Post-clerkship Survey Research Articles

Collaborative Teaching and Curricular Integration in Pre-Intern Clinical Placements: Insights from the Greater Bay Area.

The rising demand for knowledge updates and technological innovations in China has made clinical placement teaching challenging. Reforms for innovative teaching models through pilot classes have shown to improve students' academic performance. This novel integration led to the announcement of healthcare collaboration in the Guangdong-Hong-Kong-Macao Greater Bay Area for projects within China's "Global-Innovation-Hub" zones. First Affiliated Hospital (FAH) of Sun Yat-sen University (SYSU) in Guangzhou and the Faculty of Medicine (FMD) of Macau University of Science & Technology (MUST) in Macau have developed an inaugural project for FMD/MUST medical students to perform pre-internships at FAH-SYSU. This study aimed to reflect on students' experiences with collaborative teaching and learning through medical curricular integration in the "Global-Innovation-Hub" zones designed by both institutions for developing integrated curriculum. FMD/MUST students attended medical clerkships at FAH-SYSU using a system-integrated curriculum in China's "Global-Innovation-Hub" zones, allowing different education systems at different locations. Post-clerkship surveys ranked teaching models in conjunction with written reflections in response to post-clerkship questionnaires for all participating students. The teaching models were defined by the way supervisors' interaction with students, and written reflections in response to the post-clerkship questionnaire were descriptively and semantically analysed. The top-ranked teaching models include first "Student-led consultation under supervision in observers' chair with discussion", second "Observe consultation and discuss with the teacher in-between patients in observers' chair" and third "Student-led consultation under supervision in consultants' chair with discussion". The post-clerkship questionnaires showed positive outcomes. This study demonstrates the successful delivery of collaborative teaching and learning through medical curricular integration in China's "Global-Innovation-Hub" zones. This integration enables the development of a consistent and student-preferred teaching model being introduced into clinical placement curriculum. The unique location of China's "Global-Innovation-Hub" zones in the Guangdong-Hong-Kong-Macao Greater Bay Area allows this integration to significantly improve students' clinical reasoning learning.

Near-Peer Paradigms in Medical School: Integrating Student Teaching Assistants Into a Core Radiology Clerkship

Rationale & ObjectivesNear-peer paradigms have been demonstrated effective in supporting how students navigate novel clinical environments. In this study, we describe an innovative model of incorporating teaching assistants (TAs) into a core radiology clerkship and investigate both its perceived educational value by clinical-year learners and its perceived impact on professional growth by TAs. Materials & MethodsAt one U.S. medical school, the core clinical year includes a clerkship in radiology incorporating both reading room exposure and a didactic curriculum. Radiology faculty delivery a variety of traditional and interactive, “dynamic” lectures, while medical student TAs deliver additional dynamic sessions, including a final TA-created review session. The educational value of each didactic session by clerkship students was assessed using a five-point scale survey, and the professional value of the experience by TAs was assessed using a five-point Likert survey. ResultsSpanning from 2020 to 2023, 268 (74.4%) clinical-year students submitted the post-clerkship survey, with the didactic review sessions created and led by TAs receiving the highest ratings of any didactic session. Of 16 former TAs, 12 (75%) completed the post-service survey, with all respondents agreeing or strongly agreeing that they enjoyed and would recommend their experience, and that it enhanced their interest in radiology and in academic medicine. ConclusionNear-peer education in a core radiology clerkship enhances the experience of the learner through peer guidance and the experience of the teacher through professional development. These findings may increase student interest in pursuing academic radiology as a career and invite opportunities for broadening medical school education in radiology.

