Clerkship Students Research Articles

Development and Implementation of a Multidisciplinary Translational Course Using Rheumatoid Arthritis as a Model for Chronic Illness During the Medical Student Clerkship Year

Development and Implementation of a Multidisciplinary Translational Course Using Rheumatoid Arthritis as a Model for Chronic Illness During the Medical Student Clerkship Year

Impact of an Inpatient Family Medicine Exposure: Changing Student Perception

Introduction: Currently there is a primary care physician shortage in the United States, and this shortage is expected to worsen into the foreseeable future. In 2023, only 7.5 % of US allopathic graduates entered family medicine (FM) residencies. Opportunities to create increased interest in family medicine as a career choice and address hidden curriculum messages in career choice must be explored to address shortages in family medicine. Methods: A 5-day inpatient experience with family medicine residents on a family medicine inpatient service was implemented during a required third-year core medical student clerkship in family medicine. Students who participated in this clerkship change were invited to complete a survey on how this experience altered their perceptions on the roles of family medicine physicians in inpatient medical care, intrapartum care, and care of the newborn, and how it affected their view of FM as a career choice. Results: Of the eligible students, 34% completed the survey. Participating in the FM inpatient experience significantly enhanced students’ perceptions about the depth of knowledge and skill needed for the specialty, increased students’ respect for the specialty, and contradicted students’ perceptions about the complexity of cases treated in the specialty. Conclusion: Adding an inpatient component to a third-year FM clerkship experience can significantly change the perceptions of medical students about the specialty of FM. Brief inpatient exposure to medical students has an impact on hidden curriculum messaging about family medicine.

Effectiveness of different strategies to teach empathy among medical students: A randomized controlled study

ObjectivesTo explore the effectiveness of two educational strategies for teaching empathy to medical students, focusing on their skills and on the theoretical knowledge and self-perception of empathy by patients, professors, and observers. MethodsThis is a randomized controlled study. Clerkship students were divided into two groups: an active group - Role Play and Reflection Group(RRG), and a more traditional group - Lecture Presentation Group(LPG). They were assessed pre- and post-intervention using the Jefferson Empathy Scale(JSPE), ESWIM Empathy Scale, CARE, empathic skills through simulated patient encounters, and a theoretical knowledge test. ResultsA total of 169 students were included. The RRG had higher scores (d=0.81) and greater gains (d=0.82) in empathic skills than the LPG. However, there were no significant differences in knowledge or other scales. Upon assessing skill acquisition (Post–Pre gains), there was a significant increase in both groups for all outcomes, except for JSPE in the LPG group and ESWIM for both groups. ConclusionMedical empathy can be taught, and active learning methodologies can lead to better outcomes, especially on the ability to provide empathic care. Practice implicationsThese findings reinforce existing literature and helps medical schools make informed decisions regarding their teaching methodologies. Trial registryhttps://ensaiosclinicos.gov.br/rg/RBR-8rwx89c.

Exploring Bias in Health Care: Using Art to Facilitate a Narrative Medicine Approach among Third-Year Medical Students.

Teaching medical students about biases in health care poses challenges due to the complexity of modifying preexisting beliefs and the possibility of triggering strong emotional reactions. Narrative medicine fosters reflection and discussion among healthcare providers, and visual thinking strategies (VTS) enable providers to improve diagnostic ability through close and methodical examination of art. This study investigated the effectiveness of a session integrating narrative medicine and VTS to enhance third-year medical students' understanding of bias in health care. A 90-minute "Narrative Medicine Rounds" session was implemented in the Family Medicine clerkship for all third-year medical students in the Florida International University Herbert Wertheim College of Medicine class of 2024. The session included a faculty-facilitated discussion of Robert Colescott's painting Emergency Room, an overview of narrative medicine principles, and a sharing of student narratives related to bias experienced in the healthcare setting. After the session, students wrote and submitted their narrative essays. Students also completed an anonymous, optional, computer-based evaluation with Likert-type and free-response questions. Likert questions were analyzed using descriptive statistics. For the short-answer questions, teams of two researchers (D.G. and S.E.S., E.E. and M.S.) analyzed responses for themes and subthemes, met to reach consensus on a codebook through discussion, and recoded data as needed until frequencies of themes were mutually determined. Of 101 students, 87 (86%) provided responses to the Likert questions. Seventy percent of respondents agreed that Robert Colescott's Emergency Room was a useful tool for discussing bias in medicine, whereas 25% were neutral. Fifty-one percent of respondents agreed that the session enhanced their understanding of bias in patient care, with 33% being neutral. Forty-seven percent of respondents agreed that the session made them more familiar with narrative medicine as a tool that they can use in patient care, with 28% being neutral. Students identified five themes for recognizing bias: empathy (16%), self-reflection (60%), active listening (17%), communication (13%), and education (7%). When addressing bias, students outlined five strategies: drawing from personal experiences (1%), self-reflection (64%), communication (29%), education (15%), and advocacy (26%). Combining narrative medicine and VTS in a single session offers a promising approach for discussing bias in healthcare education. Through reflective experiences and art interpretation, students demonstrated an awareness of often interconnected strategies to identify and mitigate bias while caring for patients. Future next steps for this study involve exploring longitudinal impacts and integrating narrative medicine strategies throughout the medical school curriculum.

