US Medical Students Research Articles

Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students

BackgroundMedical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course.MethodsWe developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study.ResultsData was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group’s performance decreased, and the control group remained the same. The PGY1 groups’ knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized.ConclusionsAn asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.

ASO Visual Abstract: Assessing the Complex General Surgical Oncology Pipeline-Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

ASO Visual Abstract: Assessing the Complex General Surgical Oncology Pipeline-Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

Assessing the Complex General Surgical Oncology Pipeline: Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

Cancer incidence is expected to increase in coming decades, disproportionately so among minoritized communities. Racially and ethnically concordant care is essential to addressing disparities in cancer outcomes within at-risk groups. Here, we assess trends in racial and ethnic representation of medical students (MS), general surgery (GS) residents, and complex general surgical oncology (CGSO) fellows. This is a retrospective review of data from the American Association of Medical Colleges and the Accreditation Council of Medical Education (ACGME) from 2015 to 2020. Self-reported race and ethnicity was obtained for MS, GS, and CGSO trainees. Race and ethnicity proportions were compared with respective representation in the 2020 US Census. Mann-Kendall, Wilcoxon rank sum, and linear regression were used to assess trends, as appropriate. A total of 316,448 MS applicants, 128,729 MS matriculants, 27,574 GS applicants, 46,927 active GS residents, 710 CGSO applicants, and 659 active CGSO fellows were included. With every progressive stage in training, there was a smaller proportion of URM active trainees than applicants. Further, URM, Hispanic/Latino, and Black/African American trainees were significantly underrepresented compared with 2020 Census data. While the proportion of White CGSO fellows increased over time (54.5-69.2%, p = 0.009), the proportion of Black/African American and Hispanic/Latino (URM) CGSO fellows did not significantly change over the study period, though URM representation was lower in 2020 as compared with 2015. From 2015 to 2020, minority representation decreased at every advancing stage in surgical oncology training. Efforts to address barriers for URM applicants to CGSO fellowships are needed.

Comparison of Multinational Medical School Students Experiences in the Face of the COVID-19 Pandemic: A Qualitative Analysis

Background: In the midst of the COVID-19 pandemic, countries, and governments around the world have implemented different measures and guidelines for the containment and mitigation of the COVID-19 virus. In addition to implemented policies and initiatives, social media and personal beliefs have affected medical students’ social, emotional, financial, and academic stability and success both domestically and internationally. The objective of this study was to assess medical student's perspectives, attitudes, and insight in the face of the COVID-19 pandemic and determine if differences exist between countries. Methods: This qualitative study, recruited students enrolled in the Global Seminar for Health and Environment elective course in their respective medical schools to complete a weekly, non-graded journaling assignment for 6 weeks. To measure outcomes, open-ended questions within the assignment asked students across four different countries questions regarding the COVID-19 pandemic including personal beliefs and knowledge, policies and initiatives within their country, global policies and initiatives, and social media presentations. Thematic analysis was then completed using the QCoder package in R Studio. Results: Both internationally and in the US, COVID-19 has had a large impact on medical students; however, their perspectives are distinct in personal beliefs, policies, and social media. International medical students believed that their country's COVID-19 response contained more restrictions than the global response, with the theme being expressed in 11 of 67 responses (16.4%) compared to 1 of 75 responses (1.3%) of US responses. This was enforced by the US medical students' views that the US had fewer COVID-19 restrictions. US medical students had a higher number of responses with the theme “more restrictions internationally” which was present in 21 of 75 responses (28%). US medical students were more likely to express a decrease in the number of academic opportunities and academic performance. The theme “decrease in academic opportunities and performance” was present in 15 of 75 US responses (20%) compared to 9 of 67 international responses (13.4%). A US response containing this theme was as follows: “I have had to adjust to a new way of doing school, mainly online, as well as coming to terms with the fact that I am not getting to experience many of the social aspects of medical school that I was looking forward to.” The US responses showed less of a mental health impact and expressed stronger negative views on how COVID-19 was handled with 40 of 75 US responses (53.3%) reporting the theme “need better initiatives and policies. Conclusion: The COVID-19 pandemic continues to affect medical students globally. The current study was limited by responses and student participation each week. Future studies aimed at analyzing specific COVID-19 policies around the world and the extent of the pandemic’s impact on mental health may provide greater insight into medical students' beliefs, attitudes, and well being which have been challenged over the last year. Regardless, it must be acknowledged that the medical school experience has changed for both international and United States medical students and affected them not only academically but mentally, socially, and financially.

