Presenting Author: Liam McLoughlin - Rutgers New Jersey Medical School
Co-Authors: Jeremy Grachan - Rutgers New Jersey Medical School
George Holan - Rutgers New Jersey Medical School
Phoebe Li - Rutgers New Jersey Medical School

The Rutgers New Jersey Medical School (NJMS) anatomy curriculum primarily utilizes internal anatomy guides and supplemental podcasts created by the faculty that explain key learning topics and relevant clinical correlations for every anatomy session. These guides provide the foundation for the anatomy curriculum, which includes a small group discussion with clinical case vignettes and dissection of human donors (i.e., cadavers). Student assessments include anatomy-specific individual and group quizzes, as well as integrated systems-based internal end-of-unit, NBME customized shelf, and anatomy practical examinations.

In addition to the anatomy guides and podcasts, students have access to the course textbooks through the institution's online library. Students also incorporate supplemental materials (e.g., online videos, third-party question banks, NJMS student-created slideshows and Anki cards) as they work to gain a foundational understanding of the anatomical content. While the curriculum provides students with many resources, students can individualize how they want to learn anatomy by engaging with the different resources in the ways that work best for them.

Preliminary data revealed that most students use the internal guide created by the anatomy faculty and do not commonly use the recommended course textbooks. In addition, students are utilizing third-party resources when preparing for anatomy discussions and assessments, including but not limited to Anki cards designed by previous NJMS students and other online videos. This study explores how NJMS students prepare for anatomy small group learning and assessments as well as its effect on their academic performance. Surveys will be utilized to identify the resources students used to prepare for the discussions and assessments, which will then be compared with their performance on assessments. The goal is to identify the materials students utilize to learn and prepare for the anatomy curriculum, assess the effectiveness of the materials, and utilize this data to augment further strategies to enhance student learning.

Categories:
Teaching: The Death of Textbooks

Presenting Author: Sherita Love - Baylor College of Medicine
Co-Authors: Travis Kelleher - Baylor College of Medicine
Nancy Moreno - Baylor College of Medicine
Malford Tyson Pillow - Baylor College of Medicine

Purpose
The Center for Teaching and eLearning, delivers active-learning workshops in support of active-learning curriculum across the degree-granting programs and schools at Baylor College of Medicine. As instruction across programs and schools shifts away from didactic lectures to a more student-centered participatory-learning approach, educators need professional development in active learning and technology integration, as well as a safe place to experience and practice delivering active-learning instruction. The Collaborative Interactive Learning Lab was proposed, developed, and created in response to these needs.

Methods
The Center for Teaching and eLearning hosted focus groups to gather attitudes and needs for the development of the learning lab. Focus group attendees included stakeholders from both academic branches (educators and administrators), academic technologies (staff and leadership), and clinical faculty. During the focus group, attitudes and needs were discussed and gathered, and the learning lab was designed and developed based on the feedback received.

Results
Based on the information gathered from the focus group, the following themes emerged: 
•Theme 1: Experience & Explore Enable BCM faculty and other course instructors to experience and practice integrating new, innovative technologies through educator professional development opportunities and vendor demos. 
•Theme 2: Connect, Partner, and Support Serve as a collaborative space for faculty consultations, walk-in support, and Studio One, a self-service video recording studio available to all faculty) connecting instruction at the Temple campus. 
•Theme 3: Communicate and Showcase Faculty Work: Provide a platform for showcasing and disseminating innovative faculty work. 
•Theme 4: Discover, Develop, Improve & Integrate Serve as an incubator and research space for the integration and utilization of innovative teaching strategies and academic technologies.

The learning lab opened in April 2022. Since then, over a hundred Active Learning Professional Development and Teaching with Innovative Learning Technologies workshops have been conducted by the Center for Teaching and eLearning. The Center has received positive feedback from educators who attend workshops within the Collaborative Interactive Learning Lab, most notably around the adaptable technology, room layout, and flexible seating. The technology used in the learning lab is also being tested by academic technologies for enterprise-wide adoption in the classrooms and best practices for technology integration in support of active learning. 

