Medical Education Consortium Research Articles

Student Experience and Clinicians' Longitudinal Evaluations Demonstrate Diversity of Experience and Achievement of Day One Competency in a Distributed Model of Clinical Education: A Mixed Methods Study.

Numerous colleges utilize distributed veterinary education (DVE) to deliver most or all their students' clinical education. This study explored students' experiences and development of competence in a DVE program. Veterinarians evaluated 120 final-year students' performances at the end of each 4-week clinical rotation using a four-point RIME (Reporter, Interpreter, Manager, Educator) scale. Evaluation items linked to 16 competencies, including the AVMA's Council on Education's (COE) nine competencies and the North American Veterinary Medical Education Consortium's (NAVMEC) seven competencies. Students were surveyed at graduation about their clinical year experience and preparedness for an expanded set of 21 competencies/subcompetencies derived from those published by the AVMA COE, NAVMEC, and the American Association of Veterinary Medical Colleges (AAVMC). Students logged 56,305 cases in ePortfolios during the year, averaging 469 cases per student. Competency scores increased during clinical year (p < .001); scores rose most quickly in the middle third of the year. Students scored higher on some competencies than others (p < .001), though different competencies improved at a similar rate. Seven students required remediation, which consisted of repeating one or more rotations with individualized goals and oversight; all remediated successfully. Students reported diverse spectrum of care experiences and praised the amount of hands-on experience. Students suggested additional oversight for some clinical affiliates. In conclusion, the DVE program provided a robust number and diversity of cases. Students demonstrated longitudinal gains in competency scores and reported confidence in performing competencies upon graduation. The DVE program appeared effective at meeting programmatic competency goals.

Peer review journal publication rates of award-winning presentations from a multi-disciplinary multi-institutional medical education consortium annual research forum: 40-year experience

IntroductionResident research has been mandated by the Accreditation Council of Graduate Medical Education across all specialties. Southeast Michigan Center for Medical Education (SEMCME) has an annual Research Forum for resident competition, and we assessed the publication status of award-winning presentations. MethodsThe SEMCME Research Forum's winning presentations from 1978 to 2018 were reviewed. The author's information and keywords from the abstract's title were used to search PubMed and Google Scholar databases for publications. Descriptive statistics were generally used to characterize the data. ResultsOf 147 winning projects, 62% (78/126) were oral and 48% (10/21) were poster presentations; 88 (60%) were published. Obstetrics and gynecology had the highest publication rate (71%), followed by surgical (61%) and medical specialties (48%). ConclusionWhile 60% of the award-winning presentations at the SEMCME Research Forum were published, more work needs to be done to examine the barriers preventing the publication of the remaining projects.

Maintaining Community During Disruption: Lessons From the Accelerating Change in Medical Education Consortium.

When the COVID-19 pandemic emerged early in 2020, the American Medical Association's (AMA) Accelerating Change in Medical Education Consortium focused on maintaining its community of 37 medical schools and 11 graduate medical education projects along with the core substance of its work. The initial response was to cancel events and reduce the workload of consortium members, but it quickly became clear that the consortium needed additional strategies. The constituents needed resources, support, and community. The authors, along with the rest of the AMA team, learned to maximize the benefits and minimize the drawbacks of operating virtually. These insights supported the continuation, and even expansion, of the consortium's innovations despite extremely stressful circumstances. In this Scholarly Perspective, the authors outline the actions that they and the AMA team took in 2020 and 2021 at the beginning of the pandemic and as that crisis progressed and was further intensified by the significant distress reflected in the protests after the murder of George Floyd. The goal of these actions was to maintain the consortium's core substance, innovation, momentum, and sense of community. The authors describe lessons learned in 2020 and 2021 via a novel model developed to facilitate ongoing collaboration and respond rapidly to the needs of overwhelmed medical educators. This model is composed of 4 phases: assessing needs, mining experts, convening people, and generating products. This model for leveraging a community of practice can help educators optimize collaboration, whether educators are pursuing innovation in the training of physicians or other health care professionals and whether in times of extreme stress or stability, the model provides a pathway for maintaining community. The prepandemic way of working will not return. Virtual participation and collaboration will remain a part of work and daily life for the foreseeable future and beyond.

