Pre-clerkship Years Research Articles

Implementation status of the nationally harmonized competency-based, integrated, modular medical curriculum in Ethiopia: opportunities and challenges

BackgroundWell-designed curriculums are crucial for quality education. This study aimed to assess the implementation status of a harmonized competency-based medical curriculum (CBMC) in Ethiopia, as well as identify the associated challenges and benefits.MethodsA mixed-method approach was used. Data collection took place from September 1, 2023, to October 15, 2023. Eleven medical schools were randomly selected from a list of 28 public medical schools in Ethiopia. Participants were purposively chosen from selected medical schools using a controlled sampling method. A total of 121 participants took part in the survey. Interviews and focus group discussions were conducted with key informants to complement the quantitative findings. Descriptive statistics, such as frequencies and percentages, were used to summarize the quantitative survey responses. Thematic content analysis was used to analyze the qualitative data.ResultsThe implementation of a CBMC in Ethiopian public universities faces various challenges and provides opportunities. Around 22% of respondents mentioned that the whole group session (WGS) had never been implemented in their school. Regarding community-based learning (CBL), 64.6% of respondents noted that it was intermittently implemented in their institution. Only 32% of respondents considered students’ clinical exposure during preclerkship years to be reasonable. Interestingly, approximately 73% of respondents stated that problem-based learning (PBL) activities were regularly conducted in their school. Around 68% of respondents believed that competency-based assessment methods were moderately utilized. While many participants perceive the curriculum as having positive content alignment and structure with intended learning outcomes, challenges related to practical sessions, resource limitations, and uneven access to training opportunities persist. Resource constraints are a prominent challenge. The opportunities identified include early clinical exposure and enhanced communication skills.ConclusionsThis survey highlights the need for ongoing curriculum evaluation and fine-tuning to ensure its success.

An Exploration of Cognitive Diagnosis in Medical Education: Constructing Comprehensive Feedback for Enhanced Student Learning.

Feedback stands as a cornerstone in facilitating knowledge and skill acquisition, particularly in the realm of self-directed learning. Drawing from Vygotskian theory, which posits learning as an apprenticeship process within the zone of proximal development (ZPD), effective feedback becomes a crucial scaffold for students navigating their educational journey. This article delves into the significance of feedback, guided by Hattie and Timperley's three pivotal questions. While clinical environments recognize the importance of feedback in patient care, its application during the formative preclerkship years often remains overlooked.

Use of Virtual Interactive Patient Encounters to Prepare First-Year Medical Students for Clinical Practice.

With the dissolution of the Step 2 Clinical Skills exam, medical programs have a greater responsibility to teach and assess clinical skills in the preclerkship years. Clinical teaching this early has traditionally been avoided because of insufficient integration with biomedical sciences, curricular time constraints, and concerns about overwhelming novice learners with clinical learning objectives. To overcome these barriers, the authors created a clinical framework for the biomedical science curriculum by integrating a series of virtual interactive patient (VIP) videos. Matriculating first-year medical students were enrolled in a clinically integrated biomedical science course that used VIP videos to teach and assess clinical skills. The VIP videos were enhanced with interactive pop-in windows, and at the conclusion of each video, students performed a clinical documentation task and received immediate feedback. The authors implemented 7 VIP cases during fall 2021 in which first-year medical students wrote the patient care plan, problem representation statement, or clinical reasoning assessment. Student responses were independently evaluated by course faculty using a 4-level scoring scale. The authors calculated the pooled mean scores for each documentation task and examined student feedback. Seven VIP encounters were assigned to 124 students (mean response rate, 98.5%). Pooled mean scores on the clinical documentation tasks showed that most students were able to achieve levels 3 or 4 when writing the patient care plan (97 [82%] to 113 [94%]), addressing social determinants of health (80 [67%]), writing an accurate problem representation statement (113 [91%] to 117 [94%]), and performing clinical reasoning skills (48 [40%] to 95 [82%]). VIP encounters were feasible to produce, effective at integrating course content, successful at assessing student clinical documentation skills, and well received. The authors will continue to produce, implement, and study the VIP as an integrating learning tool in undergraduate medical education.

