Free-response Questions Research Articles

Telesimulation Use in Emergency Medicine Residency Programs: National Survey of Residency Simulation Leaders

Introduction: Coronavirus 2019 (COVID-19) accelerated the need for virtual learning including telesimulation. Many emergency medicine (EM) programs halted in-person simulation and trialed telesimulation, but specifics on its utilization and plans for future use are unknown. Telesimulation has been defined as “a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location.” Our objective in this study was to describe the patterns of telesimulation usage in EM residency programs during COVID-19-induced learning restrictions as well as its anticipated future utility. Methods: We identified EM simulation leaders via the EMRA Match website, institutional websites, or personal contact with residency coordinators and directors, and invited them to participate by email. Participants completed a confidential, web-based survey consisting of multiple-choice items and one free-response question, developed by our study team with consideration of survey research best practices and Messick’s validity framework. We collected data between January–February 2022. We calculated descriptive statistics for multiple-choice items and examined the free-response answers for common themes. Results: We obtained contact information for simulation leaders at 139 EM residency programs. Survey response rate was 65% (91/139). During in-person restrictions, 62% (56/91) of programs used telesimulation. Assuming all restrictions lifted, 38% (34/90) of respondents planned to continue to use telesimulation, compared to 9% (8/91) using telesimulation before COVID-19. Most respondents planned to use telesimulation for medical knowledge (26/34, 76%) and communication/teamwork-focused cases (23/34, 68%). In response to the free-response question regarding experience with and plans for use, we identified three major themes: 1) telesimulation is a valuable alternative to in-person learning; 2) telesimulation is an option for learners unable to participate in person; and 3) telesimulation is challenging for procedural education. Conclusion: Despite the relatively limited use of telesimulation in EM residencies prior to COVID-19, an increased number of programs have plans to continue incorporating telesimulation into their curricula. This plan for continued use opens opportunities for further innovation and scholarship within simulation education.

Core psychosocial insights, challenges, and opportunities in the orthopedic surgery care of children and adolescents.

This is the second phase in an investigation of the psychosocial impact of orthopedic surgery on adolescents. What are the core psychosocial factors that shape the experience of adolescent patients aged 11-18 who are undergoing orthopedic surgery? Two 43-question surveys (preoperative and postoperative) were developed as modified versions of the survey used in phase 1. The preoperative survey was administered 2 weeks before surgery. The postoperative survey was administered 6 weeks later. Responses were collected from free-response and Likert-scale questions exploring patient-physician relationships, office visits/hospital stays, family, peers, academics, sports, and surgical expectations. The survey was administered prospectively to patients aged 11-18 undergoing limb lengthening/reconstruction, pediatric, spine, sports, or hand/upper extremity orthopedic surgery. In all, 135 patients were identified; 105 were enrolled and completed both surveys. There were some statistically significant changes in responses to questions regarding office visits/hospital stays, patient-physician relationships, friends/community, academic performance, and expectations for surgical experience throughout the perioperative period. There were no statistically significant changes in responses to questions regarding the role of parent/family and sports. There was no statistically significant difference between the female and male genders or between age groups in any of the domains. Overall statistical significance in this study did not consistently correlate to clinical significance. Adolescents require psychosocial support from their surgeons, caregivers, and peers in addition to respect for their independence and personal needs. Level II.

Identifying strengths and weaknesses at the bench, an institution’s quest to improve the Gram stain bench experience and patient care

