Community-based Medical School Research Articles

The Importance of Research Experience With a Scoreless Step 1: A Student Survey at a Community-Based Medical School.

As of January 26, 2022, the United States Medical Licensing Examination (USLME) step 1 exam went from a scored test to pass-fail step 1 (PFS1). The authors were interested in surveying medical students at a community-based medical school to observe their perceptions of the importance of student research given this recent change. A Qualtrics survey was disseminated to medical students (years 1-4) via school emails. Data were analyzed using the Mann-Whitney test to assess Likert scale scores, and narrative comments were grouped as qualitative feedback. Survey dissemination and analysis of data were both conducted at a large community-based medical school. The survey sampled 104 students categorized into pre-clerkship (PC) and clerkship (CL) years, with a response rate of 33%. A contradiction was found, as indicated by the higher number (p = 0.047) of clerkship students interested in Primary Care/Family medicine residency compared to pre-clerkship students at 41% and 59%, respectively. Whereas participants who indicated they are interested in pursuing a competitive specialty for residency were 51% of pre-clerkship students over 41% of clerkship students (p = 0.047).Additionally, given the assessment change to pass/fail, students did in fact believe that residencies would now view research as a higher assessed component than before (79% pre-clerkship and 72% clerkship). However, a minority of students said that they increased their research efforts (41% and 47%). Most students supported the research opportunity improvements proposed in our survey. Efforts to make the step 1 exam pass/fail may have alleviated some stress related to performance but may have increased the perception of the importance of other components in a student's residency application. Our survey highlights how medical students at a community-based medical school perceive this change and how it has affected their research efforts.

Clerkship director confidence in medical student career advising in obstetrics and gynecology

Given the increasing complexities of the residency application processes, there is an ever-increasing need for faculty to serve in the role of fourth-year medical student career advisors. This study aimed to investigate obstetrics and gynecology clerkship directors' confidence and fulfillment with serving in the role of faculty career advisors. A 25-item electronic survey was developed and distributed to the 225 US obstetrics and gynecology clerkship directors in university-based and community-based medical schools with active memberships in the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, confidence in fourth-year advising, satisfaction with this aspect of their career, and resources used for advising. Of 225 clerkship directors, 143 (63.6%) responded to the survey. Nearly all clerkship directors (136/143 [95%]) reported advising fourth-year students. A median of 5.0 hours (interquartile range, 3.0-10.0) was spent per student in this advisory role, with 29 of 141 clerkship directors (20.5%) reporting some form of compensation for advising. Confidence in the ability to advise fourth-year medical students correlated significantly with number of years as a faculty, number of years as a clerkship director, and a higher full-time equivalent allotted as clerkship director. Fulfillment as a faculty career advisor was correlated with number of years as a clerkship director and a higher number of students advised. Obstetrics and gynecology clerkship directors regularly serve in the crucial role of faculty career advisor. Confidence in advising fourth-year students, advising fulfillment, and satisfaction with advising resources were all significantly correlated. We recommend that clerkship directors review resources available for advising and that they be provided academic time to serve as career advisors.

Graduating Medical Students’ Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ)

The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates. Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models. Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis. Our study included data for 15,451 GQ respondents (74% of all 2021 graduates). Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3). The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

Oral examination of fourth-year medical students on surgery rotations allows faculty to assess Core Entrustable Professional Activities for entering Residency (CEPAR): Proof-of-concept and analysis of student submissions

