersonal skills are necessary both for patient care and the well-being of the physician workforce. There is increasing evidence for building resiliency and increasing students' sense of belonging through community building, defined as a set of practices intended to enhance relationships among individuals within a group. One such practice is the establishment of community agreements - a list of goals for conduct in a group setting, agreed on by the group members when they begin working together. These promote students' ownership of the learning environment, set expectations for discussion, and provide avenues for accountability and growth.

Significance of the Problem
Medical students experience higher rates of depression and anxiety compared to the general population. To address this and improve the classroom experience, there is increasing evidence for building resiliency and increasing students' sense of belonging through community building.

Hypothesis/Research Question
We hypothesize that community building through community agreements improves students' opinions on their learning experiences.

Experimental Design
We developed a series of 25 questions (23 Likert scale, 2 free response) from established community agreements developed by two study authors (YB and RB). Study participants were chosen from current members of the College of Medicine Classes of 2025 (Group A) and 2026 (Group B). Community agreements were provided to each group at their matriculations and were available online for reference. Groups were divided based on recency of matriculation and introduction of community agreements (16 months and 4 months for Groups A and B, respectively). Data was collected from January 3rd-March 17th, 2023. Student t-test was performed.

Results:
A total of 71 students completed the survey, with n=26 in Group A and n=45 in Group B. Group B agreed more strongly with the statement "I feel that other students in my small group try to understand their own biases and work on addressing them." (Group A: 3.65+/-.032; Group B: 4.11+/-.206; p<0.05). Group B also identified more strongly with the statement "Curiosity, vulnerability, and readiness to learn are valued and celebrated during small group discussion." (Group A: 3.77+/-.307; Group B 4.22+/-.282; p<0.05). Overall, 34 respondents (47.9%) identified positive traits of the community agreements and their use, mentioning common themes of safe and respectful learning environment, uplifting marginalized voices, and ease of understanding.

Conclusion:
Individuals exposed more recently to community agreements report greater feelings that their peers work on addressing their biases and that the small group environment values curiosity, vulnerability and readiness to learn.

Categories:
Students: Mental Health and Resilience
Curriculum: Curricular Policies

Presenting Author: Rebecca Greenblatt - SUNY Upstate Medical University Department of Microbiology & Immunology
Co-Authors: Thomas Duncan - SUNY Upstate Medical University, Department of Biochemistry & Molecular Biology
Joanna Suser - SUNY Upstate Medical University, Department of Academic Affairs

Like most medical school currriculums, the Norton College of Medicine (NCOM) program at SUNY Upstate Medical University begins with a Foundations course. NCOM's foundational "Molecules, Cells and Microbes" is primarily concerned with medical applications of undergraduate-level biochemistry, cell biology, genetics, molecular biology, bacteriology, virology, and immunology. Our faculty designed the course while keeping in mind NCOM pre-matriculation requirements for undergraduate coursework and scores on the Medical College Admission Test (MCAT). However, student feedback has consistently indicated that some of our students feel overwhelmed by the course content. Students who are less prepared include those who have been working full-time in clinical medicine for two or three years since completing their undergraduate coursework. They also include students who have entered NCOM through new pathway programs that do not require MCAT scores. Because NCOM is currently expanding these MCAT-optional pathways, the population of students who perceive themselves to be underprepared for foundational coursework could grow in the coming years. To begin addressing this issue, we created the MedReady Checkup. The Checkup is a self-assessment administered through RedCap consisting of five undergraduate-level multiple-choice items representing each of the seven foundational topic areas above. Students who answer fewer than four of the items in a section correctly are alerted that they may struggle with that topic area when it appears in the foundations course. They are directed to review faculty-curated resources before the course begins. They are also provided with contact information for the major instructor in that topic area. This year, students completed the MedReady Checkup as a required activity on the first day of academic orientation. In future years, we plan to distribute the Checkup to accepted students early in the summer, so that they can take their scores into account when deciding whether to attend our MedSET summer preparatory course.

Categories:
Curriculum: Curricular Innovations

Presenting Author: Stephen D. Schneid - University of California, San Diego School of Medicine and Skaggs School of Pharmacy & Pharmaceutical Sciences

Over the past two summers (2022 and 2023), we recruited a total of 26 senior medical students to be academic coaches for 44 incoming medical students enrolled in our online seven week prematriculation course (PMC). We recruited student coaches who were starting a Masters degree or research project after their third year. Each coach was randomly assigned between one to three students and volunteered to meet with their coachee once a week for approximately one hour. The coaches received a two-hour training session and were encouraged to use free online coaching resources which included a coaching book and series of videos. While the prematriculation course is focused primarily on biomedical sciences, we have incorporated health systems science and professional identity formation (PIF).

The prematriculation students respond to the nine-question Professional Identity Essay (PIE) and send their PIEs directly to educational psychologists with expertise in PIF and the PIE. They are provided detailed written feedback within one week. After they receive feedback from the educational psychologists, there is a debrief session to the entire class. The coachees are supposed to discuss their PIE feedback with their coaches, who also go through the exact same process of taking the PIE and receiving feedback.

