Clerkship Students Research Articles

OPTIMIZING MEDICAL EDUCATION FOR CLINICAL STUDENTS DURING COVID-19 PANDEMIC: A LITERATURE REVIEW

Background: COVID-19 pandemic has impacted numerous of matters and medical education is one of them. It is crucial to dissect measures that could be taken to optimize medical education for clinical students during COVID-19 pandemic. There is still limited evidence or data on how to approach this situation. The aim of this literature review is to unfold guidance on optimizing medical education for clinical students during COVID-19 pandemic.Methods: The literature was searched by accessing the PubMed, PubMed Central, and Google Scholar databases. Literature search was conducted from December 1, 2019 to April 24, 2020, using the key words of “medical education”, “clinical students OR clerkship students”, “covid-19”.Results: Based on the literature search, 20 literatures related to medical education of clinical students during COVID-19 pandemic were obtained. Institutions have taken a differing approach during COVID-19 pandemic. Implementing teleteaching, creating an integrated learning environment, strategies to improve role models, telemedicine, training programs and psychological support are approaches in order to optimize medical education for clinical students during COVID-19 pandemic.Conclusion: Institutions had to instantly alter medical education during COVID-19 pandemic. The lives of many students have been hugely impacted in terms of financial, psychological, delay in graduation, uncertainty, residency application and clinical placements. There are ways in which technology can ease some of these problems, albeit not fully resolving all these issues. Therefore, it is still crucial to further shine a light on how to optimize medical education during this unprecedented time.

Teaching medical students to choose wisely through simulation.

The Choosing Wisely (CW) campaign aims to encourage dialog among physicians and patients about the costs and benefits of medical care. The purpose of the present study was to describe the implementation of the CW campaign among medical students in the pediatrics clerkship using different teaching strategies and to evaluate the students' perception and performance. A prospective, interventionist, open study with a control group was conducted. All sixth-year undergraduate medical students that were on their pediatric clerkship at the Emergency Department during the study period were invited to participate. The study consisted of two strategies: a remote video class about the CW initiative and in situ simulation training. By the end of the rotation, all participants were evaluated through an Objective Structured Clinical Examination (OSCE). A total of 50 students were included, of which 24 watched only the online video (control group) and 26 were exposed to both the online video and the simulation scenarios (intervention group). Students in the intervention group had a significantly higher total score in the OSCE compared to students in the control group (median 90 vs 90; range 78-100 vs 50-100; p: 0.047). Median scores of behavioral items of the OSCE grouped together were significantly higher in the intervention group compared to the control group (median 60 vs 50; range 40-60 vs 20-60; p: 0.002).Conclusion: Simulation training about principles of the CW campaign had a greater impact on behavioral aspects of undergraduate students. This learning strategy was well accepted by participants. What is Known: • The Choosing Wisely (CW) campaign aims to encourage dialog among physicians and patients about the costs and benefits of medical care. • Teaching high-value and cost-conscious care to medical students is highly desired.. What is New: • Simulation training about principles of the CW campaign had a greater impact on behavioral aspects of undergraduate students.

Gynecologic Surgery and Obstetrics Leadership Roles in Academic Military Treatment Facilities by Subspecialty and Gender.

Gender distribution in academic ob-gyn leadership positions has previously been examined in the civilian sector, but not in military medicine. To characterize the distribution of department-level leadership positions by gender and subspecialty in academic military facilities in comparison to those reported in the civilian sector. This is an observational cross-sectional study. We queried military obstetrics and gynecology (ob-gyn) specialty consultants, for title and gender of personnel assigned to academic military treatment facilities. Roles were characterized by gender and subspecialty, and the proportion of female leaders was compared to published civilian leadership data. Women comprised 25% of Department Chairs, 45% of Assistant Chairs, and 42% of Division Directors. In educational leadership roles, women comprised 25% of Residency Program Directors, 0% of Fellowship Directors, and 62% of medical Student Clerkship Directors. Female department chairs were most often uro-gynecologists (44%) followed by specialists in ob-gyn (37%). Most female residency program directors were specialists in general obstetrics and gynecology. The proportion of women in leadership roles in military departments was not different than in the civilian sector. In contrast to civilian academic leadership positions, Department Chairs were most likely to be uro-gynecologists. Similar to civilian programs, women remain underrepresented as chairs, Assistant Chairs, Fellowship Directors, and Division Directors and similarly represented as Residency Program Directors. Despite a smaller pool of women available to fill academic leadership positions in military ob-gyn departments, the proportion of women in leadership roles reaches parity with the civilian sector. This suggests that a greater proportion of women rise to leadership positions in military academic ob-gyn departments than in the civilian sector.