Addressing COVID-19 Disparities Between Hispanic and Non-Hispanic White Populations of Arizona

Introduction: The coronavirus disease (COVID-19) pandemic1,2 contributed to over 1.03 million deaths in the United States (U.S.) and 30,768 deaths in Arizona3. Nationwide, Hispanics are at increased risk for infection, hospitalization, and death, when compared to non-Hispanic White (NHW)4. Although Hispanic COVID-19 disparities are clear in the U.S., study of Hispanic COVID-19 disparities in Arizona are less clear. Objective: To compare COVID-19 interventions and clinical outcomes between Hispanic and NHW populations in rural and urban healthcare settings of Arizona. Methods: A retrospective cohort of COVID-19 patients from January 1, 2020 through June 17, 2022 admitted to hospitals affiliated with the Midwestern University Graduate Medical Education consortium were assessed. Data was abstracted to counterbalance NHW and minority patients by date of admission. Data collected included patient demographics, presenting symptoms, vital signs, laboratory values at the time of emergency department presentation, treatment modalities, and clinical outcomes. Results: A total of 627 patients were analyzed with 31.7% (199/627) identifying as Hispanic, 41.8% (262/627) female, and 61.9% (388/627) allocated to the rural hospital group. No difference in mortality was seen in the rural or urban setting and there was no difference in administered COVID-19 therapeutics. Kaplan-Meier curves were parallel between Hispanic and NHW patients who survived COVID-19 with no difference in the length of stay (LOS) days. Kaplan-Meier curves differed between Hispanics and NHW patients who expired from COVID-19 with Hispanics at a greater LOS prior to mortality. Differences between Hispanic and NHW mortality patients included Hispanics presenting at a younger age, increased CRP elevations, and a greater delay between symptom onset and COVID-19 testing. Hispanics who expired were more likely to present with shortness of breath, hypoxia, and a documented bacterial infection during hospitalization as compared to Hispanics who survived. Conclusion: Following admission, patients regardless of Hispanic or NHW identification, received equitable care in our Arizona subset which resulted in comparable rates of mortality. Hispanics initially presented at increased disease severity, which is suggestive of factors outside of the hospital, prior to admission, responsible for the disparities seen at the national level with variation between states.

A Descriptive Study of Health Literacy and Social Determinants of Health as Curricula Topics in Medical School Education

The purpose of this investigation was to assess the extent to which health literacy and social determinants of health exist together in medical school curricula, and the attitudes and beliefs of medical school educators toward the relevance of these topics taught in the curriculum. The research used a descriptive cross-sectional survey design of institutions that comprised the Accelerating Change in Medical Education (ACE) Consortium of the American Medical Association. The study population was 36 ACE institutions, but only 11 ACE institutions made up the study sample. Results also showed that five health literacy items were taught as curricula topics in medical school education with 100% (n = 10) of the respondents teaching how to use plain language skills for oral communication. Respondents rated the level at which their institution prioritized instructional methods to explicitly teach social determinants of health as a topic in the medical curriculum with three (27.3%) ranking the priority level as extremely high, seven (63.6%) ranking it as high, and one (9.1%) ranking it as low. Medical educators rated five social determinants of health influencing a person’s health status, with “economic stability” and “social and community context” having the first and second highest mean rankings, respectively. Nine (81.5%) medical educators agreed that health literacy is a social determinant of health (M = 8.73) and a predictor of health status (M = 7.82).

Advocacy for Health Justice: An Innovative Pilot Course for MD and Master of Public Policy Students

Problem : U.S. medical schools are searching for ways to address issues of health justice in undergraduate medical education. Physicians have not typically received training in how to be effective advocates for systemic change and individuals in policy fields are not usually equipped to understand the complex issues of health science and their intersection with the health system and society. To address this gap, medical school faculty partnered with school of public policy faculty on a collaborative learning model that engaged MD and Master of Public Policy students together to strengthen their collective knowledge of the healthcare landscape, and to build skills to work for health justice. Intervention: We hypothesized that pairing medical students with public policy students to learn about the intersections of health justice and advocacy could enhance the efficacy of each group and provide a new model of collaboration between medical and policy professionals. The students collaborated on a health justice advocacy project through which they provided consultation to an established community organization. Context : The 8-week course took place in the spring of 2021 in Los Angeles, California. Due to Covid-19 the course was taught online and included asynchronous learning modules and live Zoom sessions. The project also served as a pilot for the post-clerkship phase of a new longitudinal health justice curriculum for MD students that launched in August 2021. Impact : Analysis of student work products, course evaluations, partner interviews, and student focus groups showed that students valued learning through their interdisciplinary collaborative work which gave them new perspectives on health justice issues. The community partners indicated that the students consultative work products were useful for their initiatives, and that they found working with MD and MPP students to be a valuable way to think about how to build stronger and more inclusive coalitions to advocate for health justice. This project has the potential for national impact as it aligns with the Association of American Medical Colleges’ renewed focus on the responsibility of academic medicine to partner with communities for health justice. The project also contributed to the national conversation on how to align health systems science education with the aims of health justice through our participation in the American Medical Association Accelerating Change in Medical Education Consortium. Lessons Learned : Leveraging faculty relationships with community partners was crucial for developing meaningful projects for students. Cultivating and expanding community partner networks is necessary to sustain and scale up this type of intervention. Centering the needs of communities and supporting their on-going work for health justice is essential for becoming an effective advocate. Learning communities that bring interdisciplinary students, healthcare providers, policy professionals, and community partners together to learn from one another can create key opportunities for ameliorating health inequities.

