Objectives The British Medical Association announced a successful vote towards industrial action to achieve ‘pay restoration’ on 20 February 2023; with 11 walkout periods occurring in the following months. During industrial action, concerns arose about the role medical students would play and the pressure placed upon them to ‘act up’. The objective of this study was to assess the guidance issued by medical schools and local placement sites during industrial action. Design, setting and participants This cross-sectional study collected online survey data between 7 March 2023 and 7 April 2023 from medical students across England. Main outcome measures Reports about guidance issued by medical schools and hospital placements. Results 62% of the medical schools issued guidance stating they were not cancelling clinical placements; of these, 10% said attendance was a personal choice. 17% of medical schools cancelled all clinical placements and 7% did not issue guidance. 52% of medical schools monitored attendance on strike days. 1 medical school and 3 clinical placement sites advertised paid work for students during the industrial action. Conclusion The impact industrial action has on medical students has not been examined. Our results show mixed guidance from medical schools that can contradict local placement guidance. This lack of guidance is mirrored in the existing, yet limited, literature. If students feel pressured to perform tasks outside their remit, with inadequate supervision, it can impact patient safety and their license to practice. For the safeguarding of patients, and students, further work is needed to produce standardised guidance during industrial action.

Background: The COVID-19 pandemic necessitated the transition of in-person examinations into virtual formats. As cases decreased, some examinations returned to in-person, while others remained virtual or instituted hybrid models. Virtual examinations offer benefits including decreased travel costs, and the opportunity to share examiners globally. We assessed a virtual trainee practice examination strategy and investigated perceptions and preferences regarding the virtual formats. Method: Ten ophthalmology residents from the Tennent Institute of Ophthalmology, Glasgow, Scotland, and the University of Arkansas for Medical Sciences, Little Rock, United States, participated in virtual mock oral exams conducted by two examiners. Examiners and examinees answered questions graded on a Likert scale to determine perceptions of the format. Results: Most examinees and examiners were satisfied or very satisfied with the overall examination, as well as the internet connectivity, video quality, and audio quality. The majority of examinees (70%) had either no preference or a preference for in-person examination. One examiner preferred the virtual format, and the other had no preference. Conclusion: Virtual oral examinations can be a feasible and effective alternative to in-person examinations. They have the added benefit of decreased travel costs and the ability to share examiners amongst institutions to replicate a more realistic examination experience for trainees.

Purpose The Instructional Materials Motivation Survey (IMMS) was developed to measure motivational characteristics of a learning activity, building on Keller's Attention, Relevance, Confidence, Satisfaction (ARCS) motivation model. We aimed to validate IMMS scores using validity evidence of internal structure and relations with other variables. Methods Participants were internal medicine and family medicine residents who completed the IMMS following an online module on outpatient medicine, from 2005 to 2009. We used confirmatory factor analysis (CFA) to examine model fit using half the data (split-sample approach). Finding suboptimal fit, we conducted exploratory factor analysis (EFA) and developed a revised instrument. We evaluated this instrument with CFA using the remaining data. Associations were evaluated between IMMS scores and knowledge and other measures of motivation (Motivated Strategies for Learning Questionnaire, MSLQ). All analyses accounted for repeated measures on subjects. Results There were 242 participants. Although internal consistency reliabilities were good (Cronbach alpha ≥0.70), CFA of the original 36-item, 4-domain instrument revealed poor model fit for data sample 1. EFA found that reverse-scored items clustered strongly together. Further EFA using data sample 1, followed by CFA using data sample 2, found good fit for a 13-item, 4-domain model that omitted reverse-scored items (standardized root mean square residual 0.045, root mean square error of approximation 0.066, comparative fit index 0.96). Linear regression confirmed positive, statistically significant associations for most hypothesized relationships, including IMMS total with knowledge (r=0.19) and MSLQ total (r=0.53; both p<.001). Examination of reverse-scored items suggested participant inattention but not acquiescence. Conclusions IMMS scores show good reliability and relations with other variables. However, the hypothesized and empirical factor structures do not align, and reverse-scored items show particularly poor fit. A 13-item, 4-domain scale omitting reverse-scored items showed good model fit.

Background Most studies on palliative medicine (PM) undergraduate education have focused on contents and organizational issues but not the outcome. Students’ learning outcomes should be studied to improve teaching in medical schools. Methods A questionnaire about perceived PM education and attitudes on palliative care (PC) was sent to 543 last year students in all five Finnish medical schools in 2018–2019. In total, 175 (32 %) responses were received from four universities. The students evaluated both the quantity and quality of their PM teaching, implementation of European Association for Palliative Care (EAPC) guidelines and their satisfaction to the training. There were two palliative case scenarios, and the students were asked to find the best treatment option. In addition, students´ attitudes towards end-of-life (EOL) care issues were examined. Results In the Finnish universities, PM education was available mainly integrated with oncology, geriatrics, and general medicine. A total of two universities also offered a specific PM course. In average, 50–70% of the EAPC curriculum was covered by lectures, small-group teaching, seminars, and bedside teaching with significant differences between faculties. Only 30–60 % of students were satisfied with the education received. The highest rankings were given in the universities with a special PM course. Students from these universities expressed less anxiety in facing EOL issues. Conclusions In Finland, the coverage of EAPC curriculum is satisfactory, but the PM education is mainly given integrated with other specialties. The dedicated course on PM was associated with increased perceived knowledge and satisfaction of PM education. However, PM training was not associated with students’ attitudes on PC.