A Mixed-Methods Needs Assessment for a Longitudinal Surgical Preparation Course in Undergraduate Medical Education

To assess the unmet needs associated with surgical education and skill development during the pre-clerkship years of medical school. A mixed-methods design was employed that leveraged semi-structured interviews and quantitative surveys followed by qualitative analysis. A large midwestern academic medical center. Eighteen participants were enrolled representing second year medical students with an interest in surgery, surgical residents, and attending surgeons from a diverse array of surgical specialties. Unanimous support for the creation of a pre-clerkship surgical skills course emerged due to 2 main themes: (1) gaps in current surgical education offerings and (2) the value of early exposure to surgery and surgical skills followed by longitudinal practice. The components that participants deemed essential to a well-designed course were also revealed. Each stakeholder group (medical students, residents, surgeons) would benefit across all factors uncovered. There is a significant unmet need across all stakeholder groups for the creation of a longitudinal surgical skills course for pre-clerkship medical students. Future studies should seek to design a curriculum based on these study results and assess a pilot version of the curriculum to understand its feasibility under application.

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

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

Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia.

Stress and food habits seem to be associated with acne, but no study has been reported from in Taif, Saudi Arabia. The aim of this study was to determine the association between the severity of acne, stress, and food habits of undergraduate medical students. A cross-sectional study was conducted among 585 undergraduate medical students. Data was collected on students' demographics, academic year, and level. The Global Acne Grading System (GAGS) was utilized for a clinical evaluation of acne severity and an assessment of the presence and location of acne lesions. To assess respondents' stress, the Perceived Stress Scale (PSS) was employed, and adolescent food habits checklist (AFHC) assessed the food habits. To test for statistical significance, Chi-squared test was used for qualitative data, whereas Mann-Whitney U test and, Kruskal-Wallis tests were performed for quantitative variables. The mean age of students was 21.16 ± 1.81 years, 53.5% were female and 53.8% were in the preclerkship academic level. Of these, 9.7%, 78.5%, and 11.8% had low, moderate, and high stress levels. The overall prevalence of acne was 88.2%; Mild, moderate, severe and very severe acne were present among 59%, 23.9%, 3.9% and 1.4% of students respectively. Female students had a significant higher percent of severe acne and students in preclerk ship years had significant higher mean AFHC scores. Students with severe stress had a significant higher mean GAGS score and lower mean AFHC scores. A significant positive correlation was found between GAGS scores and PSS. The high rates of stress and acne of the study's participants demand that medical students be given greater attention with regard to dermatology and psychiatric diseases.

Frequency of Student Resource Use and Academic Performance in Preclerkship Education: A Survey Study

Medical students have unprecedented access to a large variety of learning resources, but patterns of resource use, differences in use across education cohorts, and the relationship between resource use and academic performance are unclear. Therefore, the purpose of the current study was to evaluate student resource use and its relationship to academic performance during preclerkship years. First-year and second-year medical students completed a 10-question electronic survey that assessed likelihood of using outside resources recommended by others, reasons for using outside resources, frequency of use of resources, and use of outside resources for specific disciplines. Outcomes were compared between the 2 cohorts of students. First-year students were more likely to use instructor-produced resources and self-generated study resources, and second-year students were more likely to use board review resources. Although differences were found between cohorts for frequency of use of certain resources, correlations between resource use and academic performance were modest. Overall, our results indicated that student use of study resources changed between the first and second years of medical school. These results suggest opportunities for medical educators to guide students in the selection and effective use of outside resources as they mature as self-regulated learners. Further, since students seem to extensively use external resources for learning, institutions should consider calibrating their curriculum and teaching methods to this learning style and providing high-quality, accessible resource materials for all students to reduce the potential impact of socioeconomic factors on student performance.

Abstract 9733: Echocardiography Workshops Are an Effective Learning Tool for Pre-Clerkship Medical Students