The Development of a Set of Coaching Competencies for Medical Education Using a Modified Delphi Approach.

Purpose: Coaching is emerging as a way to support learners’ academic, professional identity, and well-being goals in medical education. 1,2 To date, there is scant literature on ways to assess coaches and evaluate coaching programs so that the benefits of coaching can be quantified and investments into coaching justified. 3 One piece of this gap is to identify the core competencies of a coach. The International Coaching Federation (ICF) has published coaching competencies, 4 though these relate to leadership and executive coaching. The National Board of Health and Wellness Coaches, in collaboration with the National Board of Medical Examiners, has developed coaching competencies and national certification for health care providers to support patients and providers. These have more basis in science and incorporate positive psychology, self-determination theory, and are aligned with intentional change theory, which academic coaching often incorporates. However, neither of these competency frameworks were specifically designed for coaching in medical education. Coaching competencies specific to medical education can allow for better program evaluation and also guide the hiring and training of individual coaches. We describe the creation of a set of coaching competencies for medical education using a modified Delphi approach. 5 Methods: The expert panel study team comprises 7 national experts in the field of coaching and/or assessment, 4 of whom are certified coaches. A modified Delphi approach was taken with the following steps: (1) A national American Medical Association Thematic Coaching Meeting was held in October 2018. Attendance was open to the AMA Accelerating Change in Medical Education Consortium schools and we also solicited and invited experts in the fields of coaching, adaptive learning, neuroscience, and medical education. At the conference, an initial discussion was held, led by the study team and informed by our review of the literature. The discussion allowed participants to brainstorm categories and individual competencies, using the ICF model as a starting point. (2) Three rounds of consensus process followed among members of the expert panel in which 4 domains were identified and competencies were finalized. Results: All 7 members participated in the 3 Delphi rounds. Panelists were asked to focus on expected competencies for a coach working with learners across the medical education continuum. This process resulted in 13 competencies in 4 domains: (1) Coaching process and structure: establishing the coaching agreement, meeting management, managing process and accountability, and coach self-monitoring. (2) Relational skills: establishing meaningful coaching relationships, emotional intelligence, adaptability, and effective communication. (3) Coaching skills: fostering development of master adaptive learners, facilitating coachee well-being and professional fulfillment, and emphasizing cocreative collaboration. (4) Coaching theories and research: identifying current coaching models and tools to support learning and flexibility. Discussion: We identified competencies for coaches working with medical learners. They share overlap with the ICF competencies but have important differences that reflect the unique learning environment in medicine and needs of these learners. Future directions would include identifying more granular ways to assess coaches based on each competency, creating tools to support coach development across the competencies, and assessing how each competency affects the effectiveness of the coach. Significance: These competencies can be used to develop learning objectives and coach development curricula. They can also form the basis of coach assessment and evaluation of individual coaches and coaching programs, which are essential components to demonstrating efficacy and value.

Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations.

The American Medical Association's Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment. Authors performed a single-institution qualitative study using transcribed phone interviews with eligible Vanderbilt residency program directors, associate program directors, and core faculty. Participants described observations of successful residents within each HSS domain. Two researchers independently coded, discussed, and reconciled deidentified transcripts using inductive-deductive approaches to identify themes. Seventeen faculty participated across specialties (17/39, 45%). Faculty responses emphasize precurricular experiences including professional degrees, work experience, extracurriculars, and medical school exposure. Importantly, successful residents exhibit foundational core workforce characteristics including growth mindset, curiosity, and a desire to learn about systems. GME faculty identified HSS domain-specific skills, noting distinctions among learning environments. Outcomes resulting from residents' application of HSS concepts include delivering high-quality, person-centered care and systems improvements. Descriptions of successful practice within HSS domains highlight preparatory experiences and core workforce characteristics and outline entry-level HSS behaviors. Conceptualized in a logic model framework, these findings describe key inputs, learning activities, outputs, and outcomes for systems-prepared entering residents bridging the UME-GME transition.

