Clerkship Rotation Research Articles

A Retrospective Study of Virtual Hospital Experiential Learning Across Clerkship and Pre-clerkship Doctor of Osteopathic Medicine Students at a Medical School Based in the United States.

During the COVID-19 pandemic, a medical institution in the United States implemented a virtual clerkship rotation to replicate the skills that students would develop during an in-person clinical site rotation. The primary objective of thisstudy was to identify the efficacy and benefits following the implementation of the Virtual Hospital Experiential Learning (VHEL) model, as demonstrated by increased perceived confidence and skill growth among medical students. Cases were presented to five to six medical students each week. On the Monday of the week, students entered a virtual conference platform for a standardized patient encounter. Staff and faculty randomly assigned all students to sessions. A post-VHEL survey was conducted to determine the level of perceived student confidence (measured via the Likert scale, self-reported). From the 193 students randomly assigned to VHEL sessions, 49 survey responseswere gathered, resulting in a 25% response rate. According to our dataset, one week following the VHEL sessions, students reported a significant increase in their perceived confidence regarding diagnostic skills and problem-solving within a clinical setting. The majority of respondents felt that they had gained confidence and skills through the sessions. Additionally, they noted that the sessions effectively mirrored the experiences of in-person clerkships in a hospital environment. Most medical student respondents reported an increase in perceived overall confidence following the completion of the VHEL sessions. First-year medical student data displayed a moderately higher level of perceived total confidence overall, suggesting that the implementation of VHEL sessions during the spring semester of the first year of medical school may offer the most significant gains.

Prevalence of pelvic examinations on anesthetized patients without informed consent.

The pelvic examination is a fundamental tool for the evaluation and diagnosis of women's health conditions and an important skill for all medical students to learn as future physicians for the early detection of treatable conditions such as infection or cancer. Although the American College of Obstetricians and Gynecologists (ACOG) asserts that performing pelvic examinations under anesthesia for educational purposes should only occur if the patient provides explicit and informed consent, there still have been reports of medical students performing pelvic examinations on anesthetized patients across the country, and many states are now starting to pass bills requiring informed patient consents to conduct pelvic examinations under anesthesia. The objectives of this study are to evaluate the prevalence of pelvic examinations performed by osteopathic medical students on anesthetized patients without consent while fulfilling their third-year OB-GYN clerkship requirements. The survey was administered and distributed to all osteopathic medical schools in the country via the Student Osteopathic Medical Association's (SOMA's) chapter emails, outreach emails, and SOMA's social media accounts to collect data. Inclusion criteria included third- or fourth-year osteopathic medical students who completed their OB-GYN clerkship rotations when taking the survey. The exclusion criteria included any osteopathic medical student who had not completed their OB-GYN clerkship rotation. We utilized descriptive analysis to summarize the final data. We received 310 responses. The final number of responses was 291 after meeting the exclusion criteria. Most osteopathic medical students (94.2 %, n=274) considered the practice of performing pelvic examinations on anesthetized patients without their explicit consent unethical. Among theparticipants, 40.9 % (n=119) admitted to performing pelvic examinations on patients under anesthesia while on OB-GYN rotations, but most of them (57.1 %, n=68) did so without obtaining prior consent from the patients. Notably, the number of pelvic examinations performed by medical students on patients under anesthesia ranged widely from 1 to 25 with a median number of 10. Moreover, 58.9 % (n=70) indicated that they had not been properly educated to obtain specific consent before performing pelvic examinations under anesthesia. Many participants cited efficiency of practice, lack of policy awareness and personal education by medical students, andfailure to refuse to perform pelvic examinations on anesthetized patients as trainees when asked by their seniors or preceptors. This study demonstrates that although most osteopathic medical students consider performing pelvic examinations on anesthetized patients unethical, many still admit to practicing pelvic examinations on patients under anesthesia, while on OB-GYN rotations for efficiency of practice, lack of policy awareness and personal education, and being in unique positions in which grades are determined by seniors and preceptors for their willingness to do what is asked even if the practice does not align with their conviction. This study highlights the importance of ongoing research and implementation of policies at institutional and state levels that will procure the value of pelvic examinations while protecting and upholding the ethics of patients' rights and autonomy of medical students.

