Preclinical Curriculum Research Articles

Advising Orthopaedic Hopefuls in the Wake of a Pass/Fail US Medical Licensing Examination Step 1: A Proposed Method for Predicting US Medical Licensing Examination Step 2 Clinical Knowledge Outcomes.

Matching into orthopaedic residency has become difficult, and the US Medical Licensing Examination Step 1 transition to pass/fail scoring has complicated the process. Advisors' ability to mentor students has decreased, and program directors may rely on Step 2 Clinical Knowledge (CK) scores in selecting which candidates to interview. This study aims to offer a method to predict Step 2 CK outcomes based on preadmission and preclinical performance. The study investigated 486 students from a US medical school who enrolled in 2017 and 2018. Data on demographics, preadmission, and preclinical performance were collected. Before model creation, it was found that sex, Medical College Admission Test scores, Comprehensive Basic Science Examination performance, and preclinical curriculum performance produced optimal models. Multivariate ordinal logistic regression models were built to predict probabilities of four outcome levels of Step 2 CK: <235, 235 to 249, 250 to 265, and >265. Finally, nomograms were created to visualize probability calculations. Each model's odds ratios revealed that female sex, higher MCAT scores, and better Comprehensive Basic Science Examination and preclinical performance were associated with an increased likelihood of being in higher Step 2 CK scoring groups. Preclinical performance had a profound effect, especially for those in the top 1/3. Models were successful in assigning higher probabilities to students in higher Step 2 CK scoring groups in more than 80% of instances. Nomograms presented provide examples of how to apply these models to an individual student. This study presents a novel method for predicting probabilities of Step 2 CK outcomes that can be used to mentor students at a time point when Step 1 previously filled this role. It may assist in identifying orthopaedic hopefuls at risk of performing poorly on Step 2 CK and can foster the development of individualized guidance and mitigation strategies.

Evaluation of Peer Simulations Utilizing Student-Generated Case Studies with Pre-clinical Veterinary Students.

A novel student-driven model of peer simulations using reverse case studies was developed during the COVID-19 pandemic to provide virtual instruction to fourth-year clinical veterinary students. Focus groups suggested that, while this teaching method could not replace hands-on clinical experience, it could be a valuable tool to clinically prepare students during their pre-clinical curriculum. The primary aim of this study was to determine whether this teaching method enhanced earlier curricular student comfort with clinical reasoning, communication, and peer role play as measured by pre- and post-surveys. A secondary aim was to evaluate clinical reasoning ability using the validated Modified Lasater Clinical Judgment Rubric (MCJR). Eighteen pre-clinical veterinary students participated in a 1-week course where they designed and presented clinical cases and participated through virtual role play as clients, clinicians, and observers. Our results demonstrated that students' comfort in clinical reasoning and peer role play significantly improved (p < .001 and p = .003, respectively) after participating in this activity. The role perceived to be the most helpful at developing clinical reasoning and communication skills was clinician, followed by client then observer. Results from the MCJR found significant discrepancies between facilitator scoring and student self- and peer-assessment (p < .001). Common themes emerged including the benefits of engaging in self-reflection, peer-to-peer learning, experiencing case ownership and autonomy, and practicing communication and clinical reasoning skills. This teaching method provides a valuable alternative to client simulators and suggests having students create a case as a client offers a unique educational opportunity.

Teaching Tip: Designing Three-Dimensional (3-D) Printed Struvite and Calcium Oxalate Crystals for Microscopic Examination.

Accredited colleges of veterinary medicine are required by the American Veterinary Medical Association (AVMA) Council on Education (COE) to provide learners with hands-on diagnostic method training, including urinalysis. Although teaching hospitals and affiliated clinical partners offer opportunities to test and interpret urine, caseload is unpredictable. Textbook images and published case reports offer substitutes for experiential learning. However, these read-only modalities lack experiences for learners to evaluate slides microscopically for crystalluria. This teaching tip describes the development of three-dimensional (3-D) printed struvite and calcium oxalate models for skills training. Micro-precision 3-D printed models were designed using computer-aided design (CAD) software. Geometric representations in the Standard for the Exchange of Product Data (STEP) file format were exported for 3-D printing on 2 μm resolution platforms. Prints were manufactured from high temperature laminating (HTL) resin and affixed to glass slides. Although these 3-D prints are macroscopic rather than microscopic, their orientation on a fixed template side by side allows learners to differentiate between shapes, a skill that is key to urine sediment examination. These proof-of-concept prototypes will be integrated into the author's pre-clinical curriculum so that learners can gain experience identifying and differentiating between printed struvite, calcium oxalate monohydrate, and calcium oxalate dihydrate models as they would during routine inspection of urine. Formal feedback on the efficacy of these printed models will be solicited from learners and the instructional team. Future iterations will miniaturize the printed models to reflect their real-to-life microscopic dimensions more accurately.

