Large Medical School Research Articles

Implementation of a Trauma-Informed Care Elective in Medical Education

Background: Education about the harm trauma does to one’s health is lacking in traditional medical school curricula. The goal of our elective extracurricular course on trauma-informed care (TIC) was to provide students with experience, knowledge, and resources to care for future patients who may have lived through traumatic experiences. Methods: We created a semester-long elective TIC course for first year medical students at a large, public medical school. We developed one - and one retrospective /post-course survey for studentsusing a mix of sliding scale and free text responses to capture student evaluations of the course. ANOVA was used for statistical analysis. Results: Of the 11 students who completed the retrospective - and post- surveys, there was a significant increase in student’s rating of their knowledge regarding impact of trauma on health by the end of the course (retro : 45.55+24.73, post: 81.64+11.79). Importantly, the group felt significantly more comfortable screening for intimate partner violence (retro : 34.09+31.05, post: 77.00+23.81), performing a physical exam for patient’s experiencing intimate partner violence (retro : 17.55+22.17, post: 67.27+18.35), accessing resources for patients experiencing addiction and recovery (retro : 35.00+32.25, post: 76.82+17.79), and caring for patients who have had adverse childhood experiences (retro : 28.27+32.18, post: 66.36+21.46). Discussion: This study is limited in a small sample size and the biases that accompany survey-based qualitative studies. It can only be interpreted in the context of a large public medical school in the southern United States. Conclusion: An elective course on TIC can be a way to make medical students feel more comfortable providing trauma-informed care. Additional research is needed to evaluate the long-term influence of a TIC course on medical students’ patient interactions.

Hypertension and depression among medical students: is there an association?

IntroductionSeveral studies suggested a higher prevalence of hypertension and depression among medical students. Patients with depression have a higher prevalence of hypertension and vice versa. In this study, we assessed the frequency of hypertension and depression in a sample of medical students and the impact of depression on hypertension. MethodsWe recruited medical students from the largest medical school in Jordan. For each participant, we measured blood pressure and heart rate under standardized measurement conditions. Participants were also surveyed using the 9-item Patient Health Questionnaire (PHQ-9). We performed univariate analysis followed by linear regression analysis of factors affecting mean arterial pressure. Results354 medical students were included. The mean age was 21 years. 196 (55.4%) were females and 158 (44.6%) were males. 139 (70.9%) of females had normal blood pressure (BP), 7 (3.6%) had elevated BP, 44 (22.4%) had stage 1 hypertension (HTN), and 6 (3.1%) had stage 2 HTN. Within males: 60 (38.0%) had normal BP, 27 (17.1%) had elevated BP, 55 (34.8%) had stage 1 HTN, and 16 (10.1%) had stage 2 HTN. 114 participants (32.2%) had no or minimal depression, 197 (55.6%) had mild-moderate depression and 43 (12.1%) had moderately severe-severe depression. There was an association between higher depression scores and higher diastolic blood pressure. ConclusionThe frequency of hypertension and depression was notably high in our sample. There was an association between higher depression scores and higher diastolic blood pressure. We strongly believe that this association should encourage us again to screen our hypertensive patients in general for depression and vice versa. We also recommend adopting screening programs for depression and hypertension in general.

P049Characterizing physician concerns with publicly supporting abortion

<h3>Objectives</h3> To examine factors associated with physicians' level of concern with, and perceived consequences of, publicly supporting abortion. <h3>Methods</h3> We surveyed physicians at Wisconsin's largest medical school about their knowledge, attitudes, and referral practices regarding abortion care from February to May 2019. Three survey items gauged participant level of concern that taking a strong public stance on abortion would result in: 1) alienating patients; 2) alienating coworkers; and 3) harassment or harm from protestors who held opposing views. Among those who expressed support for abortion (n=701), we analyzed sample characteristics and perceived concerns about publicly supporting abortion. <h3>Results</h3> Nearly one-quarter (22%) of respondents felt very or extremely concerned that taking a strong public stance on abortion would alienate patients, and 17% felt very or extremely concerned that doing so would alienate coworkers. More than one-quarter (27%) felt very or extremely concerned that publicly supporting abortion would lead to harassment or harm — including approximately one-third of radiologists (33%), anesthesiologists (36%), and obstetrician gynecologists (31%), and nearly half (46%) of emergency medicine physicians. Those with greater concerns about expressing public support for abortion were comparatively less willing to refer for or participate in abortion care themselves. <h3>Conclusions</h3> Many physicians who support abortion reported worries over publicizing their support for this common healthcare service. These concerns may render physicians less likely to refer patients for abortion care or weigh in on abortion policy, as well as undermine physicians' potential to be powerful and effective advocates against abortion stigma and other barriers to abortion access.