Otolaryngology Simulation Curriculum Development and Evaluation for Medical Education in Rwanda.

This study aimed to assess the feasibility and acceptability of a new low-cost otolaryngology simulation training curriculum for medical students in Rwanda. Given the limited access to hands-on training and equipment in low-middle-income countries, building confidence in performing basic otolaryngology skills is vital for all medical students, especially where all graduates initially serve in primary care before specializing. Preintervention and postintervention assessments of simulation training. Conducted at the University of Global Health Equity in Rwanda. The simulation program comprised 3 primary components: (1) a low-cost, moderate-fidelity model for cricothyrotomy and tracheostomy practice, (2) a low-cost, low-fidelity ear model for foreign body and cerumen removal, and a high-fidelity manikin for practicing, (3) epistaxis management, and (4) nasal foreign body removal. Students underwent pretest and posttest assessments measuring their knowledge, experience, perceived skill, and confidence in performing these procedures. A survey collected feedback on the program. A total of 29 medical students participated in the simulation program, integrated into a 1-week otolaryngology "boot camp" preceding a 3-week clerkship rotation. All models were created using basic, locally available materials, at a total cost of $1.02 for cricothyrotomy and $0.20 for foreign body models. Knowledge and perceived confidence increased for all 3 simulations. All students found the simulations useful, enjoyable, and anticipated using these skills in future training. The study's results demonstrated that the low-cost otolaryngology simulation was well-received and enhanced knowledge, interest, and confidence in performing basic otolaryngology skills across all simulations.

Frontline assessors’ opinions about grading committees in a medicine clerkship

BackgroundCollective decision-making by grading committees has been proposed as a strategy to improve the fairness and consistency of grading and summative assessment compared to individual evaluations. In the 2020–2021 academic year, Washington University School of Medicine in St. Louis (WUSM) instituted grading committees in the assessment of third-year medical students on core clerkships, including the Internal Medicine clerkship. We explored how frontline assessors perceive the role of grading committees in the Internal Medicine core clerkship at WUSM and sought to identify challenges that could be addressed in assessor development initiatives.MethodsWe conducted four semi-structured focus group interviews with resident (n = 6) and faculty (n = 17) volunteers from inpatient and outpatient Internal Medicine clerkship rotations. Transcripts were analyzed using thematic analysis.ResultsParticipants felt that the transition to a grading committee had benefits and drawbacks for both assessors and students. Grading committees were thought to improve grading fairness and reduce pressure on assessors. However, some participants perceived a loss of responsibility in students’ grading. Furthermore, assessors recognized persistent challenges in communicating students’ performance via assessment forms and misunderstandings about the new grading process. Interviewees identified a need for more training in formal assessment; however, there was no universally preferred training modality.ConclusionsFrontline assessors view the switch from individual graders to a grading committee as beneficial due to a perceived reduction of bias and improvement in grading fairness; however, they report ongoing challenges in the utilization of assessment tools and incomplete understanding of the grading and assessment process.

R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation

ABSTRACT To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.

Medical students' perspectives on and understanding of anesthesiology: a Canadian cross-sectional survey.

In Canada, three out of 17 medical schools do not mandate an anesthesia rotation in their clerkship curriculum. Understanding the effects of a mandatory anesthesiology rotation is important in determining its value to the specialty and guiding decision-making for medical educators.We sought to determine whether a mandatory anesthesia rotation affected students' understanding of anesthesiology, as well as their perspectives on anesthesia. We conducted an anonymous cross-sectional survey of Canadian medical students graduating in 2021. Our survey consisted of 46 questions related to student's perspectives of anesthesiology, understanding of anesthesia, their interest in the specialty, and participant's demographics. This included 16 Likert-scale questions, 19 quiz-style questions, four free-text response questions, and seven demographics questions. The survey was hosted by SurveyMonkey® (SurveyMonkey Inc., San Mateo, CA, USA) and distributed to the participants by each individual institution. We collected a total of 331 responses across 13 different Canadian medical schools, representing a 17.3% response rate of students surveyed and 11.7% of all graduating medical Canadian students in 2021. A mandatory rotation in anesthesiology was associated with a more positive perspective (P = 0.01) but not understanding (P = 0.07) of the specialty. A mandatory rotation was not related to students' application to anesthesiology at a statistically significant level (P = 0.06). The results of this national survey study show the benefits of including a mandatory clerkship rotation in anesthesiology, namely on increasing positive perceptions of the specialty, while also revealing avenues for future research and insights on how to further optimize a mandatory anesthesiology rotation in clerkship.