Conclusions
Active-learning strategies increase learner outcomes, and a flexible classroom environment is an important component of delivering active learning instruction. Based on the initial feedback, we hope to continue to develop the learning lab and establish formal feedback loops between academic and technology departments

Categories:
Teaching: Active Learning

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: Bruce Wright - Lake Erie College of Osteopathic Medicine 
Co-Authors: Elisabeth Frieda Maria Schlegel - Western Atlantic University School of Medicine

Integration is defined by Ronald Harden as "the organization of teaching matter to interrelate or unify subjects frequently taught in separate academic courses or departments'' (1). As outlined in the 11 steps of the integration ladder (2), close collaboration between subject experts results in joint teaching, whereby new content is not only introduced but also applied and contextualized. Team teaching (or co-teaching) is an effective educational approach by which the knowledge and expertise of two or more educators complement the learning process and model interdisciplinary discourse and application. Usually representing basic and clinical sciences, this integration can improve diagnostic skills in early learners, underscore the scientific underpinnings of medicine, and stimulate knowledge transfer (3). However, recent studies cite challenges such as a disconnect between discipline-specific learning objectives LOs, a disjointed flow of these objectives, or the lack of coordination in its execution. We present a new approach to educational integration in undergraduate medical education: micro-integration. This novel concept involves sharing LOs from creation through execution. It offers the dual advantages and benefits of deliberate co-teaching and contextualizing of several LOs within individual active teaching sessions. Further, just-in-time (JiT) medical education and answering students' questions from individual experts are possible within the same session, which optimizes access to knowledge and learning. Thus, experts from different but complementary disciplines can immerse learners in basic and clinical aspects of the same topic. We demonstrate how micro-integration can be executed by illustrating shared LOs from different perspectives of two scientists (Physiology; Microbiology) and a clinician at a workshop on the Basics of Neurotransmission and the Neuromuscular Junction. Pre-work, class session, and formative MCQs were developed in a coordinated fashion to accomplish the LOs. Overall, micro-integration as a new and timely approach to contextualized JiT medical education and deliberate co-teaching applies adult learning theory and extends attention spans. In addition, and as experienced by Willey and colleagues (2018; 4), when instructors converse and listen to each other and students, they become model learners in a way that is impossible for solo teachers. Thus, combined with a flipped-classroom framework, micro-integration can be an effective strategy for deliberate collaborative teaching in undergraduate medical education.

(1) Harden et al. (1984). Educational strategies in curriculum development: The SPICES model. Med Educ. (2) Harden, R. M. (2000). The integration ladder: A tool for curriculum planning and evaluation. Med Educ. (3) Ginzburg et al. (2015). Integration: A strategy for turning knowledge into action. Medical Science Educ. (4) Willey et al (2018)

Categories:
Teaching: Active Learning
Teaching: Team Teaching

Presenting Author: Matthew McMillin - Baylor College of Medicine
Co-Authors: Stephen Charles - Baylor College of Medicine
Stephanie Richardson - Baylor College of Medicine
Sherita Love - Baylor College of Medicine

Purpose
Baylor College of Medicine (BCM) is establishing a Temple regional campus requiring a shift in how medical education sessions will be delivered between campuses. BCM is also adopting a new medical education curriculum that will emphasize active learning sessions. To achieve effective large group active learning sessions between campuses, various technologies were evaluated to determine the best methodology to deliver content and promote student engagement.

Methods
Active Learning Strategies and Backward Design (Learning Objectives and Assessments) guided the initial evaluation and recommended selection of academic technologies. Consultations with academic technology leadership, School of Medicine Deans, the Center for Teaching and eLearning, and the Department of Education, Innovation and Technology were conducted. Based on those discussions, recommended educational tools were discussed, evaluated, and their relative effectiveness was determined by multiple criteria. These included the ability to work with currently supported existing academic technologies, the information technology infrastructure, the capability to accommodate under 500 students between multiple campuses, and cost.

Faculty ease of use and integration in the delivery of active learning was also a criteria.

Results
For the delivery of content between BCM Houston and BCM Temple, Zoom was the tool designated to ensure a stable connection between campuses and was easily usable for both students and faculty when compared to Microsoft Teams. While a variety of tools were evaluated, Poll Everywhere was designated as an effective tool to promote active learning due to its ability to be incorporated into Microsoft PowerPoint, which was familiar to content developers. The ability of Poll Everywhere to be flexible, such as having the ability to use word clouds, multiple choice questions and open-ended answers, in addition to showing the results live, made this tool effective. Other improvements were upgrading to better designed camera and microphone systems at both sites so that when students asked questions or shared out, they would be able to be seen and heard by students at the other campus, which promotes engagement and active learning.

