American Medical Students Research Articles

Effective Clinical Externships for International Medical Students: A Qualitative Study.

International student exchanges are a significant part of medical education, and experiences of North American and European medical students abroad have been extensively examined. By contrast, knowledge of visiting medical students in the United States (US) is limited largely to surveys of administrators and course directors. To understand US attending physicians' thoughts on visiting international student clinical externships. Three clinician-educator physician focus groups were conducted across two US medical schools with broad representation of training backgrounds, clinical disciplines, and career stages. Focus groups and constant comparison analysis of transcripts were performed iteratively to identify emerging themes. Qualitative themes and subthemes. Two main themes emerged from the data: (1) administrative requirements for success: hosting international students requires careful planning and coordination, which is daunting amidst demanding faculty responsibilities. Externships must address experiences of the people directly involved in the clinical setting, leadership, communication, and institutional, financial, physical, and personnel resources. (2) Impact of student qualities: When working with international students, the importance of administrative details and student characteristics increases due to higher student variability overall, inconsistent language and cultural fluency, and the consequent recognition of the student as an ambassador for their home institution and country. Amidst already busy schedules, clinician educators identify the hosting of international medical students as a commitment resembling that for their own trainees. Linguistic and cultural distances, and the overall variability of international students amplify the importance of effective administration. The findings have influenced related processes at the University of Pittsburgh.

I can't get no satisfaction: Burnout, stress, and depression in Latin medical students.

The state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress, known as Burnout Syndrome (BS), is not only affecting the medical workforce but medical students in training. Gender, race, ethnicity, and potentially other variables can serve as significant risk factors contributing to BS among medical students. Despite the importance of understanding these disparities, very few studies in the U.S. have analyzed race or ethnicity amongst their cohorts. However, there exists extensive information on burnout in students from Latin America, which serves as the primary focus of this review. A systematic literature search was conducted using pertinent terms in English and Spanish. Our review found that the prevalence of BS in Latin American countries varies widely, ranging from 4.3 to 43.90% pre-COVID-19 pandemic. Variability in the educational environment and the complex interplay of cultural, academic, and systemic factors appear to contributing to burnout among students. Post-pandemic investigations reveal even higher prevalences, particularly among women. High rates of depression and anxiety are also reported during the COVID-19 pandemic. The reviewed data showed that BS can become further exacerbated and complicated by existing psychiatric comorbidities amongst Latin American medical students. It is possible that we may observe continued upward trajectories in burnout trends among both healthcare workers and medical students in this post-COVID-19 pandemic era. These insights call for tailored interventions addressing not only burnout but also the interconnected mental health challenges faced by medical students in Latin America.

Medical School Curricula and the Role of Third-Party Resources in Medical Student Urology Education

To assess the quality and extent of the urology education provided to medical students both by third-party resources (TPRs) and by the curriculum provided by medical schools METHODS: TPRs were assessed by systematically comparing the content of the 4 most common resources (Anking, Pathoma, Uworld, and First Aid) to the American Urological Association's Medical Student Curriculum (AUA-MSC). Medical school curricula were assessed via a survey sent to the top-150 allopathic medical schools in the United States. The survey asked about clinical and pre-clinical exposure to urology received by medical students at their school. The TPRs for Step 1 together covered 73.3% of the AUA-MSC topics, and for Step 2 covered 81.9%. First Aid covered 49.5% of Step 1 topics and 58.4% of Step 2 topics, Uworld covered 58.6% and 67.9%, respectively, and Anking covered 61.8% and 58.8%, respectively. Pathoma covered 28.1% of Step 1 topics. Survey results showed that 33/39 (84.6%) of schools have required urology coursework in preclinical years, but only 3/39 (7.7%) have required urology rotations in the third or fourth years. Of those without required rotations, 35/36 (97.2%) indicated that they offer an elective rotation in urology. There is little emphasis placed on urology after the preclinical years of medical school, pointing to a need for greater exposure to these topics regardless of the student's selected specialty. This need stems from incomplete knowledge provided by TPRs compared to the AUA-MSC. Drawing attention to this gap can provide insight for those creating future iterations of medical curricula and shed light on areas in need of improvement, which would ultimately benefit both patients and providers.