Design and Implementation of a Safe Equine Radiation-Free Radiographic Simulator for Veterinary Skills Training in the Pre-clinical Curriculum.

The ninth standard of accreditation as outlined by the American Veterinary Medical Association (AVMA) Council on Education (COE) mandates that all accredited colleges of veterinary medicine must provide instruction in medicine and surgery, including principles of practice, hands-on experiences with diagnostic methods, and interpretation of clinical findings. In equine practice, diagnostic imaging is used as a first-line diagnostic approach and is an integral part of pre-purchase and lameness examinations. Accuracy and consistency of radiographic interpretation relies heavily upon procedural techniques to acquire diagnostic images and overcome both motion artifacts and obliquity. Because the sizes and temperaments of equine patients potentiate hazardous working conditions for the veterinary team, learners might benefit from simulations that allow them to practice holding the x-ray generator and the imaging plate for diagnostic image acquisition in the absence of live horses. This teaching tip describes the development of a novel equine radiographic simulator for skills training in the veterinary curriculum. The model allows learners to handle imaging equipment safely and without radiation exposure as they develop proficiency positioning radiographic plates and placing directional markers. Learners can also test their understanding of radiographic positioning in reverse: if given a radiograph, they can be asked to describe how the x-ray generator was positioned to obtain the diagnostic image. Future iterations will investigate the simulator's efficacy with respect to learning outcomes when the model is paired with an assessment rubric as part of an objective standardized clinical examination.

Faculty and Student Perceptions of Unauthorized Collaborations in the Preclinical Curriculum: Student or System Failure?

Unauthorized collaboration among medical students, including the unauthorized provision of assistance and sharing of curricular and assessment materials, is a reported problem. While many faculty view such sharing as academic dishonesty, students do not always perceive these behaviors as problematic. With the trend toward more small-group and team-based learning and the proliferation of resource-sharing and online study aids, collaboration and sharing may have become a student norm. This multi-institutional, qualitative study examined faculty and student perceptions of and student motivations for unauthorized collaboration. Using a constructivist approach, the authors conducted scenario-prompted semistructured interviews with faculty and students in the preclinical curriculum. Participants were asked to reflect on scenarios of unauthorized collaboration and discuss their perceptions of student motivation and the influence of personal or environmental factors. The authors performed inductive thematic analysis of the interview transcripts using open and axial coding followed by abstraction and synthesis of themes. Twenty-one faculty and 16 students across 3 institutions were interviewed in 2021. There was variation in perceptions among faculty and among students, but little variation between faculty and students. Both participant groups identified the same 3 areas of tension/themes: faculty/curriculum goals vs student goals, inherent character traits vs modifiable behavioral states, and student relationships with their peer group vs their relationships with the medical education system. Student behaviors were perceived to be influenced by their environment and motivated by the desire to help peers. Participants suggested cultivating trust between students and the education system, environmental interventions, and educating students about acceptable and unacceptable behaviors to prevent unauthorized collaboration. Given the various tensions and positive motivations behind unauthorized collaborations, institutions should consider explicitly preparing students to make thoughtful decisions when faced with competing priorities in addition to developing mitigation strategies that address the environment and its interactions with students.