Abstract Introduction/Objective The Gram stain is the first actionable result reported to guide treatment. In our laboratory, we noted instances of initial Gram stain results discrepant to subsequent cultures. In reevaluating the Gram stain bench, we devised a survey for medical laboratory scientists (MLS) to determine the strengths and weaknesses of the current workflow to search for areas of improvement. Results of the survey will help both leadership and MLS approach improving the interpretation and reporting of Gram stains. Methods/Case Report A 16-question survey was issued to all MLS in the microbiology lab over three weeks in January 2024 (Table 1). Questions (Q) 1 through 5 pertain to years of experience, how long it takes to review slides, and shift scheduling. Q6 through Q15 - addressing aspects of the bench including culture of the laboratory to ask for assistance, pressure to read slides, turnaround times, and confidence - were on a Likert scale from 1 to 5, 1 is strongly disagree and 5 is strongly agree; mean responses are in Table 1. Q16 was a free response question to input additional thoughts or comments. Responses were recorded on the secure local network using Microsoft Forms. Welch’s t-test was performed on the responses for statistical analysis. Statistical significance is achieved in a p-value is < 0.05. Results (if a Case Study enter NA) Among the 33 respondents (Table 1), first shift has the longest MLS work experience (Q2). Third shift perceived significantly more pressure to read Gram stains correctly than first shift (Q8 2.6; 4.6), and turnaround time pressure was felt to hinder their ability to read (Q11 2.1; 3.3). Individuals who perceived the field was too large for review also took more time to review slides (Q12 2.2; 3.0). Being staffed on the Gram stain bench less frequently was associated with taking longer to interpret Gram stains. Conclusion Our laboratory environment is, overall, conducive to asking for assistance, there is assistance when needed, there is confidence and allotted time to read stains, and there is perceived adequate training. However, the data indicate that second and third shifts are disproportionately comprised of MLS who read the most Gram stains, have the fewest years of experience, and are least inclined to ask for assistance. This information is invaluable for redesigning the Gram stain bench in a manner that benefits and empowers MLS to maximize their expertise to read Gram stains and provide the best care for patients. Further discussion is planned to redesign the workflow using this information.

The Development of Free-Response Questions to Assess Learning Assistants’ Pedagogical Content Knowledge

The Development of Free-Response Questions to Assess Learning Assistants’ Pedagogical Content Knowledge

Student-created videos in online STEM education: a large, interdisciplinary, randomized control study

Student-created videos engage students’ interests, creativity, and content knowledge and enrich collaborative learning in STEM education. These videos enhance critical thinking and analytical skills, which are essential tools in the fields of science, technology, engineering, and mathematics (STEM). This study presents the results of such an assignment across several STEM areas (biology, chemistry, exercise science, information technology, and mathematics) at a minority-serving, liberal arts higher education institution in the southeast region of the United States. Undergraduate students (n = 557) across varied, online course modalities (synchronous and asynchronous) were required to create four problem-solving videos 3–8 min in duration. Assessment tools included a self-assessment of learning gains survey given to control and experimental groups and a post-video creation survey given only to experimental groups. Grade data was also collected from all sections. Comparing the experimental and control groups, students showed a statistically significant gain in their ability to give oral presentations, create videos, and edit videos. Qualitative data from free-response questions corroborate these gains and suggest that students also grew in content knowledge and conceptual understanding through these assignments. Our study implements a multimedia theoretical framework which suggests students learn more effectively from consuming presentations with both auditory and visual components. Our results suggest students see similar gains from producing presentations with both auditory and visual components. Further our results suggest that multimedia production enhances students’ presentation skills. From a practical perspective, this study suggests that faculty should incorporate student-created videos in online classes, which typically require oral presentations in person. Faculty are also advised to require oral and visual components within these videos to maximize learning gains from the perspective of a multimedia theoretical framework.

Challenges and Opportunities to Work and Industry Practice in Occupational Therapy: A Practitioner Survey.