Evaluation of bias and gender/racial concordance based on sentiment analysis of narrative evaluations of clinical clerkships using natural language processing

There is increasing interest in understanding potential bias in medical education. We used natural language processing (NLP) to evaluate potential bias in clinical clerkship evaluations. Data from medical evaluations and administrative databases for medical students enrolled in third-year clinical clerkship rotations across two academic years. We collected demographic information of students and faculty evaluators to determine gender/racial concordance (i.e., whether the student and faculty identified with the same demographic). We used a multinomial log-linear model for final clerkship grades, using predictors such as numerical evaluation scores, gender/racial concordance, and sentiment scores of narrative evaluations using the SentimentIntensityAnalyzer tool in Python. 2037 evaluations from 198 students were analyzed. Statistical significance was defined as P < 0.05. Sentiment scores for evaluations did not vary significantly by student gender, race, or ethnicity (P = 0.88, 0.64, and 0.06, respectively). Word choices were similar across faculty and student demographic groups. Modeling showed narrative evaluation sentiment scores were not predictive of an honors grade (odds ratio [OR] 1.23, P = 0.58). Numerical evaluation average (OR 1.45, P < 0.001) and gender concordance between faculty and student (OR 1.32, P = 0.049) were significant predictors of receiving honors. The lack of disparities in narrative text in our study contrasts with prior findings from other institutions. Ongoing efforts include comparative analyses with other institutions to understand what institutional factors may contribute to bias. NLP enables a systematic approach for investigating bias. The insights gained from the lack of association between word choices, sentiment scores, and final grades show potential opportunities to improve feedback processes for students.

Family Medicine Clerkship Preceptors’ Experiences Welcoming and Supporting Medical Students of Color

Purpose: Medical students of color (MSoC) regularly experience discrimination and mistreatment during medical school. Preceptors have the potential to provide meaningful support for MSoC while on their family medicine clerkship rotation. This mixed-method study explores family medicine clerkship preceptors’ challenges, current practices, and institutional needs related to welcoming and supporting MSoC. Methods: Any lead preceptor at a University of Washington-affiliated Family Medicine clerkship teaching site was eligible for this study. From June to September 2022, 7 focus groups were conducted with a total of 32 participants. Study team members coded transcripts for key themes related to participants’ experiences of working with MSoC. All participants were asked to complete a short survey, which included both demographic questions and questions regarding their beliefs and abilities to welcome and support MSoC. Results: Many preceptors felt underprepared and unsure about when and how to support MSoC. Current strategies employed by participants included adding a semi-scripted orientation conversation to discuss how they will be supported during the rotation and who they can talk to if they encounter any discrimination and/or microaggressions. Participants also suggested that the medical school should offer additional trainings for preceptors, such as mitigating microaggressions toward students. Conclusions: Lead preceptors are well positioned to empower and support the students they teach. This exploratory, single-institution study offers some insights into the challenges, current practices, and suggestions for institutions to support MSoC during clinical rotations. We recommend additional research to help validate our findings.

Integrating basic sciences into clerkship rotation utilizing Kern’s six-step model of instructional design: lessons learned

BackgroundIt is generally agreed that basic and clinical sciences should be integrated throughout the undergraduate medical education, however, there is still need for continued formal integration of basic sciences into clinical clerkship in many medical schools across the globe.MethodsUtilizing Kern’s Six-Step Model of Instructional Design, we aimed to develop an intervention that would facilitate cognitive integration of basic and clinical sciences. After problem identification and targeted needs assessment through focused group discussion with the students and faculty, objectives were devised with an implementation plan of using flipped class approach to develop a content-focused and learner-centered teaching strategy. This intervention was piloted in the 2-week cardiology clerkship in Year 5. Evaluation of the content, integration, student and faculty experiences were recorded through in-depth interviews, FGDs and a formative MCQ test.ResultsFlipped classroom based integrated sessions were successfully developed. The implementation phase was met with challenges that primarily stemmed from the diverse teaching styles among faculty members, hesitance to deviate from conventional practices, variations in clinic timings, and demanding schedules. Noteworthy observations were in terms of ownership of the project, the need for faculty development in modern student-centered teaching pedagogies, opportunities for content improvement, scheduling of sessions, and suggestion of revisiting fundamental concepts in basic sciences through a brief boot camp-style session at the onset of the clerkship. The role of flipped case model and clinical cases in integrating basic sciences into clinical sciences were appreciated by the students. Standardization in teaching practices was identified as the major challenge by the faculty.ConclusionsA functional, learner-centered framework of cognitive integration of basic sciences in clinical sciences curriculum of cardiology rotation was developed with a potential to be implemented in other clerkship rotations.

