Presenting Author: William Pearson - Via College of Osteopathic Medicine, Auburn Campus
Co-Authors: Joseph Brewer - Via College of Osteopathic Medicine, Auburn Campus

Multifaceted approaches to promoting mental health and resilience among medical students, including mindfulness and self-awareness, self-care initiatives, supportive mentorship programs, resilience training, cultures of support, work-life integration, and reducing student workload, have been widely implemented. However, the persistence of a discrepancy between students' career paths and their initial aspirations, as well as the manifestation of maladaptive perfectionism, imposter syndrome, physician impairment, and moral injury, highlights a need to examine the underlying system that perpetuates these challenges. A systems approach recognizes the narratives embedded in training environments and practices and aims to create new pathways for flourishing and formation. The prevailing understanding of education as a mere transfer and assessment of information and skills overlooks the formative process that students undergo. Adopting a flourishing approach acknowledges the potential to develop practices and training environments aligned with the narrative of human flourishing. Addressing the challenges of physician formation within an overburdened medical education system represents a complex, wicked problem. To tackle this, we have employed a developmental evaluation strategy (DES) rooted in systems thinking, allowing for emergent solutions. Stakeholder engagement, guided by the Kern National Network for Flourishing in Medicine framework, served as the foundation for repurposing existing structures, such as the anatomy course and student advising system, to foster flourishing. We employed measures of individual and community flourishing developed by Tyler VanderWeele of the Harvard Human Flourishing Program to assess the outcomes of these interventions. This educational innovation talk will explore the rationale, strategy, and data derived from our project, demonstrating the value of a systems-oriented approach to promote flourishing and formation to address mental health and resilience among medical students. 

Categories: 
Students: Mental Health and Resilience

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: Sarah-Ann Keyes - Baylor College of Medicine 
Co-Authors: Valerie DeGregorio - Baylor College of Medicine

Background
Burnout, described as emotional exhaustion, depersonalization, and reduced sense of personal accomplishment is a topic of focus in the healthcare setting and medical education. While burnout syndrome is well-studied in medical students, residents, and physicians, it has not been extensively examined in other health professions or health professions trainees. Given the rigor of health professions education, specifically physician assistants (PA), and the established prevalence of burnout in this population, it is reasonable to consider possible mechanisms of curricular methods to improve trainee recognition and management of burnout.

Methods
A hybrid asynchronous/synchronous module-based curriculum was developed and piloted in the fall of 2021. The curriculum consisted of three modules: an initial asynchronous module including a podcast on burnout and reflective prompts, a second module with pre-work consisting of the ACGME AWARE videos and a synchronous facilitated workshop over Zoom, and a final self-directed project for students. The curriculum was piloted during the clinical year of training for 27 PA students at a private institution in the Southwest United States. The curriculum was evaluated using a self-assessment of confidence survey given at three time points across delivery.

Results
Only participants with data available for all time points were included in the analyses. Consequently, data from 13 participants was used in the confidence in recognizing burnout analyses. A Friedman test was conducted to determine if there were differences in confidence in recognizing burnout over the three time points. Results of the analysis showed that there was a significant difference, χ2 (2) = 13.79, p = .001. Follow-up sign tests with a Bonferroni correction showed that while there was no difference in confidence between the fall of year one and the fall of year two or between the fall of year one and the spring of year one, participants did indicate lower median levels of confidence in the spring of year one than they did at the fall of year two.

Conclusions
A hybrid asynchronous/synchronous module-based curriculum was effective at increasing student self-perceived confidence in recognizing burnout and in implementing measures to intervene on burnout. The asynchronous and virtual portion of the curriculum made the content and activities accessible and less time intensive for the students. The synchronous virtual portion of the curriculum gave students a chance to connect over the material. The use of a virtual curriculum facilitated incorporation of new curricular content into an already dense curriculum.

Categories: 
Students: Mental Health and Resilience

Presenting Author: Andrew Binks - Virginia Tech Carilion School of Medicine
Co-Authors: Judith M. Brenner - NYU Long Island School of Medicine
Cecilia T. Gambala - Tulane School of Medicine
Renée J. LeClair - Virginia Tech Carilion School of Medicine
Joanne M. Willey - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Background
The momentous decision to change from a three-digit score to pass/fail grading of the US Medical Licensing Exam (USMLE) Step 1 was intended to reduce the emphasis of Step 1 scores in residency application. The intention, and our study hypothesis, was that change to pass/fail grading would relieve student anxiety and there by mitigate anxiety's negative impact on learning and promote curiosity. 