Work and industry (W&I) is a vital yet underrepresented area of occupational therapy practice. Describing the current practice trends, challenges, and opportunities in W&I provides a foundation for future development and advancements. To describe the state of W&I occupational therapy practice and to identify challenges and opportunities in this specialty practice area. Cross-sectional survey conducted June 12 to July 17, 2020. Online survey distributed through direct email invitations and online platforms (i.e., CommunOT, LinkedIn). One hundred twenty occupational therapy practitioners who had worked in W&I within the most recent 5 yr. We used 30 multiple-choice, Likert-scale, and free-response questions across three topics: (1) training, resources, and research; (2) challenges and barriers; and (3) opportunities. Most respondents were occupational therapy practitioners working in clinical settings with >5 yr of experience; 29.2% identified as male. The most frequently provided services were ergonomic consultation and worksite evaluation; clinic-based W&I services were less frequently provided. Workplace injury prevention, management of psychosocial issues, and employee wellness programs were ranked as the top opportunities for occupational therapy in W&I. A shortage of accessible training and resources to support W&I practice was found, particularly mentoring and occupational therapy-focused research evidence. Maintaining referrals, competition from other professions, and limited support from professional organizations were key challenges. This study illustrates the evolution of W&I occupational therapy practice and highlights an urgent need for increased professional recognition and educational support to maintain occupational therapy's presence in this practice area. Plain-Language Summary: In this study, we describe the current practice trends in work and industry occupational therapy practice. We identify challenges related to resources and training in this practice area and provide insights into opportunities for future development. The study findings show the evolution of work and industry occupational therapy practice and highlight an urgent need for more professional recognition and educational support to maintain occupational therapy's presence in this practice area.

GRCI: An investigation into the feasibility of a General Relativity Concept Inventory

The study outlines the early-stage development of a free-response General Relativity Concept Inventory (GRCI), an educational instrument designed to test for conceptual understanding of General Relativity. Data were collected for the study by having 26 participants from General Relativity courses work through the questions on the GRCI. Interviews were conducted with four of the participants to gain further insight about their experience of working through the GRCI. The written responses revealed that participants were proficient when answering questions which required mathematical thought processes, but were more limited when answering questions which required conceptual and physical thought processes. The interviews revealed that participants found that free-response questions were appropriate to test for conceptual understanding of General Relativity. Participants identified that General Relativity has physical interpretations and mathematical constructs, and both are important to understand the theory. Participants thought that the GRCI could be given a formative purpose in a teaching context. The study was <i>proof of concept</i> in scope, with the aim of highlighting important points pertaining to the feasibility and development of the GRCI. Additional work to further investigate the above points highlighted by the study is encouraged.

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.

Unveiling the influence of pedagogical content knowledge in questioning on college students’ conceptual learning of introductory physics

Learning assistants (LAs) play a pivotal role in transforming traditional physics instruction toward a more inquiry-oriented approach. While empirical evidence supports the effectiveness of LA-involved physics instruction, there is a research gap regarding the specific competencies of LAs that contribute to improved conceptual understanding. One conjectured reason is LAs’ inquiry-oriented pedagogical skills, like questioning, which engender more effective interactions with students at points of instructional needs. This study addresses the gap by constructing a model delineating the contribution of LAs’ competencies of questioning, referred to as pedagogical content knowledge in questioning (PCK-Q), to students’ conceptual learning in introductory classical mechanics and electromagnetism. The participants included an instructional team comprising instructors, graduate teaching assistants, and LAs, and students from two sections over two semesters. PCK-Q was measured using a prevalidated instrument of free-response questions from our previous study, which could predict LAs’ questioning practices. Employing a pre-post design, students’ learning gain in conceptual understanding and critical thinking was assessed, and separate models were constructed to explore the relationship between LAs’ PCK-Q and students’ learning gain. Findings suggest that LAs’ PCK-Q has a significant but slight impact on students’ conceptual learning, with little impact on critical thinking. Furthermore, we developed Likert-scale questions, derived equations to quantify PCK-Q from Likert-scale ratings, verified the feasibility of this streamlined approach in measuring LAs’ PCK-Q, and discussed its limitations. The implications of the research findings are discussed in the context of physics instruction and LA preparation. Published by the American Physical Society 2024