Transvaginal Ultrasound Simulation/Curriculum for Third-Year Medical Students Improves Educational Experience on Obstetrics and Gynecology Clerkship [ID 2683421

INTRODUCTION: The purpose of this study was to assess the effect of transvaginal ultrasound (TVUS) curriculum with simulation on third-year medical students' obstetrics and gynecology clerkship. METHODS: Institutional review board approval was waived for this study. The TVUS curriculum was introduced in May 2023. A 2-hour educational session with simulation was held at the beginning of the 6-week obstetrics and gynecology clerkship. At the end of the clerkship, a survey was administered to assess students’ experience and comfort level with TVUS. Students who completed their obstetrics and gynecology clerkship prior to the curriculum (July 2022 to April 2023) or were not present for the TVUS educational session were administered the same survey. Likert scale responses were compared using ordered logistic regression. RESULTS: Forty-one of 69 students present for the TVUS curriculum, and 66 of 187 who were absent, completed the post-clerkship survey. Students present for the TVUS curriculum were more likely to report greater understanding of the TVUS they observed during their obstetrics and gynecology clerkship (OR 2.63 [1.25, 5.65]; P=.012). They were more likely to report increased comfort recognizing normal anatomy (OR 5.18 [2.42, 11.59]; P<.001), and gynecologic pathology (OR 8.40 [3.84, 19.24]; P<.001), on real-time TVUS. Additionally, they were more likely to report increased overall understanding on their obstetrics and gynecology clerkship because of their TVUS knowledge and experience (OR 5.47 [2.56, 12.20]; P<.001). CONCLUSION: Universal implementation of TVUS curriculum with simulation should be considered in undergraduate medical education given the potential to improve educational experience on the obstetrics and gynecology clerkship.

Teaching Sideways: Implementing a Peer-Led Medical Student Orientation Bootcamp and Survival Guide for Internal Medicine Clerkship.

Transitioning from classroom learning to clerkships presents a challenge for medical students because there is often sparse preparation material on how to effectively contribute to the medical team as a clerkship student. Although some medical schools have implemented transition-to-clerkship sessions, they often are led by faculty and lack the practical and contemporary guidance from students who have recently completed clerkships themselves. Using a sideways mentorship approach, we implemented a 1-hour near-peer Internal Medicine (IM) clerkship orientation bootcamp at our medical school and wrote an accompanying survival guide to teach students how to function as part of a medical team and to increase the transparency of student expectations and evaluations during the clerkship. The 1-hour session covered the following core topics: clerkship logistics, how to gather/present clinical information, a resident/student question-and-answer panel, and how to contribute to the medical team. A postclerkship medical student and second-year IM resident conducted the bootcamp for four student cohorts (105 students total) during the January to December 2022 clerkship year before the IM rotation of each cohort. After the bootcamp, students received a copy of the survival guide to solidify concepts covered in the session. A preclerkship survey included questions to assess student confidence in 10 core IM clerkship domains pre- and postbootcamp. Both pre- and postclerkship surveys asked students to provide feedback on bootcamp strengths and weaknesses. Wilcoxon signed rank tests revealed a significant increase in postbootcamp student confidence rating for all 10 clerkship domains in the early clerkship cohort and in the late clerkship cohort for all of the domains, except finding clinical reference resources (P = 0.15). The bootcamp had the largest effect size (r) on student confidence in both early and late clerkship cohorts for the following clerkship domains: familiarity with IM clerkship evaluation (early: r = 0.61, P < 0.001; late: r = 0.56, P = 0.002), identification of ways to contribute to the medical team (early: r = 0.58, P < 0.001; late: r = 0.63, P < 0.001), and prerounding/chart checking (early r = 0.52, P < 0.001; late: r = 0.55, P = 0.001). The percentage of students rating the helpfulness of both the bootcamp and survival guide as a 3 to 5 on a 5-point Likert scale in the postclerkship survey was highest for the following domains: being familiar with the structure of a subjective, objective, assessment, and plan presentation (88% and 97%), prerounding/chart checking (82% and 95%), writing progress notes (82% and 92%), and identifying ways to contribute to the medical team (82% and 95%). Students commented that the main strengths of the bootcamp included its specific tips on synthesizing and presenting clinical information and its transparency about student expectations and experiences. A structured student-led bootcamp can increase clerkship preparation in core domains. The bootcamp is now part of mandatory clerkship didactics at our medical school, given its success during the 2022 clerkship year, and its content is continuing to be expanded upon by postclerkship students and residents. In addition, the format of the bootcamp also is being adapted to other clerkships, including surgery and obstetrics/gynecology.