What Makes a Near-Peer Learning and Tutoring Program Effective in Undergraduate Medical Education: a Qualitative Analysis.

The online version contains supplementary material available at 10.1007/s40670-022-01680-0.

Feedback, fairness, and validity: effects of disclosing and reusing multiple-choice questions in medical schools

ABSTRACT Background Disclosure of items used in multiple-choice-question (MCQ) exams may decrease student anxiety and improve transparency, feedback, and test-enhanced learning but potentially compromises the reliability and fairness of exams if items are eventually reused. Evidence regarding whether disclosure and reuse of test items change item psychometrics is scarce and inconclusive. Methods We retrospectively analysed difficulty and discrimination coefficients of 10,148 MCQ items used between fall 2017 and fall 2019 in a large European medical school in which items were disclosed from fall 2017 onwards. We categorised items as ‘new’; ‘reused, not disclosed’; or ‘reused, disclosed’. For reused items, we calculated the difference from their first ever use, that is, when they were new. Differences between categories and terms were analysed with one-way analyses of variance and independent-samples t tests. Results The proportion of reused, disclosed items grew from 0% to 48.4%; mean difficulty coefficients increased from 0.70 to 0.76; that is, items became easier, P < .001, ηp 2 = 0.011. On average, reused, disclosed items were significantly easier (M = 0.83) than reused, not disclosed items (M = 0.71) and entirely new items (M = 0.66), P < .001, ηp 2 = 0.087. Mean discrimination coefficients increased from 0.21 to 0.23; that is, item became slightly more discriminating, P = .002, ηp 2 = 0.002. Conclusions Disclosing test items provides the opportunity to enhance feedback and transparency in MCQ exams but potentially at the expense of decreased item reliability. Discrimination was positively affected. Our study may help weigh advantages and disadvantages of using previously disclosed items.

Comparing the Assessment Quality of Trained Versus Untrained Peer Examiners in Obstetrics and Gynaecology in OSCE

Background: Assessment has been shown in studies to have a significant impact on the learning process. There has been a lot of interest in making assessment an important element of the learning process for students. Senior medical students may be able to assist teachers with peer evaluations. There is little evidence to support the idea that peer examiners should be officially trained before taking on the job. Aim: To find the difference in teaching faculty scores of untrained and trained peer examiners in Obstetrics &amp; Gynecology OSCE. Study design: Cross-sectional (analytical) study Place and duration: The study was conducted at Sialkot Medical College Sialkot” affiliated with Imran Idrees Teaching Hospital in Obstetrics /Gynecology department over the period of 6 months from January 2022 to June 2022 Methodology: One hundred and five medical student of 4th year were enrolled for practice of OSCE examination. Forty final year medical students took part in the assessment program as peer examiners. One group of examiners were given 2-hour training session describing about the assigned OSCE stations, marking method, evaluation, and feedback methods. Other group was given only checklist to read with no prior training. Using the checklist and a global rating, senior faculty and peer student examiners (both trained and untrained groups) simultaneously assessed students in basic Obstetrics /Gynecology clinical skills at 4 OSCE stations. Every station ran for five minutes (3 minutes of evaluation while 2 minutes of feedback). A comparison between the check list and global rating scores of trained and untrained peer student examiners was made. SPSS version 21 was used to calculate intra-rater reliability was assessed to build the consensus of faculty examiners with the trained and untrained peer examiners according to checklist scores and global rating. Results: Student examiners found sitting at OSCE stations as a useful learning experience. Observing different performances at OSCE stations was so absorbing and it gave them awareness about examination procedure. Practical implication. Peer assessors in a formative OSCE could be successfully implemented in the curriculum of a large medical school with more than 100 students annually. They can be trained to conduct undergraduate assessments of their junior peers and can prove to be very reliable and effective assessors. Conclusion: Peer markers who underwent the formal training session showed the capacity to assess fourth-year students with suitable consistency and devotion. Hence training helped to improve peer marker consensus with faculty. Keywords: Peer examiners, OSCE, trained peer examiner, untrained peer examiner.