340 Training cognitive skills to improve integration and application of knowledge in animal physiology

Abstract Case-based learning immerses students in real-world scenarios, prompting observation, action, and reflection to enhance cognitive skills. The open-ended nature of such learning can challenge students to reach greater levels of critical thinking; however, we have noticed that without guidance, students often do not know how to approach these types of questions. Therefore, the objective of this study was to investigate how two low-input interventions strategies may help train cognitive skills and improve student performance. Three semesters of an undergraduate physiology course employed a case-based assessment strategy, which included three-unit case studies and one cumulative final case study. Semester 1 (S1; n = 48) represented no intervention, Semester 2 (S2; n = 59) included two dedicated class periods of instructor led guidance on approaching case studies, and Semester 3 (S3; n = 95) utilized an online peer evaluation platform, where students evaluated and provided feedback to each other. For S2 and S3 the interventions first took place between case study 1and case study 2. In all semesters, students also received individualized feedback from the instructor or teaching assistants after each case study. In S2 and S3 pre-semester and post-semester surveys were administered to understand changes in perceptions of their own cognitive skills. In S2 and S3, case study grades decreased and increased (P < 0.05), respectively, between the first and second case study. The average grade on case studies after intervention was greatest (P < 0.05) in S3 where peer intervention was employed, compared with S1 or S2, which did not differ. When comparing changes in perceptions between the beginning and end of the semester, student confidence in their cognitive skills, determined by agreeance with Likert scale statements, tended to increase more (P < 0.10) in S3 compared with S2 (7.9% vs. 3.4%, respectively). The most notable change was agreeance with the statement “I can take multiple ideas from different concepts and combine them to create new understanding” which increased 7.0% and 16.5% in S2 and S3, respectively. Interestingly, free response questions indicated that students did not enjoy peer evaluation and felt that it was not beneficial to their learning. However, these data indicate that students benefited most from peer led intervention, when evaluated by student performance and perceptions of their cognitive skills. Peer evaluation provides a unique opportunity for students to actively engage in the learning process and to practice cognitive skills. This process holds dual benefit as reviewing peers requires students to reflect, analyze, and evaluate, which are cognitive skills also needed to solve the case studies.

Universal screening of colorectal tumors for lynch syndrome: a survey of patient experiences and opinions

BackgroundLynch syndrome represents the most common hereditary cause of both colorectal and endometrial cancer. It is caused by defects in mismatch repair genes, as well as EPCAM. Universal screening of colon tumors for Lynch syndrome via microsatellite instability (MSI) and/or immunohistochemistry (IHC) can identify patients and families at risk to develop further cancers and potentially impact surveillance and treatment options. The approach to implementation of universal screening, taking ethical considerations into account, is critical to its effectiveness, with patient perspectives providing valuable insight.MethodsPatients whose colon tumors underwent universal screening at Penn State Hershey Medical Center over a period of 2.5 years were mailed a survey on universal screening in 2017. Along with the survey, they received a recruitment letter and a summary explanation of research. The survey included both multiple choice and free-response questions that covered topics including respondent knowledge of Lynch syndrome, attitudes toward universal screening and experiences with the screening protocol as implemented.ResultsSixty-six of 297 possible patients (22.2%) responded to the survey, including 13 whose screening results raised concern for Lynch syndrome. 75.8% of respondents supported universal tumor screening without informed consent. 92.4% preferred receiving screening results regardless of outcome. Respondents described benefits to screening for themselves and their families.ConclusionsWhile broadly supporting universal tumor screening without informed consent, respondents also wanted more information shared about the screening policy, as well as their results. These patient preferences should be one of many factors considered when implementing universal screening and can also inform practices regarding both tumor profiling and universal genetic testing, which is becoming more prevalent.

Learning Abstract Chemistry Concepts with Virtual Reality: An Experimental Study Using a VR Chemistry Lab and Molecule Simulation

In this 2 × 2 between-subject experimental study, a virtual reality (VR) laboratory simulation is paired with a VR molecular world intervention to teach chemistry concepts. The independent variables are the implementation timing of the molecular world intervention (Pre-lab vs. Integrated) and the level of embodiment (Traditional vs. VR). Eighty students (N = 80), ages 11–18 years old, from a community center in New York City participated, completing a pretest, a laboratory simulation, a molecular intervention, and a post-test. The pre- and post-test measures included multiple-choice, free-response, and drawing questions. A key finding was that integrating the intervention within the lab simulation, no matter which level of embodiment, led to significantly higher gains in learning. The combination of using physical manipulatives and integrating them within the lab exercise (Integrated Traditional condition) demonstrated the greatest gains overall. On drawing measures, the Integrated VR condition showed significant improvement in three out of the four drawing categories (i.e., molecule shape, atom quantity, and relative sizes). The implications are that even though using a VR molecular world intervention can lead to significant learning of abstract chemistry content, the use of physical manipulatives is still a more effective tool.