Methods
Two cohorts of pre-clerkship medical students at three medical schools completed a questionnaire prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022. The questionnaire was comprised of four validated instruments: the Short Grit Scale, State-Trait Anxiety Inventory, the Interest/Deprivation Type Epistemic Curiosity Scale and the revised two-factor Study Process. The responses of the two cohorts were compared (Mann Whitney U) and multiple regression path analysis was performed to determine which of the measured variables most likely impacted learning strategies.

Results
Comparison of the 3-digit (n=86) and pass/fail exam takers (n=154) showed no difference in grit (median scores 3.88 vs. 3.69 respectively, p=0.22), anxiety (STA-I scores, 50 vs. 49, p= 0.85), shallow learning strategies (22 vs. 23, p = 0.84) or interest curiosity scores (median scores 15 vs. 15, p = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs.11, p = 0.03) and engaged in fewer deep learning strategies (30 vs. 27, p = 0.0012). Multiple regression path analysis suggested the change in exam scoring to pass/fail was a major contributor to the decline in deep learning strategies (B = -2.0428, P < 0.05). There was no such relationship for shallow learning strategies.

Conclusion/Discussion
Counter to our original hypothesis, there was no reduction in anxiety with the change to pass/fail grading. We suggest the source of anxiety may have changed from the overemphasis of Step 1 (3-digit cohort) to concern over the unknown metrics that will be used by residency directors (pass/fail cohort). The negative impact on curiosity and deep learning strategies may reflect pass/fail exam taker reprioritizing their focus toward activities and metrics that might improve residency applications. While this study only measures the immediate impact of the change in Step 1 scoring, continued study is planned as the priorities and metrics and used by residency directors will become clearer in subsequent years.

Categories: 
Students: Distinctiveness for Residency With Pass/Fail Boards
Students: Mental Health and Resilience

Presenting Author: Giuliano Romano - Oakland University William Beaumont School of Medicine
Co-Authors: Stefanie Attardi - Oakland University William Beaumont School of Medicine
Jickssa M. Gemechu - Oakland University William Beaumont School of Medicine

As educators, it is essential to monitor the students' learning progress so that we can make adjustments to our teaching based on the class's evolving learning needs. While formative assessment provides feedback to the students so that they can make adjustments to their learning, it does not communicate to the teacher about the students' specific needs during the learning process. It is especially difficult to obtain this kind of feedback from students in large-group settings and for a comprehensive range of concepts. Using gross anatomy as a model, the aim of this work is to implement an efficient and convenient mechanism for the communication of students' progress to faculty and their peers. At Oakland University William Beaumont School of Medicine (OUWB), students (N=125) participate in self-guided full-body dissection laboratories (60 hours) in the first year curriculum. During each of four units, small groups dissect a list of structures (~300) on their donor, which will later be tagged on donors for identification-based practical examinations. While this format promotes peer communication and collaboration within the groups, in a large class setting it is challenging for the small faculty team to assist every group with finding every structure and to gauge their progression. To improve student-teacher communication regarding the progress and level of understanding of anatomical dissections, the anatomical structure checklists were built in Google Sheets, a free internet-based collaborative spreadsheet program. The checklists include a master structure list and a checklist for each dissection group (N=21) to complete in tandem with the dissection. Using Google Sheet formulas and App Script code, the total number of groups finding each structure will be calculated, and a list of groups that found each structure will be generated. Implementation of these checklists will provide clarity to faculty about which structures students are struggling to find, which will aid the design of targeted supplementary resources unique to that class year. Secondarily, it will enable students to study more efficiently by quickly identifying which donors have structures that they have not found and improve the efficiency of pinning structures by faculty for examination purposes. These checklists will be implemented in the anatomy laboratory and have the potential to be utilized across multiple disciplines during large group teaching involving a large breadth of content.