Dual Coaching of Medical Clerkship Students’ History-Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom during the COVID-19 Pandemic [Letter

Dual Coaching of Medical Clerkship Students’ History-Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom during the COVID-19 Pandemic [Letter

Calculating the Notional Learning Hours (NLH) for Final-year Medical Students in a Clinical Surgery Clerkship Course

Background: The main objective of this study is to design a method to calculate the notional learning hours (NLH) of final year medical students doing a surgical clerkship course. Secondary objectives include derivation of the Oman Qualification Framework (OQF) credits and setting a benchmark of NLH in clinical courses.Methods: This is an observational cross-sectional study which uses a quantitative way to estimate students’ NLH. A questionnaire was designed and filled by final year medical students at the end of their surgical rotation. Ethical clearance was obtained. The data were uploaded and analyzed using SPSS 25. The NLH was then calculated and mapped on the OQF template.Results:Ninety-seven students participated in the study. Students spent an average of 1.20 (0.99) hours/day to study their clinical sessions and 2.86 (1.4)/day to study for their theory sessions. The mean weekend hours of study on Friday and Saturday were 3.1 hours (2.6), and 3.2 hours (2.5), respectively. The average preparation for the end rotation and the final MD exams were 9.7 (3.3) and 10.4 (3.6) hours, respectively. We calculated the NLH of our students by adding the above data to the contact teaching hours from our course timetable. We compared our results with worldwide medical schools.Conclusion: The NLH of our surgical clerkship students was calculated and subsequently the OQF credits were derived. This suggested method is evidence-based and could be used as a guide by other clinical clerkship courses.

Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success. Step 1 completion before clerkships promotes learning outcomes (e.g., integration and mastery of foundational material), may encourage students to focus on the curriculum, and may better prepare students for clinical science exams (CSEs). However, delaying the exam ensures that students maintain foundational knowledge and may encourage clinical educators to demonstrate basic science illustrations. An early Step 1 may affect learner behavior by allowing clerkship students to focus on clinical learning. The associated National Board of Medical Examiners performance report may also be used for Step 2 and CSE preparation. However, delaying Step 1 allows greater scheduling flexibility based on developmental milestones. Administration of Step 1 before clerkships removes a significant stressor from the clinical year and decompresses the residency application period. However, a delayed Step 1 reduces the pressure on students to engage in numerous extracurricular and research activities to distinguish themselves due to the pass/fail change. An early Step 1 exam may also lead to improved CSE performance, which is often linked to clerkship honors criteria, an increasingly valuable distinction for residency match success after the change to pass/fail. In contrast, delaying Step 1 is associated with higher first-time pass rates, which may be especially important for students at risk for failure. Medical educators and students should collaboratively approach the question of Step 1 timing, considering these factors within the context of the medical school program, curricular constraints and priorities, and students' individual needs and goals.

Objective Comparison of the First-Person-View Live Streaming Method Versus Face-to-Face Teaching Method in Improving Wound Suturing Skills for Skin Closure in Surgical Clerkship Students: Randomized Controlled Trial.

The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person-view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills. This study aims to objectively assess the effectiveness of the first-person-view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students. A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed. A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant's pre-experiment and postexperiment DOPS scores revealed that the LS method's outcome is comparable to the FTF method's outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students' surgical skills. First-person-view LS training sessions could enhance students' ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method.