Impact of a Virtual Introduction to Radiation Oncology Presentation on Stimulating Interest in the Specialty Among Diverse Medical Students at Multiple Institutions.

Many US medical students lack access to radiation oncology (RO). Our hypothesis is that a virtual, cross-institutional presentation introducing students to a career in RO will be valuable in exposing students to RO who are less likely to access it otherwise, and will increase students' interest in a career in RO regardless of their gender, race, and ethnicity. A 1-hour, live, virtual, extracurricular presentation was offered to Deans of US medical schools lacking an affiliated RO department and/or having a high enrollment of students underrepresented in medicine (UIM), and also student groups comprised primarily of UIM students. Presentations were given individually to each school by a single radiation oncologist. An electronic survey captured data from participating students. 197 students from 13 institutions attended a presentation; 114 students responded to the survey (response rate 58%). Ninety-two students (81%) were aware of the specialty of RO before the presentation; however, UIM students were significantly less likely to be aware of RO than all others (69% vs. 87%, p=0.05). Only 19 students (17%) reported previously hearing a presentation from a radiation oncologist (29% among 2nd-4th years vs. 9% among 1st years, p=0.01). Ninety-eight students (86%) expressed more interest in pursuing a career in RO after the presentation. There was no significant difference in interest in RO for any demographic subgroups. Virtual RO exposure was feasible to deliver to students less likely to be exposed otherwise, and successfully stimulated interest in the specialty regardless of students' gender, race, or ethnicity.

If You Build It, Will They Come? Exploring the Impact of Medical Student Engagement on Clerkship Curriculum Outcomes.

Inconsistent or superficial access to workplace learning experiences can impede medical students' development. Well-designed clerkship curricula provide comprehensive education by offering developmental opportunities in and out of the workplace, explicitly linked to competency objectives. Questions remain about how students engage with clerkship curriculum offerings and how this affects their achievement. This study investigated student engagement as the source of an apparent clerkship curriculum malfunction: increasing rate of substandard summative clinical competency exam (SCCX) performance over 3years following curriculum reform. We sampled from three cohorts of US medical students (classes of 2018-2020) based on their post-clerkship SCCX performance: substandard (N = 33) vs. exemplary (N = 31). Using a conceptually based, locally developed rubric, a five-person team rated students' engagement in a curriculum offering designed to provide standardized deliberate practice on the clerkship's competency objectives. We examined the association between engagement and SCCX performance, taking prior academic performance into account. Rate of substandard SCCX performance could not be explained by cohort differences in prior academic performance. Student engagement differed across cohorts and was significantly associated with SCCX performance. However, engagement did not meaningfully predict individual students' SCCX performance, particularly in light of prior academic performance. Engagement with a particular learning opportunity may not affect clerkship outcomes, but may reflect students' priorities when navigating curricular offerings, personal learning goals, and curriculum policy. Proposing four patterns of engagement in clerkship learning, this study prompts reflection on the complex interaction among factors that affect engagement and outcomes.

Nutrition Education in Medical Schools: What do Medical Students Think?

To examine medical students' perceptions of the nutrition education received and their ability to apply that knowledge in clinical settings. This is a qualitative study using a structured survey with free responses to solicit the perspective of US medical students regarding their nutrition education. A national online survey was distributed by the American Academy of Pediatrics, Section on Pediatric Trainees. An expert committee in nutrition education evaluated and conducted a thematic analysis of the survey responses. Twenty-four surveys were completed (10 medical students and 14 pediatric interns). The survey revealed students were not satisfied with the nutrition education they received in several areas including nutritional recommendations for obesity and prediabetes/diabetes; nutritional needs during pregnancy, childhood, and adolescent age-related dietary recommendations; cultural influences on diet and eating habits; and food insecurity. Students also reported a lack of confidence in providing healthful nutrition counseling to adolescent patients and delivering culturally appropriate nutrition advice. Survey responses revealed the need for improvements in several areas of nutrition curricula related to health and chronic disease management and suggest broader social determinants of health such as cultural influences on nutrition practices and food insecurity. The results of this survey provide unique insight into the medical student perspective on nutrition education and can inform the development of future medical school nutrition curriculums.