One-week radiology boot camp for pre-clerkship medical students: A novel format improving image interpretation and confidence

Rationale and objectivesTo measure change in radiology knowledge, confidence in radiology skills, and perceptions pertaining to radiology following a one-week boot camp elective for undergraduate medical students. Materials and methodsA five-day comprehensive radiology boot camp was developed including sessions on image interpretation, procedural skills, and appropriate image ordering. A multiple-choice quiz was administered before and after the elective, utilizing radiology questions from the validated AMSER STARS database. Additionally, a pre- and post-elective survey was administered assessing radiology career interest, confidence in radiology-based skills, and the potential ability of radiology-based skills to increase confidence in specialties other than radiology. Responses from the assessments were analysed using paired t-tests. Results15 students enrolled in the course and 14 completed all assessments. The average score on the quiz increased from 50.1% to 66.0% (p<0.001). On the post-elective survey, the average student confidence score increased by more than one point on a six-point Likert scale in each of radiographic interpretation (p=0.004), ultrasound interpretation (p=0.0002), CT/MRI interpretation (p=0.02), general radiology knowledge including procedural skills (p=0.0001), and appropriate image ordering (p=0.004). Average student satisfaction with the elective was 8.1 out of 10. ConclusionA one-week radiology boot camp for pre-clerkship medical students improved radiology knowledge and confidence in radiology skills, showing potential for this format to meet the demand for increased radiology content in undergraduate training. Students indicated that confidence in radiology knowledge would increase confidence on non-radiology clerkship rotations, highlighting the importance of how a one-week radiology bootcamp can impact both future radiology and non-radiology clerkship experiences.

Assessing Abdominal Examination Skills in a Surgery Clerkship Standardized Patient Encounter for Curriculum Improvement.

Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum. We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups. In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely. This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.

A Verbal De-escalation Standardized Patient Workshop for Third- and Fourth-Year Medical Students.

Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation. We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance. A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter. This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills.

Impact of Psychiatry Clerkship Rotation in Attitudes Towards Mental Illness and Psychiatry as a Career Among Medical Students.

Stigma associated with mental illness (MI) permeates many professions, including healthcare. Recognizing and correcting bias is critical in delivering impartial and beneficial healthcare for all patients. Early educational interventions providing exposure to individuals with MI have shown to be effective at reducing MI stigma. The primary aim of our study was to assess the impact of a psychiatry clerkship on attitudes to MI. A secondary aim was to determine if the psychiatry clerkship influenced medical students' perceptions of psychiatry as a career. A cohort of third-year medical students in Florida was invited to complete an online survey before and after participating in their first 4-week-long psychiatry clerkship during the 2021-2022 academic year. The voluntary, anonymous survey consisted of the Attitudes to Mental Illness Questionnaire (AMIQ) and a 3-item questionnaire on interest and knowledge in psychiatry. The Wilcoxon Sign-Rank test was used to determine statistical significance (P < .05) for pre- and post-clerkship values. Among 39 invited students, 22 participated before (56.4%), and 23 participated after their psychiatry rotation (59.0%). Overall, there was a statistically significant increase in the perceived level of general interest in psychiatry (P = .027), psychiatry knowledge (P < .001), and career interest in psychiatry (P = .040). There was also a significant decrease in the stigmatized attitude score for depression and self-harm after their psychiatry rotation (P = .042). Finally, the participants initially showed the highest stigmatized attitude score for intravenous drug abuse among the 4 mental illnesses presented, which also included depression and suicidal ideation, alcohol use disorder, and schizophrenia. The findings suggest that a psychiatry clerkship provided a positive exposure to the field, enhanced medical students' overall interest in psychiatry, and positively impacted medical students' attitudes towards MI.