Impact of the Rural Physician Associate Program on Workforce Outcomes.

The Rural Physician Associate Program (RPAP) at the University of Minnesota Medical School (UMMS) is a 9-month rural longitudinal integrated clerkship (LIC) for third-year medical students built on a foundation of family medicine. The purpose of this study was to examine the relationships between participation in the RPAP program and the desired workforce outcomes of practice in Minnesota, primary care specialty (particularly family medicine), and rural practice. We analyzed workforce outcomes for UMMS graduates who completed postgraduate training between 1975 and 2017, comparing RPAP participants (n=1,217) to noparticipants (n=7,928). We identified graduates through internal UMMS databases linked to the American Medical Association (AMA) Physician Masterfile and the National Provider Identifier (NPI) registry. We identified workforce outcomes of rural practice, practice in Minnesota, primary care specialty, and family medicine specialty based on practice specialty and practice location data available through the AMA and NPI data sets. Proportionally, more RPAP graduates practice in state (65.7% vs 54.4%, P<.01), in primary care (69.0% vs 33.4%, P<.01), in family medicine (61.1% vs 17.3%, P<.01), and rurally (41.2% vs 13.9%, P<.01) than non-RPAP graduates. We demonstrate a significant association between participation in RPAP and a career in family medicine, rural practice, and primary care, all outcomes that promote meeting urgent rural workforce needs.

Evaluation of a Quality Improvement Experience for Family Medicine Clerkship Students.

There is emphasis on systems-based practice competencies and quality improvement (QI) training in postgraduate medical education. However, we lack effective approaches to provide experiences in these areas during undergraduate medical education. To address this, we developed a novel approach to providing didactic and experiential learning experiences in QI during a third-year family medicine clerkship. We implemented and evaluated a QI curriculum combining self-directed learning with real-world experience to increase knowledge and confidence in the plan-do-study-act (PDSA) process for family medicine clerkship students. Students collaborated and presented their change ideas in a "Shark Tank" format for practice leaders at the end of their rotation. We used pre- and postcurriculum surveys to assess knowledge of and comfort with completing QI projects. Three hundred eighty-nine students completed precurriculum surveys and 242 completed postcurriculum surveys. Pre- and postlearning evaluations revealed an increase in agreement or strong agreement with self-reported understanding of specific QI topic areas of 50%. Almost all (91.3%) reported feeling confident or reasonably confident in their ability to create change in health care after exposure to the curriculum, compared with 66.3% in the precurriculum survey. One-third of students (34%) reported intent to complete the Institute for Healthcare Improvement Open School curriculum in QI. Self-directed learning about QI, combined with practice observation, small-group discussion and presentation in a Shark Tank format was effective and engaging for learners. Students had limited preexisting knowledge of QI principles, suggesting a need for preclinical exposure to this topic. The family medicine clerkship provides an ideal environment for teaching QI.

Applying Coactivity Scales to Entrustable Professional Activity Assessments of Clerkship Students.