BackgroundAs a community-based medical school which recruited faculty preceptors new to teaching, we sought to create objective assessments for fourth-year surgery experiences via administration of an oral exam. Students provided three authentic cases, which faculty used as a springboard to ascertain student proficiency in five entrustable professional activities: 1-oral presentation, 2-recognition of urgency/instability, 3-calling consults, 4-transitions of care, 5-informed consent. We present proof-of-concept and analysis of student case submissions. MethodsTwenty-seven student submissions (79 cases in total) were evaluated for case complexity, level-appropriateness, and an estimation of the ability to conduct a quality exam based on the information provided (subjective measures). Objective metrics included word count, instruction adherence, inclusion of figures/captions. A resident-in-training rated cases via the same metrics. In-examination data was separately culled. ResultsThe average word count was 281.70 (SD 140.23; range 40–743). Figures were included in 26.1% of cases. Faculty raters scored 29.0% as low-complexity, 37.7% medium-complexity, and 33.3% high-complexity. Raters felt 62.3% of cases provided enough information to conduct a quality exam. The majority of cases submitted (65.2%) were level-appropriate or higher. The resident rater scored cases more favorably than surgeons (Cohen's kappa of −0.5), suggesting low inter-rater agreement between those of differing experience levels. ConclusionStudent's case submissions lessened faculty burden and provided assessors with adequate information to deliver a quality exam to assess proficiency in clinical skills essential for residency. Cases demonstrated sufficient complexity and level-appropriateness. The request to correlate case rating with exam performance is under review by our institution's assessment office. Near-peer tutoring by resident alumni is a program under development.

Introduction of Balint Groups as a Reflective Practice Method

Cynicism and burnout are well-described among new medical school graduates. At the new medical school in Washington state, the trend toward placing importance on wellness and creating a culture of healing was present from the outset. To encourage reflective practice, Balint groups were introduced as a method to teach students to think deeply about patient relationships and to address particular curricular objectives, including to demonstrate empathy for healthcare trainees and for patients, and to practice active listening skills in the context of the student Balint groups. The approach presented here will focus on the introduction of Balint groups into the pre-clerkship curriculum as a longitudinal tool to prepare students to use the method with more facility in their clerkships. The presentation at the 2022 American Balint Society Annual Meeting highlighted the introduction of Balint groups to the clinician faculty using the Intensive on the Road format, the introduction of Balint groups to pre-clerkship medical students, and the use of Balint groups in the pre-clerkship curriculum. The operational aspects, including faculty recruitment and retention, as well as student groupings and scheduling, were addressed in the context of the overall theme of monitoring student progress toward open communication about their challenging patient relationships. Programmatic evaluation and current trends were emphasized, along with the anticipated evolution and future directions of the program at our community-based medical school.

The Influence of COVID-19 on Medical Student Resource Preferences.

IntroductionOver the past decade, pre-clerkship medical education has shifted from solely relying on didactic lectures to implementing more group learning and clinical experience to promote individualized, self-directed, and patient-centered education. COVID-19 required medical schools to examine their curricula and determine which portions were adaptable to virtual learning. This study compared first-year medical students’ (MS1) perceptions of an online curriculum, focusing on the students’ preferred resources before and after the transition to virtual courses.Materials and methodsAt one community-based allopathic medical school, a decision was made to move the entire pre-clerkship curriculum to a virtual format in the setting of the pandemic. An end-of-course survey evaluation was distributed via email to 64 first-year medical students at a community-based allopathic medical school. The participants were asked numerous questions about their overall perceptions of each course, including questions about the usefulness of lectures, small group activities, course administration, and faculty communication. Quantitative and qualitative data were collected during the standard program evaluation process for the two courses, and a third survey that focused on learning resources asked questions regarding virtual learning.ResultsOf the students, 29.7% reported being disappointed with the virtual curriculum, while the other 70.3% reported an unchanged or improved overall medical education. Regarding resource preferences, 56.5% of the students viewed most (76%-100%) course lectures, while 35.5% of the students viewed less than half of the course lectures. In contrast, 75.8% of the students said the majority (>50%) of their learning comes from outside resources. Furthermore, 31% reported that they are satisfied with the resources provided by the school, while 42% reported that they would like the school to provide additional resources. With that being said, 61% reported using more outside resources with the onset of a virtual curriculum, while 34% reported no change in outside resource use. Only 2% reported using fewer outside resources.ConclusionThis study found that pre-clerkship medical students preferred some aspects of the in-person setting, such as social interaction and clinical exposure that is lacking in the virtual setting. However, students preferred many aspects of the virtual setting, such as having more independent study time and a more efficient learning process. Overall, before and after the transition, students were less satisfied with traditional curricular resources and more likely to choose external, board-specific resources with hopes of building strong residency applications, and these preferences were heightened in the online format.