Evaluation of high-fidelity and virtual reality simulation platforms for assessing fourth-year medical students’ encounters with patients in need of urgent or emergent care

Background Medical students in the U.S. must demonstrate urgent and emergent care competence before graduation. Urgent and emergent care competence involves recognizing, evaluating and initiating management of an unstable patient. High-fidelity (HF) simulation can improve urgent and emergent care skills, but because it is resource intense, alternative methods are needed. Study Objective Our primary purpose was to use program evaluations to compare medical student experiences with HF and virtual reality (VR) simulations as assessment platforms for urgent and emergent care skills. Methods During their emergency medicine clerkship, students at The Ohio State University College of Medicine must demonstrate on HF manikins, competence in recognizing and initiating care of a patient requiring urgent or emergent care. Students evaluated these simulations on a five-point quality scale and answered open-ended questions about simulation strengths and weaknesses. Faculty provided feedback on student competence in delivering urgent or emergent care. In 2022, we introduced VR as an alternative assessment platform. We used Wilcoxon Signed Ranks and Boxplots to compare ratings of HF to VR and McNemar Test to compare competence ratings. Comments were analyzed with summative content analysis or thematic coding. Results We received at least one evaluation survey from 160 of 216 (74.1%) emergency medicine clerkship students. We were able to match 125 of 216 (57.9%) evaluation surveys for students who completed both. Average ratings of HF simulations were 4.6 of 5, while ratings of VR simulations were slightly lower at 4.4. Comments suggested that feedback from both simulation platforms was valued. Students described VR as novel, immersive, and good preparation for clinical practice. Constructive criticism identified the need for additional practice in the VR environment. Student performance between platforms was significantly different with 91.7% of students achieving competence in HF, but only 65.5% in VR (p≤.001, odds-ratio = 5.75). Conclusion VR simulation functions similarly to HF for formative assessment of urgent and emergent care competence. However, using VR simulation for summative assessment of urgent and emergent care competence must be considered with caution because students require considerable practice and acclimation to the virtual environment.

Normal Pregnancy Care and Physiology and Select Pregnancy Complications: A Flipped Classroom Case for the OB/GYN Clerkship.

This module teaches core knowledge and skills for undergraduate medical education in reproductive health, providing instruction in the management of normal and abnormal pregnancy and labor utilizing interactive small-group flipped classroom methods and case-based instruction. Advance preparation materials were provided before the education session. The 2-hour session was facilitated by clinical educators using a faculty guide. Using voluntary surveys, we collected data to measure satisfaction among obstetrics and gynecology clerkship students and facilitators following each education session. Capturing six clerkships spanning 9 months, 116 students participated, and 64 students completed the satisfaction survey, with 97% agreeing that the session was helpful in applying knowledge and principles to common clinical scenarios. Most students (96%) self-reported that they achieved the session's learning objectives utilizing prework and interactive small-group teaching. Nine clinical instructors completed the survey; all agreed the provided materials allowed them to facilitate active learning, and the majority (89%) agreed they spent less time preparing to teach this curriculum compared to traditional didactics. This interactive flipped classroom session meets clerkship learning objectives related to the management of pregnancy and labor using standardized materials. The curriculum reduced preparation time for clinical educators as well.

Teaching Population Panel Management: A Patient Outreach Activity in a Family Medicine Clerkship.

The delivery of population health education in medical school can be challenging. We developed a patient outreach activity for third-year students to teach them the role of population panel management in primary care. The family medicine undergraduate medical education and population health teams collaborated to develop an educational patient outreach toolkit. After an orientation, family medicine clerkship students were assigned to call patients on their faculty adviser's patient panel to discuss care gaps and identify barriers and potential strategies to improve care. After the experience, students completed reflection questions, which we analyzed. From February to August 2022, 82 third-year medical students participated in the patient outreach activity during their 6-week clerkship. Of the 1,235 total attempted calls, 24% of the patients scheduled their appointments afterward. After analyzing the reflective student feedback, we identified six main takeaways, which focused on the importance of population health, the identification of barriers to care, positive and negative feelings that students experienced when making calls, student self-identified areas of growth, and the fragmentation/inefficiency of the health care system. An opportunity exists to continue to teach students about how to communicate with patients about their health and how to address and improve social determinants of health. This curricular activity can be a step toward efforts to align population health and clinical practice and a way for medical students to add value by educating patients.

Using the electronic health record to provide audit and feedback in medical student clerkships.

This article focuses on the role of the electronic health record (EHR) to generate meaningful formative feedback for medical students in the clinical setting. Despite the scores of clinical data housed within the EHR, medical educators have only just begun to tap into this data to enhance student learning. Literature to-date has focused almost exclusively on resident education. Development of EHR auto-logging and triggered notifications are discussed as specific use cases in providing enhanced feedback for medical students. By incorporating predictive and prescriptive analytics into the EHR, there is an opportunity to create powerful educational tools which may also support general clinical activity. This article explores the possibilities of EHR as an educational resource. This serves as a call to action for educators and technology developers to work together on creating health record user-centric tools, acknowledging the ongoing work done to improve student-level attribution to patients. EHR analytics and tools present a novel approach to enhancing clinical clerkship education for medical students.

