Liaison Committee On Medical Education Research Articles

Bringing a Structural Competency Framework to the (Simulated) Bedside: The Premature Discharge Objective Structured Clinical Exam.

Structural competency is increasingly valued as a framework to address health equity within undergraduate medical education. As of academic year 2023-2024, the Liaison Committee on Medical Education (LCME) requires that medical schools have content regarding basic principles of structurally competent health care. Despite encouraging data about the effectiveness of structural competency curricula, most occur within the walls of a classroom and do not enter the authentic or simulated clinical space. From 2022 to 2023, an objective structured clinical exam (OSCE) focused on premature discharge, previously known as discharge against medical advice, was integrated into the required fourth-year Health Policy course at Weill Cornell Medical College, which uses the framework of structural competency. After a simulated clinical encounter, students completed a reflection assignment and participated in group debriefing to reflect on how policy coursework affected their simulated clinical experience. Students completed an evaluation about their OSCE experience, and OSCE checklist performance was analyzed. Of 82 students who participated in the curriculum, 68 completed a curricular evaluation, and 62 consented to have their OSCE performance evaluated for research. Mean overall OSCE checklist performance evaluating students' patient-centered communication skills, harm reduction skills, and discharge planning and counseling was 14.3/16 (89.6%; standard deviation 9.8%). Students reported it was valuable to focus on structural factors affecting care within the simulated clinical encounter by using the structural competency framework. To the authors' knowledge, this is the first OSCE for medical students designed to deepen their understanding of structural competency by embedding the experience into an existing course using the framework. Future work should explore how this curriculum affects students' attitudes toward structurally vulnerable patients. With structural competency as an LCME requirement, the use of OSCEs may give educators a means to teach and assess fundamental concepts.

Evaluating the medical curriculum: Bias, problems, solutions

Medical school curriculums have increasingly shifted to an integrated curriculum and have been replacing lecture with ‘flipped classroom’ approaches. Analyses of the benefits of the integrated curriculum and flipped classroom model typically report enhanced student performance. However, the question is whether institutional self-evaluation of curricular success is biased to demonstrate success that may not objectively exist and/or whether such biased data are presented during Liaison Committee on Medical Education (LCME) site visits. An objective determination of curricular effectiveness requires an absence of bias and of efforts to put an institutional ‘thumb on the scale’ to obtain desired results. In addition, bias may exist in the rationale for implementing these curricular changes in the first place; these can include, for example, with respect to career advancement as well as ideological motivation. Thus, in this paper I examine potential problems with institutional bias with evaluation of curriculum and how to overcome these.

A Survey Evaluating Extent of Undergraduate Medical Education Regarding Sex-Based Differences in Pathophysiology

Introduction A historical gap in research on sex differences in health outcomes has led to a lack of education on sex-based differences in pathophysiology. The primary objective of this research study was to survey pathophysiology professors of medical schools in the United States (US) to understand the current extent to which the impact of sex on disease is included in the pre-clinical curricula of undergraduate medical institutions in the US. Methods A survey tool was created via literature review to assess the extent of education on sex-based differences in pathophysiology. This survey was distributed using the Qualtrics electronic platform to the head professor of pathophysiology at each of the 141 Liaison Committee on Medical Education (LCME) accredited medical schools in the United States. Results The survey response rate was 14.9%. The most taught topics were epidemiology of most common cancers affecting each sex and risk factors for development of osteoporosis between different sexes. Sex-based differences in zolpidem dosing, smoking cessation, and the physiologic mechanism of narcotic addiction had the least curricular coverage. 28.57% of faculty and 38.10% of faculty agree and somewhat agree, respectively, their institution provides faculty development for teaching about topics relating to sex differences in pathophysiology. Medical students are primarily evaluated on their knowledge of sex pathophysiology in the form of written examination, followed by evaluation by standardized patients, and lastly faculty observed patient interactions. Discussion Curricular topics relating to sex-based differences in pathophysiology are taught to varying degrees in medical school preclinical curricula. Improved efforts can be made to increase instruction on specific topics and to support faculty development in teaching about sex-based differences in disease evaluation and management, enhancing the education of the next generation of physicians and facilitating better care for patients.