Outcomes and quality of life in patients receiving durable left ventricular assist device with biventricular support.

Patients requiring biventricular support (BIVAD) face higher morbidity than those undergoing durable left ventricular assist device (LVAD) implantation alone. The goal of the current study was to evaluate quality of life (QOL) of patients with LVAD therapy in the modern era, stratified by use of biventricular support. All patients undergoing LVAD at our center were reviewed between October 2017 and September 2021. Patients were stratified by perioperative use of BIVAD. Patients were administered a telephone survey consisting of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) as well as free-responses regarding satisfaction surrounding their operation. Outcomes included survival, KCCQ-12 metrics, and thematic analysis of free response questions. 92 patients were identified, of whom 26 (28%) received BIVAD support. BIVAD patients had more preoperative ECMO use (54% vs. 12%, p < 0.001) and lower INTERMACS scores (Category 1: 46% vs. 14%, p = 0.001). Three-year survival was 73.8% among LVAD-alone patients and 50.1% among BIVAD patients (log-rank p = 0.022). Median composite KCCQ-12 score was 78 (57-88). No differences in composite or any component scores were noted between groups. 76% of patients report they would be moderately or extremely like to go through surgery again if given repeat choice. The most common themes expressed were overall gratitude (24%) and disappointment with device-related restrictions (20%). Patients requiring BIVAD therapy have more advanced shock, longer associated hospital courses, and lower long-term survival. However, those that survive enjoy similar overall quality of life, and many endorse positive outlooks on their surgical course. Continued assessments of quality of life are important in providing patient-centered LVAD care.

Making Sense of Teacher Turnover: A Mixed-Methods Exploration of Why Teachers Leave

Background/Context: High teacher turnover has directed a great deal of scholarly attention toward the connection between teacher retention and teacher working conditions. Prior work has identified a set of key working conditions associated with teacher retention, including supportive school leadership, school safety, a collaborative professional community, a manageable workload, and autonomy. These working conditions are often identified using Likert-based surveys, which allow for the analysis of large and representative samples but cannot fully show the nuance of teachers’ experiences. Purpose/Objective/Research Question/Focus of Study: This study examines why teachers leave their positions and how these reasons for leaving appear differently in Likert-style fixed-response questions and free-response questions. This comparison can reveal important distinctions in teachers’ understanding of how their working conditions can contribute to their turnover that may be hidden in simpler surveys. Research Design: This study takes advantage of teacher exit surveys administered by a large urban district that included both fixed- and free-response questions about why teachers left their positions. I use a convergent mixed-methods design to examine how reasons for leaving converged and diverged across question types across the entire sample and within individual teachers. Conclusions or Recommendations: I find confirmatory evidence that, when given the opportunity to describe their reasons for leaving in their own words, many teachers identify the same general categories of reasons as identified in Likert questions: school leadership, evaluations, workload, personal reasons, pay, and student behavior. Additionally, teacher free responses add new shades of meaning to our understanding of working conditions. The outsized importance of school leadership, already well established in prior literature, was strongly tied to the influence of school leadership on other aspects of teacher work that are generally considered as separate working conditions. Teachers who left because of student behavior concerns had diverse and often contradictory proposed policy solutions to increase student safety, and teachers who left for personal reasons like retirement or having children were still responsive to more malleable aspects of their work. Finally, many teachers were concerned about their workload, specifically unnecessary work added by school and district policy.

Does Reframing Do-Not-Resuscitate to Beneficial Care Only Increase Acceptance of No-CPR Orders?