Categories: 
Students: Learning Resources
Teaching: Active Learning

Presenting Author: Mondel George - St. George's University
Co-Authors: Oke-Oghene Philomena Akpoveso - All American Institute of Medical Sciences, Jamaica
Venkat Venkataraman - Rowan-Virtua School of Osteopathic Medicine

The medical curriculum is undergoing significant changes especially over the last several years. One such change is the emphasis on scholarly activity. While different definitions of scholarship do exist, the emphasis is unmistakable. Boyer's pivotal work lays out the 4 components of scholarship: discovery, integration, application, and teaching. For undergraduate medical education, it is gaining even more importance as many board exams move to "pass/not yet" results; at the same time, it also creates a deep divide between Institutions that have an established infrastructure of and resources for scholarship and those that do not. At the student level, is there a willingness to engage in the additional challenge posed by scholarship activities? At the educator level what are the resources available and is there guidance and training towards best practices? The three of us were grouped together to generate a research question during the Medical Scholarship session at the recent IAMSE meeting and had met for the first time. We felt that examining the student perspective on scholarly engagement was worth probing. That we were representing three different institutions - both culturally and geographically - was an added incentive. We have chosen the lens of the self-determination theory (since motivation is an inseparable component of scholarly pursuits) to examine student engagement in scholarly activities. At our institutions, we are assessing the student's perspective on the intrinsic factors (student qualifications, experience, drive) and extrinsic factors (curriculum design, infrastructure, resources provided etc.) that contribute to their self-determined level of engagement in scholarship. We would like to share our approach and the first set of findings from the literature as well as our own studies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863137/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546601/ https://eric.ed.gov/?id=ED326149

Categories:
Students: Professionalism
Students: Distinctiveness for Residency With Pass/Fail Boards

Presenting Author: Micah Trautwein - Geisel School of Medicine
Co-Authors: Evie Marcolini - Geisel School of Medicine

Introduction
Narrative ethics relies on the idea that we can gain ethical insight from stories and experiences, rather than rules or constructs alone. Just as understanding experiences, values, and stories of our patients can build trust and help guide shared medical decision-making, so listening staff members' stories can build trust, improved lines of communication, understanding of the challenges, and in the end, better patient care.

Methods
A qualitative study was conducted using a semi-structured guide, with the goal of listening and gaining understanding of current clinical team dynamics and support networks in order to broaden perspectives and connections across roles. Participants were recruited by department-level messaging as well as the snowball effect. Interviews occurred in a private setting, were recorded and transcribed verbatim. 30 one hour-long interviews were conducted. Audio clips taken directly from the interviews were recorded to highlight individual experiences that reflect broader themes that emerged. Member checking for accuracy and participant autonomy occurred prior to public sharing of any information.

Results
Breakdown in communication was the most frequently mentioned challenge. Other challenges include staffing, physical safety, lack of mobility, uncertainty, and emotional burden of work. Staffing is a challenge on multiple levels, not enough physical bodies to do the work but also lack of experience within the remaining workforce. One of the major frustrations of low staffing is inability to match patient needs or provide optimal care. Fear of physical harm stemmed from societal-level issues, equipment failures, not enough staff, and harm caused by patients, both intentional and unintentional. As for mobility, several felt there was little opportunity to learn or grow in the workplace. Uncertainties described range from possibility of losing job to not knowing work assignment, from unknown patient outcomes to not knowing who to turn to. Four major ways that people feel valued emerged. 1. People showing up. An interviewee felt supported when their supervisor came and worked a lower role in order to keep everything running as smoothly as possible. 2. Being listened to sends the message that both the individual and their words matter. 2. Being acknowledged. One engineer described that being thanked directly after completing a job was much more gratifying than receiving a chocolate or catered lunch. 4. Someone being willing to share knowledge. When sharing how a doctor taught her about a procedure, a tech explained, "Knowing why you do something and having someone explain that to you makes a huge difference."

Discussion
One surprising finding was the amount of impact physician actions and words have on other team members. This finding feels discordant with the small amount of time medical students, soon to be doctors, learn about and from the wide range of roles that together facilitate patient care.

Categories:
Students: Professionalism
Students: Learning Resources

Presenting Author: Catarina Vale - Florida International University Herbert Wertheim College of Medicine
Co-Authors: Maria Camas - Florida International University Herbert Wertheim College of Medicine
Ligia Perez - Florida International University Herbert Wertheim College of Medicine
Jenny Fortun - Florida International University Herbert Wertheim College of Medicine
Diego F. Niño - Florida International University Herbert Wertheim College of Medicine

Background
Flipped classrooms are a pedagogical approach in which students learn course material outside of class and then use class time for active learning activities. The preparatory phase of flipped classrooms is often supported by a variety of resources, including textbook readings, pre-recorded lectures, and online learning modules. However, the effectiveness of different preparatory resources in flipped classrooms has not been well established. We hypothesized that using an interactive multimedia online learning module (OLM) enhances content retention and academic performance compared to text or a pre-recorded lecture.