Physician Trainees' Perception of Cannabidiol Use in Medicine: A Survey Study.

Given the ongoing national opiate crisis, physicians have been challenged with mitigating the risk of opiate dependence in their patients. With current physician efforts to mitigate the risks of treating pain with opioid prescriptions, this study evaluates medical students' and residents' understanding and perceptions regarding cannabidiol (CBD) in current medical care and their future medical practice. Orthopedic residents from all American programs and medical students from 50 medical schools, regardless of training year or future specialty plans, were eligible to participate in this survey-based study administered from December 2022 to March 2023. The surveys ask questions about demographic information, what education they receive on CBD utilization in medicine, thoughts on CBD effectiveness in pain control, and future plans on utilizing CBD. A total of 55 residents (1.4%) and 53 medical students (5.1%) responded. Trainees in CBD-legal states were more likely to work with physicians who use CBD in their practice. Most trainees, regardless of location, believe CBD use has a stigma attached to it. Many responders were concerned about the role of CBD in pain control. Finally, most trainees believed that CBD is easy to access if desired and is affordable to purchase. The trajectory of CBD use in the United States indicates that the therapeutic benefits of CBD will be targeted, and future physicians are not always provided adequate educational opportunities to learn about its potential medical uses. Continued training as well as interactions with patients may help decrease the stigma surrounding medical CBD use and help solidify its therapeutic use in pain control.

History of neurosurgery at Howard University: the nation's only historically black academic institution that practices neurological surgery.

Howard University Hospital has been a pillar for healthcare delivery in the Black community, an underserved sector of Washington, DC, since its founding in 1862. Neurological surgery, one of the many areas of service provided, was established by trailblazer Dr. Clarence Greene Sr., who was appointed the division's first chief in 1949. Because of the color of his skin, Dr. Greene had to complete his neurosurgical training at the Montreal Neurological Institute, as he was refused the opportunity to train in the United States. He went on to become the first African American to be board certified in neurological surgery in 1953. Drs. Jesse Barber, Gary Dennis, and Damirez Fossett, the subsequent division chiefs, have all continued Dr. Greene's legacy of providing academic enrichment and subserving a disparate population. Many patients who may not have received treatment otherwise have been able to receive exemplary neurosurgical care from them. Under their tutelage, numerous African American medical students have gone on to train in neurological surgery. Future directions include developing a residency program, collaborating with other neurosurgery programs in continental Africa and the Caribbean, and establishing a fellowship for training international students.

Celebrating culture in American dermatology part I: A special tribute to Dr E. A. (Billy) Hankins III, dermatologist with American Indian heritage as a minor part of his ethnic background

This contribution honors the life of Dr E. A. (Billy) Hankins III, a board-certified dermatologist and dermatopathologist with 40 years of practice experience, now retired, having American Indian heritage as a minor part of his ethnic background. Hankins spent many years as a physician volunteer for an indigent clinic serving the urban American Indian community of the city and county of Los Angeles, California (the American Indian Free Clinic). He is a Vietnam era war veteran as well as a master sculpture taxidermist and wildlife recreation artist. He has been active for many years with the Association of American Indian Physicians, of which he is a member. Hankins is the founder and curator of vertebrate zoology and chief preparator for the World Museum of Natural History, an international, nonprofit public museum of natural history located on the campus of La Sierra University in Riverside, California. Dr Hankins’ life story offers insight into American Indian culture as it relates to dermatology, and hopefully it will inspire more American Indian medical students to pursue a career in that specialty.

Experiences with Racism Among Asian American Medical Students

Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students. To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment. This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years. The medical school experiences of Asian American medical students. Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future. In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.

Sacred-in-Practice: A Framework for Teaching Religion, Health, and Medicine.