Teaching Health Equity: A Medical School and a Community-Based Research Center Partnership.

To address the persistent health inequities in the United States, medical education must prepare future physicians to understand the systemic causes of these inequities, as well as health care's role in alleviating them. Limited time and faculty expertise often necessitate innovative strategies to augment existing medical education curriculum with content and experiences to expose medical students to these facets of health inequity. In this report, we describe a partnership between the Chicago Medical School (CMS), a community-based medical school, and the Sinai Urban Health Institute (SUHI), a community-focused research center in Chicago, Illinois. As a part of this partnership, SUHI hosts a summer internship for 7 to 15 medical students per year to teach about health equity, population health, and public health research. The internship includes project-based learning, a structured curriculum, and community tours and volunteering. A total of 62 CMS medical students have participated. Student surveys consistently showed high levels of satisfaction with the program across all years (2013-2018, 2020). Almost all students report that they were exposed to new ideas and issues (96.6%), and that the new knowledge and skills were applicable to their future work as physicians (91.7%). Other medical schools may benefit from collaborative models with public health research organizations to complement existing curriculum, opportunities for research, and engagement with marginalized populations.

The Making of a Community-Based Medical School Branch Campus: A Study in Healthcare System Dynamics on Medical Education Drexel University College of Medicine at Tower Health, West Reading, Pennsylvania

The Making of a Community-Based Medical School Branch Campus: A Study in Healthcare System Dynamics on Medical Education Drexel University College of Medicine at Tower Health, West Reading, Pennsylvania

Increasing Student-Perceived Readiness for Obstetrics and Gynecology Clerkship Using a Student-Created Curriculum [A56

INTRODUCTION: Among third-year medical students at a community-based medical school, students report feeling less prepared at the start of an obstetrics and gynecology clerkship compared to other clerkships. We sought to determine if a student-led curriculum is an effective resource for third-year clerkship preparation and how this curriculum affects student interest in obstetrics and gynecology, perceptions of the obstetrician-gynecologist attending lifestyle, comfort with obtaining a specialty-specific history and physical (H&amp;P), and obstetric ultrasound techniques. METHODS: Fourth-year medical students pursuing obstetrics and gynecology designed clerkship-specific curricula and administered a lecture to third-year medical students via Zoom. This lecture focused on obtaining obstetrics and gynecology-specific H&amp;P, interpreting tests of fetal well-being, labor and delivery (L&amp;D) triage cases, and obstetric ultrasound techniques. An eight-question pre and postlecture survey using a Likert scale was distributed to all attendees. RESULTS: The pre and post lecture survey had 26 and 22 respondents, respectively. Attendees reported increased comfort with obstetrics and gynecology-specific patient presentations (P&lt;.001), taking obstetric and gynecologic histories (P&lt;0.001, P&lt;.001), performing a pelvic exam (P&lt;.001), and performing obstetric ultrasound (P&lt;.001) after attending the lecture. Respondents overall felt more prepared for the obstetrics and gynecology clerkship relative to Family Medicine (P&lt;.001). In terms of career guidance, students believed obstetrics and gynecology to be less demanding post-lecture (P&lt;.03); however, student interest in the specialty did not significantly change. CONCLUSION: This study suggests that a single, remotely conducted, upperclassmen-led lecture centered on applied clinical knowledge in obstetrics and gynecology significantly improves third-year medical student comfort with performing specialty-specific history and physical exams, obstetric ultrasound techniques, and perception of attending lifestyle. It also confirms that student-led curriculum is an effective resource for third-year clerkship preparation.