Conclusions
Careful evaluation of educational technology is necessary to determine the best tools and solutions to promote effective learning. For BCM, the incorporation of Zoom, Poll Everywhere, and upgraded microphones and speakers allowed for improved simulated active learning sessions. We will validate these preliminary results with the incoming students this fall.

Categories:
Teaching: Active Learning

Presenting Author: Andrea-Nicaise Bikay - American International University of West Africa
Co-Authors: Tambe Priscilla Bessem-Enow - American International University of West Africa
Deva Kumaran Mohan - All American Institute of Medical Sciences
Dhilip Dhamodharan - All American Institute of Medical Sciences
Oke-Oghene Philomena Akpoveso - All American Institute of Medical Sciences

In comparison to passive lectures, active learning is suggested to improve student retention and depth of understanding. For effective implementation of active learning methods, the students are encouraged to attain a level of self- study skills. However, in a multilingual context, there might be a need to modify these active learning sessions to enhance student learning. This preliminary study describes how TBL and active learning sessions were modified to encourage student engagement in a multilingual context. Cardiovascular and Respiratory Pharmacology was taught in an integrated curriculum to the same cohort of students for 10 weeks. There were 17 students in this cohort. The majority of them spoke Hindi and English (as a second language), and one of them was Jamaican (a fluent English speaker).

In the Cardiovascular pharmacology sessions, in-person 1hr lecture sessions of the concept on preassigned readings were taught. Afterwards, 5-10 open book Individual Readiness Assessment Tests (RATs) where performed within 24hrs. RATs were designed to require some level of application. The following day, the students were split in groups of 4-5 and Team RATs were performed with the same questions. The lecturer gave further explanation for questions with high failure rate after TRAT assessment. In the same day, application cases were given to the students to discuss. The sessions ended with a randomly selected group telling the whole class their answers. These answers were assessed by the class with input from the lecturer. The Respiratory pharmacology classes were 90 min lecture sessions. They consisted of an initial overview of the concepts with dedicated time slots in which the students provided individual written or oral answers to case-based questions. The lecturer with the class, analyzed the answers that contained misconceptions. The lecturer referred to related information from pre-assigned text for clarification.

After 10 weeks, the students wrote compulsory final examinations based only on Multiple-choice questions (MCQ). Six weeks after the final examinations, new MCQs and Short answer Questions (SAQs) on the topics taught in both Respiratory and Cardiovascular pharmacology were generated; and the same students were re-tested.

The data showed no difference in average score between final exam grade and MCQs re-test score. The students do not write SAQs in their final examinations. However, the average score of SAQs in Cardiovascular Pharmacology and Respiratory Pharmacology was compared. The data showed that, students scored higher in Respiratory pharmacology SAQs (47.6% + 20) compared to Cardiovascular SAQs (31.5% + 20). Taken together, the data suggests that retention and in-depth learning may occur with both teaching methods. Also, feedback from the students on their perspective of both teaching methods suggests, that a mixture of didactic and active learning/ teaching methodologies enhances learning, for multilingual students

Categories:
Teaching: Active Learning
Teaching: Team Teaching

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: 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: Joanna Appel - University of South Carolina School of Medicine, Columbia
Co-Authors: Kevin LaFleche

At many institutions, the foundational sciences have traditionally been delivered as lecture-based courses within preclerkship curricula. In line with evolving pedagogical theory & approaches, there has been a shift towards incorporating more active learning elements & evidence-based teaching methods into the curriculum, including offering more flipped learning opportunities. In a flipped learning environment, students are provided with material to review and study prior to attending an in-person scheduled class session (pre-work). In-class, the instructor facilitates active learning opportunities to promote learning & application at higher levels upon the Bloom taxonomy of learning. Studies show that students who complete assigned pre-work before an in-person learning session perform better in a course than those who do not, yet motivating students to complete assigned pre-work in advance has been identified as a significant challenge in the flipped classroom.