BackgroundThe terminology of a do-not-resuscitate order (DNR) can be confusing and controversial for patients at the end of life. We examined whether changing the name to “Beneficial Care Only” (BCO) would increase patient acceptance. Research QuestionWould individuals be more willing to forgo full code status and accept a no-CPR order if the order title was “Beneficial Care Only”? Study Design and MethodsWe conducted a cross-sectional survey of 599 adults residing in the United States, presenting participants with a hypothetical scenario of a terminal patient. Half were given a choice between “full code” (FC) and “DNR” status, and half were given a choice between FC and BCO status. The 20-item survey included multiple-choice responses and one free-response question. ResultsIn our nationally representative survey of U.S. participants who were 50% female and 26% nonwhite (99% response rate, n = 599/600), there was no difference in participant preference for BCO or DNR overall (p = 0.7616) and across participant sociodemographic characteristics. While themes of participant reasons for choosing against CPR were similar for both DNR and BCO preferences, including (1) harms imposed by CPR, (2) lack of quality of life, (3) trust in the medical team, (4) avoidance of suffering, two additional themes appeared only for BCO responses: (1) CPR would be useless, and (2) the patient would continue to receive beneficial care. InterpretationWe found no statistically significant difference in preference between BCO and DNR orders for a terminally ill patient. These findings suggest changing the terminology of DNR to BCO may not lead to changes in decisions to forgo CPR. The additional themes identified with the use of BCO support the concept that BCO terminology conveys to the recipient that all beneficial care will continue to be provided to the patient.

“This should be a compulsory placement for all nursing students”: An evaluation of pre-registration nursing students’ perceptions of learning on a mental health clinical placement

AimTo conduct a longitudinal exploration of pre-registration nursing students’ perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BackgroundEnriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DesignA survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students’ perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. MethodsSecond- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. ResultsAcross five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student ‘learning from lived experience’ remained uniformly high and steady throughout 2020–2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in ‘student enthusiasm for nursing’ was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. ConclusionsOver the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people’s lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

Simulation in admissions interviews: applicant experiences and programmatic performance prediction

Background: Admissions interviews are frequently used to assess personal and interpersonal attributes required for successful medical practice. Using simulation in interviews to engage applicants in realistic medical scenarios to assess these attributes is novel. This study evaluates applicant perceptions of simulation within multiple mini-interviews (MMI) and reports on subsequent student program performance. Methods: Physician assistant (PA) program applicants were invited to complete an anonymous post-interview survey that included one free-response question about their admissions experience. We chose to qualitatively analyze the free-response question. Additionally, success metrics of students who experienced simulation-based MMI were compared to prior cohorts who were admitted using traditional interviews. Results: Applicants undergoing simulation-based interviews in MMI had decreased incidences of major professionalism events, greater on-time program progression, and similar board pass rates compared to applicants who experienced traditional interviews. Several themes, highlighting the applicants’ varied responses to the simulation-based MMI, emerged including showcasing strengths and passion, feelings of fairness, accessing program faculty, and impacts on certainty. Conclusions: The use of simulation in admissions interviews is a valuable tool for assessing an applicant’s personal attributes in a clinical setting. Applicants admitted using simulation had improved programmatic performance compared to applicants admitted using traditional interviews. Applicants’ perceptions of simulation in interviews are helpful when designing the admissions experience.

Development and Implementation of an Experiential Longitudinal Health Systems Science Thread Into an Existing Medical School Curriculum.

Medical school graduates enter a complex health care delivery system involving interprofessional teamwork and multifaceted value-based patient care decisions. However, current curricula on health systems science (HSS) are piecemeal, lecture based, and confined to preclinical training. The VISTA program is a longitudinal, immersive learning curriculum integrated into the University of Chicago Pritzker School of Medicine curriculum between 2016 and 2018. Key components include a unit-based nursing interprofessional team experience, a discharge objective structured clinical examination (OSCE), a patient safety simulation, and the implementation of a Choosing Wisely SmartPhrase. Graduates before 2016-2017 and after 2018-2020 VISTA implementation completed a Likert-style survey assessing attitudes, knowledge, and behaviors on HSS topics. A free response question solicited improvement areas. The Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) was also examined. The overall VISTA survey response rate was 59%, with 126 fourth-year medical student respondents before VISTA and 120 after VISTA. Compared with pre-VISTA graduates, post-VISTA graduates reported a significantly higher rate of competence on the HSS questions, with the greatest increases seen in effective communication at discharge (n = 73/126 [57.9%] to 116/120 [96.7%], P < .001), knowledge on safety event reporting (n = 53/126 [42.1%] to 96/120 [79.8%], P < .001), and considering costs in making health care decisions (n = 76/126 [60.3%] to 117/120 [97.5%], P < .001). All were directly addressed through experiential learning interventions, and 2 were intended practice behaviors. VISTA graduate responses to free-text questions demonstrated a more nuanced understanding of HSS compared with pre-VISTA responses. The AAMC GQ data showed increased agreement with an item that mapped to HSS understanding. The VISTA program provides a model for institutions to enhance HSS education between curricular overhauls. Next steps include implementing value-added roles and additional immersive learning exercises.