Creating a Pipeline for Minority Physicians: Medical-Student-Led Programming.

Medical School Outreach Programming provides value to medical schools and the community by: (1) fulfilling medical school accreditation requirements, (2) creating pipelines to promote diversity in future healthcare professionals, and (3) providing medical students with opportunities for extracurricular community-level engagement. An Outreach Program initiated at a U.S. community-based medical school provides a medical student-led model with primary goals of improving college candidacy and healthcare career representation for underserved and under-represented minorities in the United States. The Outreach Program also promotes the personal growth and education of medical students.

Characteristics of Medical School Applicants: A Single-Institution Study.

Medical schools aim to admit talented learners who are honest, patient centered, and caring, in addition to possessing the required cognitive skills. The Association of American Medical Colleges (AAMC) describes core competencies for entering medical students in three categories: science, preprofessional, and thinking and reasoning. The authors sought to determine desired characteristics of medical school applicants at a rural, community-based medical school in light of the published core competencies. This qualitative study involved an analysis of data from discussion groups, all from a convenience sample of participants. The authors led the discussion groups, and large sticky note pads and pens were provided to scribe responses. Group members were given the prompt, "What do you see as traits or characteristics of your ideal doctor?" We used a content analysis approach to analyze the data. The total number of responses across groups was 243, representing 15 unique characteristics. The 15 characteristics, listed in decreasing order of frequency, included good communicator, knowledgeable, dedicated, compassionate, respectful, community oriented, well rounded, patient, team player, available, leader, positive attitude, equal treatment, prevention focused, and urgency when needed for patient care. Of the top characteristics with 20 or more responses, alignment with AAMC competencies was noted, but less so with being community oriented as defined by study participants. This study demonstrates that there are unique characteristics that a rural community and its medical school consider when admitting applicants to their medical program. Further research is needed to explore the need for additional competencies for rural medical schools to consider for entering medical students.

Florida State University College of Medicine.

Florida State University College of Medicine.

Michigan State University College of Human Medicine.

Michigan State University College of Human Medicine.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

University of Nevada, Reno School of Medicine

University of Nevada, Reno School of Medicine

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Charles E. Schmidt College of Medicine at Florida Atlantic University.

Establishing a Multi-Institutional Quality and Patient Safety Consortium: Collaboration Across Affiliates in a Community-Based Medical School.

The landscape of health care delivery and medical education is evolving. Institutions must continually reassess priorities, strategies, and partnerships to align the knowledge and skills of the health care workforce with the delivery of quality, socially accountable, collaborative health care that meets the needs of diverse populations in communities. This article describes the development, implementation, and early outcomes of the University of Missouri-Kansas City's Health Care Quality and Patient Safety Consortium. Inspired by an actual patient safety event, the consortium aimed to improve patient outcomes by establishing quality improvement and patient safety (QIPS) education and scholarship as foundational within its unique, horizontal-matrix academic health center, which comprises 6 affiliated hospitals and 4 university-based health sciences schools. The consortium established a governance structure with leaders who, collectively, represent the diverse members and stakeholders of the consortium. The members share a common agenda and mutual goals. The consortium measures success by applying published conceptual frameworks for evaluating the outcomes of educational programs on learners (Kirkpatrick) and patients (Bzowyckyj and colleagues). Consortium learner and patient outcomes span all levels of these frameworks. Undergraduate and graduate QIPS-based projects with meaningful health system or improved individual health outcomes signify a Level 4 outcome (the highest level) for learners and patients alike. Factors critical to success include a financial gift, leadership buy-in and support, a clear champion, shared goals and a united vision, a willingness to collaborate across health systems with varied strengths and priorities, and a stable communication platform. Aspirational goals of the consortium include increasing involvement across health professional schools, incorporating simulation into QIPS activities, and aligning the consortium's projects with broader community needs.