Reconciling LCME Diversity With Federal Law Mandates for Affirmative Action on the Basis of Disability, Gender, Race/Ethnicity, and Veteran Status.

To the Editor: Meeks and colleagues criticize the Liaison Committee on Medical Education (LCME) for defining diversity “with specific references to many marginalized groups” (e.g., racial, ethnic, socioeconomic), “but not to individuals with disabilities.” 1 Golden and Petty similarly call for the “integration of disability into diversity and inclusion initiatives” 2 and for inclusion of disability into diversity data collection, because measurement is necessary for improvement. The authors would be pleased to learn that academic medical centers (AMCs), as federal contractors, are required “to take affirmative action to employ and advance in employment qualified individuals with disabilities” 3 and to collect disability diversity data under Section 503 of the Rehabilitation Act. 3,4 These and other affirmative action requirements are not currently reflected in the LCME’s diversity standard. The LCME’s diversity standard requires AMCs to engage in “recruitment and retention activities, to achieve mission-appropriate diversity outcomes” for faculty and senior administrative staff, 5 and tells AMCs that they have discretion to choose their own diversity categories “based on the program’s mission, goals, and policies.” 5 In reality, however, AMCs do not have unbridled discretion to choose their own diversity categories for faculty and senior administrative staff recruitment and retention activities. As federal contractors, AMCs are required to engage in employment affirmative action, collect diversity data, and adopt specific numerical placement/hiring goals for persons with disabilities under Section 503 of the Rehabilitation Act; for women, Blacks, Hispanics, Asians/Pacific Islanders, and American Indians/Alaskan Natives under Executive Order 11246; and for veterans under the Vietnam Era Veterans’ Readjustment Assistance Act. 4 Though AMCs may include additional diversity categories, they may not omit these groups from their lists of diversity categories for the purposes of recruitment, retention, and other activities to achieve diversity outcomes for faculty and senior administrative staff. The LCME’s standards and policies, and the diversity data collection activities of the Association of American Medical Colleges and American Medical Association, should be amended accordingly.

Development and evaluation of a pre-clerkship spiral curriculum: data from three medical school classes

ABSTRACT Pre-clerkship curricula of most Liaison Committee on Medical Education (LCME)-accredited medical schools are divided into blocks by organ system, leaving a significant amount of information susceptible to loss due to prolonged nonuse. We describe the implementation of a formal Spiral Curriculum that periodically revisits material from previous blocks. Learners were surveyed on receptivity to the curriculum across three graduating classes at a single medical school. Medical school graduate classes of 2020, 2021, and 2022 were surveyed at the end of their pre-clerkship years (2018–2020). The class of 2022 actually received the Spiraled Curriculum intervention, for which the authors created 500 board exam style multiple-choice questions, periodically administered via mandatory in-class sessions ranging from 10 to 20 questions reviewing content from previous blocks with designated expert faculty. Response rates were 36% (n = 46), 45% (n = 52), and 32% (n = 40) for classes of 2020, 2021, and 2022, respectively. On a Likert scale (1 = strongly disagree, 5 = neutral, 10 = strongly agree), the classes of 2020, 2021, and 2022 provided statistically significant differences in their belief that a Spiraled Curriculum would/did help them retain information as 8.2 (SD 1.7), 8.2 (SD 2.2), and 5.0 (SD 3.0) (n < 0.05). All classes endorsed neutral confidence in the existing pre-clerkship curriculum in themselves to prepare for United Stated Medical Licensing Examination (USMLE) Step 1, and in their retention of previous block material with no statistically significant differences between classes. USMLE Step 1 scores did not differ significantly between classes (n = 0.21). Those who did not receive the Spiral Curriculum were highly receptive to it in theory, while those who actually received the intervention gave a neutral rating. Per survey comments, implementation of a Spiraling Curriculum would ideally be administered as either team-based or self-directed activities, and a Spiraling Curriculum may be difficult to implement in accelerated (18 month) pre-clerkship formats. Practice points Question: What is the receptivity of medical students to a formal Spiral curriculum that uses time-spaced repetition sessions of board exam style questions to revisit previous block content of their pre-clerkship years? Findings: In this single-center, quasi-experimental study, the two control group medical school classes had very positive theoretical reception to a Spiral curriculum proposal (rated 8 out of 10) while the class who actually received the Spiral curriculum provided a statistically significant lower neutral rating (rated 5 out of 10), citing preference for a team-based or self-directed format. Meaning: Medical students are strongly in favor of structured time-spaced repetition with board exam style questions to revisit previous material but prefer a format that does not interfere with time to personalize their medical school experience.