Utilizing Post-Clerkship Surveys to Optimize Emergency Medicine Program Outcomes in the Match

Utilizing Post-Clerkship Surveys to Optimize Emergency Medicine Program Outcomes in the Match

Transitions curriculum impact on students and care.

Transitions of patient care from the inpatient to outpatient setting is a high-risk time often resulting in medical errors and adverse events. Transitions of care programmes have been demonstrated to reduce negative outcomes. Several professional societies have highlighted care transitions as a central pillar of patient care and therefore a crucial aspect of health professional education; however, little data exist on medical student education in this area. The Transitions of Care Curriculum was developed and delivered to all Harvard Medical School Core I Internal Medicine Clerkship students at Beth Israel Deaconess Medical Center, Boston, MA between January 2017 and March 2019, where 12-14 students participated each quarter and included didactic teaching followed by experiential learning. Student data were collected via postclerkship survey. Patient data were collected via chart review. Student self-reported comfort level with transitions in care skills and medical errors were analysed. All student measures related to comfort with transitions in care skills demonstrated statistically significant improvement after curriculum participation(p < 0.001). Of the patients with a completed postdischarge note, students identified ≥1 postdischarge related issue in 33 of 70 patients, with multiple issues identified in many of these patients. Seventy-six total issues were identified. The Transitions of Care Curriculum demonstrated promising student and patient outcomes, suggesting that students can successfully learn and advance clinical skills while having a positive impact on a highly needed and important aspect of patient care by reducing postdischarge errors and adverse events.

Improved Confidence and Clinical Application: The Effects of a Longitudinal Suture Curriculum for Medical Students.

The ability to competently suture is an expected skill for graduating medical students, but many graduates report feeling unprepared to perform this skill. This study aimed to improve student confidence and clinical readiness for third-year clerkships by implementing a novel, mandatory 7.5-hour longitudinal suturing skills curriculum across the first 3 years of medical school. The required suturing skills curriculum was implemented for all medical students throughout the first 3 years of medical school at a large academic health center in the mid-South United States. Precurriculum (n = 167) and postcourse (n = 148) surveys were administered to first-year students in the first year of the curriculum (2017-2018), and a parallel follow-up survey was administered to this cohort in 2020 after students completed their clinical clerkship year (n = 82). Aggregate changes in students' survey responses were analyzed for proper instrument position, simple interrupted sutures, and instrument ties using independent groups Mann-Whitney U tests and Rosenthal correlation coefficients for effect sizes. Statistically significant improvement from pre to post was observed in student comfort in performing three basic skills: proper instrument position (P < 0.001), simple interrupted suture (P < 0.001), and instrument ties (P < 0.001). These pre-post gains were sustained at 2-year follow-up (P < 0.001). Also, the majority of students (66%) reported they were very or completely prepared to suture wounds during their clerkships. Most (83%) also reported they had successfully sutured patient wounds during third-year clerkships without needing significant direction or guidance. We found that a longitudinal suture curriculum with dedicated faculty involvement can improve student confidence in suturing and overall preparedness for third-year clerkships. Although the study is limited to ratings of student comfort and self-reported performance as well as some attrition of responses at postcourse survey and postclerkship survey, the findings highlight the importance of a focused curriculum dedicated to teaching basic suturing skills. Our findings also contribute to the limited body of work examining longitudinal surgical skills development for medical students.

Development and Implementation of Video-Recorded Simulation Scenarios to Facilitate Case-Based Learning Discussions for Medical Students' Virtual Anesthesiology Clerkship.

The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible. We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum. Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning. We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula.

Utilization of Video Otoscopes for Otoscopy Skills Training of Third Year Medical Students.