Personalising medical education: ePortfolios for workplace- based assessment

&#x0D; &#x0D; &#x0D; There is much literature on the challenges of designing for and implementing ePortfolios. Issues include technology management and overcoming barriers to acceptance and usability. Yet as higher education practitioners we find ourselves continually stumbling over these issues. Through discussion of a work-in progress case study at a large Australian medical school, we raise some of the design and implementation issues that impacted integration and facilitation of an ePortfolio system. The system was created to support students’ personal learning, and evidencing and assessment of clinical competence. Recognising the importance of context, we focus on a Workplace Learning Portfolio (WLP) course, in which an ePortfolio system was adopted to support and deliver workplace-based assessments for students in Years 3 and 4 of a Doctor of Medicine (MD) program. Discussion centres around the promise and reality of concurrently implementing curriculum and technological change with a large cohort of domestic and international students. The complexity of using an ePortfolio system to identify students at risk of academic failure is raised, as is an example of unexpected student engagement with personalised learning.&#x0D; &#x0D; &#x0D;

Medical students’ knowledge of race-related history reveals areas for improvement in achieving health equity

BackgroundMedical schools have increasingly integrated social justice, anti-racism, and health equity training into their curricula. Yet, no research examines whether medical students understand the complex history of racial injustice. We sought to investigate the relationship between medical students’ historical knowledge and their perceptions regarding health equity.MethodsMedical students at one large urban medical school self-rated their familiarity and importance of various racially-significant historical events and persons, as well as their agreement with statements regarding health equity, education, and preparedness to act. Descriptive and multivariate analyses were conducted in R.ResultsOf 166 (RR=31.3%) participants, 96% agreed that understanding historical context is necessary in medicine; yet 65% of students could not describe the historical significance of racial events or persons. Only 57% felt that they understood this context, and the same percentage felt other medical students did not. A minority of students felt empowered (40%) or prepared (31%) to take action when they witness racial injustice in healthcare. Multiracial identity was significantly associated with increased knowledge of African American history (p<0.01), and a humanities background was significantly associated with increased knowledge of Latin American history (p=0.017). There was a positive, significant relationship between advocacy statements, such as “I have taken action” (p<0.001) and “I know the roots of racism” (p<0.001) with mean familiarity of historical events.ConclusionsThis study demonstrates that while students agree that racism has no place in healthcare, there remains a paucity of knowledge regarding many events and figures in the history of American race relations and civil rights, with implications for future physicians’ patient care and health equity efforts.

Medical information seeking practices among medical students in Kenya: A descriptive cross-sectional study

Purpose: Many medical schools in low- and middle-income countries (LMICs) have adopted a problem-based learning (PBL) approach. PBL requires medical students to independently access and correctly interpret medical information. There is paucity of information on how students in LMICs retrieve medical information and apply Evidence Based Medicine (EBM) principles. Methods: A cross-sectional survey was carried out among medical students in their clinical years at Moi University School of Medicine (MUSOM), a large medical school in Kenya between August and November 2016.Results: Authors analyzed results of 206 clinical year medical students at MUSOM (response rate of 84%). Standard textbooks (47.8%) and lecture slides (20.9%) were the most preferred sources of general medical information. Medscape®, a free mobile medical information application, was the most utilized drug information source. Sources which directly link to primary biomedical literature such as PUBMED and HINARI were used by 14.1% and 7.8% of students respectively. A quiz testing key clinical epidemiology concepts was also performed with a mean score of 49% (SD, 23.8).Conclusion: There is preference for standard textbooks. Low scores on the clinical epidemiology quiz, coupled with most students endorsing limited understanding of key EBM concepts emphasizes the need for broader EBM training.

Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school

ObjectiveEvaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. Study designA survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. ResultsThere were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84–88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. ConclusionWe identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. ImplicationsDespite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.

Exploratory Factor Analysis of Medical Students' Perceptions of Medical Cannabis Scale.

BackgroundThere are few published research articles investigating medical students’ perceptions of medical cannabis (MC), including their attitudes toward its efficacy and appropriateness in medicine, concerns for potential adverse effects, and their willingness to prescribe it to patients (in future practice). This research investigated the factor structure of a tool to assess medical students’ perceptions of MC for the purpose of curriculum enhancement.MethodsUsing a voluntary electronic survey, quantitative data were collected between January and March 2022 from 526 medical students enrolled in a large medical school in Florida, United States. A 32-item questionnaire developed by the researchers was used to investigate medical students’ perceptions of MC. The survey was anonymous and took about 10 minutes to complete. Bivariate correlation analyses were conducted prior to performing a principal component analysis with varimax rotation.ResultsUsing principal component analysis with varimax rotation, three factors were identified with eigenvalues greater than 1.0 and a cumulative variance of 59.694%. These factors are perceived knowledge of MC, concern for possible adverse effects of MC (e.g., the potential for misuse/dependence), and attitudes toward MC (e.g., cannabis having an acceptable role in medicine, willingness (as a future physician) to help patients access MC, obtaining training about MC in school and residency training, the physician’s role as a prescriber, and efficacy and benefits of MC for certain health conditions).ConclusionsThe development of this kind of brief measure may be valuable for defining the future educational needs of medical students and other health professionals as well as a tool for future research.

Flipping the Anatomy Classroom with Clinical Cases and Teamwork at a Large Medical School

Students participating in active and collaborative learning understand concepts better, perform better in coursework, and have better attitudes toward teamwork. But, the rise of the digital age has had a negative effect on classroom engagement—a topic of international concern. At UT Southwestern Medical School, voluntary attendance at didactic anatomy sessions is at an all‐time low. Because we believe contact time with students is a valuable commodity, our objective is to develop an anatomy teaching approach that will improve student engagement and teamwork. As content hours are limited, time‐efficiency is essential to the approach we seek to develop. In a pilot study, we developed two face‐to‐face case‐based active learning sessions that were conducted within the time slots formerly scheduled for two face‐to‐face anatomy lecture sessions. Content formerly covered in these didactic sessions was converted into video format and offered on‐demand through our institution’s learning management system. Students were given instructions for pre‐session preparation (i.e., review of the videos and other course materials) several days prior to each session. Due to computer technology limitations in our cadaver lab, a virtual cadaver model (Complete Anatomy, 3D4Medical from Elsevier) was used in place of human cadavers for the two case‐based sessions. During the sessions, each laboratory dissection team of 6‐7 students worked at a table outfitted with a 42‐inch monitor capable of wireless connection to student laptops. The exercises focused on the anatomical basis for several clinical cases involving cranial nerve lesions (Session 1) and abdominal hernias (Session 2). Students were allotted 45 minutes for each mandatory session at the end of which teams were required to electronically submit a completed worksheet for credit. Following each session, students were invited to participate in a brief survey with two open‐ended questions that asked them to name one thing about the exercise they would change and one thing they would keep the same. Results of the surveys revealed that the two most commonly perceived benefits of the exercises were 1) application of anatomy to real cases (41 of 131 responses) and 2) opportunity to work in teams with other students (28 of 131 responses). The most commonly perceived challenge was insufficient time to work through the exercises as a team (95 of 131 responses). Student performance on exam questions directly related to the content of the pilot sessions was higher than in years prior to the pilot; however, this difference was not statistically significant in this high‐performing group of students. The survey results demonstrate that our students perceive value in teamwork and the opportunity to practice applying their theoretical knowledge to real‐world problems. The results also highlight the importance of carving out adequate time in the curriculum for these experiences. In the future, we aim to increase opportunities, outside of dissection and didactic sessions, for our students to practice these important, career‐relevant skills.