Dispersion of NIH Funding to Surgical Departments Is Contracting

INTRODUCTION: The Blue Ridge Institute for Medical Research (BRIMR) ranking of NIH funding is the benchmark for reporting academic research productivity. We sought to understand trends in BRIMR-reported NIH funding to departments of surgery. METHODS: We analyzed BRIMR reporting of surgery vs internal medicine department NIH funding from 2011 to 2021. RESULTS: A total of 76 (50%) Liaison Committee on Medical Education (LCME)-accredited surgery departments are currently BRIMR-ranked, compared with 116 (77%) LCME-accredited medicine departments. This represents a decline over the past decade of 14% for BRIMR-ranked surgery departments vs an increase of 5% for medicine departments (p < 0.001). While there was a nonsignificant increase in the number of surgical principal investigators (PIs) during this period (557 to 649, p = 0.06), medicine PIs increased significantly (4,377 to 5,224, p = 0.001). Surgery and medicine departments both experienced a 40% increase in inflation-adjusted NIH funding in the past decade, but this was concentrated to a significantly increased number of surgery PIs/program compared with the growth of medicine PIs/program (p < 0.0001). The 15 top-ranked surgery departments, of which only 3 entered this tier since 2011, received 54% of this funding (72% for the top 25 programs), 32 times more than the 15 lowest ranked programs ($244 million vs $7.5 million, p < 0.01) (Figure).FigureCONCLUSION: The number of surgery departments receiving NIH grants has contracted over the past decade, with a relatively constant group of high-award programs receiving the majority of funds. Broadening surgery department funding could enhance access for surgeon-scientists to perform NIH-supported research.

Finessing Flexner.

To the Editor: We agree that Roberts’ June 2021 editorial 1 appropriately cites existing gender and ethnic-based inequities and credits different contributors with proposed solutions. Since a number of these racist and sexist inequities originated from Flexner, the Association of American Medical Colleges (AAMC) appropriately removed Flexner’s name from its highest award for excellence in medical education. But Roberts’ editorial also acknowledges that “The Flexner Report led to greater emphasis on scientific knowledge and the pursuit of science in medical school curricula.” 1 Flexner’s scientific culture spread to the schools’ teaching hospitals, which evolved into cutting-edge academic medical centers. Flexner’s positive scientific advocacy, however, has not penetrated uniformly into all of allopathic medical education. This failure is most apparent in the group of newer allopathic medical schools, termed “community schools.” Using the Research Portfolio Online Reporting Tools that demonstrate funding between 1993 and 2019, 2 we noted that mean levels of funding in 2019 at MD Flexner schools ($120,042,857, n = 120) dwarfed funding at both MD community schools ($6,585,056, n = 33) and DO schools ($1,113,972, n = 33; P < .001). These dramatic differences held for all years, even controlled for school age. The community school movement originated in the 1970s when the AAMC called on academic medical centers to “develop a model of primary care that can be taken into the community.” 3 Around the same time, the Liaison Committee on Medical Education (LCME) called for schools to have “enough” funding to reflect faculty research efforts, but little more. 4 The new community schools resultingly focused on accreditation and not research per se. Medical schools lacking extramural funding limit opportunities for medical students and generate fewer physician–scientists. 5 Such schools fail to catalyze a research culture in their hospitals, which leads to a dramatic lack of clinical trials especially of non-Whites. 6 All of this shortchanges their communities. Failing to uniformly integrate science into medical education thus becomes another insidious path to disparities in health care. Both the LCME and the AAMC can shape the culture of allopathic medical education, especially in the newer community schools. At a minimum, the LCME should mandate a certain level of peer-reviewed extramural support at all candidate schools, requiring incremental increases with progressive stages of accreditation. Since grants beget grants, LCME baseline research requirements would become the nidus on which a research culture would crystallize. The AAMC’s continued advocacy for advancing equity can help ensure that Flexner’s endorsement of science integration into medical education will also achieve equity.