Purpose: The purpose of this study was to evaluate the feasibility of applying coactivity scales to entrustable professional activity (EPA)-based assessments by comparing (1) the ratings of students performing EPAs with increasing levels of difficulty and (2) the ratings of cohorts of students performing the same EPAs over time. Background: Clinical clerkships provide critical opportunities to evaluate medical student performance on Association of American Medical Colleges (AAMC) Core EPAs for Entering Residency. However, there is no standardized method for assigning entrustability. 1 The AAMC proposes the use of the Modified Ottawa coactivity scale to anchor entrustability assessments. 2 Design: We adapted a modified PRIME scale (professionalism, reporter, interpreter, and manager) to assign a developmental hierarchy to the EPAs. 3 To assess student skills in selected EPAs, we used the modified Ottawa coactivity scale, and assigned a value of 1–4 in order of increasing entrustability to anchors in the scale. Mean ratings of EPAs over time were calculated and compared. IBM SPSS Statistics version 25 (IBM, Armonk, New York) was used for descriptive analyses, ANOVA, and general linear models. Outcomes: A total of 2,623 evaluations (Cronbach’s alpha of 0.927) were completed for 247 medical students and showed a significant increase over time for professionalism (P = .011), reporter (P = .007), interpreter (P = .004), and manager (P = .007). EPAs with increasing intellectual demand were associated with lower student EPA ratings: 3.51 (±0.50) for professionalism, 3.45 (±0.47) for reporter, 3.35 (±0.59) for interpreter, and 3.28 (±0.60) for manager. Strengths and Limitations: The University of Miami EPA assessment tool provides a useful measure of student readiness for patient care. Raters entrusted students more with skills of professionalism, reporting, and interpreting than with managing, a more sophisticated skill. In every domain, entrustability increased with clinical experience. A limitation of this study is that the tool was used at a single institution. Feasibility and Transferability: The tool can potentially be deployed across multiple clerkships at other medical schools as an effective and practical tool for medical student evaluation.

Improving Student Understanding of Clerkship Expectations With an Online, Interactive Frame-of-Reference Training Module.

Purpose: Assessment of medical students during clerkships is largely driven by clinical performance ratings, but many students perceive clinical evaluations to be “unfair” and call for more training of evaluators. 1 Limitations in self-assessment may contribute to this perception, 2 and frame-of-reference training may improve students’ ability to recognize different levels of performance. 3 The objective of this study was to determine if an online, frame-of-reference training module can improve students’ understanding of clerkship expectations for clinical performance in the medicine clerkship. Methods: Core faculty in the medicine clerkship developed multiple case presentations that demonstrated different levels of performance in the Reporter, Interpreter, Manager, and Educator (RIME) components of our clerkship evaluation form. The case presentations were revised in an iterative fashion to reach a consensus in defining each of the case presentations as below, at, or exceeding expectations for clerkship students. Using these presentations, an online, interactive frame-of-reference training tool was developed where students, before starting clerkships, rated a set of case presentations, compared their ratings with those determined by core faculty (correct ratings), and received feedback about why a given presentation merits a particular rating. At the start of the clerkship, students completed another training module with a new set of case presentations, either remotely on their own (odd-numbered clerkship blocks) or in-person with group discussion facilitated by the clerkship director (even-numbered blocks). We used chi-square tests to compare proportion of students choosing correct ratings on case presentations at baseline versus in-clerkship training and to compare student responses between remote versus in-person training groups with an end-of-clerkship survey on the effect of training on their understanding of clerkship expectations. Results: All rising third-year students (N = 177) completed baseline training, and 140 students (100% enrolled in blocks 1–6 of medicine clerkship) completed the in-clerkship training. Students enrolled in blocks 7 and 8 were excluded due to COVID-related cancelations/rescheduling of clinical rotations. Overall, the percentage of cases answered correctly at baseline was 64.8% and improved to 74.5% at in-clerkship training (P < .001). In looking at individual domains of RIME, improvements were seen for all domains except interpreter:reporter 55.7% to 67.6% (P = .002), interpreter 74.3% to 62.8% (P = .001), manager 68.0% to 82.5% (P < .0001), and educator 62.5% to 85.1% (P < .0001). The pattern of improvement was not statistically different between remote versus in-person training groups. The majority of students agreed or strongly agreed that the online training improved their understanding of clerkship expectations (66.0% of remote versus 75.0% of in-person training groups, P = .604). Discussion: In this study of frame-of-reference training for students, we found a significant increase in proportion of cases rated correctly from baseline to in-clerkship training. The lack of improvement in the interpreter domain likely reflects the challenges posed by clinical reasoning required for interpreter, which is a component of RIME students are most uncomfortable with during preclinical years, and a skill most heavily emphasized in the medicine clerkship. Repeating the training module at the end of the medicine clerkship may have shown different results. Our finding that student perception regarding usefulness of the training was similar between remote versus in-person training is worth noting because faculty time and effort, which are often seen as barriers to many educational efforts, in this case did not significantly improve effectiveness of training. Significance: While much of the effort to improve clinical evaluations has focused on rater training, this study assessed whether training students can improve their understanding of clerkship expectations. Our findings show that a brief, online, frame-of-reference training tool can improve student understanding of different levels of clinical performance. Acknowledgments: The authors thank their faculty and medical students for their contribution and participation in this study.