Student Perspectives of Threshold Concepts in Undergraduate Medical Education for Understanding the Structure and Function of the Human Body

The purpose of a curriculum is to produce individuals with proficiency in content knowledge, ability to apply knowledge, and eventually become experts in a given field. One theory of how students transition into thinking like an expert is through the acquisition of threshold concepts. Threshold concepts are pieces of knowledge in a field that, once understood, produce a qualitative shift in a student’s thinking and increases their potential to become an expert in that field. There is sparse research in threshold concepts in medical education, and most of the current literature either focuses on aspects of clinical practice or serves as a discussion piece with no empirical evidence. There are even fewer studies that attempt to identify the threshold concepts for understanding the scientific principles that underlie medicine as a field, and these studies often rely only on expert opinions. This is a shortcoming since experts in undergraduate medical education, often Ph.D. researchers, have a very different perspective than the medical student currently grappling with the scientific concepts for the first time. This study aims to address this gap in the literature by conducting focus groups with medical students in all four years of undergraduate medical education (M1‐M4) at a large allopathic medical school to examine which concepts students identify as threshold concepts in medical education for understanding the human biology. All curricular years were included determine the student perspectives at each stage of undergraduate medical education and capture any potential shifts throughout the medical curriculum in the clinical and pre‐clinical years. Sessions were semi‐structured and asked questions that inquired about the threshold concepts for understanding the human biology for medical practice. Focus group sessions were recorded, transcribed and analyzed using thematic analysis. Three M4 students, ten M3 students, nine M2 students and four M1 students participated in focus groups. At the present time, data are still undergoing thematic analysis. Thus far, the major codes emerging pertain to cardiovascular, pulmonary, renal physiology and neurobiology as potential threshold concepts. Students also identified as pathology as a potential threshold concept since it integrates the knowledge they have previously learned and applies it to medical practice. A theme that appears to be emerging is the importance of hands‐on patient/clinical experience to push students through the threshold into understanding a particular scientific concept. As the analysis of the data is completed, the results of this study will offer insight for medical educators on how to adapt their curricula to better suit the needs of their students. This may include further integration of basic science and clinical education, providing students opportunities to work with patients earlier in their education and/or shifting the emphasis to the most clinically relevant systems.

EP440: Developing medical genetics interest and literacy through student interest groups: The why, the how, and the challenges

According to the American Board of Medical Genetics and Genomics, the US has slightly more than 3000 diplomats of all genetics specialties, of which there are about 1700 clinical geneticists. Additionally, the US has less than 5000 active genetic counselors. We need to increase the attention of medical students to the field of genetics since it is becoming more relevant to clinical care, especially with the expansion of personalized medicine. At minimum, all medical students and other healthcare trainees should be encouraged to attain genetic literacy, with the hopes that some of them will join the medical genetics work force. The American College of Medical Genetics and Genomics (ACMG) currently has 35 ACMG student interest groups (SIGs) registered. ACMG established the SIG program with the goal of expanding students’ knowledge and interest in the field of medical genetics and providing these groups support and information about careers in medical genetics. We present the combined perspectives of five institutions at varying stages of the development of medical genetics SIGs, at institutions with, or without genetics residency programs, with large and small medical school class sizes. Our objective is to share our varied experiences, including the process of establishing the SIG, student participants involved, activities hosted by the SIG, the impact that SIGs have had on students’ careers, and challenges to implementation. The process to set up a SIG begins by establishing a SIG at a host institution, followed by an ACMG application listing the nature of the group (medical or GC students, etc.), a student contact and faculty advisor. Students targeted by the SIG vary by institution, and can include medical students, medical genetics fellows, laboratory genetics and genomics fellows, genetic counseling students, undergraduate or graduate students enrolled in life sciences, or veterinary medicine, etc. Events within our respective SIGs include activities focused on increasing the visibility of genetics within the medical school, increasing knowledge of the field of medical genetics as a career, and increasing medical genetics content knowledge. Activities focused on increasing genetics visibility include film viewing-discussion groups, debates on ethical issues, discussion on direct-to-consumer genetic testing, genetic trivia game nights, journal clubs, podcast productions, and community lectures. The genetics SIGs have often partnered with other medical student SIGs at their local institutions to illustrate how genetics is pervasive in medicine. Activities focused on medical genetics careers include a “meet a genetics team”, genetics lab virtual tours, and workshops on clinical note writing and interpreting genetic test results. Activities focused on medical genetics knowledge include presentations about genetic conditions, meet the patient sessions, and collaboration on events with other genetics SIGs at other institutions. Within an institution, an active SIG can result in increased recognition of genetics as a standalone specialty with the potential to increase the number of residency applications to genetics programs. Furthermore, the presence of an active medical genetics SIG on campus results in an increased acknowledgement of the role of genetics in the care of patients from all specialties. Anecdotal evidence suggests that student engagement in SIG leadership is recognized as a desirable attribute by program directors during residency interviews. A dynamic genetics SIG depends on an active faculty advisor and a student board to create programming that enables engagement of the students in the SIG and the larger student body to increase genetics awareness. Ideally, in addition to medical students, a genetics SIG will have diverse members such as students from pre-professional (BSc) and genetic counseling (MSc) programs, laboratory genetics fellows, healthcare professionals, and other interested faculty.