A 5-Year Update and Comparison of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States.

The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all allopathic orthopaedic surgery residency programs during the 2021 to 2022 academic year. The number of female residents and interns; the number of female faculty, professors, and associate professors; and the number of women in leadership positions were compared with data from the academic year 2016 to 2017. Continuous data were analyzed with independent t-tests, and significance was set at p < 0.05. A total of 696 female residents (19.2%) were identified from 3,624 orthopaedic residents, an increase from 13.5% in 2016. Programs in the top quartile of female residents had 3 times the number of female residents per program when compared to other quartiles and almost double the number of female interns per program. Programs in the top quartile of female residents had a significantly greater number of female faculty per program than the lower quartiles; 5.76 vs. 4.18. Compared with 2016 to 2017, there were significant increases in female faculty per program from 2.77 to 4.54 along with female full professors from 0.274 to 0.694. These increases contribute to the overall growth in the number of women in leadership positions per program over the past 5 years to 1.01 from 0.35 (p < 0.001). In the past 5 years, the percentage of female residents has increased from 13.5% to 19.2%. Furthermore, women make up 22.1% of interns. Orthopaedic surgery residency programs with higher percentages of female faculty had higher numbers of female residents. By encouraging programs to promote female representation within leadership and residents, we may continue to see the gap in orthopaedic sex diversity close. III.

“They were there because they were pregnant. Which is a really apolitical thing”—Medical student discussions of politics in abortion care in the United States

ObjectivesState abortion policies can vary widely. Geographic location and political climate could influence a medical student's abortion education experience. We compared how medical students training in one permissive and one restrictive state discussed politics in abortion care. Study designFrom 2018 to 2019, we interviewed US medical students during their Obstetrics and Gynecology rotation from two Midwestern academic centers with differing state abortion policies—one in Ohio (restrictive) and one in Illinois (permissive). In-depth interviews occurred following an abortion shadowing experience and included questions about politics in abortion care. We sorted data using flexible coding, with index codes around “politics,” followed by specific analytic coding. We compared codes by medical school using NVIVO software. ResultsWe interviewed 28 students (50% in Ohio). Students in Ohio discussed specific barriers to patient care and how politics infringed upon the quality of medical care, describing abortion as stigmatized care. Students in Illinois described abortion as high-quality medical care, delivered without the infringement of restrictive laws. Students at both schools described their medical school climates as supportive to abortion, yet in Ohio, students described exposure to more diverse abortion views than Illinois students. Ohio students also described engaging in abortion advocacy work, while Illinois students felt more politically disconnected. ConclusionsEven as clinical training opportunities decline, restrictive states may hold unique advocacy opportunities. Educators should tailor abortion curricula to address state level differences, as disparities in abortion access and student learning opportunities widen. ImplicationsStudents training in permissive states see abortion as routine health care, occurring without political interference. Students in restrictive states see abortion as hindered by politics and stigmatized, which may encourage advocacy. Educators should tailor curricula to address state level differences as disparities in abortion access and student learning opportunities widen.

Disability, program access, empathy and burnout in US medical students: A national study.

The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students. The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures. Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]). Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.

Allergy and immunology interest and exposure among US medical students and residents.

Despite the immense burden of allergic disease, the allergy and immunology (AI) workforce in the United States continues to shrink. Fellowship applications for AI have declined sharply in contrast to those in more popular specialties. Here we have sought to evaluate the current level of AI interest and exposure among early trainees in the United States, as well as their perspective on how to improve interest in the field. An 18-item questionnaire was sent via e-mail list-serve to 2 groups: (1) mostly residents in the American Academy of Allergy, Asthma & Immunology (AAAAI) with interest in AI and (2) medical students in the American Medical Student Association (AMSA) whose specialty interests were not known. In the AAAAI group, 412 members were surveyed and 70 responses were received. In the AMSA group, 4778 members were surveyed and 47 responses were received. More individuals in the AAAAI group interacted with their AI division than in the AMSA group (73% vs 19% [P< .001]). On average, the AAAAI group would "probably" pursue AI whereas the AMSA group who would "definitely not" do so (P<.001). Almost all of the AMSA group (94%) had heard of AI before, but only 19% of them interacted with AI at their program. Regarding ways to increase interest in AI, the top responses for both groups were clinical exposure via electives and shadowing (a score of 4.69 on a 5-point scale) and didactic exposure via lectures and presentations (a score of 4.29). Our study suggests that increasing AI opportunities for didactics and clinical exposure may lead medical students to develop more interest in pursuing the field. Some strategies are also discussed.