The Effect of a Microlearning Module on Knowledge Retention in Surgery Clerkship Students

Ichiuji, Brynne A. BA; DeAngelis, Erik J. MD; Corpodean, Florina MD; Thompson, Jamie MD; Arsenault, Lauren MS; Vaziri, Khashayar MD, FACS; Lee, Juliet MD, FACS; Jackson, Hope T. MD, FACS Author Information

Multi-Institutional Virtual Medical Student Clerkship in Radiation Oncology

<h3>Purpose/Objective(s)</h3> Medical student education in radiation oncology traditionally takes place in-person during 3^rd or 4^th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to implement this virtual medical student clerkship in radiation oncology at multiple institutions and analyze the impact and utility of this platform. <h3>Materials/Methods</h3> An IRB-approved virtual clerkship was created and implemented at 7 institutions. Students enrolled in home or away rotations. Clerkships offered general and disease subsite-specific oncology topics through recorded didactics geared towards medical students on www.radoncvirtual.com, as well as clinical vignettes, telehealth visits, chart rounds, contouring, and capstone presentations. Surveys were given pre- and post-clerkship to assess baseline comfort and knowledge. At the end of each clerkship, a course exam was given consisting of 48 questions. Clerkship directors were given a survey to assess comfort and ease of implementing the virtual clerkship. Surveys and course exams were analyzed using Wilcoxon Signed rank test and t-test, 2-sided. <h3>Results</h3> Seventy-two (72) students enrolled at 7 institutions between 4/2020 and 2/2021. Survey response rates were 100% pre- and post-clerkship as well as from course directors. The majority of students were MS4 (57%) and MS3 (33%) with equal distribution in gender. Each institution's median number of total medical students doing an away rotation was 4 (range 3-9) and home rotation number of students 2 (range 0-36). The median length of each virtual rotation was 2.5 weeks (range: 1-4 week). 71% (n = 51) of medical students had never previously enrolled in a radiation oncology elective. Improvements in the overall knowledge of radiation oncology, as well as specific knowledge in the scope of radiation oncology, roles of radiation physicist, dosimetrist and therapist, contouring, treatment planning, and training path to the field (all <i>P</i> < 0.001). There was no significant difference in course final exam scores between students who had attended a radiation oncology elective before enrollment and those who had not (<i>P</i> = 0.27). Course directors reported spending an additional 5-10 hours per week with students. The survey revealed 100% were satisfied with content and delivery of this virtual elective, and 83% (n = 6) indicated they would utilize the material for future rotations. <h3>Conclusion</h3> Implementation of a multi-institutional virtual radiation oncology elective was successful at improving knowledge for medical students at all levels, even those that had exposure previously. This virtual elective platform can be utilized to improve access to multiple institutions, resources, mentors, and networking opportunities. Resources in the virtual rotation platform can also be integrated into traditional educational paradigms to increase exposure in the field.