For the summer of 2022, the academic coaching and PIF/PIE components of the course received student evaluations of 4.44/5 and 4.25/5, respectively (N=16). We learned that having weekly coaching sessions was essential in building the coach-coachee relationship in such a short timeframe. A major piece of feedback we received was to give students several more days to work on the PIE they spent several hours constructing their responses. In 2023, we have informed students the PIE may take one to three hours and they are now given ten days to complete it. We also scheduled the PIE in a relatively lighter week of biomedical science content. Students and coaches commented that some of written feedback was hard to make sense of at first, particularly the PIF stage description, until the debrief session. They suggested that the debrief session be expanded to two hours and also have more explanation of the PIF theory and PIE at the beginning of the course, which we have implemented in 2023. Coaches reported that their experience improved their motivational interviewing and communication skills, which was unanticipated. Coaches and coachees also expressed interest in training of the next cohort of academic coaches which happened in 2023. We learned that introducing PIF prior to the start of medical school was very well-received by students, and in some cases had a profound impact based on student evaluations.

Categories:
Curriculum: Curricular Transformation and Transition
Curriculum: Curricular Innovations

Presenting Author: Santiago Romo - Universidad San Francisco de Quito
Co-Authors: Ivan Sisa Caiza - Universidad San Francisco de Quito

Context
In Ecuador there is little information on the training of human resources in health. For example, there are no comprehensive evaluations of how postgraduate physicians are trained and evaluated.

Objective
To evaluate the state of training of postgraduate physicians in anesthesiology in Ecuador, analyzing the current programs and the competencies of their residents.

Methodology
A cross-sectional study was carried out using all the medical directors of the universities in Ecuador with current programs in anesthesiology and all the program residents in their last year of the specialty. Two surveys were used, the first developed by the American Society of Anesthesiologists and the second based on the milestones defined by the Accreditation Council for Graduate Medical Education of the United States. In addition, the portfolios of the resident physicians were analyzed.

Results
It was found that only seven universities in the country have a specialization program in anesthesiology, and these are mainly located in the cities of Quito and Guayaquil. The response rates of the surveys sent to directors and senior resident physicians were 57% and 31.2%, respectively. In relation to current programs, deficiencies were found at the summative and formative evaluation levels. In general, the residents evaluated themselves as competent in the milestones assessed, although there are areas of deficiencies that call attention. Finally, only one program uses the portfolio to evaluate its residents.

Conclusions
The surveys indicated areas for improvement in both summative and formative evaluations and in key competencies of the specialization that universities and local supervisory bodies should pay attention to in order to improve postgraduate medical education in Ecuador.

Keywords
Ecuador, postgraduate, students, universities, anesthesiology, programs, competencies, summative and formative evaluations

Categories:
Curriculum: Curricular Transformation and Transition

Presenting Author: Sheba Luke - University of Texas Medical Branch
Co-Authors: Bruce Adcock - University of Texas Medical Branch
Sarah Burnett-Greenup - University of Texas Medical Branch
Andrea Colburn - University of Texas Medical Branch
Shinu Joy - University of Texas Medical Branch
Janna Mcgaugh - University of Texas Medical Branch

Background
Interprofessional education (IPE) occurs "when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes" (WHO, 2010). Incorporating simulation into interprofessional education can support collaboration by altering attitudes about teamwork and communication among students of different disciplines (Costello et al, 2017). Purpose: The purpose of the activity was to integrate interprofessional education and simulation in a multi-modal blood transfusion activity. The activity further sought to evaluate students' experience and detect any changes in perceived knowledge surrounding interprofessional competencies, including teamwork, leadership, and communication.

Methods
An interprofessional, multi-modal blood transfusion simulation was conducted for students from the Nursing, Physical Therapy, Respiratory Care, and Clinical Laboratory Science departments.

A modified Performance Assessment Communication and Teamwork (PACT) survey consisting of Likert scale questions was administered to students electronically before and after the activity. In addition, qualitative feedback was also collected at the end of the activity.

Results
Students' (n=26) perceived understanding of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) concepts were higher following the activity than before the activity (Wilcoxon Signed Rank Test for related samples, all differences positive, p < 0.001). 92.3% of students rated their experience as good, very good, or excellent. All the students completing the survey agreed or strongly agreed that they would recommend the simulation to a classmate. Student responses to "What is the most important learning experience you took away from the interprofessional training?" focused primarily on increased awareness of the importance of communication and teamwork in healthcare.

Conclusion
The IPE learning activity improved the participants' understanding of interprofessional collaboration skills and provided an enjoyable experience for students. Future efforts will focus on refining and implementing the activity in each discipline's curriculum.

References
World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice (No. WHO/HRH/HPN/10.3). http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf Costello, M., Huddleston, J., Atinaja-Faller, J., Prelack, K., Wood, A., Barden, J., & Adly, S. (2017). Simulation as an effective strategy for interprofessional education. Clinical Simulation in Nursing, 13(12), 624-627.