Academic health centers have a responsibility to foster professional development approaches and engagement environments for faculty to elevate both knowledge and sense of belonging as medical educators. This new educational methods submission depicts faculty development and engagement initiatives implemented at a single institution that were created and influenced by the psychological framework of Professional Identity Formation. The authors suggest ways that academic medical centers can draw upon the formation of these programs to best serve their faculty for cultivating development and engagement for professional growth.

Clinical pharmacists are responsible for safe medication use in hospitals. Most clinical pharmacists are perfectionists. However, in their decision-making process, they have to embrace uncertainty, while interpreting available data, and integrating knowledge and clinical experience. In clinical practice, how to teach and master clinical pharmaceutical reasoning is unclear. We developed the DRIP framework including different aspects on drug, indication and patient and a stepwise approach to support clinical pharmaceutical reasoning by students, residents in hospital pharmacy and clinical pharmacists. The DRIP framework was first introduced during the daily report with residents and faculty of the clinical pharmacy. The framework was implemented in daily clinical practice to handle drug safety alerts, and to optimise drug therapy during ward rounds, multidisciplinary consultations, and in entrustmentbased discussions with residents. Pharmacists using the DRIP framework felt more confident that relevant aspects of a complex pharmaceutical problem had been considered, they learned to anticipate on the issues behind an apparently simple pharmaceutical question, and to explain their reasoning. Several CANMEDS roles can be simultaneously trained by using our approach. We are developing a course for residents in clinical pharmacy and pharmacology to teach the competency of clinical pharmaceutical reasoning using the DRIP framework.

Background The homeless population is growing across the United States, particularly in urban areas. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. These services gaps are frequently identified by needs assessments and utilized by community agencies to inform outreach efforts and program development. Community outreach by medical students through participation in community-based service learning projects is critically important for the preparation of future physicians to care for underserved and vulnerable populations. This study describes the stepwise approach taken by medical students to design and administer a needs assessment for the purpose of informing the development of a new street medicine program. This study is intended to serve as a guide to students who aspire to launch a new street medicine program but is generalizable to other student-led service learning outreaches. Methods We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, chi-squared analysis, and multivariable logistic regression. Results Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized Emergency Departments as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an Emergency Department (OR 2.05, 95% CI: 0.81-5.25). Conclusions Pairing health care with meals and other primary needs may be an effective strategy to increase service utilization by this population. Needs assessments provide an opportunity for health professional students to learn about social needs and more effectively connect patients with services from community agencies and health care organizations.

Background The rapid transition from in-person to online delivery of medical curriculum has facilitated the continuation of medical education during the COVID-19 pandemic. Whilst active learning approaches, including Team-Based Learning (TBL), are generally more supportive of the learner’s needs during such transition, it remains elusive how different learning environments affect a learner’s motivation, engagement, and perceived learning over a prolonged period. We leveraged on the Self-Determination Theory (SDT) and key learners’ characteristics to explore the levels of student’s engagement and perceived learning in two TBL learning environments, online and in-person, over an extended period. We hypothesize that students’ self-reported perceptions of engagement and learning will be lower in online compared to in-person TBL classes. Methods This is a mixed methods study with 49 preclinical graduate medical students completing the same questionnaire twice for each learning environment, online TBL and in-person TBL, over an eight-month period. Quantitative data were collected on learners’ characteristics, basic psychological needs satisfaction, motivation, student’s engagement and perceived learning. Additionally, the final questionnaire also explored the participants’ perception on which learning environment better supported their learning. Results We found that autonomy support, perceived competence and needs satisfaction, and perceived learning were higher in-person than online. Additionally, most learners felt that in-person TBL was better for learning, as the concepts of learning space and the community of practice were mediated by being in-person. Conclusions TBL, being an active instructional method, can maintain students’ engagement because it supports many aspects of SDT constructs and perceived learning. However, online TBL is unable to fully support the students’ needs and perceived learning. Hence, we strongly advocate for any in-person opportunities to be included in a course, as in-person classes best support students’ engagement and perceived learning.

Background The transition of the United States Medical Licensing Exam: Step 1 to Pass/Fail (P/F), from scored, caused uncertainty about students’ preparedness and wellbeing related to the exam. Comparison of study behavior and results, before and after the P/F transition can provide insights for the medical curriculum and student support. The aim of this study is to evaluate students’ perceptions of their efforts in Step 1 preparation, as compared to cohort performances to determine the impact of the transition of Step 1 to P/F on medical students. Methods Data from four cohorts of second-year medical students (Class of 2022–25, N = 204) were collected from their dedicated Step 1 self-study block. Student study regiments, aggregate practice test results, Step 1 pass rates and post-block self-reported surveys were analyzed qualitatively to compare student effort and outcomes for scores and P/F cohorts. Results Analysis of practice exam averages across the four student cohorts demonstrates a potentially slower and less rigorous start to Step 1 self-studying during the dedicated preparation block for the cohorts that took the P/F Step 1 exam format as compared to the previous cohorts that prepared for a scored Step 1 exam. Similarly, self-reported study regiments decreased in the median number of hours/day and number of weeks of study for the cohorts with P/F Step 1 exam. There was also a slight shift in the type of study resources used, between the two groups, with the scored group using more traditional board preparation resources. Conclusions The P/F transition of the Step 1 exam may lead to reduced student preparedness and may require adjustments in the resources and support provided by institutions.