Social network analysis of publication collaboration of accelerating change in MedEd consortium

Introduction The American Medical Association formed the Accelerating Change in Medical Education Consortium through grants to effect change in medical education. The dissemination of educational innovations through scholarship was a priority. The objective of this study was to explore the patterns of collaboration of educational innovation through the consortium’s publications. Method Publications were identified from grantee schools’ semi-annual reports. Each publication was coded for the number of citations, Altmetric score, domain of scholarship, and collaboration with other institutions. Social network analysis explored relationships at the midpoint and end of the grant. Results Over five years, the 32 Consortium institutions produced 168 publications, ranging from 38 papers from one institution to no manuscripts from another. The two most common domains focused on health system science (92 papers) and competency-based medical education (30 papers). Articles were published in 54 different journals. Forty percent of publications involved more than one institution. Social network analysis demonstrated rich publishing relationships within the Consortium members as well as beyond the Consortium schools. In addition, there was growth of the network connections and density over time. Conclusion The Consortium fostered a scholarship network disseminating a broad range of educational innovations through publications of individual school projects and collaborations.

Defining GME Librarianship: Creating and Developing a New Graduate Medical Education Library Program and Librarian Position

An academic research institution and a corporate hospital system formed a new graduate medical education (GME) consortium. The consortium objectives were to increase the scholarly activity of the residents and fellows in a national hospital system’s GME residency program to match the requirements set forth by the Accreditation Council for Graduate Medical Education. A GME librarian position was created specifically to serve the GME research programs at Florida area hospitals to help with this objective. This paper describes the experience, activities, and lessons learned from the creation of an entirely new GME library program and librarian position for a nine-hospital region in Florida.

Assessing the Transition of Training in Health Systems Science From Undergraduate to Graduate Medical Education.

The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation. This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME). ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models. At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups. Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.

Suicide deaths among medical students, residents and physicians in India spanning a decade (2010-2019): An exploratory study using on line news portals and Google database.

Despite having one of the world's largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010-2019). Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.

Expanding innovation from undergraduate to graduate medical education: A path of continuous professional development

A hundred years after the Flexner report laid the foundation for modern medical education, a number of authors commemorated the occasion by commenting on how the medical education system had to change once more to serve 21st century patients. Experts called for standardized outcomes and individualized learner pathways, integration of material across traditional areas, attention to an environment of inquiry, and professional identity formation. The medical education community responded and much has been achieved in the last decade, but much work remains to be done. In this paper we outline how the American Medical Association Accelerating Change in Medical Education Consortium, launched in 2013 through significant funding of transformation projects in undergraduate medical education, expanded its work into graduate medical education, and we look to the future of innovation in medical education.

Realizing the vision of the Lancet Commission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium

In the last two decades, prompted by the anticipated arrival of the 21st Century and on the centenary of the publication of the Flexner Report, many in medical education called for change to address the expanding chasm between the requirements of the health care system and the educational systems producing the health care workforce. Calls were uniform. Curricular content was missing. There was a mismatch in where people trained and where they were needed to practice, legacy approaches to pedagogical methods that needed to be challenged, an imbalance in diversity of trainees, and a lack of research on educational outcomes, resulting in a workforce that was described as ill-equipped to provide health care in the current and future environment. The Lancet Commission on Education of Health Professionals for the 21st Century published a widely acclaimed report in 2010 that called for a complete and authoritative re-examination of health professional education. This paper describes the innovations of the American Medical Association Accelerating Change in Medical Education Consortium schools as they relate to the recommendations of the Lancet Commission. We outline the successes, challenges, and lessons learned in working to deeply reform medical education.