Methods
Three flipped classroom sessions focused on cardiovascular physiology were developed for a first-year medical curriculum, each with a different type of preparatory resource. We used pre- and post-tests, readiness quizzes, and performance on NBME course examinations to assess knowledge retention and academic performance. We also collected student perceptions of the different preparatory resources using an end-of-course feedback survey.

Results
Initial learning of the material using text (p<0.01) and an OLM (p<0.01) was effective as demonstrated by the increased performance in pre- and post-tests, as opposed to using a pre-recorded lecture (p=0.102; paired t-test). Analysis of academic performance found a significant difference in readiness quiz scores between preparatory resources (F (2, 246) = 3.034, p =0.05, n=125), with readiness quiz scores for text (-0.132(95% CI, .01 to .253)) 1.14 points lower than online module (Bonferroni) on a 10 point-scale quiz. Average class performance on combined NBME midterm and final exam questions mapped to each session and its preparatory materials was 91% for text, 90.2% for OLM and 73% for pre-recorded lecture. Student survey responses (n=86) indicated a strong preference for audiovisual resources over text.

Conclusions
Our findings suggest that text preparatory resources are more effective for knowledge retention and academic performance in flipped classrooms than audiovisual resources. However, students generally prefer audiovisual resources. These findings will help instructors to make informed decisions about the type of preparatory resources to use in flipped classrooms.

Categories:
Students: Learning Resources
Teaching: Active Learning

Presenting Author: Mary Bond - Augusta University/University of Georgia Medical Partnership
Co-Authors: Timothy Brown - UGA College of Pharmacy, AU/UGA Medical Partnership
Julie K Gaines - AU/UGA Medical Partnership
Janette R. Hill - UGA College of Education
Suzanne H. Lester - AU/UGA Medical Partnership

There is a need for medical students to become aware of and to use evidence-based medication reference mobile applications (MRMAs) so that as they move into clinical settings, they have the "habit" of using MRMAs to assist with information gathering and decision making, rather than relying on memory or non-evidence-based sources . This longitudinal study explores medical students' knowledge of MRMAs, the strategies that work well to help them learn to use MRMAs, and to track over time to see if medical students form the habit of using MRMAs in pre- and clinical settings. 

Methods
Current medical students and recent graduates of the 4-year AU/UGA Medical Partnership were surveyed at the start of AY 22-23 about their baseline knowledge and use of MRMAs. Throughout AY 22-23, all students were surveyed regarding their use of MRMAs immediately following patient care activities (real or simulated) that occur in the current curriculum. As an intervention, Year 2 students were explicitly taught the use of a MRMA app at the midpoint of the second year. All students will be surveyed on their use of MRMAs at the completion of AY 22-23.

Results
We plan to compare utilization of MRMAs by classes before and after the intervention in Year 2. At baseline, we expect the incoming Year 1 students to have minimal experience with these apps unless they possess prior healthcare experience, Year 2 students to have limited experience related to their early clinical experiences in Community and Population Health, and Year 3 and 4 students to have some experience related to their clinical clerkship rotations. We expect utilization to increase in both the Year 1 and 2 students after the intervention and yearly thereafter.

Conclusions
We hope to see increased awareness of and usage of MRMAs after a formal intervention in Year 2 and with repeated opportunities in clinical settings available in Years 1-4.

Categories: 
Students: Learning Resources

Presenting Author: Thomas Thesen - Geisel School of Medicine at Dartmouth
Co-Authors: Karen Blackmon - Brain & Mind Institute Aga Khan University
Matthew Duncan - Geisel School of Medicine at Dartmouth
Abigail Konopasky - Geisel School of Medicine at Dartmouth
Wesley Marrero - Thayer School of Engineering, Dartmouth College

The escalating mental health crisis among medical students is often met with generalized solutions that overlook substantial variations between individuals that can affect mental health outcomes. Furthermore, an exclusive focus on mental illness tends to overshadow the necessity of fostering the positive aspects of medical trainee well-being. In this Lightening Talk we will introduce a novel, data-driven precision well-being approach for medical education that is built on a more comprehensive and individualized view of mental health.