Assessing the understanding and utilization of integrative oncology among patients with a history of cancer.

e23231 Background: Integrative oncology (IO) is an evidence-informed field of cancer care the utilizes mind-body practices, natural products, lifestyle medicine from different traditions alongside conventional therapies. Many of these components have growing evidence of benefit and are part of guideline recommendations. The Sidney Kimmel Cancer Center (SKCC) at Thomas Jefferson University has an integrative oncology program that sought to identify patients’ understanding of integrative health, assess their utilization of integrative medicine approaches, and define interest in IO consultations. Methods: Patients with a history of cancer or at high risk for cancer who presented for care at an SKCC clinical site received an electronic record invitation to complete a brief survey with binary and free-response questions regarding current knowledge, experiences, and interest in IO. At the end of the survey, patients also had the option to express interest in an IO consultations at SKCC. Results: Among 1327 responders, 900 (67.8%) were female, and 998 (75.2%) were between 45-75 years of age. Most were white (980, 73.9%), followed by Black or African American (279, 21.0%). Breast cancer (435, 32.8%) and hematologic cancers (277, 20.9%) were the most reported malignancies. Overall, 340 (26.4%) and 123 (9.27%) had previously utilized in-person IO services and virtual IO services, respectively. 887 (66.8%) patients reported that IO was never discussed during their care. 946 (71.3%) expressed interest in an IO consultation. Conclusions: Approximately a third of patients who completed the survey had previously used an IO modality. More than double that number expressed interest in and IO consultation. With the increasing evidence of benefit for IO care and the inclusion of these recommendations in clinical guidelines, expansion of IO services is indicated. IO consultations would address knowledge gaps, enhance implementation of guideline-based care, and, perhaps, improve clinical outcomes.

Emergency Medicine Physician Residents' Perceptions of Emergency Medicine Clinical Pharmacists' Involvement in Their Training.

Although the clinical impact of emergency medicine clinical pharmacists (EMCPs) on patient care outcomes is well documented, their educational impact on resident physicians' training is not. To further highlight the utility of EMCPs, this study evaluated emergency medicine (EM) resident physicians' perceptions of EMCPs' involvement in their training. A voluntary, anonymous web-based survey was sent by email to all 44 EM resident physicians in July 2022. The survey included multiple choice, 5-point Likert scale, and free response questions derived from Accreditation Council for Graduate Medical Education pharmacotherapy competency-based milestones. Thirty-six of the 44 (82%) residents completed the survey and all 10 PGY-4 class residents completed the survey. Nearly half of the respondents (44.4%) reported they consulted/interacted with the EMCPs 3 to 5 times per week and this number increased with the level of training. Respondents most often consulted the EMCPs to obtain medication indications, antibiotic dosing, pediatric dosing, and contraindications. Overall, respondents primarily reported strongly agree to all survey questions. Nearly all respondents strongly agreed the EMCPs are an important part of the patient care team and provide education that is different from what a supervising physician provides. All respondents who completed the pharmacy elective strongly agreed the elective was valuable and strongly recommended other residents to complete it. Respondents reported EMCPs are an important part of the patient care team, play a significant role in their training, and provide education that is different from what a supervising physician provides. Our findings encourage other institutions to leverage physicians' views of EMCPs to expand their service line.