It’s “not black and white”: Students’ perceptions of “altruism” content in preclinical medical education

Objective This study investigated how students as stakeholders viewed behavioral and social science (BSS) content in a preclinical longitudinal course entitled “Medicine, Body, and Society” (MBS) at UT Health San Antonio Long School of Medicine (LSOM). We present students’ perceptions of successes and challenges tied to “altruism” and other non-biomedical objectives outlined by this institution. Methods We conducted a qualitative thematic analysis of MBS course evaluation data. Two researchers independently performed initial coding followed by interrater reliability checks to revise codes and a final MAXQDA lexical search to refine three themes. Results Three major themes emerged: (1) Students shared pedagogical preferences strongly favoring stories. (2) Students detected deficits in the module content tied to identities. (3) Students labelled BSS content as “soft,” “subjective,” and “siloed” which confounded its role in the course. Conclusions Advancing altruism aligned with BSS content in preclinical medical education remains a challenge. A closer review of student evaluations framed as learner-centeredness is key to a greater understanding and resolution of competency issues in preclinical curriculum and its impact on mastery in subsequent clinical education and practice.

Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students.

Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic. The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments. We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD. Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments. A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006). There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD. This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method. Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.

Preclinical simulation integrated into a nurse practitioner disease management course: Student perceptions and learning outcomes

ABSTRACT Nurse practitioner (NP) educators have been tasked with incorporating simulation into preclinical curricula while pivoting to competency-based education. Despite evidence supporting simulation's role in preclinical health care education, limited scholarship has evaluated this educational method among NP students. We sought to evaluate student perceptions, learning satisfaction, and confidence after participation in an experientially designed, preclinical, simulation program and to compare levels of clinical communication self-efficacy and self-rated, clinical rotation preparedness before and after participation. The preclinical simulation program was designed, implemented, and evaluated within a disease management course. Students reported high levels of satisfaction and confidence with learning. Clinical communication self-efficacy (t[17] = 3.73, p &lt; .01) and self-rated levels of clinical rotation preparedness (t[17] = −2.97, p &lt; .01) were significantly higher after program participation. Simulation may be successfully implemented in preclinical disease management courses. Positive program evaluations create a foundation for further competency-based NP educational design using simulation. Faculty should consider implementing experientially designed preclinical simulation in NP programs to promote progression toward competency within the NP role and to encourage clinical readiness.

Female sexual medicine: an assessment of medical school curricula in a major United States city.

Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions. This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula. Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate. Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content. Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included. The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction. The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area. Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.

Assessing opportunities for formal exposure to clinical neurosurgery within United States allopathic medical education curricula.

The objective of this study was to evaluate opportunities for early clinical exposure to neurosurgery at US allopathic medical schools and to assess associations between early exposure and recruitment into neurosurgery. The authors conducted a standardized review of online curriculum documentation for all US allopathic medical schools, including descriptive review of opportunities for clinical neurosurgical training among medical students. Chi-square analysis was used to compare baseline characteristics of institutions. Logistic regression was performed to assess factors predictive of early exposure to clinical neurosurgery, defined as completion of a formal rotation at least 6 months prior to Electronic Residency Application Service submission. Among 155 allopathic US medical schools, 143 are fully accredited by the Liaison Committee on Medical Education. Eleven schools have no affiliated hospitals with a neurosurgery practice, and 26 do not have an American Association of Neurological Surgeons (AANS) medical student chapter. Overall, 94 (60.6%) have a traditional preclinical curriculum lasting 21-25 months, 50 (32.3%) offer an intermediate preclinical period of 15-20 months, and 11 (7.1%) report a short preclinical curriculum of 12-14 months. Early formal exposure to clinical neurosurgery was offered by 113 schools (72.9%). Early clinical exposure to neurosurgery was associated with a short (100%) or intermediate (76%) preclinical curriculum, as compared with a traditional curriculum (68.1%; p = 0.066). Early exposure was significantly associated with a shorter preclinical curriculum (OR 0.784, p = 0.005). AANS medical student chapters were present at a high majority of schools with early exposure (OR 4.114, p = 0.006). Medical schools with a higher percentage of graduating medical students matching into neurosurgery were associated with a shorter preclinical curriculum length (β = -0.287, p < 0.001), were more commonly private medical schools (β = 0.338, p < 0.001), and had early clinical exposure to neurosurgery (β = 0.191, p = 0.032). Early exposure to clinical neurosurgery is available at most US allopathic medical schools and is associated with shorter preclinical curricula and institutions with AANS medical student chapters. Medical schools with a higher proportion of medical students entering neurosurgery had a shorter preclinical curriculum length and early clinical exposure to neurosurgery. Further study is recommended to characterize the impact of early exposure on long-term pedagogical outcomes.

Knowledge Retention From Emergency Medicine Simulation-Based Learning Curriculum for Pre-clinical Medical Students.