Introduction: Point of care ultrasound curriculum is being taught in undergraduate medical education (UME) with greater frequency and demonstrable benefit to students’ learning. While echocardiography (echo) curricula have been implemented in a small number of medical schools, there is limited data on the efficacy of the learning experience. Hypothesis: Echo workshops in UME are feasible and effective as a means of introducing medical students to basic echo skills. Methods: 24 pre-clerkship medical students volunteered to undergo 4-hour echo workshops. A variety of preparatory learning materials covering basic aspects of echo were provided to students one week prior to the workshop. A short quiz was administered to all students immediately before and after the workshop. Quiz questions were coded as cardiac anatomy (6 questions), basic echo imaging (8 questions), basic ultrasound and Doppler theory (2 questions), and advanced echo imaging techniques (3 questions). During the workshop, each student was provided at least 30 minutes of hands-on imaging while another student acted as the “patient.” Certified echosonographers and pediatric cardiologists served as the instructors during the workshop. Students completed a survey to characterize the quality of the learning experience. Students’ performance on the quiz pre- and post-workshop were compared using student’s t-test. Results: The mean overall pre- and post-workshop quiz scores were 6.8/19 and 11.4/19, respectively (p&lt;0.00001). Mean pre- vs post-quiz scores for cardiac anatomy were 2.0 vs 3.8/6 (p=0.0001); for basic echo imaging were 3.5 vs 5.3/8 (p&lt;0.001); for basic ultrasound and Doppler theory were 0.5 vs 1.5/2 (p&lt;0.00001); and for advanced echo imaging were 0.7 vs 0.9/3 (p=0.5), respectively. All students characterized the quality of their learning experience through the workshop as a very effective use of their time. Conclusions: Echo workshops targeted to pre-clerkship medical students are feasible, and provide effective learning experiences in cardiac anatomy, basic echo imaging, and basic ultrasound and Doppler theory in the short-term, and are very well-received by students. Providing basic echo curriculum in the pre-clerkship years of medical school should be further explored.

Exposing Racial Bias to Confront Care Chasms: Innovations in the Sickle Cell Disease Curriculum at Rush Medical College.

Purpose: Sickle cell disease (SCD) is an autosomal recessive blood disorder that affects 100,000 Americans and 1 in 365 African American births. Individuals with SCD face lifelong complications, such as pain crises, infections, anemia, acute chest syndrome, gallstones, and strokes. Despite the severity and complexity of this condition, it is not uncommon for SCD patients to face significant challenges accessing quality health care. 1 Many providers have implicit biases surrounding treating pain crises with prescription pain medications, and others have not been adequately trained on how to prevent complications or identify changes in organ function. 2,3 Discontinuity of care, disease complexity, and the racialization of “drug seeking behavior” has led to poor outcomes, distrust of the health care system, and a failing therapeutic alliance. Approach: Our vision is to improve SCD patient care by empowering patients, improving care plans, and enhancing medical student education. The latter will be the focus of this abstract, and has been a key focus area in our efforts thus far. We started by formulating a survey to assess Rush students’ baseline knowledge in the domains of racial bias, health inequities, and pathophysiology (pulmonary, neurologic, hematologic, gastrointestinal, and immune systems). After uncovering gaps in knowledge, we began the process of transforming the preclerkship education modules to highlight the complex pathophysiology and psychosocial dynamics of SCD. Patient panels, antibias training, and lectures from specialists are key elements that we are working to incorporate. In addition, we are using Rush resources like the Micro-advocate Simulation Lab to teach empathy and advocacy skills. Outcomes: We gathered data on both preclerkship and clerkship students’ baseline knowledge level to gain insight into the optimal curricular design. Initial survey results of preclerkship students (MS2s, N = 77) in November 2021 showed that only 11.3% of respondents ranked their knowledge level as “knowledgeable/able to teach others about SCD”, with 47.9% of students ranking their knowledge level as “limited/low”. Particular knowledge gaps included medication mechanics, stem cell technology, important clinical labs and inflammatory markers, pathophysiology, screenings for pulmonary and neurologic function, blood transfusion criteria, and the politicization of the Sickle Cell Trait. Clerkship students (MS3s, N = 78) took a similar survey in August 2021, following a focused 2-hour workshop on SCD Pathophysiology & Bias that was piloted this year and featured personal reflections from three patients. Students showed an improvement in every knowledge domain, including qualitative knowledge regarding historic injustice. Of note, 76.8% of clerkship students agreed with the statement, “We need more training on the multiorgan system manifestations of SCD during M1 + M2 year.” Discussion: Our initial results underscore the importance of approaching curricular content with a critical lens that prioritizes equity, advocacy, and patient outcomes. Learners’ SCD knowledge grew significantly after interactive and informative modules that highlighted patient perspectives. Most learners felt these sessions would be best placed in the foundational preclerkship years alongside other “high yield” conditions like Cystic Fibrosis and Hemophilia (which each affect fewer than half the number of U.S. patients than SCD), further underlining the need to empower future generations of physicians to promote social justice. Significance: Our longitudinal project highlights the importance of making sustainable curriculum changes to include diseases that have traditionally been left out despite their prevalence, complexity, and severity. We are currently engaging in a myriad of other SCD initiatives, including planning a health fair in Lawndale, incorporating individualized pain plans into the EMR, designing training modules for different health care roles, and engaging in policy reform with our Illinois House Rep. We are hopeful that our efforts to address SCD-related health inequities will inspire innovative efforts at other hospitals, and we hope to collaborate with other institutions.

The Influence of the STORM Program and Other Elective Experiences During the Summer Between the First and Second Year on Medical Students' Career Interests.

IntroductionThe purpose of this study was to investigate the influence of the Summer Training Option in Rural Medicine (STORM) program and other elective experiences during the summer between the first and second pre-clerkship years of medical school on medical students’ career intentions.MethodsA retrospective voluntary and anonymous cohort study was conducted by distributing an email survey to the 211 second-year medical students at the University of Kansas School of Medicine (KUSM). The survey consisted of a variety of questions regarding their recent summer break elective experiences.ResultsEighty-nine students (42.2% response rate) completed the survey; 21 respondents participated in the STORM program. Important factors influencing the choice of an elective included, working one-on-one with an educator, hands-on experiences, and receiving academic credit. Sixty-seven respondents (75.3%) concluded that their experience met their expectations, 50 (56.2%) concluded that their experience helped solidify their career goals, while 20 (22.5%) concluded that their experience made them question their career goals. Eleven respondents (12.4%) wished they had participated in a different summer experience, and 16 respondents (18.0%) changed their career plans after their summer experience.ConclusionsA break between first and second years of medical school allowed students to explore career options; such experiences may ignite a particular passion, solidify an already determined specialty choice, or dissuade a student from pursuing a particular career pathway. Medical school affirmation of the importance of significant, sustained, and student-chosen opportunities to work one-on-one with a mentor and engage in hands-on learning during the pre-clerkship years is crucial. The STORM program was one elective option that delivered on students’ expectations.

Emergency Medical Technician Training in Medical School on Preparation for Required National Board Exams and Clerkship Rotations: Results from a Student Survey.

PurposeThe University of South Carolina School of Medicine Greenville has incorporated Emergency Medical Technician (EMT) training into the first semester curriculum with students becoming state-certified EMTs and completing one ambulance shift per month throughout their pre-clerkship years. Although there have been programs that have reported EMT experiences in the pre-clinical years of medical education, student perceptions of how the EMT experiences help prepare them for board exams and clerkships is limited. Therefore, the aim of this study was to measure student perceptions regarding the impact of an EMT course and training in the pre-clerkship curriculum in medical school on helping prepare them for national board exams (ie USMLE® Step 1, 2 Clinical Knowledge (CK), 2 Clinical Skills (CS)) and clerkship rotations.MethodsSecond-, third-, and fourth-year medical students at the University of South Carolina School of Medicine Greenville completed an anonymous voluntary survey with response rates of 66.3%, 55.2%, and 56.9%, respectively. The study was reviewed and exempted by the University of South Carolina Institutional Review Board.ResultsSeventeen percent, 14%, and 41% of students agreed/strongly agreed an EMT course helped prepare them for the USMLE Step 1, Step 2 CK, and Step 2 CS exam, respectively. Sixty-four percent of students agreed/strongly agreed that an EMT course and experience helped prepare them for clerkship rotations.ConclusionThe findings in this study support EMT training and experience as an EMT as one method to help prepare students for clerkship rotations.

Factors Contributing to Cognitive Enhancement (CEM) and Psychostimulant Medication (PSM) Use Among First Year Medical Students

Medical students perceive elevated levels of stress within their pre‐clerkship years in part due to select curricular factors such as grading scale or method of content delivery (e.g. traditional or integrated). Medical students cope with these stressors in a variety of ways. Alcohol and nicotine use are among the top coping methods. There are many changes being made to the medical curriculum to alleviate this perception of stress and increase effectiveness of the curriculum. An additional manifestation of perceived stress is the exhibition of non‐medical prescription drug use. Non‐medical prescription drug use (NMPDU) of cognitive enhancement (CEM) and psychostimulant medications (PSM) (i.e. Adderall) is associated with elevated perceived levels of stress within both the undergraduate college and practicing physician populations. The prevalence of non‐medical prescription drug use of CEM/PSMs among medical students is scarcely documented, while the perception of stress is heavily documented. This pilot study sought to address this gap in the literature by describing the prevalence of NMPDU of CEM/PSMs among first year medical students at an American allopathic institution in addition to perceived stress levels and the potential factors contributing to it. Ten students (less than 10% response rate) completed a questionnaire regarding CEM/PSM use, alcohol and nicotine use, sleep and study habits, and perceived stress. Student responses indicated presence of CEM/PSM use, with four of those students reporting non‐prescription use. “School” was the top reason for taking CEM/PSMs and the number one contributor to perceived stress. Additionally, half of the respondents reported an increase in use within their first year of medical school. The results, while limited, confirm presence of NMPDU of CEM/PSMs within this population, with potential correlations with levels of perceived academic stress. This work provides initial insights from which future work can build to analyze the relationship between NMPDU and curricular factors which may shed light on additional benefits to curricular redesign or evidence to necessitate proactive measures to prevent the phenomenon of NMPDU within the medical student population.

Acing the Fundamentals of Radiology: An Online Series for Medical Students and Interns.

The current undergraduate radiology education predominantly integrates radiology with other disciplines during preclerkship years and is often taught by nonradiologists. Early exposure to radiology and profound understanding of scientific fundamentals of imaging modalities and techniques are essential for a better understanding and interest in the specialty. Furthermore, the COVID-19 pandemic-related impact on in-person medical education aggravated the need for alternative virtual teaching initiatives to provide essential knowledge to medical students. The authors designed an online 7-session course on the principles of imaging modalities for medical students and fresh graduates in the United States and abroad. The course was delivered online and taught by radiologists from different US institutions. Pretests and posttests were delivered before and after each session, respectively, to assess change in knowledge. At the end of the course, a survey was distributed among students to collect their assessment and feedback. A total of 162 students and interns initially enrolled in the program by completing a sign-up interest form. An average of 65 participants attended each live session, with the highest attendance being 93 live attendees. An average of 44 attendees completed both the pretest and posttest for each session. There was a statistically significant increase in posttest scores compared with pretest scores ( P < 0.01) for each session; on average, the posttest scores were 48% higher than the pretest scores. A total of 84 participants answered the end-of-course survey. A total of 11% of the respondents described themselves as first year, 17% as second year, 18% as third year, 21% as fourth year, and 33% as "other." Attendees were enrolled in medical schools across 21 different countries with 35% of the respondents studying medicine in the United States. More than 76% of the respondents stated that they "strongly agree" that the program increased their understanding of radiology, increased their interest in radiology, and would be useful in their clinical practice in the future. Eighty-three percent of the respondents stated that they "strongly agree" that "this course was a worthwhile experience." Particularly, more than 84% of the respondents stated that among the most important components in enhancing their understanding of radiology were "the interpretation of normal imaging" and "interpretation of clinical cases." Ninety-two percent of the respondents stated that "the amount of effort to complete the requirements for this program was just right." Participants were also asked to rate each of the 8 sessions using the following scale: poor = 1 point, fair = 2, good = 3, and excellent = 4. The average rating for all 8 sessions was 3.61 points (SD = 0.55), which translates to 96% of the sessions being rated good or excellent. Eighty percent of the participants reported that the topics presented in the program were "excellent and clinically important to learn," and 20% of the participants reported that the topics presented were "good and somewhat important to learn." The participants were asked to evaluate their confidence regarding basic radiology skills before and after the program using the following scale: not confident at all = 1 point, somewhat confident = 2, moderately confident = 3, and very confident = 4. Figure 2 summarizes the responses of the participants. An online course to teach the fundamentals of imaging modalities could be delivered through a webinar format to medical students and interns in several countries to address the potential gaps in radiology education, therefore increasing their understanding of the different imaging modalities and their proper use in medicine.

Using project-based learning to enhance curricular integration and relevance of basic medical sciences in pre-clerkship years