Musculoskeletal ultrasound training encourages self-directed learning and increases confidence for clinical and anatomical appreciation of first-year medical students.

Best-practice guidelines have incorporated ultrasound in diagnostic and procedural medicine. Due to this demand, the Arizona College of Osteopathic Medicine initiated a comprehensive integration of ultrasound into its first-year anatomy course attended by more than 280 students. Ultrasound workshops were developed to enhance student conceptualization of musculoskeletal (MSK) anatomy through visualizing clinically important anatomical relationships, a simulated lumbar puncture during the back unit, carpal tunnel and shoulder evaluations during the upper limb unit, and plantar fascia, calcaneal tendon, and tarsal tunnel evaluations during the lower limb unit. A 5-point Likert scale survey evaluated if ultrasound improved students' self-perceived anatomical and clinical comprehension of relevant anatomy, improved students' ability to orient to ultrasound imagery, and prompted further independent investigation of the anatomical area. Ultrasound examination questions were added to the anatomy examinations. Two-tailed one-sample t-tests for the back, upper limb, and lower limb units were found to be significant across all Likert survey categories (P < 0.001). Positive student responses to the Likert survey in conjunction with examination question average of 84.3% (±10.3) demonstrated that the ultrasound workshops are beneficial to student education. Ultrasound enhances medical students' clinical and anatomical comprehension and ability to orient to ultrasound imagery for MSK anatomy. This study supports early ultrasound education as a mechanism to encourage students' independent learning as evidenced by many undertaking voluntary investigation of clinical concerns associated with MSK anatomy. This study establishes the successful integration of MSK ultrasound into a large medical school program and its benefit to student clinical education.

Improving Food Insecurity Education in Medical School Through Integrative Service Learning.

IntroductionThe COVID-19 pandemic has left more than 38% of households food insecure in the United States. Improved education of food security topics in medical school can improve screening for food insecurity and improve health outcomes. The first aim of this study was to address if participation in an experiential integrative service learning program improved medical students’ understanding of food insecurity. The second aim was to compare knowledge of food insecurity between the general body of medical students and those who participated in the service learning program.MethodsThis was a cohort study at a large medical school in southeast Michigan in 2019–2020. We administered the Food Insecurity for Health Professionals (FISHP) survey to medical student participants; higher scores on the FISHP survey suggest higher knowledge and comfort with food security topics. We administered online Qualtrics surveys to the volunteer group before and after volunteering 12 hours at an urban farm. We also administered a one-time survey to a control group of medical students. We performed univariable and bivariable statistical analyses with StataSE 16. The study was exempted by the institutional IRB.ResultsMedical students in the volunteer group (n = 18) and the control group (n = 66) completed online surveys. Participants in the volunteer group had increased knowledge of food security after volunteering in the service learning program (p = .03). There was a statistically significant difference between the mean FISHP scores for the control group and the volunteer group (p = .001).ConclusionMedical student participation in an experiential integrative service learning program improved knowledge of food security topics and increased comfort discussing food insecurity with patients, compared to students who did not participate. Experiential integrative service learning may improve holistic patient care through physician recognition of food insecurity and other social determinants of health.

Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study.

BackgroundPhysician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations.ObjectiveThis study aimed to explore usability issues emerging from users’ interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system.MethodsFive attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load.ResultsSeveral measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time.ConclusionsThe usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated.