Medical student education through flipped learning and virtual rotations in radiation oncology during the COVID-19 pandemic: a cross sectional research

BackgroundThe COVID-19 pandemic has stripped many medical students worldwide of their right to quality education. In response, we developed hybrid courses involving aspects of both online and in-person teaching for radiation oncology medical student clerkship.MethodsWe entitled students to customize their own rotation schedule using Google Forms and developed a flipped learning online class, which consisted of at least one video clip on basic knowledge of radiation oncology per day (yonsei-radonc.com). Students were instructed to watch online videos before the next day’s discussion session. Required components of the medical education program (e.g., target drawing, site visits to treatment facilities) were also prepared and conducted in accordance with the appropriate level of social distancing measures. Finally, we conducted questionnaire surveys after the completion of the week-long course and clerkship.ResultsFrom March to June 2020, 110 fourth-year medical students undertook a clinical module in our 1-week radiation oncology program course. Each day, students completed the flipped learning prior to meeting with the educator and then participated in the online discussion session and conference. All activities were well performed as scheduled. Students’ motivation was high, as was their overall satisfaction with the course. The students were satisfied with the online contents, flipped learning strategy, and instructors.ConclusionsWe successfully integrated open and virtual educational platforms to improve access to and satisfaction with student clerkship. In the future “new normal,” minimized face-to-face learning interactions, such as flipped learning, should be actively utilized for medical and other students’ education.

Comparison of educational environments in different sized rural hospitals during a longitudinal integrated clerkship in Thailand.

The longitudinal integrated clerkship (LIC) curriculum model focuses on patient-centered care and continuity of clinical and cultural learning between medical students, patients, clinicians, and a system of care. In rural settings, participating medical students are expected to have an interest in rural medicine and an involvement in the community. Many schools in the USA, Canada, and Australia have implemented LICs in undergraduate programs in different ways. However, a few published reports in Asia are available. This is the first report of a modified rural LIC in Thailand. The objective was to assess the educational environment of a rural LIC using the Dundee Ready Education Environment Measure (DREEM) questionnaire and to compare students' response on the basis of year of study and different sizes of hospitals. A cross-sectional study was conducted. The study population comprised 75 clinical-year students in 2020. The modified LIC was implemented as part of integrated multidisciplinary rural clerkships for fourth-year students, and for fifth-year students undertaking clinical placements. Clinical clerkships in rural settings took place over 12 weeks for fourth-year students and over 14 weeks for fifth-year students. Practical exposure included the clinical areas of internal medicine, psychiatry, surgery, pediatrics, obstetrics and gynecology, emergency medicine, and family medicine, in outpatient and inpatient settings. The DREEM questionnaire was used to evaluate students' perceptions of learning climate. Data analysis was performed to determine the different size of hospitals and other factors associated with a favorable educational environment. The response rate to the questionnaire was 96%. The overall DREEM score average was 137.7/200. Students' perceptions of learning and of teaching had mean scores of 30.1/48 and 35.7/44, respectively. Students' academic self-perceptions scored 18.7/32. Students' perceptions of atmosphere scored 30.4 of 48, and social self-perceptions scored 18.3/28. The academic subscale had the lowest percentage of scores regarded as confidence in knowledge gain. The factors associated with positive educational environment were staff as principal preceptors and large hospitals. LIC implementation in a community health system is a model for expanding clinical clerkships. Good infrastructure of the host hospital and enthusiastic preceptors are the key success factors. Staff supervision is essential to encourage student learning, especially in academic environments. Large hospitals have better infrastructure to support learning processes than small hospitals.