ABSTRACT Achieving high levels of integration in the basic medical sciences’ curricula is challenging. Project-based learning (PtBL) is an inquiry-based learning approach that can be used in multiple educational contexts with various designs. We used PtBL to enhance curricular integration during the pre-clerkship years. The study was done at The Faculty of Medicine, Helwan University, Cairo, Egypt. We designed interdisciplinary clinically relevant integrated research project tasks. Tasks followed curricular objectives. Students worked in teams to write and deliver project reports. Based on their understanding of the basic medical sciences, they analyzed the assigned tasks and used reasoning to create diagnoses. They related the condition to the disrupted normal structure/functions, suggested/contraindicated specific treatment and preventive plans. A cross-sectional survey was introduced to assess students’ perceptions of the learning approach used. Response rate was 52% (n = 694). Students’ responses were analyzed. Most students (84.6%) were satisfied by the integrated interdisciplinary PtBL. They (57.9%) preferred substituting the traditional lectures completely by it. Students understood the relation between objectives of disciplines after PtBL completion (mean 3.66, SD ±0.92) higher than before it (mean 3.46, SD ±0.91), (P = 0.000). Students’ ranking for the degree of integration between basic/clinical sciences in the PtBL was significantly associated with the developed clinical reasoning rank (P = 0.000). It was also associated with responses supporting the future implementation of the PtBL again (P = 0.002). Various ways of adding PtBL approach to the curricula were suggested. The PtBL can be used as a complementary learning method to elevate the level of integration within a multidisciplinary approach to boost students’ learning.

Reflective Essays During Clerkship Following a Pre-clerkship Leadership Curriculum.

IntroductionLeadership curricula in medical student education require assessment - to determine if leadership skills can be taught to medical students and applied during clinical and medical team interactions to aid in medical student leadership development.ObjectivesTo examine whether medical students applied principles of their pre-clerkship leadership curriculum (character, competence, context, and communication elements across four levels: personal, interpersonal, team, and organizational) during an internal medicine clerkship.MethodsUsing art as a prompt, Uniformed Services University (USU) internal medicine clerkship students completed a structured reflection on a critical incident. Medical student essays written during a 10-week internal medicine clerkship at USU in 2019 were collected. 158 medical student submissions were de-identified and analyzed.ResultsSixty-four submissions (40.5%) focused on leadership or leadership and professionalism. Students identified as male (n = 34, 53%), female (21, 33%), or not reported (9, 14%). Most, 48 (75%), did not describe PITO explicitly in their essay. They instead focused on personal and interpersonal aspects (17, 27%) of leadership, the attending physicians they worked with (33, 52%), and effective leadership strategies (46, 72%). The most common themes written about were responsibility (30, 47%), teamwork (18, 28%), competence (17, 27%), and character/integrity (15, 23%).ConclusionAlthough the students’ explicit use of the PITO model was limited, student essays centered on themes that reflected leadership concepts taught in pre-clerkship years, such as character, competence, and responsibility. This study demonstrates that an internal medicine clerkship rotation can feasibly implement a leadership reflection.

Early generalist placements are associated with family medicine career choice: A systematic review and meta-analysis.

Many developed countries have reported shortages of Primary Care (PC) physicians. The lack of a regular primary physician is associated with inferior health outcomes. One strategy to address this shortage is to increase the proportion of medical students selecting a Family Medicine (FM) or PC career. The purpose of this systematic review is to identify whether pre-clerkship general practice placements increase students' interest in, and selection of FM or PC residencies. Three databases (PubMed, Embase, Web of Science) searched for interventional studies of pre-clerkship generalist placements in medical school. Pooled statistical analysis and meta-analysis were performed, along with narrative summaries when possible. Intervention participants (IP) were compared to controls matched (MC) for baseline interest in FM and an unmatched sample (UC) of contemporary students. A 11 studies were identified including a total of 5430 students (2428 intervention participants and 3002 controls). IPs were more likely to match to FM than both MC (Risk Ratio: 1.62 [95% CI: 1.03-2.55]) and UC (RR: 2.04 [1.46-2.86]). Participation in long interventions (4-11weeks) matched to FM at higher rates than short (25-40hours) interventions (RR: 3.15 [2.28-4.35]). The percentage of students with FM/PC as their top specialty of interest increased after the placements (mean difference: +12.8%, n=586). Medical students who participated in pre-clerkship general practice placements were more likely to match to a FM residency. Longer pre-clerkship placements had a stronger association with FM specialty choice. The implementation of longitudinal block generalist placements in the pre-clerkship years is one strategy for increasing interest in generalist careers. IV, systematic review of level III and IV studies.