Effective teaching and assessment of otologic examinations are challenging. Current methods of teaching otoscopy using traditional otoscopes have significant limitations. We hypothesized that use of all-in-one video otoscopes provides students with an opportunity for real-time faculty feedback and re-practicing of skills, increasing self-reported confidence. An otoscopy microskills competency checklist was provided to third-year medical students during their pediatric clerkship to self-assess otoscopy technique during patient examinations, and to clinical preceptors to assess and provide feedback during exams. Over the course of two years, we collected data from students randomly assigned to train on a video otoscope or a traditional otoscope during the clerkship. Pre- and post-clerkship surveys measured confidence in performing otoscopy microskills, making a diagnosis and documentation of findings. For those students who trained on the video otoscope, we solicited post-clerkship feedback on the experience of using a video otoscope. Pre-clerkship confidence did not differ between the groups, but the video otoscope trained group had significantly higher scores than the traditional otoscope trained group on all self-reported technical and diagnostic microskills confidence questions items post-clerkship. Students trained on video otoscopes had a significant increase in confidence with all microskills items (p-values<0.001), however confidence in the traditional otoscope trained group did not change over time (p-values>0.10). Qualitative feedback from the video otoscope trained group reflected positive experiences regarding "technique/positioning" and "feedback from preceptors.". Teaching otoscopy skills to pediatric clerkship medical students using a video otoscope significantly enhanced confidence compared to those training on a traditional otoscope by 1. enabling preceptors and students to simultaneously visualize otoscopy findings 2. allowing preceptors to provide real-time feedback and 3. providing opportunity for deliberate practice of microskills. We encourage the use of video otoscopes to augment student confidence and self-efficacy when training in otoscopy.

The impact of preclinical clerkship in general surgery on medical students' attitude to a surgical career.

With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students' attitudes toward a surgical career. The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest. Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received. Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.

Medical student surgical proficiency and confidence on the core surgical clerkship

We investigated how students’ surgical self-proficiency and self-confidence changed during the core surgical clerkship to better understand how students learn in the operating room (OR), which receives mixed reviews as a medical student learning environment. Student demographics, self-rated ability to perform a set of core proficiencies for a common operation, and self-confidence in the OR were assessed at three clinical sites at the beginning and end of the core surgical clerkship. Self-proficiency and self-confidence metrics were created with maximum scores of 72 and 45, respectively. Pre- and post-clerkship scores were compared and analyzed for associations with student demographics. 103 (89%) students completed the pre-clerkship survey and 74 (64%) completed the post-clerkship survey. Mean self-proficiency and confidence scores significantly increased by the end of the clerkship (p < 0.001). Before the clerkship, female students (n = 46) had lower mean proficiency (20.9 ± 7.6 vs. 28.3 ± 13.1, p = 0.001) and confidence (22.5 ± 5.1 vs. 27.5 ± 5.4, p < 0.001) scores, were less likely to feel comfortable in the OR [adjusted odds ratio (95% confidence interval) 0.19 (0.07–0.54)] and to view the OR as a supportive learning environment [0.18 (0.06–0.59)], and more likely to feel anxious [3.17 (1.33–7.53)]. No significant post-clerkship gender-based differences were observed. Students with more pre-clerkship surgical experiences had higher mean proficiency (29.5 ± 11.6 vs. 19.9 ± 9.4, p < 0.0001) and confidence (27.0 ± 6.0 vs. 22.9 ± 4.9, p = 0.0003) scores, as well as a higher likelihood of feeling comfortable in the OR [adjusted odds ratio (95% CI) 7.14 (2.53–20.14)] and a lower likelihood of feeling anxious [0.32 (0.10–0.98)]. Students’ self-rated proficiency and confidence increased significantly throughout the clerkship, though various factors such as gender and prior OR experience influence baseline levels and may represent important targets for intervention.

“See One, Do One, Perceive One”: Analyzing the Role of the Third-Year Surgery Clerkship on Students’ Perceptions of Surgeons and Their Lifestyles Amidst the COVID-19 Pandemic