Do community-based Medical Schools Produce More Community-based Research? A Review of Four Medical Schools in Sudan and Saudi Arabia

PurposeDespite several publications comparing the educational outcomes of Community-Based Education (CBE) to non-CBE Medical schools, evidence on utilization of community-based research (CBR) is largely lacking. Therefore, the objective of this research was to compare the utilization and quality of community-based research approaches between four community-based education and non-CBE medical school in Sudan and Saudi Arabia. MethodsA review of the literature from four schools in Sudan and Saudi Arabia was performed by searching PubMed electronic database using predefined inclusion and exclusion criteria. Classification of studies and appraisal of quality of community engagement was performed. ResultsThe review identified a total of 573 articles, 79.4% (455) of which were produced by non-CBE medical schools (Khartoum and Taibah) and 20.6% (118) produced by CBE medical schools (Gezira and Jazan). However, only 9.08% (52) of the articles were CBR while more than a fifth (21.19%) of the school CBE articles were CBR with only almost 6% CBR from the production of non-CBE medical schools. This demonstrates that despite on-CBE schools’ significant production of articles relative to CBE schools, nevertheless researchers were more inclined to utilize hospital, laboratory and internal facilities rather than community-based facilities to conduct research activities. The mean scores obtained for quality of community participation among the 52 CBR reviewed studies conducted by CBE and non-CBE medical schools were 1.33 and 0.07, respectively which effectively translates to significantly higher quality of community engagement in research at CBE schools. ConclusionConducting a research in the community instead of the laboratory, hospital or clinical setting does not make it a community-based research. The main challenges facing Community-Based Participatory Research are therefore building and maintaining genuine partnership and trust; sustainability of relationships and commitments; developing the knowledge, capacity and values; sustaining funding, staff, programs, and policy changes. Capacity development for both researchers and communities is required a long with developing policies and funding opportunities within higher education institutions to enhance CBPR as a tool for promotion of equity and social justice.

Selected Abstracts From the Proceedings of the 2015 Society of Teachers of Family Medicine (STFM) Conference on Medical Student Education.

The Society of Teachers of Family Medicine (STFM; http://www.stfm.org) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM's mission of improving the health of all people through education, research, patient care, and advocacy. The STFM held its 41st Conference on Medical Student Education in Atlanta, Georgia from February 5-8, 2015. The conference this year was met with record attendance and student scholarship winners. The STFM Education Committee selected 10 abstracts, of which five are presented below.

Development and implementation of an interprofessional education certificate program in a community-based osteopathic medical school

Abstract Community-based medical schools face unique barriers in developing meaningful interprofessional education (IPE) opportunities for their students. Here we describe the development, implementation, and preliminary evaluation of an IPE Certificate Program at a community-based osteopathic medical school. The IPE Certificate Program was developed by incorporating new curricular components with pre-existing requirements to minimize the burden on students, administrators, and faculty. The IPE program is delivered longitudinally to medical students, in collaboration with pharmacy and nursing students, over three years using interactive, volunteer, clinical, and reflective experiences. The primary aims of the IPE Certificate Program are to promote interprofessionalism based on the Core Competencies for Interprofessional Practice and provide additional acknowledgment for the students that participate in the program. Student assessments are based on both participation and the use of standardized grading rubrics based on the various activities' learning objectives. The students' knowledge and attitudes regarding interprofessionalism is also assessed using an adapted survey, while the overall program is evaluated with an end-of-year program evaluation. Preliminary results of the attitudes survey display favorable changes towards interprofessionalism. Due to the overwhelming acceptance by students and the administration, the curriculum has transitioned to a for-credit elective course that will appear on the participants’ academic transcripts. The following resources are included: a course syllabus, the course requirements, a grading rubric, the attitudes towards interprofessionalism survey, and a course evaluation. We propose our model can be used to implement IPE at other community-based institutions.