Introduction Traditional medical school curricula rely on textbook-based learning during the first two years, often limiting students' clinical exposure. Simulation-based learning (SBL) provides an opportunity for students to gain clinical exposure and competency with common procedures as well as to gain knowledge related to common clinical topics. Retention of factual knowledge is a current topic of discussion as medical learners often have difficulty with long-term retention. The aim of this study was to assess if students would learn, retain, and enjoy emergency medicine (EM)-focused SBL. Materials and methods We developed an EM-focused SBL curriculum consisting of four main educational events: suturing, medical stabilization, mass casualty triage, and point-of-care ultrasound (POCUS). Participants were first- and second-year healthcare students enrolled in a traditional, preclinical curriculum, who completed pre- and post-event quizzes consisting of multiple-choice questions on topics covered during the SBL scenario. We compared pre- and post-event quiz scores using a one-way paired t-test. Quizzes were readministered up to 100 days after each SBL event to test knowledge retention, and scores were compared across time by repeated-measures analysis of variance (RMANOVA). Results For suture (n=22), mass casualty (n=20), and ultrasound simulations (n=17), post-event mean quiz scores increased significantly in comparison to mean quiz scores from before the event (p≤0.05). Medical stabilization simulation post-event scores were increased but did not reach statistical significance. Data collected at 45, 74, and 94 days following the suture lab as well as 29 and 49 days after the medical evacuation event, and 20 days after the mass casualty event showed no statistical decrease in quiz means suggesting retention of knowledge amonglearners. Subjective assessments of participant satisfaction demonstrated an enjoyment of the events. Discussion EM-focused SBL events offered enjoyable learning opportunities for students to effectively obtain and possibly retain clinical knowledge. Conclusion SBL has the potential to improve student retention of clinical knowledge during the preclinical years and, therefore, should be further explored and implemented as a core pillar of medical education as opposed to its current state as a learning adjunct.

A comprehensive medical Spanish curriculum model: the Vida Medical Spanish Curriculum

IntroductionRacial and language disparities in the United States healthcare system have long undermined the quality of care provided to minority patients. With the projected growth of the Hispanic population, there is an urgent need for medical schools to integrate high-quality medical Spanish and cultural competency content. We propose a comprehensive medical Spanish curriculum aligned with the preclinical curriculum as a solution to these issues. The primary goal of this study is to demonstrate the effectiveness of a clinically focused, culturally competent medical Spanish program and advocate for its widespread adoption in medical institutions nationwide.MethodsThe study utilized the Kirkpatrick Model to evaluate the success of the medical Spanish curriculum. A total of 111 medical students voluntarily enrolled in the medical Spanish course. Out of these students, 47 completed the final evaluation, which included a Spanish Objective Structured Clinical Examination and a 40-question Multiple-Choice Exam assessing the integration of Spanish language skills and cultural competency. Both assessment methods took place in clinical skills facilities. Descriptive statistics summarized exam results, and two-tailed t-tests compared mean exam scores between students of different proficiency levels.Results and discussionStudents achieved a mean score of over 80% on all components of the Spanish Objective Structured Clinical Examination and the Multiple-Choice Exam. Survey data suggest that students felt able to communicate in Spanish with patients after completing the course series. The study also provides a model for a medical Spanish curriculum that applies expert-recommended best practices to meet the needs of Hispanic patient populations.Limitations and conclusionsStudents who sat for the OSCE and MCE were self-selected. Baseline data on student perceptions and Spanish competency are not sufficient for making comparisons.

Visual Learning Equity: A Course Auditing System of Skin Color in Preclinical Medical Education.