This essay proposes an unconventional approach to teaching "religion and medicine" to American medical students. Received frameworks for such teaching-articulated around faith denomination or "spirituality"-may imply that religiosities and their health effects are grounded in theology or transcendence, respectively. These frameworks may reify, or misrepresent relationships between, religion and science-for example, in supporting notions of conflict, or of an essentially secular character of technical progress. They can neglect ways in which biomedicine and its institutions are themselves engaged with and productive of religious values. In order to move toward fuller student appreciation of diverse religious materialities and embodiments in health and biomedicine, the essay proposes "the sacred, in practice" as an organizing rubric. This pedagogical intervention pivots on notions of sacrality in anthropologies of religion and offers students a wide path to consider a spectrum of material, gestural conditions, and activities-transformative techniques, intensely valued objects, trusted texts, rituals-that mark and propagate religious valences and commitments within and around contemporary biomedicine. This sacred-in-practice approach meshes with standard theological and spiritual framings of the religion/health/medicine nexus, yet offers more capacious and flexible connections to work for which medical students are training, involving vulnerable bodies and material technologies of tremendous life- and world-shaping potency.

Toward improvement of knowledge of financial conflicts of interest in a large medical school in France.

Conflict of interests (COIs) adversely affect the integrity of science and public health. The role of medical schools in the teaching and management of COIs has been highlighted by the publication of an annual evaluation of American medical schools based on their COIs policies by the American Medical Student Association (AMSA). A deontological charter was adopted by French medical schools in 2018 but its impact on COI comprehension by students and its effects on COI prevention were not evaluated. A 10-item direct survey was conducted among about 1000 students in Paris-Cité University in order to investigate the respect of the charter regarding COIs both in the medical school and in affiliated teaching hospitals. Cumulative results show a satisfying respect of prevention policies regarding COIs in the medical school and hospitals despite the fact that the existence of the charter and its major aspects were insufficiently known. Disclosure of COIs by teachers was insufficient. This first direct study among students shows better results than expected according to current non-academic surveys. Moreover, this study demonstrates the feasibility of this kind of survey whose repetition should be an appropriate tool to improve the implementation of the charter within medical schools and teaching hospitals, in particular mandatory disclosure of COIs by teachers.

Effects of Osteopathic Training and Medical Simulation on Lumbar Puncture Landmark Identification in American Medical Students

Effects of Osteopathic Training and Medical Simulation on Lumbar Puncture Landmark Identification in American Medical Students

Anxiety and depression in Latin American medical students during the COVID-19 pandemic

Objetivos: Determinar la frecuencia de depresión y ansiedad en estudiantes de la carrera de medicina de Latinoamérica durante el distanciamiento social en el período de brote del COVID-19.

How much do Latin American medical students know about radiology? Latin-American multicenter cross-sectional study

ABSTRACT Background Radiology is a useful tool for diagnosis and intervention in medical practice, and all the components within the teaching-learning process of this subject during undergraduate studies influence successful knowledge application. Objective This study aimed to describe the level of knowledge in radiology of students in the last two years of medical school and curricular characteristics of their courses in seven Latin American countries. Methods A multicenter cross-sectional study was carried out on medical students of 7 Latin American countries (Bolivia, Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru) in their final two years of medical school, using an online questionnaire validated by experts and adapted for each country that assessed knowledge and curricular characteristics in radiology subject. Scores were assigned according to the number of correct answers for the knowledge test. The T-test, and regression analysis with one-way ANOVA were used to search for relationships between the level of knowledge and other variables. Results A total of 1514 medical students participated in this study. All countries had similar participation (n > 200); most participants were women 57.8%. The country with the highest knowledge score was Brazil. Male, sixth year (internship) and from public universities students had higher knowledge score (n < 0.05). Participants, who considered radiology more important, and who reported higher compliance with teaching staff with the proposed syllabus, and programmed classes, obtained better scores (n < 0.05). Conclusions Latin American medical students included in this study have a regular overall level of knowledge of Radiology, apparently influenced by curricular differences such as class and academic program compliance. Efforts to better understand and improve academic training are indispensable. Limitations The study was subject to selection bias determined by non-probability convenience sampling. The questionnaire assessed only theoretical knowledge and the evaluation system was designed by the investigators.

Call to Action: Disaggregating the Asian American Medical Student Experience.

To the Editor: There are general misconceptions that Asian American medical students do not experience racial discrimination and should therefore be excluded from diversity, equity, and inclusion (DEI) conversations. However, White medical students are 2 times more likely than Asian American students to enter the Alpha Omega Alpha Honor Medical Society, even after controlling for United States Medical Licensing Examination Step 1 scores and extracurricular activities. 1 White students are also significantly more likely to be described as “empathetic” and “compassionate” than Asian American students, 2 playing into the stereotype that Asian Americans are less warm than their White counterparts. Furthermore, there is significant underrepresentation among U.S. medical school leadership, with Asian American deans increasing from only 0 to 1 in the last 20 years. 3 There is also no public data on Asian subgroups in U.S. residency and beyond. Despite these examples of discrimination across the medical education continuum, Asian American medical students continue to be excluded from conversations of racism in medicine and, as a result, struggle to share their experiences with harassment and discrimination. 4 At the medical-school level, we believe the best ways to address discrimination issues faced by Asian American medical students are (1) to include mandatory coursework on the disaggregated Asian American racism and health disparities experiences, (2) to intentionally include Asian American students in DEI conversations, and (3) to conduct research on the Asian American medical student experience to better understand their specific needs. At the national level, we believe that (1) reporting disaggregated data in U.S. medical schools, residencies, and the physician working force and (2) comparing that data with U.S. census data could foster more nuanced DEI discussions.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Allergy and immunology interest and exposure among US medical students and residents.

Despite the immense burden of allergic disease, the allergy and immunology (AI) workforce in the United States continues to shrink. Fellowship applications for AI have declined sharply in contrast to those in more popular specialties. Here we have sought to evaluate the current level of AI interest and exposure among early trainees in the United States, as well as their perspective on how to improve interest in the field. An 18-item questionnaire was sent via e-mail list-serve to 2 groups: (1) mostly residents in the American Academy of Allergy, Asthma & Immunology (AAAAI) with interest in AI and (2) medical students in the American Medical Student Association (AMSA) whose specialty interests were not known. In the AAAAI group, 412 members were surveyed and 70 responses were received. In the AMSA group, 4778 members were surveyed and 47 responses were received. More individuals in the AAAAI group interacted with their AI division than in the AMSA group (73% vs 19% [P< .001]). On average, the AAAAI group would "probably" pursue AI whereas the AMSA group who would "definitely not" do so (P<.001). Almost all of the AMSA group (94%) had heard of AI before, but only 19% of them interacted with AI at their program. Regarding ways to increase interest in AI, the top responses for both groups were clinical exposure via electives and shadowing (a score of 4.69 on a 5-point scale) and didactic exposure via lectures and presentations (a score of 4.29). Our study suggests that increasing AI opportunities for didactics and clinical exposure may lead medical students to develop more interest in pursuing the field. Some strategies are also discussed.

288 Relationship Between Socio-Economic Background of International Medical Graduates and Residency Match Results

Up to 25% of practicing American physicians are international medical graduates (IMGs). There are multiple studies characterizing the social and economic background of American medical students and residents. However, studies of IMGs are lacking despite their substantial prevalence in American health care. Little is known about the countries of origin of international physicians and determinants of their success. Our study is aimed to characterize the impact of IMG socio-economic background on the rate residency match success.

Indigenizing Medicine.