One common mode of delivery for pre-work in the flipped classroom is via pre-recorded lecture content. The format, duration, and design of pre-recorded lectures varies widely across disciplines, depending almost entirely upon the determination of the instructor. Within the literature, reports regarding most effective design methods for pre-recorded lectures vary, with little evidence linking characteristics of pre-recorded lectures with student motivation to complete the recordings before an in-person learning session or the overall effectiveness of pre-recordings in delivering course content and preparing students for an in-person learning session. We sought to address these questions by examining the experiences of students at the University of South Carolina School of Medicine, Columbia following their encounters with pre-recorded lecture content. Preclerkship medical students who had been assigned a series of pre-recorded lecture content as a component of the curriculum were invited to participate in semi-structured focus group interviews to discuss their experiences with pre-recorded lecture videos and the subsequent in-person learning sessions. Interview transcripts were analyzed to identify factors that motivated students to view pre-recorded lecture content in advance as well as factors that impeded their ability to do so. We hope that other educators may use this information to optimize the design and delivery of the flipped learning environment.

Categories:
Teaching: Active Learning
Teaching: Synchronous Versus Asynchronous Learning

Presenting Author: Orla O'Donoghue - New York University Grossman Long Island School of Medicine
Co-Authors: Sandra Yingling -New York University Grossman Long Island School of Medicine
Jeannine Nonaillada - New York University Grossman Long Island School of Medicine
Judith Brenner - New York University Grossman Long Island School of Medicine
Gladys Ayala - New York University Grossman Long Island School of Medicine

Background
The effectiveness of Active Learning (AL) in both UME and GME has been elucidated in many recent studies. Two initiatives were implemented at our institution (medical school and teaching hospital) over a 6-month period to increase instructor inclusion of AL strategies across UME and GME settings.

Aim
To implement initiatives promoting the use of AL strategies by instructors across UME and GME in a single institution.

Methods
Two initiatives were implemented over a 6-month period promoting the use of AL. 1) One-hour workshops increasing AL awareness and benefits, capturing current use by participants, and increasing exposure to strategies via experiential learning (GME faculty n=20, faculty development program educators n=6, residents n=9 in OB/GYN and n=12 in Surgery). A survey was conducted on participants' current use of AL and challenges of implementation. Benefits of AL were shared and participants were immersed in at least five AL strategies within the session. 2) Five 10-minute AL spotlight sessions were implemented within pre-clerkship and clerkship faculty meetings providing a platform for faculty to share and build upon existing AL strategies. A template was created for faculty to share their AL strategies and their impact on teaching and student learning. Faculty development program educators provided narrative feedback informally, results of which were collated.

Results
100% of surveyed workshop participants reported using AL in teaching sessions (GME faculty n=20, faculty development educators n=6). However, only 5% of GME faculty and 17% of the faculty development program educators use it in all of their teaching sessions and 65% of workshop participants use AL in just 50% or less of their sessions. The major AL challenges perceived were learner participation (42% of participants) and time (31% of participants). Other challenges included choosing a method, accessing creativity, and overcoming logistics related to space and equipment. Preliminary feedback received from faculty and residents on both the AL workshop and spotlight initiatives was overwhelmingly positive. Participants stated how "informative and stimulating" the workshops were and that they "learned a lot from the session". There was feedback about how much the residents "loved the sessions," and requests for additional resident and faculty AL sessions.

Conclusion
The implementation the AL workshops and spotlights suggest these initiatives were successful in both identifying the need for, and increasing the opportunity to, strengthening participant awareness of AL and its benefits, and expanding exposure to AL strategies at our medical school and teaching hospital. Further studies involve gathering and reviewing formal end of session evaluations from faculty and analyzing evaluations already collected from resident participants to ascertain the impact of these initiatives on promoting use of AL across UME and GME.

Categories:
Teaching: Active Learning

Presenting Author: Lisa Tshuma - A.T. Still University

Introduction
There is a tremendous need to expand integrated behavioral health (IBH) training in the current and future healthcare workforce in the USA. Many health professionals have not had the opportunity to learn about evidence-based IBH delivery models or participate in related quality-improvement (QI) projects. To address this need, an inter-professional community of practice network called the Integrated Care Alliance (The Alliance) was developed. The Alliance is a collaboration between a medical school, a dental school and 7 community health centers (CHCs) across the USA. It aims to support the professional development of integrated care teams at clinical training sites while increasing student opportunities to participate in IBH care delivery and QI projects during the clinical phase of training.