COVID-19 Vaccines Programs: adverse events following immunization (AEFI) among medical Clerkship Student in Jember, Indonesia

IntroductionCoronavirus Disease (COVID-19) caused by Novel Coronavirus named as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was declared Pandemic by The World Health Organization (WHO) and a Public Health Emergency of International Concern (PHEIC) on January 30, 2020. Many COVID-19 vaccines have been developed, including CoronaVac vaccines by Sinovac. Health care workers, along with medical clerkship students are the priority to receive the vaccine. However, the Adverse Events Following Immunization (AEFI) of the CoronaVac remains unclear. This study aims to describe and analyze the adverse events following immunization (AEFI) of COVID-19 vaccination in medical students in clerkship programs.MethodWe conducted a cross-sectional study using a questionnaire to assess AEFI after CoronaVac vaccination among medical clerkship students. A Chi-Square test with 95 % of CI was used to determine whether gender correlated with symptoms of AEFI.ResultWe identified 144 medical clerkship students. The most common AEFI of SARS-CoV-2 vaccinations was localized pain in the injection site during the first dose with 25 (45 %) reports and the booster dose with 34 (67 %) reports. Then followed by malaise, the first dose with 20 (36 %) reports and the booster dose with 21 (41 %) reports. Other symptoms like headache, fever, shivering, sleepiness, nausea, dysphagia, and cold were also reported.ConclusionsCoronaVac SARS-COV-2 vaccine has several mild symptoms of AEFI and not correlated with gender. Nevertheless, follow-up after vaccination is needed to prevent immunologic responses that may occur in some patients.

Abortion Opt-in Experience in Third-Year Clerkship.

Despite the public health imperative that all medical practitioners serving reproductive-aged women know the components of abortion care and attain competency in nondirective pregnancy options counseling, exposure to abortion care in US medical school education remains significantly limited. Florida International University Herbert Wertheim College of Medicine offers an opt-in clinical exposure to abortion care during the obstetrics and gynecology clerkship. During clerkship orientation, students watched a recorded presentation reviewing components of abortion care and emphasizing that participating students may increase or decrease involvement at any time without explanation. Students opting in completed a form specifying their desired level of involvement for each component as "yes," "no," or "not sure." Of 350 clerkship students over 23 6-week rotations, 98 (28%) chose to opt in, with opt-in form data available for 90 students. Ninety students chose to observe counseling for first- and second-trimester surgical abortion and medical abortion. Seven students used the option "no" for history taking and examine second trimester fetal parts. Twenty-four students marked "not sure" for participating in evacuation of first-trimester pregnancy. This educational intervention proved feasible and offers an opportunity for students to have experiential learning about abortion care in an inclusive, respectful manner. This experience may be incorporated into undergraduate and graduate medical education. Providing learners the opportunity for exposure to abortion care improves their overall medical education and will impact the care they provide as future clinicians.

Professional identity formation-oriented mentoring technique as a method to improve self-regulated learning: A mixed-method study

Introduction: Previous studies indicate that professional identity formation (PIF), the formation of a self-identity with the internalised values and norms of professionalism, may influence self-regulated learning (SRL). However, it remains unclear whether a PIF-oriented intervention can improve SRL in clinical education. The aim of this study was to explore whether a PIF-oriented mentoring platform improves SRL in a clinical clerkship. Methods: A mixed-methods study was conducted. Forty-one students in a community-based clinical clerkship (CBCC) used a PIF-oriented mentoring platform. They articulated the values and norms of professionalism in a professional identity essay, elaborated on future professional self-image, and reflected on their current compared to future selves. They made a study plan while referring to PIF-based self-reflection and completed it. The control group of 41 students completed CBCC without the PIF-oriented mentoring platform. Changes in SRL between the two groups were quantitatively compared using the Motivated Strategies for Learning Questionnaire. We explore how PIF elements in the platform affected SRL by qualitative analysis of questionnaire and interview data. Results: A moderate improvement in intrinsic goal orientation (p = 0.005, ε2 = 0.096) and a mild improvement in critical thinking (p = 0.041, ε2 = 0.051) were observed in the PIF-oriented platform group. Qualitative analysis revealed that the PIF-oriented platform fostered professional responsibility as a key to expanding learning goals. Gaining authentic knowledge professionally fostered critical thinking, and students began to elaborate knowledge in line with professional task processes. Conclusion: A PIF-oriented mentoring platform helped students improve SRL during a clinical clerkship.

Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study

ObjectiveBecause work and educational environments are closely related and can affect each other, this study examined whether medical students’ negative perceptions of their colleagues’ work–life balance (NWLB) during their clinical...

Remote Virtual Reality Teaching: Closing an Educational Gap During a Global Pandemic.

Resident physicians are expected to recognize patients requiring escalation of care on day 1 of residency, as outlined by the Association of American Medical Colleges. Opportunities for medical students to assess patients at the bedside or through traditional simulation-based medical education have decreased because of coronavirus disease 2019 restrictions. Virtual reality (VR) delivered remotely via video teleconferencing may address this educational gap. A prospective pilot study targeting third-year pediatric clerkship students at a large academic children's hospital was conducted from April to December 2020. Groups of 6 to 15 students participated in a 1.5-hour video teleconferencing session with a physician facilitator donning a VR headset and screen sharing interactive VR cases of a hospitalized infant with respiratory distress. Students completed surveys assessing the immersion and tolerability of the virtual experience and reported its perceived effectiveness to traditional educational modalities. Comparisons were analyzed with binomial testing. Participants included third-year medical students on their pediatric clerkship. A total of 140 students participated in the sessions, with 63% completing the survey. A majority of students reported VR captured their attention (78%) with minimal side effects. Students reported remote VR training as more effective (P < .001) than reading and online learning and equally or more effective (P < .001) than didactic teaching. Most students (80%) rated remote VR as less effective than bedside teaching. This pilot reveals the feasibility of remote group clinical training with VR via a video conferencing platform, addressing a key experience gap while navigating coronavirus disease 2019 limitations on training.

Family Medicine Clerkship Assessment Analysis: Application and Implications.

Clerkship assessment structures should consist of a systematic process that includes information from exam and assignment data to legitimize student grades and achievement. Analyzing student performance across assessments, rather than on a single assignment, provides a more accurate picture to identify academically at-risk students. This paper presents the development and implications of a structured approach to assessment analysis for the Family Medicine Clerkship at Florida International University Herbert Wertheim College of Medicine. The assessment analysis included a table presenting the distribution of all assessment performance results for 166 clerkship students from April 2018 to June 2019. A correlation table showed linear relationships between performance on all graded activities. We conducted a Pearson analysis (r), coefficient of determination (r 2), multiple regression analysis, and reliability of performance analysis. Performance on one assessment-the core skills quiz-yielded a statistically significant correlation (r=.409, r 2= .16, P<.001) with the final clerkship grade. The reliability of performance analyses showed low performers (<-1.7 SD), had both a low mean quiz score (59.6) and final grade (83). Top performers (>-1.7 SD) had both a high mean quiz score (88.5) and final grade (99.6). This was confirmed by multiple regression analysis. The assessment analysis revealed a strong linear relationship between the core skills quiz and final grade; this relationship did not exist for other assignments. In response to the assessment analysis, the clerkship adjusted the grading weight of its assignments to reflect their utility in differentiating academic performance and implemented faculty development regarding grading for multiple assignments.

Surgical clerkship: Do examination scores correlate with clinical performance?

BackgroundThis study aims to determine if there are correlations between clinical performance and objective grading parameters for medical students in the third-year surgery clerkship. MethodsClerkship grades were compiled from 2016 to 2020. Performance on clinical rotations, NBME shelf exam, oral exam, and weekly quizzes were reviewed. Students were divided into quartiles (Q1-Q4) based on clinical performance. Standard statistical analysis was performed. ResultsThere were 625 students included in the study. Students in Q1+Q2 were more likely than those in Q3+Q4 to score in the top quartile on the shelf exam (29% vs. 19%, p = 0.002), oral exam (24% vs. 17%, p = 0.032), and quizzes (22% vs. 15%, p = 0.024). However, there was negligible correlation between clinical performance and performance on objective measures: shelf exam (R2 = 0.027, p < 0.001), oral exam (R2 = 0.021, p < 0.001), and weekly quizzes (R2 = 0.053, p = 0.092). ConclusionsClinical performance does not correlate with objective grading parameters for medical students in the third-year surgery clerkship.

WBAs in UME-How Many Are Needed? A Reliability Analysis of 5 AAMC Core EPAs Implemented in the Internal Medicine Clerkship.

Reliable assessments of clinical skills are important for undergraduate medical education, trustworthy handoffs to graduate medical programs, and safe, effective patient care. Entrustable professional activities (EPAs) for entering residency have been developed; research is needed to assess reliability of such assessments in authentic clinical workspaces. A student-driven mobile assessment platform was developed and used for clinical supervisors to record ad hoc entrustment decisions using the modified Ottawa scale on 5 core EPAs in an 8-week internal medicine (IM) clerkship. After a 12-month period, generalizability (G) theory analysis was performed to estimate the reliability of entrustment scores and determine the proportion of variance attributable to the student and the other facets, including particular EPA, evaluator type (attending versus resident), or case complexity. Decision (D) theory analysis determined the expected reliability based on the number of hypothetical observations. A g-coefficient of 0.7 was used as a generally agreed upon minimum reliability threshold. A total of 1368 ratings over the 5 EPAs were completed on 94 students. Variance attributed to person (true variance) was high for all EPAs; EPA-5 had the lowest person variance (9.8% across cases and four blocks). Across cases, reliability ranged from 0.02 to 0.60. Applying this to the Decision study, the estimated number of observations needed to reach a reliability index of 0.7 ranged between 9 and 11 for all EPAs except EPA5 which was sensitive to case complexity. Work place-based clinical skills in IM clerkship students were assessed and logged using a convenient mobile platform. Our analysis suggests that 9-11 observations are needed for these EPA workplace-based assessments (WBAs) to achieve a reliability index of 0.7. Note writing was very sensitive to case complexity. Further reliability analyses of core EPAs are needed before US medical schools consider wider adoption into summative entrustment processes and GME handoffs.

Cardiothoracic Surgery Training Program Director Awareness of Available Visiting Medical Student Clerkships for the Underrepresented in Medicine

A diversity gap exists within cardiothoracic (CT) surgery that might be addressed with currently available medical student pipeline programs. We sought to assess CT surgery residency/fellowship program directors' (PD) awareness of and participation in underrepresented in medicine visiting medical student clerkship programs (UIM-VMSCPs). We reviewed the ACGME program finder database and medical school websites to identify thoracic surgery training programs that: (1) offer visiting student clerkships (VSCs), (2) are affiliated with an institution offering a UIM-VMSCP, (3) are at an institution where the existing UIM-VMSCP specifically offers rotations in CT surgery. The PDs in the second group were surveyed via e-mail, assessing their level of awareness of UIM-VMSCPs at their institution, participation in UIM-VMSCPs over the past 3 years, and desire to participate in a UIM-VMSCP in the future. All (n=76) ACGME CT surgery training programs were affiliated with institutions that offered VSCs in multiple disciplines. Over half, 55.3%, of the programs offered access to visiting students and 61.8% were at institutions with existing UIM-VMSCPs. Our response rate for the 47 PDs from institutions with UIM-VMSCPs was 38.2%. Of the respondents, 61.1% were aware of the UIM-VMSCP at their institution and 44.4% participated in the past 3 years. Most, 88.9% were interested in participating in their institution's UIM-VMSCP in the future. Only half of CT surgery training programs offer VSCs and even fewer are at institutions with an existing UIM-VMSCP that offers a CT surgery clerkship. This is a lost opportunity to broaden exposure to the specialty and increase diversity within the CT surgery workforce.