Competency-Based Frameworks in Medical School Education Programs: A Thematic Analysis of the Academic Medicine Snapshots, 2020.

Educational program objectives (EPOs) provide the foundation for a medical school's curriculum. In recent years, the Liaison Committee on Medical Education (LCME) endorsed an outcomes-based approach to objectives, to embrace the movement toward competency-based medical education (CBME). The purpose of this study was to explore the CBME frameworks used by medical schools in formulating their EPOs. A secondary aim was to determine factors related to the selection of specific frameworks. The authors performed a quantitative content analysis of entries to the 2020 Academic Medicine Snapshot. Publicly available data gathered included demographic features of each program (e.g., year founded, accreditation status, affiliation, etc.), participation in national medical education consortia, and presence of specific CBME frameworks identified in EPOs. Descriptive statistics were used to examine trends in frameworks used by medical schools. Bivariate comparisons between factors and frameworks were conducted using chi-square tests. Logistic regression was used to examine factors predicting use of more recently developed CBME frameworks. A total of 135 institutions submitted Snapshots (RR = 88%). All institutions endorsed 1 or more CBME frameworks, with 37% endorsing 2 and 20% endorsing 3 or more. The most common was the Accreditation Council for Graduate Medical Education core competencies (63%). In addition to published frameworks, 36% of institutions developed their own competencies. Schools with pending LCME visits were 2.61 times more likely to use a more recently developed curricular framework, P = .022. Medical schools in the United States have embraced the CBME movement through incorporation of competency-based frameworks in their EPOs. While it is encouraging that CBME frameworks have been integrated in medical school EPOs, the variability and use of multiple frameworks identifies the pressing need for a unified CBME framework in undergraduate medical education.

Fostering student and faculty scholarship in an accelerated three-year medical school.

Background: In acknowledgement of the importance of research competency in academic medicine, an extracurricular student research program and faculty development researcher pathway was developed to promote scholarly productivity at New York University (NYU) Long Island School of Medicine (LISOM), a three-year accelerated Liaison Committee on Medical Education (LCME)-accredited medical school. The aim was to enhance medical students' and faculty scholarly productivity, by creating new training programs targeting research skills and academic collaboration. Impact was assessed by initial review of the extracurricular student research program and faculty development researcher pathway. Methods: Electronic surveys via Google were sent out to all current (n = 72) students on 9/20/2021 and the faculty identified based on their primary appointment to NYU LISOM in the learning management system on 9/17/2021 to determine participation in research, presentation of research findings, satisfaction with the program, and research opportunities for students. Student scholarly productivity was tracked using PubMed, restricted to search years 2020 through 2022. For the faculty development researcher pathway, publications were tracked for each participant before and after completion of the program, with pre- and post-completion dates ranging from 2012 through 2020. Results: Student survey results (29 responses out of 72) indicated 28% of students were involved in research with institutional faculty and 59% were interested in starting a research project. Most students involved in extracurricular research were satisfied with their experience and eight students have publications with faculty. For the faculty development researcher pathway, 35% of the participants increased publications after program graduation. Conclusions: Outcomes from the student research program and faculty researcher pathway were positive regarding student research engagement and faculty scholarly productivity, though long-term outcomes are yet to be evaluated. Progress will be tracked as students continue through undergraduate and graduate medical education, and as both students and faculty progress throughout their career.

A Retrospective Analysis of Medical Student Performance Evaluations, 2014-2020: Recommend with Reservations.