Visual learning equity is a health justice effort in response to the lack of representation of brown and black skin images in medical education. This paucity creates a knowledge gap and decreases providers' competence in managing skin disease in minoritized populations. Herein, we aimed to create a standardized course auditing system to assess the use of brown and black skin images in medical education. We performed a cross-sectional analysis of the 2020-2021 preclinical curriculum at one US medical school. All human images in the learning material were analyzed. Skin color was categorized as light/white, medium/brown, and dark/black using the Massey-Martin New Immigrant Survey Skin Color Scale. We included 1,660 unique images in our analysis; 71.3%, (n=1,183) were light/white, 16.1% (n=267) were medium/brown and 12.7% (n=210) were dark/black. Dermatologic images of skin, hair, nails, or mucosal disease made up 62.1% (n=1,031) of the images and 68.1% (n=702) were light/white. The pulmonary course presented the highest proportion of light/white skin (88.0%, n=44/50) and the dermatology course presented the lowest proportion of light/white skin (59.0%, n=301/510). Images of infectious diseases were more frequently presented in darker skin colors (χ2 [2]=15.46, P&lt;.001). Light/white skin was the standard used for visual learning images in the medical school curriculum at this institution. The authors outline steps to perform a curriculum audit and diversify medical curricula to ensure the next generation of physicians are educated to care for all patients.

Teaching Students How to Think: A Longitudinal Qualitative Study of Preclerkship Clinical Reasoning Instruction

ABSTRACT Introduction An objective of undergraduate medical education is to teach students how to think like physicians through a process called clinical reasoning. Currently, clerkship directors often feel that students enter their clinical years with a marginal comprehension of clinical reasoning concepts; instruction in this area could be improved. Although there have been previous educational studies assessing curricular interventions to improve the instruction of clinical reasoning, it is not yet known what happens at an individual level between an instructor and a small group of students in the teaching of clinical reasoning. This research will identify how clinical reasoning is being taught in a longitudinal clinical reasoning course. Methods The Introduction to Clinical Reasoning course is a 15-month-long case-based course held in the preclinical curriculum of the USU. Individual sessions involve small-group learning with approximately seven students per group. Throughout the academic year of 2018-2019, 10 of these sessions were videotaped and transcribed. All participants provided informed consent. A thematic analysis was performed using a constant comparative approach. Transcripts were analyzed until thematic sufficiency was reached. Results Over 300 pages of text were analyzed; new themes ceased to be identified after the eighth session. Topics included obstetrics, general pediatric issues, jaundice, and chest pain; these sessions were taught either by attendings, fellows, or fourth-year medical students with attending supervision. The thematic analysis revealed themes associated with clinical reasoning processes, themes associated with knowledge organization, and a theme associated with clinical reasoning in the military. The clinical reasoning process themes included problem list construction and refinement, differential diagnosis, naming and defending a leading diagnosis, and clinical reasoning heuristics. The knowledge organization themes included illness script development and refinement and semantic competence. The final theme was military relevant care. Conclusions In individual teaching sessions, preceptors emphasized problem lists, differential diagnoses, and leading diagnoses in a course designed to strengthen diagnostic reasoning in preclerkship medical students. The use of illness scripts was more often implicitly used rather than explicitly stated, and students used these sessions to use and apply new vocabularies related to a clinical presentation. Instruction in clinical reasoning could be improved by encouraging faculty to provide further context to their thinking, by encouraging the comparing and contrasting of illness scripts, and by using a shared vocabulary for clinical reasoning. Limitations of this study include that it was done in the context of a clinical reasoning course and that it was done at a military medical school, which may limit generalizability. Future studies could determine if faculty development could improve the frequency of references to the clinical reasoning processes that could improve student readiness for clerkship.

Attitude and Perception of Dental Students and Dentists toward Efficacy of Typhodont Exercise Practiced as a Part of Preclinical Conservative Dentistry Curriculum for Routine Clinical Practice

Abstract Objective Dentistry is a blend of both surgery and medicine. Cavity preparation in dentistry is a routine procedure used to remove defects or dental caries, which is irreversible and requires advanced skills. Preclinical training is done on typhodont, which are replicas of teeth that exhibit tooth morphology, as part of the dental curriculum. The aim of this study was to assess the attitude of dental professionals toward the efficacy of typhodont exercise in clinical practice. Materials and Methods This study was a cross-sectional study conducted on dental professionals to understand the efficacy of typhodont exercise in clinical practice. The questionnaire consisted of 23 close-ended questions. The responses were coded as number/score (1–10). Responses were compiled on a MS Excel Worksheet and subjected to SPSS package. Chi-squared test and Mann–Whitney U test were used to analyze data. Results A total of 250 responses were collected. About 72.8% participants stated that it helped them get oriented to the operating position. Regarding the preclinical exercises relevance to clinical exercise, a score of about 7 was obtained. However, the simulation of gingiva received a score of 5. Suggestions like integration of augmented reality (AR), virtual reality (VR), haptic technology along with extracted teeth as a conjunct to the typhodont exercise were received. Conclusion This study suggested that preclinical typhodont exercises help the students in preparing for the upcoming clinical postings. However, the augmentation of typhodont exercise with AR, VR, haptic technology, and use of extracted teeth can furbish the current state of preclinical curriculum for conservative dentistry.