Near-Peer Paradigms in Medical School: Integrating Student Teaching Assistants Into a Core Radiology Clerkship

Rationale & ObjectivesNear-peer paradigms have been demonstrated effective in supporting how students navigate novel clinical environments. In this study, we describe an innovative model of incorporating teaching assistants (TAs) into a core radiology clerkship and investigate both its perceived educational value by clinical-year learners and its perceived impact on professional growth by TAs. Materials & MethodsAt one U.S. medical school, the core clinical year includes a clerkship in radiology incorporating both reading room exposure and a didactic curriculum. Radiology faculty delivery a variety of traditional and interactive, “dynamic” lectures, while medical student TAs deliver additional dynamic sessions, including a final TA-created review session. The educational value of each didactic session by clerkship students was assessed using a five-point scale survey, and the professional value of the experience by TAs was assessed using a five-point Likert survey. ResultsSpanning from 2020 to 2023, 268 (74.4%) clinical-year students submitted the post-clerkship survey, with the didactic review sessions created and led by TAs receiving the highest ratings of any didactic session. Of 16 former TAs, 12 (75%) completed the post-service survey, with all respondents agreeing or strongly agreeing that they enjoyed and would recommend their experience, and that it enhanced their interest in radiology and in academic medicine. ConclusionNear-peer education in a core radiology clerkship enhances the experience of the learner through peer guidance and the experience of the teacher through professional development. These findings may increase student interest in pursuing academic radiology as a career and invite opportunities for broadening medical school education in radiology.

Adverse events following immunization of mRNA-1273 (Moderna) booster vaccine in clerkship students

Two-dose primary vaccine administration was the best strategy to reduce the prevalence and severity of COVID-19. Improved immunity and antibody response to the new variant virus by administering a booster vaccine is needed. Health workers are the main priority for administering the mRNA-1273 (Moderna) booster vaccination in Indonesia. This vaccine has high effectiveness, and safety, however, data and evaluation of adverse events following immunization (AEFI) is required. This study aimed to determine the AEFIs of mRNA-1273 booster vaccination in clinical clerkship students as an early adult age group. The research design was a repeated cross-sectional study using purposive sampling technique. There were 214 subjects who met the requirements. Subject filled out an online questionnaire containing evaluation of AEFIs. The most local AEFIs symptoms were pain at the injection site (79.0%), while the common systemic symptoms were headache, drowsiness, weakness, and fever (37.4%; 26.2%; 9.8%; 9.3%). Most AEFIs were felt within 30 minutes to three days. No respondents required hospitalization, experienced anaphylactic shock, became disabled, or died. The AEFIs did not have a significant relationship with gender, history of allergies, co-morbidities, or history of COVID-19. This information is used as a preventive or educational effort to support implementation vaccine in Indonesia.

Implementing the Radiology Rotation-Model-22 in Clerkships: The RRM-Pocket Card for Medical Students – Part 2

Practical training for medical students in radiology clerkships takes place in busy clinical routine. We introduced the Radiology Rotation-Model-22 (RRM) as the department-related RRM-pocket card for student rotation (SR) settings in part one of this study. RRM was developed as a documentation tool and pocket card with department sections for radiology (10) and imaging specialties (1) for medical students in clerkships. With the RRM-tool, and while exploring departments for practical experience, students can log data details on rotations and tasks by the method of participant observation (PO). By PO, students can track SR and training progress. In part two, we present attempts on implementing the RRM-tool as a rotation concept for students to gain efficient training experience. The RRM-pocket card provides students, radiologists, and radiographers with an overview of SR and tasks. RRM can be implemented to optimise clerkships’ structure, and to generate self-action for students, while actively optimising SR.

Effect of a workplace-based learning program on clerkship students’ behaviors and attitudes toward evidence-based medicine practice

ABSTRACT In clinical clerkship (CC), medical students can practice evidence-based medicine (EBM) with their assigned patients. Although CC can be a valuable opportunity for EBM education, the impact of EBM training, including long-term behavioral changes, remains unclear. One hundred and nine fourth- and fifth-year medical students undergoing CC at a medical school in Japan attended a workplace-based learning program for EBM during CC (WB-EBM), which included the practice of the five steps of EBM. The program’s effect on the students’ attitudes toward EBM in CC was assessed through questionnaires. A total of 88 medical students participated in the program. Responses to the questionnaire indicated high satisfaction with the WB-EBM program. The most common theme in students’ clinical problems with their assigned patients was the choice of treatment, followed by its effect. Based on the responses in the post-survey for the long-term effects of the program, the frequency of problem formulation and article reading tended to increase in the ‘within six months’ group comprising 18 students who participated in the WB-EBM program, compared with the control group comprising 34 students who did not. Additionally, the ability to self-assess problem formulation was significantly higher, compared with the control group. However, among 52 students who participated in the WB-EBM program more than six months later, EBM-related behavioral habits in CC and self-assessments of the five steps of EBM were not significantly different from those in the control group. The WB-EBM program was acceptable for medical students in CC. It motivated them to formulate clinical questions and enhanced their critical thinking. Moreover, the WB-EBM program can improve habits and self-evaluations about EBM. However, as its effects may not last more than six months, it may need to be repeated across departments throughout CC to change behavior in EBM practice.