The drive to the reservation took me through busy highways and shopping centers, then slowed down on winding roads through rising hills and rocky scenes. Just an hour-long drive from the University of California San Diego campus took me to a drastically different landscape, both geographically and culturally. The Tribal Ambulatory Healthcare Experience, an elective created by our Association of Native American Medical Students, provided a formative experience for me as a Chickasaw medical student. Everyone was so kind and welcoming as I found my way to my preceptor’s office at the Indian Health Center. This is not always the experience of a medical student navigating a new clinic. My preceptor, who grew up on a nearby reservation, went out of his way to introduce me and even emailed my picture with a short biography to the staff. It seemed like everyone was family and they made me feel right at home. It was clear that the staff had great relationships with each other and their patients. When discussing the day ahead, they knew the patients’ stories and families. When patients called or came into the office, they were greeted as relatives. I began to notice a stark difference in the treatment of patients as family, rather than strangers or customers. We first saw an adolescent girl with an inflamed inguinal lymph node and ordered tests to check for sexually transmitted infections. When we disclosed that she was positive for chlamydia and that we would prescribe antibiotics, I noticed how comfortable she seemed discussing a sensitive issue—evidently due to the long-standing relationship she had with my preceptor. After taking time to answer her questions, she inquired about my medical training and mentioned her own interest in becoming a lab technician. My preceptor suggested she consider a local medical assistant program, which she was visibly excited to hear about. Throughout the day, I observed how youths and adults alike were comfortable opening up to my preceptor. Whether discussing career advice or recommending nearby hiking trails for exercise, each patient was met with care attentive to their Native identity and where they lived. I even learned there was a sweat lodge in the back of the clinic to foster holistic and communal healing. Receiving care within this relational context fostered trust in the clinic staff, many of whom were community members. Trust in a government structure like the Indian Health Service (IHS) is rightfully hard to build, but placing relationships at the center of care allowed my preceptor to do so. This is not the typical approach that has been modeled to me in medical school. I am often taught to empathize with patients, but to stay removed; to acknowledge culture, but keep it disintegrated from Western medicine. Yet, it was easy to see how relationship-centric care was making an impact on this community. This approach to care is an ideal way to promote health equity on a broad scale. Within a space of trust, we might be better able to promote open communication to guide care, health literacy for patients, adherence to treatment regiments, and continuity of care. On my drive back through those same serpentine roads, I thought of our patients that day. I thought of their comparison to reductive statistics in literature: sexually transmitted diseases, diet and exercise counseling, painful peripheral neuropathy from chronic alcohol consumption. Each visit personified how structural determinants of health drive inequity in Native communities. These are not problems unique to Indigenous peoples but a fault of our systems. They are the result of inadequate federal resources allocated to Indigenous health; food deserts and abused ecosystems; and the trauma of genocide, dispossession, and assimilation still carried in Indigenous bodies and minds. In the face of all these issues, how can I advocate for a healthier future for tribal nations? My preceptor showed me how relationship-centric care fosters medical trust and builds community. Within this space, I saw the potential to impactfully care for individuals and families. This requires longitudinal commitment to a place and people. It specifically requires training a workforce made up of community members. IHS facilities nationwide are understaffed and experience significant turnover. We must encourage Native youth to consider careers in health care, just as my preceptor and I did in conversation at clinic. And then, I think about how I will bring Indigenous values into Western medicine; how I can relate to the whole person in front of me, rather than tending toward efficiency and detachment; how I will see where our systems may have positioned them and take time to build trust; how I will see my patient’s health as tied to their culture, land, and community. Indigenizing medicine certainly has the potential to promote health equity, but also enables us to see and partake in the interconnected human experience.

Intersection of anxiety and negative coping among Asian American medical students.

PurposeAsian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students.Materials and methodsA survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific American Medical Students Association enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping.ResultsA total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills.ConclusionProfessionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population.

Understanding the Experiences of American Indian and Alaska Native Students Enrolled in Allopathic and Osteopathic Medical Degree Programs.

Despite a growing population, American Indian and Alaska Native (AI/AN) students have seen no meaningful increase in representation in allopathic and osteopathic medical degree programs. While AI/AN medical students are more likely to practice in underserved areas, they face financial and sociocultural obstacles towards doing so. This underscores the need to understand the experiences of these trainees, and identify barriers and facilitators to the successful recruitment, retention, and advancement of AI/AN trainees. A survey was administered to members of the Association of Native American Medical Students (ANAMS), an organization representing self-identified Native medical students. This survey elicited demographic information, opinions of institutional climate, and aspects of academic and social experiences during medical school. There were n = 39 complete responses. Over fifty percent of respondents (n = 21) identified as AI/AN alone and not in combination with another racial or ethnic group. Overall, respondents were: Generally, not satisfied with their school's engagement with Native communities and AI/AN health curricula. Likely to report barriers towards their timely advancement in training, namely being a first-generation or low income student, and feelings of imposter syndrome. Likely to report an interest to work in primary care fields and serve AI/AN communities in the future. This survey identified several barriers to successful AI/AN medical trainee advancement, highlighting opportunities for institutions to foster inclusion of AI/AN trainees and grow the number of Native physicians.

Racial differences in transfusion practices: Time to address structural racism

See article on page 1519–1526, in this issue