Student performance and satisfaction in the first iteration of an integrated renal and respiratory systems course in a redesigned one-pass preclinical curriculum

Texas Tech University Health Sciences Center School of Medicine converted its legacy two-pass preclinical curriculum to a one-pass organ system-based format and changed the grading system from categorical to pass/fail (&gt;70%). Our objective was to assess first-year medical student (MS1) performance and satisfaction in the first iteration of Organ Systems-2:Renal and Respiratory ( RNR), an 8-week block taught at the end of Year I. RNR integrates the physiology, pathophysiology, infectious diseases, and pharmacology of the renal system (Weeks 1-4) and respiratory system (Weeks 5-8), using reorganized and updated material from legacy Year-I blocks ( General Principles &amp; Infectious Diseases and Structure &amp; Function of Major Organ Systems) and Year-II blocks ( Immunity &amp; Multisystem Disorders and Systems Disorders). Instruction was delivered via didactic lectures, team-based activities, case-based reviews, dry labs, cognitive integration of clinical reasoning (CICR) sessions, and simulations. Formative weekly quizzes and practice exams were assigned before each exam. Learning in the renal physiology, renal pathophysiology, and respiratory physiology units was assessed by instructor-generated exams at the end of Weeks 2, 4 and 6, respectively, and a final customized, comprehensive NBME exam at the end of Week 8. Aggregate performance on instructor-generated renal and respiratory exam questions was compared to that on similar questions from legacy curriculum exams. Aggregate performance on the NBME exam was compared to USMLE Step 1 exam difficulty, as the legacy curriculum did not include a dedicated renal/respiratory NBME exam. Aggregate performance on instructor-generated renal physiology and pathophysiology and respiratory physiology questions was comparable to that in the legacy curriculum. Average performance on the renal portion of the NBME exam was 0.76 vs. Step 1 exam difficulty of 0.78; average performance on the respiratory portion of the exam was 0.77 vs. Step 1 exam difficulty of 0.78. Per end of block survey and student focus group feedback, overall student satisfaction with RNR was 73%. Thus, the first iteration of the integrated organ systems-based renal and respiratory systems course in Year I yielded a MS1 performance on the NBME that was comparable to USMLE Step 1 source difficulty, and student satisfaction was positive overall. More detailed analysis of exam performance is needed. Further modifications of RNR will include additional simulations and flipped-classroom sessions. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Enhancing medical student neuroscience training with a team-based learning curriculum (P4-2.005)

<h3>Objective:</h3> To assess the effects of a transition to clinician-educators and active learning in a pre-clinical neuropathology curriculum. <h3>Background:</h3> Neurophobia, the fear of and dislike of clinical neurology, is frequently due to poor experiences in pre-clinical neuroscience education. Methods to mitigate neurophobia include increasing active learning, engaging clinicians, and demonstrating clinical relevance. <h3>Design/Methods:</h3> We identified an under-performing neuropathology curriculum within a second-year medical student neuroscience course and implemented a traditional team-based learning curriculum to deliver this content. In addition, we transitioned to primarily clinician-led lectures. We assessed student opinions of the curricular changes through end-of-course feedback, a novel survey, and semi-structured interviews with students. We assessed outcomes on course examinations and overall course performance, comparing performance in the pre-implementation phase (2020–2021) to the post-implementation phase (2021–2022) using a two-sample t-test. <h3>Results:</h3> Student opinions of the curricular changes were positive on the end-of-course evaluation (79.4% rated team-based learning as good or excellent) and novel survey (89–96% of students rated the portions of the curriculum positively). Themes identified in qualitative analysis included an appreciation of streamlined course content and a sense that the sessions within the curriculum reinforced learning. Student performance on the final examination was similar in the pre-implementation vs post-implementation phases (81.2% correct vs 80.3% correct; p=0.37). Performance on the neuropathology subsection of the final examination was also similar (82.6% correct vs 83.9% correct; p=0.36). <h3>Conclusions:</h3> We demonstrate the feasibility and utility of a transition to neurologist and neurosurgeon-led lectures and the implementation of a team-based learning curriculum within a neuroscience course. While we report data from implementation at a single center, these results have relevance to other courses given our demonstration that team-based learning is a useful method to deliver neuroscience learning, non-pathologist lecturers can effectively provide neuropathology education, and a small number of educational faculty can be engaged to deliver this material. <b>Disclosure:</b> Dr. Tarolli has received personal compensation for serving as an employee of University of Rochester. The institution of Dr. Tarolli has received research support from Biosensics. The institution of Dr. Tarolli has received research support from National Institutes of Health. The institution of Dr. Tarolli has received research support from Biogen. Dr. Tarolli has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Davis Phinney Foundation. Dr. Tarolli has received personal compensation in the range of $500-$4,999 for serving as a Speaker, Committee Member with American Academy of Neurology. Dr. Tarolli has a non-compensated relationship as a Committee Member with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Jozefowicz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology.