INTRODUCTION: Long hours, poor work-life balance, pessimism, and cynicism are the notorious perceptions of surgeons thought to be held by medical students. The impact that the third-year surgery clerkship has on these perceptions has been discussed, but it’s unclear whether changes to the clinical environments due to COVID-19 hamper such impacts. We sought to provide updated analysis on this common question. METHODS: Identical survey questions were given to third-year medical students before and after their surgery clerkship. Students were asked whether they strongly agreed, agreed, neither agreed nor disagreed, disagreed, or strongly disagreed with multiple statements about surgeons. A p-value <0.05 was considered statistically significant. RESULTS: 91 students responded to the pre-clerkship survey (82.7% response rate) and 34 students to the post-clerkship survey (38.6% response rate). Compared to pre-clerkship responses, post-clerkship responses demonstrated a significant increase in the percentage of students who believe that surgeons are good teachers (p = 0.00092), respect medical students (p=0.00326) encourage students to pursue surgery (p = 0.0114) and are compassionate physicians (p = 0.00429), and a significant decrease in the percentage of students who believe that surgeons are mean (p = 0.0394) or pessimistic (p = 0.0161). There was no change seen with respect to students’ perceptions of surgeons’ workload (p = 0.304)/lifestyle (p = 0.0796), reputation (p = 0.0873)/respect received (p = 0.750), contentment with career choice (p = 0.268) or respect for other physicians (p = 0.151). CONCLUSION: The third-year surgery clerkship appeared to have improved students’ perception of surgeons’ personality traits and role as educators but did not appear to affect students’ perceptions of surgeons’ lifestyle, inter-personal traits, or reputation.

A multisite study of medical student perspectives on the core surgical clerkship

BackgroundThe surgical clerkship is the primary surgical learning experience for medical students. This study aims to understand student perspectives on the surgery clerkship both before and after the core surgical rotation. MethodsMedical students at 4 academic hospitals completed pre and postclerkship surveys that included open-ended questions regarding (1) student learning goals and concerns and (2) how surgical clerkship learning could be enhanced. Thematic analysis was performed, and interrater reliability was calculated. ResultsNinety-one percent of students completed both a pre and postclerkship survey (n =162 of 179), generating 320 preclerkship and 270 postclerkship responses. Mean kappa coefficients were 0.83 and 0.82 for pre and postclerkship primary themes, respectively. Thematic analysis identified 5 broad themes: (1) core learning expectations, (2) understanding surgical careers, culture, and work, (3) inhabiting the role of a surgeon, (4) inclusion in the surgical team, and (5) the unique role of the medical student on clinical clerkships. Based on these themes, we propose a learner-centered model of a successful surgical clerkship that satisfies discrete student learning and goals and career objectives while ameliorating the challenges of high-stakes clinical surgical environments such as the operating room. ConclusionUnderstanding student perspectives on the surgery clerkship, including preclerkship motivations and concerns and postclerkship reflections on surgical learning, revealed potential targets of intervention to improve the surgery clerkship. Future investigation may elucidate whether the proposed model of the elements of a successful surgery clerkship learning facilitates improvement of the surgical learning environment and enhanced surgical learning.

Flipped ophthalmology classroom augmented with case-based learning.

Although the flipped classroom model provides an effective way to teach ophthalmology to medical students, there are concerns that it overburdens the learner. The purpose of this study was to assess medical students' perceptions of a case-based flipped classroom style compared with a traditional didactic lecture series and to evaluate the effects of case-based learning on students' confidence in managing common ophthalmic complaints. We created an interactive, case-based flipped classroom ophthalmology curriculum. Paired pre- and post-clerkship surveys were distributed to students on the first and last day of the 2-week clerkship. Questions were formatted as statements using a 6-point Likert scale to assess students' prior exposure to a flipped classroom, perceptions of the flipped classroom curriculum, and confidence in evaluating ophthalmic complaints. A total of 75 students were included during the period July 2019 to March 2020. Pre-clerkship questionnaires revealed no preference for either teaching modality. Wilcoxon signed-rank testing comparing pre- and post-clerkship data revealed a significant increase in students' favoring the case-based flipped-classroom model. Participants reported significant reductions in pressure to perform, course burden, and overall anxiety as well as increased confidence in triaging common eye complaints. The case-based flipped classroom modality prioritizes key learning objectives while increasing student participation and confidence. The reproducibility and accessibility of standardized prepared video lectures and cases may help institutions to better incorporate ophthalmology into preexisting rotations.