Understanding Mental Burden and Factors Associated With Study Worries Among Undergraduate Medical Students During the COVID-19 Pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic is affecting many areas of life and has led to major changes in undergraduate medical education. Even before the COVID-19 pandemic, high mental burden of medical students has frequently been reported in the literature. Additional pandemic-specific stressors could exacerbate this situation. This study aimed to assess mental health outcomes among medical students during the first semester after the COVID-19 outbreak and perception of the students on how the learning environment has changed. In May 2020, we conducted a cross-sectional survey among undergraduate medical students at a large medical school in Germany. The survey included validated mental health instruments (Distress Thermometer, Patient Health Questionnaire 4) and self-developed items to examine the perception of the study situation during the COVID-19 pandemic. Open-ended questions were analyzed by conventional content analyses. The response rate was 59.2% (914/1,545). Overall, 61.9% of the students reported distress levels above the cutoff. Year 1 students reported significantly higher levels of distress, anxiety and depression than students during their second to fourth year of studies. 48.3% of the students indicated a decrease in their study motivation since the beginning of the COVID-19 pandemic with significant differences between study years. The binary logistic regression model showed that male gender, being in study year 2, higher distress scores and higher symptoms of depression were significantly associated with a higher likelihood for experiencing serious worries. In the open-ended questions on current concerns related to the impact of the COVID-19 pandemic on their studies, students most frequently reported concerns about missing relevant practical learning experience, difficulties with self-regulated learning and self motivation as well as study-related worries. Year 4 students reported significantly more worries about the lack of practical training than students from study years 1 to 3. Analysis of gender differences showed that female students reported more frequently diverse worries. In contrast, female students shared more frequently helpful strategies in all the categories compared to male students. Our findings suggest that medical students experience significant levels of distress and mental burden during the COVID-19 pandemic and highlight the need for ongoing psychological and educational support for medical students during the COVID-19 pandemic and after.

Mental burden and perception of the study situation among undergraduate students during the COVID-19 pandemic: a cross-sectional study and comparison of dental and medical students

ObjectivesTo investigate levels of distress, depression, anxiety, stress and perception of their current study situation during the COVID-19 pandemic among undergraduate dental and medical students.DesignObservational, cross-sectional study including two consecutive...

Students with global experiences during medical school are more likely to work in settings that focus on the underserved: an observational study from a public U.S. institution

BackgroundGlobal health interest has grown among medical students over the past 20 years, and most medical schools offer global health opportunities. Studies suggest that completing global health electives during medical school may increase the likelihood of working with underserved populations in a clinical or research capacity. This study aimed to assess the association of global electives in medical school on subsequently working in global health and with underserved populations in the United States (U.S.), additionally considering students’ interests and experiences prior to medical school. We also examined whether respondents perceived benefits gained from global electives.MethodsWe surveyed medical school graduates (classes of 2011-2015) from a large public medical school in the U.S. to describe current practice settings and previous global health experience. We evaluated work, volunteer, and educational experiences preceding medical school, socioeconomic status, race and ethnicity using American Medical College Application Service (AMCAS) data. We assessed the association between students’ backgrounds, completing global health electives in medical school and current work in global health or with underserved populations in the U.S.ResultsIn the 5 to 8 years post-graduation, 78% of 161 respondents reported work, research, or teaching with a focus on global or underserved U.S. populations. Completing a global health elective during medical school (p = 0.0002) or during residency (p = 0.06) were positively associated with currently working with underserved populations in the U.S. and pre-medical school experiences were marginally associated (p = 0.1). Adjusting for pre-medical school experiences, completing a global health elective during medical school was associated with a 22% greater prevalence of working with an underserved population. Perceived benefits from global electives included improved cultural awareness, language skills, public health and research skills, and ability to practice in technology-limited settings.ConclusionMedical school graduates who participated in global electives as students were more likely than their peers to pursue careers with underserved populations, independent of experiences prior to medical school. We hypothesize that by offering global health experiences, medical schools can enhance the interests and skills of graduates that will make them more likely and better prepared to work with underserved populations in the U.S. and abroad.