Methods
Our approach to precision well-being centers on categorizing medical students into distinct and meaningful groups based on their holistic mental health by fusing concepts of mental illness with those from positive psychology, enabling the future development of tailored wellness support and interventions. We applied k-means clustering, an unsupervised machine learning technique used in precision medicine, to uncover patterns within multidimensional mental health data of medical students. Using data from 3,632 medical students, we formulated our clusters based on recognized metrics for depression, anxiety, and flourishing.

Results
The k-means cluster analysis identified three distinct clusters, each demonstrating unique patterns along the mental health spectrum. Clusters were reviewed for meaningfulness and labeled by a board-certified psychiatrist. Students in the "Healthy Flourishers" cluster expressed no signs of anxiety or depression and simultaneously reported high levels of flourishing, while students in the "Getting By" cluster reported mild anxiety and depression and diminished flourishing. Nearly half (49%) of the medical students surveyed were classified as 'Healthy Flourishers', whereas 36% were grouped into the 'Getting-By' cluster and 15% were identified as 'At-Risk'.

Discussion
The findings show that a substantial portion of US medical students report diminished well-being during their studies, with a significant number struggling with mental health challenges. This precision well-being framework represents an integrated empirical model that classifies individual medical students into distinct and meaningful well-being phenotypes based on their holistic mental health. The precision well-being approach has direct applicability to student support and can be used to monitor students' transitions between clusters, determine influencing factors, form individual risk profiles, and evaluate the effectiveness of personalized intervention strategies stratified by cluster membership.

Categories: Students: Mental Health and Resilience

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: 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: Kaitlyn Chalfant - Oakland University William Beaumont School of Medicine
Co-Authors: Brianne Lewis - Oakland University William Beaumont School of Medicine

Medical educators need to ensure that the basic needs of their learners are met, so that they can flourish and learn effectively. While medical schools have made diversity and inclusion a part of their missions, caregiving students still feel invisible to their institutions.1 Caregiving includes the care of a child or a friend or family member with a disability or chronic illness. Approximately 3% of medical school matriculants have a dependent, and 7% have a dependent at the time of graduation.2,3

This is in contrast to the number of undergraduates who have children which is estimated at 22%4,5 indicating a possible delay in familial goals. Medical students may also be faced with a caregiving role outside of parenting, such as caring for another family member. 6,7 Students with caregiving roles are more likely to be impacted academically or mentally.6 Further, they are more likely to be economically disadvantaged.6

It is currently unknown how to best support this invisible student group and how many are impacted by caregiving status during medical school. To begin this work, we assessed how medical students in the U.S are currently supporting their student caregiver population.

To evaluate the current caregiver support in medical schools, we conducted a review of AAMC medical schools from January-April 2023. We searched publicly available websites from the medical school and university. The data was extracted from each website and coded iteratively. Final data was calculated as a percentage of the number of schools reviewed (N=170).

Our analysis indicates that 48% of AAMC medical schools have at least one resource for parents, but fewer have any resource for other caregiver types (6%). The most common resources were on campus- childcare (29%) and lactation rooms (30%). Some schools offered support groups (21%). Other resources (<10%) included family study spaces, changing stations, pregnancy resources, and therapy. Support groups as a resource were either run by the students or the institution in-person or as an online forum. Pregnancy resources were minimally observed (5%). Few institutions had more robust support for parents such as housing or therapy support (<3%). Of the 6% of medical schools that had a resource for other caregiver types, it included support groups or counselors or an option of a parental or caregiver rotation option.

One limitation of this study is that we did not evaluate the efficacy of these programs. However, we hope that this work provides a foundation for further research on students with caregiving roles.

Next, we could only screen publicly available information, so resources may be undercounted. Future work should aim to assess the efficacy of current resources, identify the impact of caregiving on medical students and increase the support of caregivers in medical schools.

Categories: 
Students: Mental Health and Resilience

Presenting Author: Stephanie Neary - Medical University of South Carolina 
Co-Authors: Benjamin Doolittle - Yale University
Susan Newman - Medical University of South Carolina
Michelle Nichols - Medical University of South Carolina

Purpose
To conduct an integrative review of the drivers and barriers to flourishing for clinical health professions students in the literature through the lens of the Social Ecological Model (SEM).