The Medical Student Performance Evaluations (MSPE) is a cornerstone of residency applications. Little is known regarding adherence to Association of American Medical Colleges (AAMC) MSPE recommendations and longitudinal changes in MSPE content. Evaluate current MSPE quality and longitudinal changes in MSPE and grading practices. Retrospective analysis. Students from all Liaison Committee on Medical Education (LCME)-accredited medical schools from which the Stanford University Internal Medicine residency program received applications between 2014-2015 and 2019-2020. Inclusion of key words to describe applicant performance and metrics thereof, including distribution among students and key word assignment explanation; inclusion of clerkship grades, grade distributions, and grade composition; and evidence of grade inflation over time. MSPE comprehensiveness varied substantially among the 149 schools analyzed. In total, 25% of schools provided complete information consistent with AAMC recommendations regarding key word/categorization of medical students and clerkship grades in 2019-2020. Seventy-seven distinct key word terms appeared across the 139 schools examined in 2019-2020. Grading practices markedly varied, with 2-83% of students receiving the top internal medicine clerkship grade depending on the year and school. Individual schools frequently changed key word and grading practices, with 33% and 18% of schools starting and/or stopping use of key words and grades, respectively. Significant grade inflation occurred over the 6-year study period, with an average 14% relative increase in the proportion of students receiving top clerkship grades. A minority of schools complies with AAMC MSPE guidelines, and MSPEs are inconsistent across time and schools. These practices may impair evaluation of students within and between schools.

Students' Perception of the Anatomy Educational Environment at Regional Medical Campuses (RMC) and Main Campus

IntroductionIn 2006, the Association of American Medical Colleges (AAMC) recommended to increase medical school enrollment to address an anticipated physician shortage in the future. To accommodate this increase, medical schools not only increased students enrolled at existing medical schools, but also opened new regional medical campuses (RMCs). However, the Liaison Committee on Medical Education (LCME) has standards for medical schools with more than one geographically separate campus; specifically, the curriculum should have comparable educational experiences, equivalent methods of assessment, and uniform graduation standards across all locations. Thus, RMCs have the unique task of maintaining an autonomous identity with their own strengths and resources, all the while remaining consistent and comparable to the central campus. Indiana University School of Medicine has eight RMCs and a main campus in Indianapolis. The first‐year Human Structure course integrates gross anatomy, histology, and embryology and utilizes identical learning objectives, assessment, and state‐wide pre‐recorded lectures. This instructional design leaves the local educational team, cohort of students (75% fewer students at RMCs), and the campus climate among the differences in learning environment. The goal of this study is to explore the differences in medical students’ perceptions of the anatomy environment at RMCs versus the central campus despite comparability in formal curriculum.MethodsThis IRB‐approved study used a modified version of the Dundee Ready Educational Environment Measure, that included a 40‐item Likert survey and six free response questions to gather more information about the medical education environment. First‐year medical students were recruited from three RMCs and main academic campus. A Mann Whitney U test was used to compare survey responses of participants at RMCs and main campus (α ≤ .05) and free responses comments were analyzed using thematic analysis.ResultsA total of 15 RMC (21%) and 12 main campus students (9%) completed the survey. Students at the main campus reported significantly lower scores on 10 items compared to RMC participants (p ≤ 0.035). These items related to stimulating learning, providing student‐centered instruction, offering constructive feedback, and having a relaxed laboratory learning environment. Thematic analysis of free responses was consistent with survey results and demonstrated that students at RMCs appreciate the smaller number of students which provides more opportunity for one‐on‐one instruction, support, and camaraderie among peers.DiscussionIn considering the learning experience of students, the contributions of factors beyond the formal curriculum need to be explored. Thus, the interaction of instructor and student, through empathy, support, communication, and the learning environment as a whole need to be considered and developed. Allowing the unique qualities and identities of the RMC and central campus to flourish can improve the learning environment while maintaining comparable curriculum standards.

Anatomy Education Elective: A Model for Vertical Integration and Self‐Directed Learning in the Medical Curriculum