Categories:
Students: Professionalism
Curriculum: Curricular Innovations

Presenting Author: Amber Vargas - Frank H. Netter, MD School of Medicine at Quinnipiac University
Co-Authors: Rahul Anand - Frank H. Netter, MD School of Medicine at Quinnipiac University
Adebowale Babalola - Frank H. Netter, MD School of Medicine at Quinnipiac University
Sheila W. Chauvin - Frank H. Netter, MD School of Medicine at Quinnipiac University
Elizabeth Nemolyaeva Landry - Frank H. Netter, MD School of Medicine at Quinnipiac University
Krista Ayran Runcie - Frank H. Netter, MD School of Medicine at Quinnipiac University
Colin Uyeki - Frank H. Netter, MD School of Medicine at Quinnipiac University

Leadership is a critical competency of healthcare professionals. Leadership development has been one of the aspects of hidden curriculum at medical schools for a long time. At Quinnipiac University (QU), we used Design Thinking (which consists of an exploration phase, ideation phase and prototyping phase) to propose a framework to make leadership development purposeful and meaningful through the creation of a leadership course elective for preclinical medical students. To expand the reach of this course's impact, we decided to create a Community of Practice (CoP).

A CoP is a community with a shared domain of interest, competence, and commitment to a specific purpose. This community pursues their interest via activities, discussions, opportunities, and relationship building, and establishes a collection of resources, knowledge and skills which can continue to evolve as members phase in and out of the community. Our leadership-focused CoP was created by a group of medical students and faculty; however, this space is for anyone, including students, faculty, staff, and graduates, associated with healthcare, and interested in leadership development.

In our "exploration phase" of Design Thinking, a group of medical students from the leadership course interviewed leaders on campus (student government, faculty leaders and graduates of the leadership course) to collect information regarding leadership attributes needed or desired in healthcare. We came together after these interviews to debrief with the goal of identifying key or repetitive themes. Areas of interest included: building confidence, increasing interprofessional relationships, preparing for difficult conversations, managing conflict, navigating leadership styles, mentoring, networking, self-reflecting, and participating in leadership simulations.

In our "ideation" phase of Design Thinking, we focused on building the mission and infrastructure of our CoP. The mission of this CoP is to build meaningful relationships among health professionals at QU and support each other in developing leadership, teamwork and impacting health systems. Currently, our CoP consists of 78 students, graduates, faculty, and staff from various healthcare programs at QU to include medicine, physician assistant, occupational therapy, social work, physical therapy, and business. All members are invited to two gatherings per semester which align with the first and last day of the leadership course. Moving forward, we are constantly "prototyping." Further iterations include building a virtual platform for connection, increasing the number of planned events, and building on interprofessional programming. As we evolve, we are continuously incorporating member feedback and building this community together with member needs at the forefront.

This CoP allows students, graduates, faculty, and staff in healthcare to continue to develop their leadership and help others develop their leadership throughout their careers.

Categories:
Students: Learning Resources
Curriculum: Curricular Innovations

Presenting Author: Ayesha Ghayur - Kentucky College of Osteopathic Medicine at the University of Pikeville
Co-Authors: Cathryn J Caudill - Kentucky College of Osteopathic Medicine at the University of Pikeville

Purpose
Based on our experience with faculty-authored formative assessments that improved student performance on pathology course examination items, we began recommending and/or assigning board-style practice questions from commercial test banks, such as TrueLearn. We explored student preferences for and perceptions about these two types of assessments for developing content understanding and mastery. We also examined the influences of these assessments on student communication with faculty and examination preparation.

Methods
We administered a voluntary and anonymous SurveyMonkey survey to students enrolled in our pathology course. Survey questions asked whether students preferred faculty-authored and/or TrueLearn assessments for various types of learning approaches and skills related to course examination and board preparation, and how they engaged with the assessments and course faculty. A subset of survey questions explored student perceptions about TrueLearn assessments and their influence on motivation and study habits. We also examined TrueLearn assessment data and reviewed faculty records of student office visits and email correspondence.

Results
The student response rate to our survey was 77%. Students believed both faculty-authored and TrueLearn assessments were valuable for supporting various skills in concept development and mastery. Students were more likely to communicate with faculty about TrueLearn assessments, and reported a slight preference in their use for board preparation, although they were less likely to utilize these questions when recommended as an ungraded activity versus graded assignment. Students reported increased workload and stress with graded TrueLearn assignments, but also reported increased confidence, earlier engagement, and review of material for board preparation.

Conclusion
Students appreciate a mix of formative assessment strategies. Adding TrueLearn to the pathology curriculum is a novel approach that engages students with board-style questions early in their learning process, and results in increased student engagement with faculty for question-answering strategies. We have subsequently expanded our commercial test bank assignments to include other banks, such as UWorld.

Categories:
Curriculum: Curricular Innovations