Identification of Specific Educational Targets to Improve the Student Surgical Clerkship Experience

BackgroundThis study describes the relationship between medical student perception of surgery, frequency of positive surgery clerkship activities, and overall surgical clerkship experience. MethodsMedical students at four academic hospitals completed pre- and post-clerkship surveys assessing 1) surgery clerkship activities/experiences and 2) perceptions of surgery during the 2017-2018 academic year. ResultsNinety-one percent of students completed both a pre- and post-clerkship survey (n = 162 of 179). Student perception of surgery significantly improved across the clerkship overall (P < 0.0001) and for 7 of 21 specific items. Eighty-six percent of students agreed that the clerkship was a meaningful experience. Sixty-six percent agreed that the operating room was a positive learning environment. Multivariable logistic regression identified one-on-one mentoring from a resident (OR [95% CI] = 2.12 [1.11-4.04], P = 0.02) and establishing a meaningful relationship with a surgical patient (OR = 2.21 [1.12-4.37], P = 0.02) as activities predictive of student agreement that the surgical clerkship was meaningful. Making an incision (OR = 2.92 [1.54-5.56], P = 0.001) and assisting in dissection (OR = 1.67 [1.03-2.69], P = 0.035) were predictive of student agreement that the operating room was a positive learning environment. Positive student perception of surgery before the clerkship was associated with increased frequency of positive clerkship activities including operative involvement (r = 0.26, P = 0.001) and relationships with surgical attendings (r = 0.20, P = 0.01), residents (r = 0.41, P < 0.0001), and patients (r = 0.24, P = 0.003). ConclusionsInterventions to improve surgery clerkship quality should target enhancing student relationships with residents and surgical patients as well as providing opportunity for student operative involvement beyond just suturing. In addition, fostering positive perceptions of surgery in the preclinical period may increase meaningfulness and experience with the later surgery clerkship.

Education Research: The medical student perspective on challenging conversations.

Medical students experience difficult conversations with patients during clinical clerkships. This study aimed to characterize barriers to and opportunities for learning in the setting of challenging conversations. Neurology clerkship medical students were enrolled prospectively in a concurrent nested mixed methods study. Qualitative data were collected using a postclerkship survey and semi-structured focus groups. Students were asked to reflect on challenging conversations they experienced with patients and to identify the top reasons why conversations were challenging. Responses were analyzed using directed content analysis. A total of 159 medical students were enrolled (MS2: n = 35 [22%]; MS3: n = 97 [61%]; MS4: n = 27 [17%]). Three themes of difficulty were identified in survey and focus group data: (1) tough clinical realities: how the clinical environment makes conversations challenging; (2) communication skill needs: the difficulty of finding the words to say; and (3) navigating emotions: of patients, clinicians, and students themselves. Tough clinical realities were cited by over two-thirds of students in all years (MS2: n = 30 [86%]; MS3: n = 74 [76%]; MS4: n = 23 [85%]). Communication skills needs were cited most frequently by third-year students (MS2: n = 15 [43%]; MS3: n = 55 [57%]; MS4: n = 10 [37%]). Students early in training were more likely to cite difficulty navigating emotions (MS2: n = 28 [80%]; MS3: n = 71 [73%]; MS4: n = 19 [70%]). Medical students frequently observe and participate in challenging conversations with patients. Here, students identified what makes these conversations most difficult. Communication curricula should leverage clinical communication encounters, prepare students for inherent clinical realities, and help students navigate emotions in the health care setting.

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Theory Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.

52: Does the integration of pelvic exam simulation into standardized ob/gyn medical student clerkship orientation improve student confidence with pelvic exams?