INTRODUCTIONWith decreased curricular time devoted to anatomy courses, it is imperative that medical students have opportunities to review anatomical content in the clinical years. Vertical integration of anatomy into the clinical curriculum facilitates the transfer of anatomical knowledge from the classroom to the clinic by providing concrete examples that illustrate the clinical relevance of anatomical content. The Liaison Committee on Medical Education (LCME) also requires that medical schools provide students with opportunities to engage in self‐directed learning to cultivate the habits of lifelong learning.OBJECTIVESTo discuss the effectiveness of a 4th year Anatomy Education elective for integrating anatomy into the clinical curriculum and engaging students in self‐directed learning.DESCRIPTIONIn 2016 an Anatomy Education elective was introduced at Indiana University School of Medicine to provide 4th year medical students with an opportunity to revisit an anatomical topic during the clinical years by developing an educational module that integrates anatomical knowledge with clinical applications. The anatomy education elective is also an opportunity for 4th year students to engage in self‐directed learning on an anatomical topic that aligns with their area of clinical interest. The elective entails students generating learning objectives that their module will address, creating module content in a format of their choosing, and developing an appropriate assessment for the module. Students are encouraged to approach an anatomical topic from a clinical perspective to illustrate the clinical relevance of the anatomical structures and relationships. Twenty‐six student have taken the Anatomy Education elective as of 2021. Some examples of module topics include a review of hepatic anatomy and histology using a clinical case of portal hypertension and placement of a trans‐jugular intrahepatic portosystemic shunt; a review of abdominal anatomy through the lens of a the FAST (Focused Assessment with Sonography for Trauma) exam; and a review of facial anatomy in the context of a facial nerve injury and facial re‐animation procedure.OBSERVATIONSStudents’ experiences during the Anatomy Education elective have been overwhelmingly positive. Student feedback confirms that the elective engaged their self‐directed learning skills, and they appreciated the opportunity to explore a topic of interest. Some student comments include: “I really appreciated the flexibility that this elective allowed. I learned a great deal and was given autonomy when selecting my project topic and content. [The professor] provided excellent guidance and feedback while also allowing me, as the student, to take ownership of my project” and “I enjoyed getting to conduct independent learning about a topic of my choice. I was able to dedicate time to learning about the eye, a topic that I did not feel very confident about after first‐ and second‐year curriculum.”CONCLUSIONSThe Anatomy Education elective is an effective way to vertically integrate gross anatomy into the clinical curriculum. Student feedback confirms that the elective engaged their self‐directed learning skills and the autonomy to choose their own topic motivated students to take ownership of their project.

Applying North American medical education accreditation standards internationally in the United Arab Emirates

ABSTRACT Objective Health care and health professions education are becoming increasingly global, yet no formal international accrediting body exists for medical education. Among the challenges in developing international standards for medical education is the variation in program models, with some regions offering six-year bachelor’s degrees and others, including North America, customarily requiring a bachelor’s degree prior to admission to a 4-year graduate-level degree program. This study sought to determine the applicability of the USA Liaison Committee on Medical Education (LCME) accreditation standards internationally as the foundation for program development, quality improvement, and program evaluation in a program that follows the North American medical education model in the United Arab Emirates (UAE). Methods Using a qualitative political, economic, sociocultural, technological, legal, and environmental (PESTLE) analysis framework, we systematically assessed the applicability of each of the 93 LCME accreditation elements to the nascent doctor of medicine (MD) degree program at Khalifa University. Results All 93 elements in the most current LCME accreditation standards were deemed applicable internationally in a program developed in accordance with the North American model of medical education. Of these, three elements were deemed applicable with caveats in the legal or regulatory processes required to achieve comparable compliance outside of the USA. No elements were deemed not applicable in an international setting. Conclusions Our analysis demonstrates that the LCME accreditation standards are model-specific and can be effectively applied internationally in programs that follow the North American model of medical education. Countries in which no specialized medical education accrediting body exists can apply the LCME standards and achieve international benchmarks of quality in medical education through rigorous self-assessment and continuous quality improvement.

Institutional Accountability for Students With Disabilities: A Call for Liaison Committee on Medical Education Action.

Medical educators and leaders have called for greater diversity among the physician workforce, including those with disabilities. However, many students with disabilities are precluded from entering and completing medical training due to historically restrictive technical standards and poor internal practices to protect student privacy. This limits the possibilities for growing this part of the workforce and making progress toward the ultimate goal of having a physician workforce that better represents the patients it serves. To achieve diversity among the physician workforce, medical education must create environments that allow students with disabilities to apply to, flourish in, and feel well supported in medical school. Recent additions to Accreditation Council for Graduate Medical Education requirements have helped to catalyze work in the area of disability inclusion by incorporating disability-focused mandates into graduate medical education accreditation standards. However, similar mandates for undergraduate medical education have not yet materialized. In this article, the authors call for the Liaison Committee on Medical Education (LCME) to elevate disability as a valued part of medical school diversity in its accreditation standards and to include protections for disabled students. The authors propose that the LCME can take 5 actions to promote institutional accountability toward students with disabilities: (1) define disability as diversity, (2) mandate disability support, (3) protect from conflicts of interest, (4) protect privacy, and (5) verify schools' technical standards comply with the Americans with Disabilities Act. By adopting these recommendations, the LCME would send the powerful message that students with disabilities bring welcome expertise and value to the medical community.