Perception of Biostatistics by Lebanese Medical Students: A Cross-Sectional Study

ABSTRACT Background Inadequate use of statistics in biomedical research might not only affect science but also harm human beings if applied in medical practice. Biostatistics is fundamental to improve understanding and appraising of evidence-based medicine (EBM); yet, it is still not well understood and appreciated by medical students. Therefore, early exposure of medical students and physicians-in-training to research tools including Biostatistics is of utmost importance. Objective The aim of this study is to determine the perception of Biostatistics by medical students at a private medical school in Beirut, Lebanon, and to identify its best implementation time in the medical curriculum. Methods This is a cross-sectional study based on a self-administered questionnaire distributed among medical students in their pre-clerkship years (first three years of a 6-year program) who undertook Biostatistics. The assessment of perception was based on the 5-point Likert scale anchored by Strongly disagree = 1 and Strongly agree = 5 including 36 questions distributed into four domains to assess the course value, difficulty, behavioral, and expectations. Results 186 of 269 students responded to the questionnaire, yielding a response rate of 69.14%. Around 60% of students declared that the knowledge gained from biostatistics courses is useful to their future career, and almost 70% understood the main concepts of biostatistics. 57.7% of students perceived that lack of practicing exercises might contribute to making the course more difficult. The mean score of domains was higher in females but did not significantly differ within the three academic years. Only 35.1% of the students positively perceived the importance of biostatistics modules, mostly third-year students. Conclusion Although the majority of medical students perceived biostatistics modules negatively, they were aware of the relevance of biostatistics to their medical career and real-life health issues.

Environments, processes, and outcomes - using the LEPO framework to examine medical student learning preferences with traditional and electronic resources

ABSTRACT Changes in medical student learning preferences help drive innovation in teaching and require schools and commercial resources to quickly adapt. However, few studies have detailed the relationship of learner preferences to the environment and teaching modalities used in the pre-clerkship years, nor do they incorporate third-party resources. Our study attempts to analyze learner preferences by comparing the use of traditional and third-party resources. In 2017–18, a survey was distributed to medical students and residents at two accredited medical schools. Participants noted preferred styles of learning regarding lecture duration, timing, location, format, third-party resources, learner types and USMLE Step 1 scores. The ‘Learning Environment, Learning Processes, and Learning Outcomes’ (LEPO) framework [5] was used to examine learner preferences, with responses compared using the Mann-Whitney U and two proportion z-tests. A total of 329 respondents completed the survey: 62.7% medical students and 37.3% residents. The majority of participants identified their learning style by Kolb [6] as converging (33.0%) or accommodating (39.2%). Students preferred lectures 30–40 minutes long (43.3%), during morning hours (54.2%), in their own homes (52.0%), via online lectures with simultaneous drawings (56.0%), and classroom/podcast lectures with PowerPoint® presentations (54.3%). Overall, students rated third-party resource characteristics higher than traditional curricula, including effectiveness of teachers, length, quality, time of day, and venue (p < 0.001), but also preferred small group formats. Students reported animated videos (46.6%) and simultaneous drawings (46.5%) as the most effective means of retaining information. Understanding changing learner preferences is important in creating optimal curricula for today’s students. Using the LEPO framework, this study identifies critical preferences in successfully teaching medical students, inclusive of commercial and traditional resources. These results can also help guide changes in pedagogy necessary due to the more recent COVID-19 pandemic.

Integrating Basic and Clinical Sciences Using Point-of-Care Renal Ultrasound for Preclerkship Education.

IntroductionPoint-of-care ultrasound (POCUS) is a valuable asset in bedside clinical care. Undergraduate medical education is increasingly using POCUS as an adjunct tool for teaching anatomy, pathophysiology, and physical exam in an integrated manner. Many medical schools teach content in an organ systems–based format in the preclerkship years. POCUS teaching can be very effectively tailored to specific organ systems. Though pilot curricula for generalized ultrasound education exist, few teach organ systems–based content using POCUS. To address this gap, we designed and implemented an integrated POCUS module to supplement anatomy, pathophysiology, and physical exam teaching in the renal course.MethodsThe module consisted of (1) a 30-minute didactic lecture introducing students to renal ultrasound technique and image interpretation and (2) a practical hands-on skills session. Pre- and postmodule surveys assessed the efficacy and impact of the curriculum.ResultsA total of 31 first-year medical students completed the POCUS renal curriculum. A majority reported that the module positively affected their understanding of renal pathophysiology and the physical exam. They also reported increased confidence in using POCUS to detect renal pathology and make clinical decisions.DiscussionIt was feasible to implement a POCUS curriculum to supplement integrated teaching of renal system concepts in the first year of medical school, and students found POCUS teaching valuable. POCUS provides educators with another tool to integrate basic and clinical sciences with hands-on relevant clinical skills practice in early medical school years.

University of Minnesota Medical School.

University of Minnesota Medical School.