The purpose of this study is to examine the impact on medical student confidence with a pelvic exam by integrating a new simulation curriculum into the orientation day of their OB/GYN clerkship rotation. We integrated a new pelvic exam simulation into an established orientation day at the beginning of the OB/GYN clerkship rotation. This included direct education by a physician trained in pelvic examinations on two high-fidelity pelvic simulators and guided pelvic exams on standardized patients. An online survey was distributed prior to the orientation day (pre-clerkship), at the end of the orientation day (post-simulation), and at the conclusion of the clinical rotation (post-clerkship). We used the “The Fear of Pelvic Examination Scale” (F-PEXS), a validated questionnaire to assess the students’ confidence. This tool uses a Likert scale to assess students’ fear, disturbing thoughts, and stress levels while performing a pelvic exam. One hundred seven students completed the pre-clerkship survey, ninety-five completed the post-simulation survey, and thirty completed the post-clerkship assessment. For 30% of the medical students who completed the post-clerkship survey, OB/GYN was their first clinical rotation. All students completed at least one pelvic exam during their rotation. At the end of the rotation 80% of the students were “not at all, or probably not” nervous about performing a pelvic exam versus 25% pre-clerkship. (Figure 1) Only 3% of students felt confident performing a pelvic exam before their orientation versus 56% after simulation and 62% felt confident after the entire clerkship. (Figure 2) When asked if the simulation experience enhanced their understanding of the female reproductive system, more than 95% of the students answered positively. Pre-simulation, 30% of the students felt that they had a good understanding of basic female pelvic anatomy (major internal and external viscera) versus 93% after the clerkship. We found increased medical student confidence and less anxiety about performing a pelvic exam after the integration of a simulation experience in the clerkship orientation day. The students also expressed increased satisfaction with the modification in curriculum. By removing a large barrier that often exists in the learning process of this sensitive but extremely important clinical skill, medical students may be able to more fully participate in their OB/GYN clerkship and bring these feelings of confidence and skill into their chosen specialty.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Medical Student Perceptions of 24-Hour Call

To assess the medical student perception and experience of a 24-hour call requirement, and to learn if improvements can be made to improve the 24-hour call requirement. Medical students completing their required surgical clerkship over 1 academic year at our institution were surveyed prior to their clerkship and on the last week of clerkship regarding their perceptions and experience with 24-hour call. This study was performed at the University of Minnesota, in Minneapolis, Minnesota, a medical school and tertiary medical center. Two hundred one medical students were given the option to complete an anonymous survey before and after their required surgical clerkship. Response rate for the preclerkship survey was 70% (n = 140) and 58% (n = 117) for the postclerkship survey. The mean age of respondents was 26 years, and the majority of students were in their third year of medical school. After completing the clerkship, students interested in surgery more often agreed the 24-hour call requirement should remain (51% versus 31%, p = 0.01). Students rotating at a Level I Trauma Center were also more likely to agree the call requirement should remain (59% versus 33%, p = 0.008). Medical students generally had less concerns (mental health, fatigue, mistakes, and grade performance) related to 24-hour call after completion of the clerkship. Concerns about the effect of 24-hour call on study schedule remained high in both pre and postclerkship groups. Medical students have concerns about the experience prior to the clerkship that diminished by its completion. To improve medical student perceptions and overall experience of 24-hour call, frequency of shifts could be limited and the 24-hour call requirement sites could be shifted to Level I Trauma Centers.

The FLAME Initiative: “Five-Minute Lectures Accelerating Medical Education” Empowering Resident Teaching

BACKGROUND: The ever-increasing volume of medical knowledge and time available to acquire it are inversely proportional, creating a conundrum for resident-educators of medical students during clerkships. As learners themselves, resident teaching opportunities can be stifled by self-confidence, time, and accessibility of resources. The FLAME initiative seeks to increase the frequency and quality of teachable encounters while catalyzing resident learning through teaching. METHODS: FLAME seeks to create a short presentation for each APGO medical student learning objective. These can be readily accessed on www.flame.rocks and through an iPhone application. Our primary hypothesis, assessed by confidential survey before and after FLAME implementation, is that residents will be better able to meet their own teaching goals with FLAME as a resource. Secondary hypotheses include: residents will be more comfortable teaching, residents will teach medical students more frequently, students will be more satisfied with resident teaching, and student Shelf scores will improve. RESULTS: Of 28 residents surveyed pre-FLAME, 92% find medical student teaching important, and 88% wished they taught more. Major barriers impeding teaching are: time/clinical duties (100%), comfort with teaching (23%) and accessibility of resources (18%). The survey will be repeated in January 2017 and compared to the pre-FLAME baseline. Medical student postclerkship survey scores and Shelf scores for 12 months following FLAME introduction will be compared to the 12 months prior. DISCUSSION: FLAME's philosophy is simple: empower residents to teach by making relevant, efficient, and reliable teaching resources immediately accessible.