Approach
In 2019, a medical school partnered with 7 CHCs and a dental school to develop a community of practice network called The Integrated Care Alliance (The Alliance). The Alliance is a key component of a federally funded project aimed at improving integrated behavioral health services, opioid use disorder/substance use disorder prevention and treatment services and care-team wellness. It leverages evidence-based practices and the practical expertise of broad network of interdisciplinary clinicians, administrators and faculty to enhance CHC services and provide students with integrated behavioral health and quality improvement training experiences. The Alliance meets each quarter to collectively learn about a topic of interest. Topics are suggested by members. Prior to each meeting the project's deputy director develops and distributes a primer presentation on the chosen topic along with at least one evidence-based resource and 5-7 round table discussion questions. The round table questions encourage Alliance members to prepare questions and identify best practices to share at the meeting.

Outcomes
The Alliance serves as an exemplar of the benefits of inter-professional collaboration and team-based integrated care. At inception in 2019, there were only 35 Alliance members. Membership has steadily grown to over 100 members in 4 years, with approximately 75 currently active members. Of the 17 Alliance meetings to date, approximately 50% have focused on IBH topics such as specific integrated care delivery models, tele-health, SBIRT, ethics, financial stability and oral health integration. The remaining meetings focused on wellness (25%) and substance use disorder integration (25%) in clinical settings. Clinician membership is diverse with more than 14 different clinical disciplines represented. Physicians constitute nearly half of all members (49%), followed by licensed professional counselors (12%), psychologists (10%), midlevel providers (NP/PAs) 7% and licensed clinical social workers 7%). This presentation discusses a replicable model to advance health professions education by harnessing our strength in numbers.

Categories:
Curriculum: Curricular Innovations
Teaching: Active Learning

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: Doug Miles - University of Hawaii John A. Burns School of Medicine

The ability to perform a useful neurological exam and the ability to understand the findings of the exam are chalenging skills for medical students to acquire. Medical students throughout the US perform worse on average in the musculoskeletal and neurology clinical domains of their USMLE Step 2 Clinical Skills examination, compared to other physical exam domains.

At the University of Hawaii John A. Burns School of medicine, medical students learn neurology concepts in the first few months of their second year. This was considered an opportunity to teach the neurological exam.

Using commercially available 3D software, several videos were developed to allow students to visualize the exam of patients from their problem-based learning (PBL) cases. During the cases, rather than simply reading a textual account of a patient's neurological exam, students view the neurological exam and are asked to identify any significant findings, and interpret their significance. On the following page, student are then shown the expected interpretation of the neurological exam.

Student feedback gathered during the post-course survey was largely positive, and encouraged including these videos in more PBL cases. Current work is focused on generating videos more efficiently, and producing animations for additional PBL cases. The use of animated neurological exam videos in assessments is also planned.

Categories:
Teaching: Active Learning

Presenting Author: Jeremy Grachan - Rutgers New Jersey Medical School
Co-Authors: Sophia Chen - Rutgers New Jersey Medical School
George Holan - Rutgers New Jersey Medical School
Christin Traba - Rutgers New Jersey Medical School
Abhishek Yadav - Rutgers New Jersey Medical School

Anatomy educators who teach in medical school curriculums in the United States come from a wide spectrum of educational backgrounds. These include basic scientists from disciplines such as anatomy, cell biology, neuroscience, and anthropology as well as a variety of clinical professions. Rutgers New Jersey Medical School utilizes an interdisciplinary team approach to teach anatomy to pre-clerkship medical students. The primary anatomy teaching team includes three full-time anatomy educators: a physical therapist, a medical doctor, and an anatomist. The primary teaching team also utilizes near-peer support with a postdoctoral medical fellow and fourth-year medical students. The team is often expanded to include clinicians from surgery, orthopedic surgery, and physical medicine and rehabilitation. Every anatomy educator brings a unique perspective to help the students master the content for unit exams and integration into their clinical profession.

The NJMS anatomy curriculum is a multi-staged approach starting with small group discussions followed by a traditional small group lab dissection using human body donors. During small group discussions, students review an internal anatomy guide of key learning topics and discuss relevant clinical correlations for each session. They also work through clinical cases and complete individual and team summative assessments before completing the respective dissection. These groups meet in a large room so they can engage with the entire team of anatomy educators during their discussions and to help answer their questions. In the dissection lab, this team expands to include medical residents and clinical faculty from the respective areas of medicine related to that dissection. The expanded anatomy teaching team allows students to discuss the anatomical content in a clinical context and provide them with potential mentors to help guide them through medical school. This talk will highlight our interdisciplinary team approach to teaching anatomy in a systems-based block curriculum, as well as share preliminary data from the surveys and students' end-of-unit evaluations. This data will help guide adaptations to our team approach, including whether we should continue to use this expanded interdisciplinary team approach and provide guidance for other medical schools as they consider team-teaching in the basic sciences.