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian

C-CASE 2023: Promoting Excellence in Surgical Education01. Near-peer tutoring: an effective adjunct for virtual anatomy learning02. Surgical Exploration and Discovery: perspectives on student-led debriefs in undergraduate surgical education03. How are emotions of medical residents and faculty in general surgery affected by new assessment mandates implemented in medical education?04. Equity, diversity and inclusion in medical residency: a Web-based analysis of Canadian

Assessing medical students’ confidence in promoting high value care in clinical practice

Background Medical students who are exposed to value-based care early in their education may be more likely to practice it. Our study aimed to understand medical students’ knowledge of and ability to implement the principles of high-value care in clinical settings. Additionally, we assessed students’ confidence in using high-value care practices to both influence care decisions and educate patients. Methods We surveyed third-year medical students at Texas A&M School of Medicine during their clerkship rotations using a 7-question Likert-scale survey. Students were asked to evaluate their confidence in performing cost-conscious high-value care behaviors. Results Of the 114 students offered the survey, 34 (30%) completed it fully. The greatest variance in response occurred in students’ attitudes toward their role in controlling healthcare costs. Half of respondents agreed or strongly agreed that they played a part in cost control as medical students, with 35% somewhat or strongly disagreeing. A majority of students felt confident initiating a conversation about costs with patients, while 21% somewhat or strongly disagreed that they were confident. Conclusion Overall, our results reveal that the main area lacking in students’ education in value-based care is instilling the belief that they, as medical students, have a role to play in controlling healthcare costs.

Capturing growth curves of medical students' clinical skills performance.

A benefit of a milestone or Entrustable Professional Activity (EPA) assessment framework is the ability to capture longitudinal performance with growth curves using multi-level modelling (MLM). Growth curves can inform curriculum design and individualised learning. Residency programmes have found growth curves to vary by resident and by milestone. Only one study has analysed medical students' growth curves for EPAs. Analysis of EPA growth curves is critical because no change in performance raises concerns for EPAs as an assessment framework. Spencer Fox Eccles School of Medicine-University of Utah students' workplace-based assessment ratings for 7 EPAs were captured at 3 time-points in years 3-4 of AY2017-2018 to AY2020-2021. MLM was used to capture EPA growth curves and determine if variation in growth curves was explained by internal medicine (IM) clerkship order. A curvilinear slope significantly captured 256 students' average ratings overtime for EPA1a-history-taking, EPA2-clinical reasoning, EPA3-diagnostics, EPA5-documentation and EPA6-presentation, and a linear slope significantly captured EPA9-teamwork ratings, p ≤ 0.001. Growth curves were steepest for EPA2-clinical reasoning and EPA3-diagnostics. Growth curves varied by students, p < 0.05 for all EPA ratings, but IM clerkship rotation order did not significantly explain the variance, p > 0.05. The increase in ratings from Year 3 to Year 4 provides validity evidence for use of EPAs in an assessment framework. Students may benefit from more curriculum/skills practice for EPA2-clinical reasoning and EPA3-diagnostics prior to year 3. Variation in student's growth curves is important for coaching and skill development; a one size fits all approach may not suffice.

From skillful to empathic: evaluating shifts in medical students' perceptions of surgeons through a combined patient as teacher and arts-based reflection program.

The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. A novel, single question evaluation tool was created. Third year medical-students were asked to "list the top 5 attributes of a surgeon, in order of perceived importance" both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either "humanistic" or "non-humanistic," which were then analyzed using generalized linear regression models under a Bayesian framework. After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.

An 8 Week Rural Surgical Clerkship: Does It Help to Produce more Rural Physicians?