A pilot study of the effects of faculty status for medical librarians in the United States.

Objectives:Within many institutions, there are debates over whether medical librarians should be classified as faculty or professional staff, a distinction that may have considerable effect on the perception of librarians within their local institutions. This study is a pilot exploration of how faculty status may affect the professional experiences of academic medical librarians within their local institutions.Methods:Surveys were sent to 209 medical librarians listed as having some instructional function at Liaison Committee on Medical Education (LCME) accredited medical institutions in the United States. Survey responses were captured using Qualtrics survey tool and analyzed for frequencies and associations using SPSS version 27.Results:Sixty-four medical librarians at academic medical institutions completed the survey developed for this study. Of the respondents, 60.9% indicated that librarians at their institution have faculty status, while 71.9% believe that librarians at their institution should have faculty status. Ninety percent of librarians with faculty status reported that they are expected to generate scholarly materials, compared to 28% of those without faculty status.Conclusions:Many medical libraries offer faculty status to librarians. While many medical librarians are active in instruction, research, and other activities normally associated with faculty status, it is not clear if faculty status impacts how librarians are perceived by other health care workers within their institutions.

The Impact of Socioeconomic Factors on Medical School Acceptance Rates.

Purpose: Seventy-five percent of medical students in the United States hail from families in the top 2 income quintiles as defined by the U.S. Census Bureau, while 5% of medical students represent the bottom quintile. 1 Analyses to identify potential barriers contributing to this staggering socioeconomic disparity among our future medical workforce are sparse. Characterization of the exacerbating factors and potential bottlenecks along the premedical pipeline can help inform crucial steps toward initiatives to increase representation of medical school matriculants from all socioeconomic backgrounds. This study examined U.S. medical school acceptance rates across familial income and parental education levels and identified applicant factors predictive of medical school acceptance. Approach/Methods: The American Medical College Application Service (AMCAS) collects the highest level of parental education and childhood family income for every applicant. De-identified AMCAS data were obtained for all medical school applicants from 2014 to 2019 and included the following applicant characteristics: science and nonscience GPA, Medical College Admission Test (MCAT) 2015 score, age, parental education, family income, race/ethnicity, and the number of medical school acceptances obtained. Descriptive statistical analyses assessed acceptance rates, MCAT averages, and GPA averages, stratified by applicant’s family income and parents’ education. Low income was defined as reporting a childhood family income <$75,000, and first-generation status was defined as having no parent with a bachelor’s degree. Multivariate regression analysis modeled the effects of MCAT, GPA, race/ethnicity, first-generation status, and low-income status on acceptance to at least 1 MD program. Results/Outcomes: AMCAS data from 312,898 applicants were analyzed. Of the total, 34.3% (107,396/312,898) were low-income and 19.3% (60,328/312,898) were first- generation applicants. The overall acceptance rate over the study period was 42.3%. Low-income applicants and first-generation applicants’ acceptance rates were 36.0% (38,674/107,396) and 32.7% (19,701/60,328), respectively. On univariate analysis, acceptance was negatively associated with both family income (OR: 0.602; P < .001; CI: 0.592, 0.612) and parental education (OR: 0.581; P < .001; CI: 0.570, 0.592). On multivariate analysis, among those with MCAT2015 scores (n = 142,961), medical school acceptance was most affected by average science GPA (OR: 6.63; P < .001; CI: 6.345, 6.918), underrepresented in medicine (UIM) identity (OR: 5.119; P < .001; CI: 4.923, 5.323), and MCAT score (OR: 1.186; P < .001; CI: 1.184, 1.189). Low-income status (OR: 0.968; P < .05; CI: 0.938, 0.999) was negatively associated with acceptance; however, first-generation status (OR: 0.994; P = .758) was not significantly associated with acceptance. Discussion: These results reveal that first-generation and low-income medical school applicants have a markedly lower rate of acceptance than the general applicant population. Furthermore, both first-generation and low-income status are significantly negatively associated with medical school acceptance. This effect is mediated by UIM identity and GPA and MCAT metrics. Notably, UIM identity status had a significant effect size in predicting medical school acceptance, which is potentially reflective of beneficial race-conscious admissions practices. Furthermore, the miniscule effect size of first-generation college status and low-income status serves as evidence that disadvantaged backgrounds are not widely considered among admission practices as recommended by the Liaison Committee on Medical Education (LCME) Standard on Diversity. 2 Additionally, one study’s analysis of group differences in scores on the latest version of the MCAT revealed disparities in scores and use of preparatory materials depending on an applicant attending a school with more or fewer resources. 3 Therefore, first-generation college and low-income applicants’ relatively poorer acceptance rates may be mitigated by early academic support and access to cost-prohibitive MCAT preparatory materials. Significance: First-generation college and low-income applicants experience lower medical school acceptance rates, but high grades and test scores mediate the effect, in combination with UIM status. These applicant populations require increased support and mentorship to achieve proportional representation among medical students.