Integrating social determinants of health principles into the preclinical medical curriculum via student-led pedagogical modalities

BackgroundDismantling structural inequities in health care requires that physicians understand the impacts of social determinants of health (SDH). Although many medical schools incorporate SDH education, integration of these principles into the preclinical curriculum remains challenging.MethodsStudents and faculty at the University of Vermont, Larner College of Medicine developed the Social Medicine Theme of the Week (SMTW), a peer-teaching approach to integrating SDH topics across the preclinical curriculum as part of a broader social medicine curriculum. Students created objectives to link SDH-related topics to the weekly curriculum and presented them to the class. Student innovation led to the incorporation of creative online infographics that were published in the curriculum calendar. First year medical students and faculty members were surveyed to assess preferences and educational impact of the SMTW announcements with accompanying infographics.ResultsOf the 40 student respondents, 77.5% reported that their knowledge of SDH had improved due to the SMTW. Most students (82.5%) preferred the infographic modality over traditional teaching modalities. Faculty respondents reported limited engagement with the SMTW and, although they supported the need for these objectives, many (61%) found it difficult to integrate SDH content into their class materials.ConclusionStudent-led infographics are a popular method of integrating SDH content in the preclinical curriculum that can be optimized through faculty orientation and support. Success for this type of instruction requires opportunities for student developers, integration and formal assessment of objectives, faculty engagement and training, and institutional support for creating and delivering a robust social medicine curriculum.

Are students performing the same in E-learning and In-person education? An introspective look at learning environments from an Iranian medical school standpoint

IntroductionThis study investigated medical students’ intended learning outcomes based on e-learning and in-person education.MethodsIn this cross-sectional comparative analytical study, a group of 126 undergraduate medical students’ intended learning outcomes under two different teaching methods, including e-learning and in-person, were repeatedly measured based on the census sampling method. Participants were in the preclinical curriculum phase (physiopathology) at Mashhad University of Medical Sciences (MUMS), Iran. Due to expert panel opinion, the same medical teachers and similar difficulty of lessons were considered in two investigated academic semesters. In addition, difficulty and discrimination indexes of formative and summative assessments were controlled for two study groups. The students’ learning outcome index was the knowledge test scores participants received in the relevant lessons of the General Medicine (GM) curriculum preclinical courses.ResultsThe findings indicated that students learning outcomes were significantly higher during e-learning than in in-person education for all examined variables (P < 0.05). Moreover, the difference between students’ Grade Point Average (GPA) categories among the two groups was significant (P = 0.022). Students with a GPA of less than 14 experienced higher increments in their average scores after the e-learning compared to in-person education. Compared to face-to-face courses, improvements in pharmacology, theoretical semiology, and pathology scores after e-learning courses were statistically significant (P < 0.001). The differences in mean scores related to practical pathology and semiology in the two approaches were not statistically significant, P = 0.624 and P = 0.149, respectively. Furthermore, the overall students’ average scores increased significantly during e-learning versus in-person education (P < 0.001).ConclusionWe concluded that e-learning could be appreciated as a successful method of medical education and can be used as an alternative educational method. However, considering the importance of practical or clinical courses in medical education, further research about the efficacy of the e-learning approach is highly recommended.

Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations.

To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion. A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations. Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways. This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.