Method
The authors analyzed articles in Scopus, PubMed, and EBSCOHost, as well as hand-searched education journals, through September 2022 describing flourishing (inclusion of variations of flourishing, thriving, and eudaimonic well-being) among clinical health professions students. Whittemore and Knafl's integrative approach was used to conduct the methodical review and each article was assessed using the Mixed Methods Appraisal Tool.

Results
Of the 18 articles, 15 (83.3%) were published since 2020. Articles included medical (10/18, 55.6%), pharmacy (5/18, 27.8%), physician assistant (2/18, 11.1%), and nurse anesthetist (1/18, 5.6%) students. Results were framed by the Social Ecological Model and focus areas pertaining to the drivers and barriers for the intrapersonal, interpersonal, and organizational levels were elicited; no articles addressed community or policy level factors. Meaningful patient interactions and pride in overcoming challenging academic cases were key drivers of individual flourishing. However, performance is largely tied to personal identity which leads to trading personal wellness for academic achievement. Student belongingness and faculty buy-in drove flourishing while inflexible scheduling is a barrier to meaningful social engagements. There was a deficit in the exploration of the impact of race and/or ethnicity on flourishing despite the known discrepancies in burnout among underrepresented students.

Conclusion
Students, faculty, and programs are co-creators of environments that promote or detract from flourishing. Educators can intentionally create learning environments that promote flourishing through increased student autonomy, intentional promotion of community-building activities, and the development of individual values in the context of training. Flourishing is inter-related with the Social Determinants of Health and may be part of a diverse continuum of socioeconomic factors that affect students' individual well-being and performance through training.

Categories:
Students: Mental Health and Resilience

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: 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: Audrea Burns - Baylor College of Medicine
Co-Authors: Rebecca Blankenburg - Stanford School of Medicine
Oriaku Kas-Osoka - Kirk Kerkorian School of Medicine at University of Nevada Las Vegas
Candice Taylor Lucas - The University of California Irvine
Jyothi Marbin - University of California Berkeley
Patricia Poitevien - Warren Alpert Medical School of Medicine at Brown University
Laura Kester Prakash - University of California Davis
Alan Schwartz - University of Illinois at Chicago
Lahia Yemane - Stanford School of Medicine

Background
Underrepresented in medicine (URM) physicians comprise less than 10% of academic faculty in U.S. medical schools. Although burnout, poor sense of belonging and lack of professional fulfillment may be associated with this, few studies explore experiences with discrimination in residency and plans to pursue academic pediatric careers among URM residents.

Objective
To explore associations between pediatric residents' experiences with discrimination and burnout (interpersonal disengagement and work exhaustion), belonging, sense of professional fulfillment, and interest in a) a career in academic medicine and b) staying at their institution.

Design/Methods
In October 2020-January 2021, we conducted an IRB-approved multi-site cross-sectional PROMISE (PROmoting Med- Ed Insight into Supportive Environments) Study. The 23-item web-based survey was distributed to pediatrics and med-peds residents through the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN). This study explored categorical pediatric resident responses assessing frequencies and means in descriptive analyses, and associations using fixed effects regression models in adjusted analyses.

Results
29 residency programs; 931 total residents (19% URM, 21% Asian); 800 categorical pediatrics (20% URM, 21% Asian). URM residents were more likely to experience discrimination when compared to White residents. (See Table 1) Trainees who experienced racial discrimination by staff had increased interpersonal disengagement (p=0.02), increased work exhaustion (p< 0.01), and decreased professional fulfillment (p=0.044). In adjusting for discriminatory experiences, URM (p< 0.01) and Asian (p=0.01) trainees still reported lower sense of belonging. Also of note, when controlling for interest in staying at institution, gender, and URM status, residents who reported greater belonging also reported greater interest in staying at their institution (B(Confidence Interval): 0.46(0.34-0.57); p< 0.001).

Conclusion(s)
URM and Asian pediatric residents reported experiencing more racial discrimination and a lower sense of belonging during residency training. Programs that work to decrease incidents of racial discrimination and improve sense of belonging may enhance professional fulfillment for URM and Asian residents and have more success in retaining URM and Asian residents for fellowship and faculty positions. Further study is needed to understand and address trainees' unique experiences with discrimination and its influence on burnout, belonging, professional fulfillment, and academic career goals.

Categories:
Students: Professionalism
Students: Mental Health and Resilience

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