Designing Actionable Solutions and Curriculum for Pain Disparities Education.

The Liaison Committee on Medical Education (LCME) require medical schools to teach their students how to recognize and work toward eliminating health disparities. However, time constraints and a dearth of guidance for educators in teaching pain disparities curricula pose significant challenges. Herein we describe successes and lessons learned after designing, implementing, and evaluating an innovative pain disparities curriculum that was embedded in a longitudinal health equity curriculum for third year medical school students at an academic institution. Although the curriculum was developed for medical school students, the concepts may be broadly applicable to other training settings such as residency and fellowship programs.

Bridging The Gap: Demanding 1-1 Representation of Dark-Light Skin Tones Within Medical Lectures/Resources

Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions (e.g., acne, cancer), which present differently based on skin color and tone. Developing skin-tone-dependent diagnosing skills depends on the medical education (e.g., lectures, medical textbooks, and online board certification prep resources) and hands-on clinical experiences doctors receive. We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin. This lack of representation perpetuates race as a social determinant of health, leading to missed diagnoses and diagnosis at a later/worse stage in people of color. To combat this underrepresentation within medical education, we propose the Liaison Committee on Medical Education (LCME) amend Accreditation Standard 7: Curricular Content, Subsection 7.6: Cultural Competence and Health Care Disparities. The amendment is to include 1 of the 2 following policy changes, with preference for the top-down mandate: 1) Top-down Mandate: An objective measure and subsequent goal (1:1 representation) for the representation of skin of color within a school's medical lectures, which is evaluated by an LCME-approved curriculum committee and mandated for schools wishing to continue to be LCME accredited. 2) Bottom-up Individualized Institutional Goals: A requirement for schools to choose their own goal, create their committee, and evaluate their progress. These progress reports will be submitted to the LCME annually.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum

Audience: The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4).Length of Curriculum: The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. Introduction: The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions.Educational Goals: To provide residents with an introduction to teaching techniques that can be utilized on shift to facilitate an excellent educational experience for junior learners while balancing the resident’s patient care responsibilities.Educational Methods: The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing.Research Methods: A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course.Results: Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student’s t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies postcurriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session.Discussion: The educational content was effective in improving the residents’ comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated th feasibility and utility of running a RAT curriculum entirely in a virtual format.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum.

The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4). The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions. To provide residents with an introduction to teaching techniques that can be utilized on-shift to facilitate an excellent educational experience for junior learners while balancing the resident's patient care responsibilities. The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing. A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course. Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student's t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies post-curriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session. The educational content was effective in improving the residents' comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated the feasibility and utility of running a RAT curriculum entirely in a virtual format. Residents-as-teachers, distance learning, role-playing, virtual curriculum, video conferencing, One Minute Preceptor, feedback, "What if?" game, Aunt Minnie, SPIT, activated demonstration, self-directed teaching tools, teaching scripts, Post-It Pearls.