The critical role of infrastructure and organizational culture in implementing competency-based education and individualized pathways in undergraduate medical education

In 2010, several key works in medical education predicted the changes necessary to train modern physicians to meet current and future challenges in health care, including the standardization of learning outcomes paired with individualized learning processes. The reframing of a medical expert as a flexible, adaptive team member and change agent, effective within a larger system and responsive to the community’s needs, requires a new approach to education: competency-based medical education (CBME). CBME is an outcomes-based developmental approach to ensuring each trainee’s readiness to advance through stages of training and continue to grow in unsupervised practice. Implementation of CBME with fidelity is a complex and challenging endeavor, demanding a fundamental shift in organizational culture and investment in appropriate infrastructure. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium developed and implemented CBME, including common challenges and successes. Critical supporting factors include adoption of the master adaptive learner construct, longitudinal views of learner development, coaching, and a supportive learning environment.

Exploiting the power of information in medical education

The explosion of medical information demands a thorough reconsideration of medical education, including what we teach and assess, how we educate, and whom we educate. Physicians of the future will need to be self-aware, self-directed, resource-effective team players who can synthesize and apply summarized information and communicate clearly. Training in metacognition, data science, informatics, and artificial intelligence is needed. Education programs must shift focus from content delivery to providing students explicit scaffolding for future learning, such as the Master Adaptive Learner model. Additionally, educators should leverage informatics to improve the process of education and foster individualized, precision education. Finally, attributes of the successful physician of the future should inform adjustments in recruitment and admissions processes. This paper explores how member schools of the American Medical Association Accelerating Change in Medical Education Consortium adjusted all aspects of educational programming in acknowledgment of the rapid expansion of information.

The power of interdependence: Linking health systems, communities, and health professions educational programs to better meet the needs of patients and populations

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

The Accelerating Change in Medical Education Consortium: Key Drivers of Transformative Change.

The American Medical Association's (AMA's) Accelerating Change in Medical Education (ACE) initiative, launched in 2013 to foster advancements in undergraduate medical education, has led to the development and scaling of innovations influencing the full continuum of medical training. Initial grants of $1 million were awarded to 11 U.S. medical schools, with 21 schools joining the consortium in 2016 at a lower funding level. Almost one-fifth of all U.S. MD- and DO-granting medical schools are represented in the 32-member consortium. In the first 5 years, the consortium medical schools have delivered innovative educational experiences to approximately 19,000 medical students, who will provide a potential 33 million patient care visits annually. The core initiative objectives focus on competency-based approaches to medical education and individualized pathways for students, training in health systems science, and enhancing the learning environment. At the close of the initial 5-year grant period, AMA leadership sought to catalogue outputs and understand how the structure of the consortium may have influenced its outcomes. Themes from qualitative analysis of stakeholder interviews as well as other sources of evidence aligned with the 4 elements of the transformational leadership model (inspirational motivation, intellectual stimulation, individualized consideration, and idealized influence) and can be used to inform future innovation interventions. For example, the ACE initiative has been successful in stimulating change at the consortium schools and propagating those innovations broadly, with outputs involving medical students, faculty, medical schools, affiliated health systems, and the broader educational landscape. In summary, the ACE initiative has fostered a far-reaching community of innovation that will continue to drive change across the continuum of medical education.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

Direct Measurement of Veterinary Student Learning Outcomes for the NAVMEC Professional Competencies in a Multi-User Virtual Learning Environment.

Education in veterinary medicine, as in other allied health care-health science professions and academia in general, has been subject to the public call for accountability for the quality of its student learning outcomes. A principal stakeholder in veterinary medicine is the American Veterinary Medical Association-Council on Education (AVMA-COE). AVMA-COE has adopted program accreditation standards requiring veterinary colleges to provide evidence that they are measuring and assessing the clinical competency of students before graduation and again shortly after graduation. Schools and colleges are required to develop relevant measures to validate scientific knowledge, skills, and values aligned with North American Veterinary Medical Education Consortium (NAVMEC) core competencies. Beginning in May 2012, the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University modified the professional veterinary medical curriculum by including a required clinical rotation centered on veterinary emergency preparedness and response. A distinguishing major component of the instructional design of the clinical rotation includes Second Life, a commercially obtained computer-generated multi-user virtual simulation learning environment. The virtual reality situations require high-volume, mass-casualty medical triage decision making. The interpersonal communications and interactivity among students, faculty, and third-party actors enable faculty and instructor observers and simulation facilitators to evaluate students actively engaged in critical thinking and complex problem solving while demonstrating skill in the NAVMEC professional competencies. The Second Life virtual simulation has been adopted as a primary tool for direct measurement of student learning objectives outcomes achieved in this clinical rotation and is being implemented in other clinical teaching platforms.