Categories:
Teaching: Team Teaching

Presenting Author: Serine Torosian - St. George's University, School of Medicine
Co-Authors: Samantha Wehsener - St. George's University, School of Medicine, Grenada
Vanad Mousakhani - Frank H. Netter MD, School of Medicine
Gabrielle Walcott-Bedeau - St. George's University, School of Medicine, Grenada
Vineeta Ramnauth - St. George's University, School of Medicine, Grenada

Background
The use of virtual reality (VR) training in areas with high-stake outcomes, such as the military, aviation, and medicine, prepares individuals for perilous scenarios within a safe and controlled setting. This review article aims to investigate the application and effectiveness of VR technology during preclinical medical education.

Method
A systematic review following the PRISMA guidelines was conducted in May 2023 using the PubMed and Scopus databases and search terms "medical education", "preclinical" and "virtual reality". All relevant studies were screened and collated by two independent reviewers.

Result
The search resulted in 10/25 (40%) articles meeting the criteria for inclusion. There were articles on medical (n=7), dental (n=2), and physician-assistant (n=1) preclinical medical education. A statistically significant improvement in student performance and self-efficacy was shown in 78% (n=7/9) of the studies. There was high student satisfaction reported with the use of VR as a supplemental studying tool (67%, n=2/3). Only one study (33%, n=1/3) showed students were dissatisfied because of the limitations of the technology.

Conclusion
Virtual reality technology promises an improved and immersive experience for learners. Since its first introduction, there has been a growing interest in a positive change in attitude towards the use of VR during education. With continued improvements in technology, it is important to explore the potential for enhancing medical training during the early preclinical years. VR allows students to study anatomical structures that are difficult to visualize on traditional cadavers. It provides animation and visual guides for the easy learning of abstract topics. Additionally, VR simulated learning provides a safe environment, e.g., during Objective Structured Clinical Examinations, allowing students opportunities to practice their clinical reasoning and skills. While VR may not fully replace traditional lectures, it has the potential to surpass the usefulness of textbooks for our future medical learners.

Categories:
Teaching: The Death of Textbooks
Artificial Intelligence in Health Professions Education

Presenting Author: Chasity O'Malley - Wright State University Boonshoft School of Medicine
Co-Authors: Lindsay Benedik - Wright State University Boonshoft School of Medicine
Jeannette Manger - Wright State University Boonshoft School of Medicine
Michael Matott - Wright State University Boonshoft School of Medicine

The decision to delay taking Step 1 is a significant one that could impact a student's timeline through medical school; however, the negative impact of taking Step 1 and failing is arguably much greater. Although the shift to active learning modalities and the removal of the numeric Step 1 score should in theory be working in tandem to promote student success and lifelong learning attitudes, it has also limited the ability of students to accurately gauge their learning and Step 1 readiness. Active learning, while a long established and well supported modality for student learning, is frequently perceived by students as feeling less like "being taught" (Tsang & Harris, 2016). To date, no study has examined the Step 1 delay trends in active and traditional learning or identified other factors that could influence Step 1 outcomes. This information may not only support active learning as a positive shift in medical education but could also inform interventions for students likely to delay or fail Step 1. 

In our study, we compare cohorts of students from entirely active learning based classrooms to a more traditional lecture-based approach in medical education in terms of Step 1 delay. In our analyses, we include student specific factors which may impact medical school outcomes such as matriculating MCAT scores, course performance, demographics, and advanced degree status, as well as curricular factors, such as the transition to an active learning curriculum and the COVID-19 pandemic and virtual learning. Pearson correlation efficient and Chi Square analysis were used, with a p-value <0.05 being considered significant.

Preliminary results suggest students' performance within a module on formative and summative assessments had a high correlation with Step 1 outcomes, indicating that strong performance in an active learning environment is associated with taking Step 1 on time with positive outcomes.

With this information, we expect to drive more targeted interventions for those students who are at risk of delaying Step 1.

Tsang, A., & Harris, D. M. (2016). Faculty and second-year medical student perceptions of active learning in an integrated curriculum. Advances in Physiology Education, 40(4), 446-453. https://doi.org/10.1152/ADVAN.00079.2016/ASSET/IMAGES/LARGE/ZU10041630370003.JPEG

Categories:
Teaching: Active Learning