Level of Satisfaction of Clinical Clerkship Students on Small Group Learning in Preparation for Clinical Clerkship

Objectives: Clinical clerkship is a phase where medical students are required to deepen and implement the theory and skills acquired during the preclinical period in the hospital or healthcare center. Small Group Learning (SGL) is recalling method of learning the theoretical basis in each part of clerkship. The aim of this study is to describe the level of student satisfaction with SGL, including syllabus, presentation and suitability from student’s perspective. Methods: Every student who has completed the SGL session will fill out a questionnaire using Google Form media. Results: Two hundred of clinical clerkship students from each department, 96.5% of students stated that SGL syllabus was suitable during the clinical clerkship, 70.5% stated that the presentation of SGL was given very well, and 85% stated that the schedule was suitable. Conclusions: Clinical clerkship student's level of satisfaction is well among all parameters. Therefore, they have a good perspective from SGL during their preclinical period. A good SGL implies better knowledge provision through SGL.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S67

An assessment of barriers and facilitators of near-peer coaching on surgical clerkships: a mixed-methods study from resident’s perspective

PurposeWe implemented a near-peer (resident–student) coaching intervention in 2021–2022 to improve clerkship students’ health system science (HSS) learning and application. This study thus sought to identify implementation barriers and potential facilitators of an effective HSS near-peer coaching program for clerkship students from the resident coach’s perspective at a single tertiary-care institution.MethodsA mixed-methods study design was employed. Thirty surgical residents volunteered to serve as HSS coaches for rotating third-year medical students during the 2021–2022 academic year. Coaches were asked to complete an exit survey, and a subset was purposefully sampled to complete semi-structured interviews. Transcripts were coded and analyzed with a framework method to identify emergent themes indicative of the barriers and facilitators of effective implementation of this near-peer HSS coaching program.ResultsA total of 20/30 (67%) resident coaches completed the survey and 50% of these residents (n = 10/20) completed an interview. Coaches facilitated multiple meetings (ranging from 1 to more than 5 times) with their assigned students over the course of the 3-month surgical rotations. Most coaches who deemed themselves successful in coaching reported early prioritization of setting individualized clerkship goals. Rapport building and strong communication were also important factors identified in facilitating effective near-peer cognitive coaching relationships.ConclusionsOur study suggests that, from residents’ perspective, effective near-peer coaching by residents on surgical clerkships requires special emphasis on early goal setting, as well as training and development of coaches in skills, such as feedback delivery, and rapport building to encourage strong resident–student coaching relationships that cater to the individualized needs of the learner.

Applying a Competency-Based Medical Education Framework to Development of Residents' Feedback Skills.

Feedback is a critically important tool in medical education. This pilot program applies and evaluates a competency-based approach to develop residents' skills in providing feedback to medical students. In 2018-2019, a competency-based resident feedback skills program incorporating videorecording of skills, multi-source feedback using assessment tools with validity evidence, and sequential deliberate practice was piloted in a single-center, prospective study at the University of Rochester. Study participants included eight second-year psychiatry residents and 23 third-year clerkship students. After an introduction to foundational feedback concepts in didactic sessions, residents were videorecorded providing feedback to medical students. Recordings were reviewed with a faculty member for feedback. Skills were assessed by students who had received resident feedback, residents, and faculty utilizing a tool with validity evidence. Observations were repeated a total of three times. Mean feedback scores increased from 2.70 at the first feedback observation, to 2.77 at the second feedback observation, to 2.89 at the third feedback observation (maximum 3.00 points). The differences between the first and third sessions (0.19) and second and third sessions (0.12) were statistically significant (p values were < .001 and .007, with SE of 0.4 and 0.4, respectively). The observed competency-based feedback skills training program for residents using sequential, multi-source review and feedback was feasible and effective. Direct observation is a key component of high-quality feedback, and videorecording is an efficient methodology for observations, enabling both direct observation by the assessor and opportunity for enhanced self-assessment by residents viewing themselves in the feedback encounter.

Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers

ObjectivesHealthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative...