Medical School Training Research Articles

A Comparison of HPSP and USU Graduates’ Preparation for Residency

ABSTRACT Introduction Military medical students enter residency through two main pathways: (1) The Uniformed Services University (USU) and (2) the Armed Services Health Professions Scholarship Program (HPSP). The purpose of this study was to compare how these two pathways prepare military medical students for residency. Methods We conducted semi-structured interviews with 18 experienced military residency program directors (PDs) in order to explore their perceptions of the preparedness of USU and HPSP graduates. We used a transcendental phenomenological qualitative research design to bracket our biases and guide our data analysis. Our research team coded each of the interview transcripts. We then organized these codes into themes, which served as the results of our study. Results Five themes emerged from our data regarding the residents’ preparedness: (1) Ability to navigate the military culture, (2) understanding of the military’s medical mission, (3) clinical preparation, (4) ability to navigate the Military Health System (MHS), and (5) teamwork. The PDs described how USU graduates better understand the military’s medical mission and are more easily able to navigate the military culture and the MHS because of their lived experiences during military medical school. They also discussed the various levels of clinical preparation of HPSP graduates, in contrast to the USU graduates’ more consistent skills and abilities. Finally, the PDs believed both groups to be strong team players. Conclusions USU students were consistently prepared for a strong start to residency because of their military medical school training. HPSP students often experienced a steep learning curve because of the newness of the military culture and MHS.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness.

The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties. We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis. A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percentof students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth. After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

Personal and Planetary Health—The Connection With Dietary Choices

This Viewpoint offers strategies to help shift to plant-based diets to reduce climate change and promote individual health by encouraging patients, incorporating the environmental impact of food choices in national dietary guidelines, and adding plant-based nutrition training in medical schools.

Renato Baserga, MD: In Memoriam (1925–2023)

We are saddened by the passing of Renato Baserga, who died on March 5, 2023, several days before his ninety-eighth birthday. Renato's contributions to defining the biology and pathology of the cell cycle and growth control are highly significant and far-reaching. His impact on the understanding of physiological regulation of cell division and cancer-compromised mechanisms that govern proliferation was enormous and mechanistically, as well as clinically, significant.Renato received an MD degree and completed a pathology residency at the University of Milan. He then completed a second residency in oncology and pathology at the Chicago Medical School and graduate training in biochemistry at Northwestern University in Chicago. His early research addressed tumor initiation, progression, and metastasis in animal models, providing important insights into hormonal control of tumorigenesis, including the action of glucocorticoids on tumor growth. As a faculty member at Northwestern University, Renato pioneered the development of autoradiography and radiolabeling approaches to investigate growth control and metabolic regulation in cancer cells. These approaches were instrumental for the development of molecular pathology as a strategy to mechanistically investigate cancer, and they provided a foundation for the evolution of molecular diagnostics.In 1965, Renato moved to Philadelphia. At the Fels Research Institute, Temple University School of Medicine, and at the Thomas Jefferson Kimmel Cancer Center, he developed cancer research programs that provided transformative advances in defining the molecular parameters of cell cycle control in in vivo animal models, as well as in highly informative cell systems. Beyond identification and characterization of regulatory pathways that mediate proliferation, Renato’s work elucidated the relationships between the cell cycle and growth control, proliferation and differentiation, and cell structure and gene expression.In addition to the enormous contributions of his laboratory discoveries that advanced the understanding of cancer biology and pathology, Renato was committed to disseminating research findings. As an associate editor for Cancer Research (1990–2000), he advocated for maximizing effective communication, emphasizing accessibility to the broad biomedical community.While he was devoted to his research, Renato's priority was his family. He was immensely proud of his two daughters, Janice (1959–2016), who was a veterinarian, and Susan, who is an internationally recognized leader in RNA biology and pathology. Renato's wife, Beverly, was his treasured and dedicated partner who meant more to him than words can describe.Renato had a contagious passion for discovery. He was an exceptional mentor and role model for his students. By example, he conveyed the power of innovative thinking as the basis for rigorous and systematic investigation. Renato leaves behind a legacy of insights into aberrant regulatory mechanisms that mediate cancer initiation and progression. In addition, he provided valuable guidance to research scientists and clinical investigators who will continue exploring cancer-compromised regulatory mechanisms to further expand our understanding of cancer biology and pathology.

Editorial introductions.

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. SECTION EDITORS Ali J MarianAli J MarianDr Marian received his training in clinical cardiology and human molecular genetics at Baylor College of Medicine, Houston, USA. He was appointed as a faculty at the Section of Cardiology at Baylor College of Medicine, Houston, USA in 1992. He joined the Institute of Molecular Medicine in 2006 to lead the Center for Cardiovascular Genetics. Dr Marian is recognized for his research achievements in molecular genetics and clinical aspects of cardiomyopathies. He has published over 200 articles in peer-reviewed journals, which collectively have garnered over 12,000 citations and an H index of 60. He received the Young Investigator Award from the American College of Cardiology, the Established Investigator Award from the American Heart Association, the Clinician-Scientist Award in Translational Research from Burroughs Wellcome Fund, Distinguished Scientist Award from Baylor St Luke's Medical Center, and the Best Editor Award from the American Heart Association Circulation Research. Dr Marian is currently a Deputy Editor for Cardiovascular Research, Section Editor on Genetics for Current Opinion in Cardiology, and the Editor-in-Chief of The Journal of Cardiovascular Aging. He is a former Deputy Editor for Circulation Research, Associate Editor for Circulation and European Journal of Clinical Investigation. Dr Marian's research is supported by R01 grants from the NHLBI-NIH, Leducq Foundation Trans-Atlantic Network of Excellence, and local foundations. Gene KimGene KimDr Kim is a cardiologist with the Advanced heart failure, Cardiac transplant, and Mechanical Circulatory Support Program at the University of Chicago Medicine, USA. He is an Associate Professor of Medicine and the Advanced Heart Failure Fellowship Program Director. His medical school, residency, and fellowship training were completed at the University of Chicago, USA. Dr Kim also directs the Genetic Cardiomyopathy and Hypertrophic Cardiomyopathy Clinics at University of Chicago, USA. Dr Kim's research interests include the genetic and epigenetic regulation of heart failure and arrhythmogenesis with publications on the role of microRNAs in cardiomyopathy. His interests also include myocardial recovery, extracellular matrix in failing myocardium. He has published over 100 articles and book chapters and is an investigator in numerous clinical trials. Bhavadharini RamuBhavadharini RamuDr Bhavadharini (Dharini) Ramu is an Advanced Heart Failure & Transplant Cardiologist, Director of the Cardio-Obstetrics Program and an Associate Professor of Medicine at the University of Minnesota, USA. She completed her internal medicine residency and cardiology fellowship at the University of Connecticut, USA followed by Advanced Heart Failure Fellowship at the University of Minnesota, USA in 2016. She previously served on the faculty at the Medical University of South Carolina, USA from 2016 to 2023. Dr Ramu has been an invited faculty lecturer at scientific meetings of the American College of Cardiology (ACC), Heart Failure Society of America, American Society of Transplantation, and International Society of Heart & Lung Transplantation. She is a member of the ACC's Heart Failure & Transplant Section Leadership Council, the program planning committee for the ACC's Scientific Sessions, and serves on the leadership council of the Women in Heart Transplantation & MCS Network. Dr Ramu's research interests include increasing the understanding of and reducing the impact of health-related disparities in patients with advanced heart failure, with a goal of reducing health inequities and improving the health of disadvantaged and vulnerable populations. She has served as a peer reviewer for many journals and is an investigator in heart failure clinical trials.

Immunization requirements in medical school accreditation standards

Healthcare workers (HCW) are at risk of contracting vaccine-preventable diseases and spreading these infections to their patients. Vaccination against preventable diseases prior to clinical training can mitigate this risk. Accreditation guidance can be used as an opportunity to enforce desirable norms and standards. Standards from 144 national accreditation organizations spanning 123 member states listed in the Directory of Organizations that Recognize/Accredit Medical Schools by the Foundation for Advancement of International Medical Education and Research were reviewed and summarized. Findings were further stratified by World Bank income group and WHO region. While higher-income countries were more likely to have accreditation guidelines available than lower- or middle-income countries, few national medical school accreditation bodies specifically request immunization status of trainees as a standard. Further, almost none mention specific antigens for which immunity should be assessed. These findings should be used by medical school and other health professional training accreditation bodies to inform future policy direction to protect trainees as future HCW.

Global Impact of a Virtual Neurology Morning Report (S10.002)

<h3>Objective:</h3> Report survey results from global participants in a weekly, online clinical reasoning conference. <h3>Background:</h3> Access to neurology education is limited worldwide, particularly in low income countries (LIC) and lower-middle income countries (LMIC). The COVID-19 pandemic decreased in-person neurology education, but also increased online educational endeavors that have the potential to improve access to neurology education worldwide. <h3>Design/Methods:</h3> Neurology Virtual Morning Report (NVMR) is a weekly, virtual, case-based clinical reasoning conference, open freely to participants worldwide. A survey was distributed by email to NVMR participants to assess the impact of NVMR on participants’ interest in and confidence with neurology. The University of California, San Francisco Institutional Review Board reviewed the study and deemed it exempt. <h3>Results:</h3> The first 83 Neurology VMRs had a mean of 27.1 participants per session (IQ range: 9–90). 89 participants from 25 countries completed the survey. 25% of respondents were from LIC and LMIC. 58% percent of participants reported having a mandatory preclinical neurology/neuroscience course and 51% percent of participants reported having a mandatory clinical neurology rotation during their medical school training (53% from HIC and UMIC, 50% from LMIC and LIC). Only 20% of participants had access to in person clinical reasoning conferences of any type (i.e., not limited to neurology). 81% of participants reported NVMR increased their interest in neurology. Participants reported NVMR increased their confidence in evaluating patients with neurological symptoms (89%), understanding pathophysiology of neurological disease (88%), thinking critically about neurological diagnostic tests (85%), integrating neuroanatomy into clinical reasoning (82%), and participating in neurology case discussions (70%). <h3>Conclusions:</h3> NVMR had a broad geographic reach and increased participant interest in and comfort with neurology. Through virtual open-access educational initiatives, neurology educators have the opportunity and potential to reach learners around the world and reduce global educational gaps in neurology. <b>Disclosure:</b> Ms. Aleman has nothing to disclose. Ms. Roldan has nothing to disclose. Dr. Pucci has nothing to disclose. John Penner has received personal compensation for serving as an employee of Clinical Problem Solvers. Mr. Nematollahi has nothing to disclose. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Gidley, Sarli &amp; Marusak, LLP. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonne, Bridges, Mueller, O’Keefe &amp; Nichols. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received publishing royalties from a publication relating to health care. Dr. Berkowitz has received personal compensation in the range of $500-$4,999 for serving as a Content creator with Clinical problem Solvers.

Determinants of Working Practice Location for Clinicians According to High School, Medical School, and Resident Training Locations in Korea.

Although several regulations have been implemented for medical school admission, such as a quota system, the uneven distribution of healthcare personnel across regions is an unresolved problem in Korea. This study explores the distribution and retention rate of clinicians across regions according to the degree of experience staying in the current clinical area during high school/medical school/resident training using 2016 Korean Physician Survey data. Both in metropolitan and non-metropolitan areas, clinicians who completed high school, medical school, and resident training in the current practice region (Subgroup D) accounted for the largest proportion (Metro, n = 1611, 46.1%; non-metro, n = 1917, 52.9%). The retention rate was the highest in Subgroup D both in metropolitan (84.3%) and non-metropolitan areas (Chungcheong 86.2%, Jeolla 79.9%, Daegu/Gyeongbuk 81.6%, Busan/Ulsan/Gyeongnam 93.3%) except Gangwon and Jeju. The second, third, and fourth highest retention rates were observed in cases where clinicians completed their high school and resident training, medical school and resident training, and resident training only, respectively, in all regions, although the ranking differs by region. To increase the retention rate of physicians, this study shows that it is necessary for a student to seek ways to continue training in the same region in which they graduated from medical school.

Child-focused climate change and health content in medical schools and pediatric residencies

Anthropogenic climate change-driven primarily by the combustion of fossil fuels that form greenhouse gases-has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children's health-with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children's health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula. IMPACT: Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels. Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

A survey of motivational interviewing training experiences among internal medicine residents

ObjectiveAssess resident physicians’ training experiences and self-reported application of motivational interviewing (MI) skills. MethodsA cross-sectional nationally representative survey of internal medicine and medicine/pediatric residents from October 2021 - May 2022. Residents reported their MI skill training settings: lectures, standardized patients, role plays, group exercises, direct observation of patient encounters, and a full day or more course. Respondents reported frequency of using specific MI skills in the prior six months during behavior change conversations with patients. ResultsThe response rate 71.2% (202/281). Respondents received MI training in medical school (67.7%), residency (27.2%), both (22.7%), or none (23.5%). Respondents reported MI training through formal lectures/information discussion (77.5%), MI exercises (77.5%), direct observation of a real patient encounter (38.7%), and one or more full-day workshops (8.5%). Most respondents never or only sometimes elicited change talk statements (73.2%), responded to a patient’s sustain talk (64.3%), and developed discrepancies in behavior between individuals’ current actions and desired behaviors (75%). ConclusionsSignificant training gaps exist within resident MI education, which may reduce the application of MI skills. Practical implicationsBehavior change is crucial to many aspects of patient health outcomes. This lack of knowledge may impact future physicians’ ability to comprehensively care for patients.

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Addressing a Gap in Medical School Training: Identifying and Caring for Human Trafficking Survivors Using Trauma-Informed Care.

Human trafficking (HT) is a substantial public health problem, and health care workers are uniquely positioned to help identify and care for survivors. Despite this fact, few medical schools incorporate HT training using trauma-informed care (TIC) principles into their curricula. We developed a training session to educate medical students on recognizing HT red flags and providing TIC to HT survivors. One hundred twenty-seven fourth-year medical students at Rush Medical College attended a 2-hour session consisting of didactic lectures by expert speakers and participated in a group discussion guided by a clinical vignette. Students completed anonymous pre- and postsession surveys that assessed comfort levels in detecting HT red flags and providing TIC. We used a paired t test to compare pre- and postsession survey responses. Ninety-five pre- and postsession surveys were matched with unique identifiers and used for analysis. The results demonstrated significant improvement in all the metrics assessed. This training significantly improved medical students' comfort in identifying and caring for HT survivors, addressing an especially important gap in medical school education. This training can be implemented at other institutions to further improve awareness and efforts in identifying and caring for HT survivors while avoiding retraumatization.

Virtual Reality for Emergency Medicine Training in Medical School: Prospective, Large-Cohort Implementation Study.

Virtual reality (VR)-based simulation is being increasingly used to train medical students in emergency medicine. However, because the usefulness of VR may depend on various factors, the best practices for implementing this technology in the medical school curriculum are yet to be determined. The overall objective of our study was to assess the perceptions of a large cohort of students toward VR-based training and to identify the associations between these attitudes and individual factors, such as gender and age. The authors implemented a voluntary, VR-based teaching session in the emergency medicine course at the Medical Faculty in Tübingen, Germany. Fourth-year medical students were invited to participate on a voluntary basis. Afterward, we asked the students about their perceptions, collected data on individual factors, and assessed the test scores achieved by them in the VR-based assessment scenarios. We used ordinal regression analysis and linear mixed-effects analysis to detect the impact of individual factors on the questionnaire answers. A total of 129 students participated in our study (mean age 24.7, SD 2.9 years; n=51, 39.8% male; n=77, 60.2% female). No student had previously used VR for learning, and only 4.7% (n=6) of the students had prior experience with VR. Most of the students agreed that VR can convey complex issues quickly (n=117, 91%), that VR is a useful addition to mannequin-based courses (n=114, 88%) or could even replace them (n=93, 72%), and that VR simulations should also be used for examinations (n=103, 80%). However, female students showed significantly less agreement with these statements. Most students perceived the VR scenario as realistic (n=69, 53%) and intuitive (n=62, 48%), with a relatively lower agreement for the latter among female respondents. We found high agreement among all participants (n=88, 69%) for immersion but strong disagreement (n=69, 54%) for empathy with the virtual patient. Only 3% (n=4) of the students felt confident regarding the medical content. Responses for the linguistic aspects of the scenario were largely mixed; however, most of the students were confident with the English language (not native) scenarios and disagreed that the scenario should be offered in their native language (female students agreed more strongly than male students). Most of the students would not have felt confident with the scenarios in a real-world context (n=69, 53%). Although physical symptoms during VR sessions were reported by 16% (n=21) of the respondents, this did not lead to the termination of the simulation. The regression analysis revealed that the final test scores were not influenced by gender, age, or prior experience in emergency medicine or with virtual reality. In this study, we observed a strong positive attitude in medical students toward VR-based teaching and assessment. However, this positivity was comparatively lower among female students, potentially indicating that gender differences need to be addressed when VR is implemented in the curriculum. Interestingly, gender, age, or prior experience did not influence the final test scores. Furthermore, confidence regarding the medical content was low, which suggests that the students may need further training in emergency medicine.

Psychosocial Effects of COVID-19 pandemic on Yemeni healthcare workers: A Web-based, Cross-sectional Survey

ABSTRACT Yemeni healthcare workers (HCWs) experience high levels of psychosocial stress. The current study provides a psychosocial assessment of Yemeni HCWs during the COVID19 pandemic and the factors that influence this. Between 6 November 2020, and 3 April 2021, 1220 HCWs inside Yemen self-reported levels of stress, anxiety, insomnia, depression and quality of life using a web-based, cross-sectional survey. According to the findings, 73.0%, 57.3%, 49.8%, 53.2%, and 85.2% of all HCWs reported moderate or severe stress, insomnia, anxiety, depression, and a lower quality of life, respectively. Significant positive correlations were found between stress and anxiety, insomnia, and depression scores, as well as anxiety and insomnia and depression, and insomnia and depression (p < 0.001). There was also a significant inverse relationship between wellbeing scores and stress, anxiety, insomnia, and depression scores (p < 0.001). A high percentage of respondents (85.8%) were 40 years old or younger and 72.7% had fewer than 10 years’ experience, suggesting that experienced medics leave Yemen for safer and more secure jobs elsewhere. Psychosocial support to assist in building resilience to the prevailing conditions may need to be embedded in medical school training and continuing professional development to help support HCWs within Yemen and prevent even more from leaving the country.

Invited Commentary on Skinner S, et al.: Canadian Pediatric Surgeon Workforce: Characterization of Training, Trends Over Time, and 10-year Model for Pediatric Surgery Need

Canada, the second largest country in the world, consists of 10 provinces and three territories. Government-subsidized health service delivery to Canadians is a provincial or territorial responsibility, with federal subsidies for national health programs or as transfer payments to the provinces. Eight of 10 provinces host children’s hospitals in urban centres which offer tertiary/quaternary child health services. Pediatric heart surgery, ECMO and solid organ (liver and heart) transplantation are regionalized services with eastern and western centres. All Canadian children’s hospitals (n=16) are affiliated with a medical school and postgraduate training programs. The North American pediatric surgery match includes 8 Canadian programs: Vancouver, Calgary, Toronto, Ottawa, Hamilton, Montreal ( 2 Baird R Kisa P Muzira A Wesonga AS Sekabira J Butterworth S MacNeily AE Duffy D Blair G Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program. Pediatr Surg Int. 2022 Feb; 38: 269-276 Crossref Scopus (2) Google Scholar ), and Halifax.

Implementation of an educational intervention to improve medical student cost awareness: a prospective cohort study

BackgroundIn the context of rising healthcare costs, formal education on treatment-related financial hardship is lacking in many medical schools, leaving future physicians undereducated and unprepared to engage in high-value care.MethodWe performed a prospective cohort study to characterize medical student knowledge regarding treatment-related financial hardship from 2019 to 2020 and 2020–2021, with the latter cohort receiving a targeted educational intervention to increase cost awareness. Using Kirkpatrick’s four-level training evaluation model, survey data was analyzed to characterize the acceptability of the intervention and the impact of the intervention on student knowledge, attitudes, and self-reported preparedness to engage in cost-conscious care.ResultsOverall, N = 142 medical students completed the study survey; 61 (47.3%) in the non-intervention arm and 81 (66.4%) in the intervention arm. Of the 81 who completed the baseline survey in the intervention arm, 65 (80.2%) completed the immediate post-intervention survey and 39 (48.1%) completed the two-month post-intervention survey. Following the educational intervention, students reported a significantly increased understanding of common financial terms, access to cost-related resources, and level of comfort and preparedness in engaging in discussions around cost compared to their pre-intervention responses. The majority of participants (97.4%) reported that they would recommend the intervention to future students. A greater proportion of financially stressed students reported considering patient costs when making treatment decisions compared to their non-financially stressed peers.ConclusionsTargeted educational interventions to increase cost awareness have the potential to improve both medical student knowledge and preparedness to engage in cost-conscious care. Student financial stress may impact high-value care practices. Robust curricula on high-value care, including treatment-related financial hardship, should be formalized and universal within medical school training.

Lifestyle Medicine Electives: Options for Creating Curricula Within Medical School Training.

Lifestyle medicine (LM) offers future generations of clinicians practical tools to effectively prevent, manage and reverse chronic disease. Due to a variety of factors, introduction of such curricula in medical training has been slow. Until LM becomes more standard in medical schools, electives and tracks are an innovative way to introduce curricula in a time-efficient manner so students can have access to this valuable information during their formative training years. Creating a culture for the acceptance of LM is a critical first step and can be accomplished by collaborating with like-minded faculty as well as developing student interest groups. The latter can also be a strong driver for curricular change. This article provides an overview of several structures that can be implemented within existing curricula to offer students a foundation in LM. Included are offerings during the pre-clinical years, third/fourth year electives, culinary medicine rotations, online opportunities, and the development of a full track. Specific components of each structure are shared as well as examples of successful use of community partnerships, use of pre-existing educational resources, and activities implemented. The authors conclude that implementing electives is a promising avenue for educators to expose medical students to LM and can be molded to work within a variety of current educational structures.

Inter-Cultural Communication Skills Training in Medical Schools: A Systematic Review

Background Effective intercultural communication skills are an essential graduate outcome for medical students in a globalised world. Educational theory would suggest that combining an understanding of cultural competence with patient centred communication skills through an experiential, immersive, reflective and longitudinal curriculum may be the most effective way to develop intercultural communication skills. Aims To determine the scope and most effective teaching methods in training medical students in intercultural communication with ethnically diverse populations. Method A systematic review of the literature was performed using the PRISMA Guidelines to identify articles that described methods for teaching intercultural communication to medical students. A search of the literature was performed in five databases: Cochrane, EMBASE, ERIC, PubMed and Web of Science. Relevant papers were interrogated for impact (Kirkpatrick level), quality (Colthart scale) and learning mechanism. Results We found 22 studies that described teaching methods for developing intercultural communication for ethnically diverse people in medical schools. There were a diverse range of teaching methods, durations and time of delivery in the medical course. Better teaching interventions were underpinned by learning theory and usually included practice with standardised patients, reflection and immersive experiences with members of ethnically diverse communities. Evaluation of these studies was limited mostly to short term student satisfaction surveys or performance assessments which hampered determining their effectiveness. Conclusion While there are indications that intercultural communication is best learnt as a continuum of cultural and communication skill development through immersive experiences, iteratively through medical school, there remains a need for high quality longitudinal studies to confirm this hypothesis.

P696: Assessing human genetics’ training in Ecuadorian medical schools

P696: Assessing human genetics’ training in Ecuadorian medical schools

Effectiveness of a Formal Business of Ophthalmology Course for Trainees.

Objective In medical school and residency training, there is little emphasis on the administrative and business aspects of running a clinical practice as either an employee or a business owner. However, by the first day of practice, young ophthalmologists need to have a basic understanding of the business of medicine to be successful in clinical practice and to avoid common pitfalls. Areas such as risk management, negotiation, financial health, lawsuits, marketing, coding, and professionalism are particularly important for practicing ophthalmologists to grasp. We instituted a formal practice management course to increase the early exposure of our trainees to the business aspects of ophthalmology. Methods Ophthalmology trainees engaged in 11, 1-hour sessions over 3 weeks during a practice management course covering 10 of the most relevant business topics for early career ophthalmologists. A precourse needs assessment, and a postcourse satisfaction and outcomes survey were administered. Results Of the 24 trainees who completed the presurvey, 96% of respondents had no previous training in contract negotiation, 88% lacked training in lawsuits, and 88% had no training in liability insurance. 96% had no inpatient coding education, and 88% had no outpatient coding training. Seventeen trainees completed the postsurvey, and statistically significant improvements in confidence ratings were found in all domains including coding, malpractice claims, and building a practice. 88% of trainees reported that the course improved their ability to code, and 100% agreed that the course improved their understanding of lawsuits, ability to negotiate a contract, and their understanding of the business of ophthalmology. Conclusion A formal, targeted business of ophthalmology course improved the knowledge of trainees on essential business concepts. This course can serve as a model for other programs looking to meet this educational need.