Purpose: The purpose of our study was to determine what effect an 8-week rural surgical clerkship rotation during the 3rdyear of medical school has on future practice site location. Methods: We report the subsequent practice site for ninety-five 3rd year medical students who completed an 8-week rural surgical clerkship from 2013-2016 compared to a cohort from the same time who completed this clerkship on the urban campus, matched by year and specialty chosen. Findings: On first analysis, there is a significant correlation (p=.0026) between rural clerkship and subsequent rural practice. With secondary analysis, all but one of the students in the rural clerkship group who chose rural practice were rural track students completing most of both clinical years in the rural setting. Conclusions: As found previously, longer duration rural exposures are associated with more frequent subsequent rural practice, but we found no such association for the 8-week rural surgical clerkship. The previous report of positive attitude changes among urban-based medical students completing this rural clerkship may help them understand rural patients seeking their care in an urban setting, but such attitude changes are not adequate to affect the complex decision of practice choice. Future studies of rural exposures during medical school should focus on intermediate duration exposures as well as different specialty clerkships beyond surgery and seek an association with subsequent practice site location.

A Comparison of the Checklist Scoring Systems, Global Rating Systems, and Borderline Regression Method for an Objective Structured Clinical Examination for a Small Cohort in a Saudi Medical School.

This study aims to compare the effectiveness of using the checklist and global rating scores to evaluate the clinical competency of medical students in Objective Structured Clinical Examinations (OSCEs). Additionally, the study assesses the appropriateness of using the borderline regression method to set standards for small-scale OSCE exams and determines if the estimated passing marks differ significantly from the university's prefixed passing score of 70%. The study also examines whether the university should utilize the borderline regression method to determine passing scores for each OSCE exam instead of a set passing score. The study analyzed medical students' grades in 11 OSCE exams in the 2022-2023 academic year at Alfaisal University, Riyadh, Saudi Arabia. Students received family medicine clerkship rotations, and after each rotation, they took an OSCE exam consisting of three stations that family medicine consultants graded. The exam included a checklist of 30 tasks and a five-level global rank scale. The study collected all the checklist marks and global rank grades and analyzed them using IBM® Statistical Package for Social Sciences (SPSS® Statistics) software. The statistical tests used were descriptive statistics, the T-test, chi-square tests, Fisher's exact test, and Pearson correlation. The study showed that students were more likely to pass when using the global rating system than the checklist scoring system. Additionally, students had a significantly lower passing rate when using the higher cut-off passing score estimated using the borderline regression method compared to the pre-set passing score of 70% established by the university (with a p-value of 0.00). Each scoring system has advantages and disadvantages, but they complement each other. Combining scoring systems can produce a more comprehensive and precise evaluation of a candidate's performance. The study also emphasizes the importance of carefully selecting and validating cut-off points in OSCE exams to ensure fairness and consistency in assessment.

A Retrospective Observation of Medical Students Matching into Neurology Residencies Following a Change to Clerkship Curriculum (P11-2.004)

<h3>Objective:</h3> To retrospectively observe the proportion of the graduating medical school class pursuing residency training in neurology following a transition of the neurology clerkship to the third year of medical school. <h3>Background:</h3> Neurology is a rapidly growing field, resulting in adaptations in education over the years. In medical schools, there has been a trend to shift neurology clerkship rotations from fourth-year to third-year curriculums which has resulted in improved academic performance and higher enthusiasm for the field of neurology. <h3>Design/Methods:</h3> A retrospective observational study evaluating enrolled clerkship medical students at the Loyola University Chicago Stritch School of Medicine and the match rates into adult and child neurology specialties from 2001–2021. The students were divided into two groups involving those enrolled in clerkship when neurology was during the fourth-year curriculum (2001–2012) and students enrolled in clerkship when neurology was during the third-year curriculum (2013–2021). <h3>Results:</h3> Among the 3,093 students observed during 2001–2021, 59 students (1.9%) matched into adult neurology residencies and 15 students (0.48%) matched into child neurology residencies. There was a higher rate of students matching into both adult and child neurology specialties when neurology clerkship had transitioned to the third-year curriculum (37 students at 2.5% for adult; 11 students at 0.67% for child; <i>p</i> = 0.02) compared to the fourth-year curriculum (22 students at 1.4% for adult; 4 students at 0.28% for child; <i>p</i> = 0.11). <h3>Conclusions:</h3> There was a statistically significant observation of medical students matching into adult neurology residencies after the transition of neurology clerkship to the third-year curriculum. The match into child neurology was not statistically significant and likely due to an overall low events number. This data suggests earlier exposure to neurology can lead to a higher likelihood of students matching into neurology for residency training. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Garg has nothing to disclose. Dr. Raedy has nothing to disclose. Dr. Pardieck has nothing to disclose.