Influence of demographic and socio-economic factors in choosing hospitalist careers among US medical students

BackgroundThe subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students.MethodsWe analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020.ResultsWe analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM.ConclusionAbout one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.

Radiation Oncology Microclerkship: A Day in Radiation Oncology as a Component of Other Related Clerkships

<h3>Purpose/Objective(s)</h3> Many US medical students have opportunities for clinical exposure to medical oncology, surgical oncology (or other surgical subspecialties) during the required internal medicine, pediatrics, surgery, and OB/GYN clerkships. However, radiation oncology (RO) lacks a similar natural pathway into the clinical clerkships, and only a small percentage of students choose to rotate in RO, thus substantially limiting a broader understanding of the role of radiation therapy in multidisciplinary cancer care among other practicing physicians. The hypothesis of this study is that incorporating a 1-day "microclerkship" exposure in RO as part of other related clerkships will be feasible, and perceived as valuable to participating students. <h3>Materials/Methods</h3> The RO clerkship director at a single institution partnered with clerkship directors in medical oncology, palliative care, and radiology so that every 3^rd or 4^th year student rotating in those specialties would spend 1 day in RO during those clerkships. Students were given educational materials to review beforehand, a 30-minute introductory recorded presentation about general principles of RO to watch, as well as a slide deck or article describing how radiation therapy is relevant to patient care for the subspecialty of the primary clerkship they were on. At minimum, the day in RO included shadowing a single radiation oncologist in clinic, and the therapists as patients were treated, but sometimes also included tumor board, brachytherapy or treatment planning if part of the attending's day. Students completed a follow-up electronic survey about their experience afterwards. <h3>Results</h3> Pilot data of 18 students are reported, of whom 4 reported being 3rd year medical students and 12 reported being 4th year medical students. Only 1 had ever seen a prior lecture from a radiation oncologist and 1 had visited a RO department. On a 5-point Likert-type scale, 16 students (89%) rated the experience a 4 or 5 (quite or extremely valuable). Seventeen students (94%) felt moderately to extremely more knowledgeable about the role of radiation therapy in cancer management. Ten students (63%) were potentially more interested in doing a full RO rotation, and 4 students (25%) were more interested in a career in RO, after this experience. <h3>Conclusion</h3> Preliminary data suggest a valuable role of incorporating RO exposure into other related medical student clerkships. In the coming months, more students will participate from these clerkships as well as others, and the project will be expanded to multiple institutions. We believe that utilizing this approach will drastically improve the amount of RO exposure for US medical students, and all subsequently have a positive impact on referral patterns and multidisciplinary patient care.

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Impact of a Virtual Introduction to Radiation Oncology Lecture on Stimulating Specialty Interest among Diverse Medical Students at Multiple Institutions

<h3>Purpose/Objective(s)</h3> Many US medical students lack access to basic education in radiation oncology (RO). This is particularly common at schools with higher enrollment of students underrepresented in medicine (UIM), which may contribute to inadequate diversity in the RO workforce. We hypothesize that a virtual, cross-institutional lecture introducing students to a career in RO will be valuable to students less likely to have access to it otherwise, and increase their interest in RO as a career. <h3>Materials/Methods</h3> A 1-hour, live, virtual, extracurricular lecture was offered to all (A) 15 US medical schools with at least 15% enrollment of UIM students per AAMC data, (B) 23 other medical schools lacking an affiliated RO residency program or department, and (C) a convenience sample of 22 medical student groups comprised of primarily UIM members at any US medical schools with contact information available online. Each lecture was promoted broadly, and the overall number of students invited is unknown. The lectures were given individually to each school by a singular academic radiation oncologist. A post-lecture electronic survey of 6 multiple choice and Likert-type questions was used to capture data from participating students. Descriptive statistics are reported. The Fisher's Exact test and Mann-Whitney U test were used to compare subgroups of students based on medical school year, gender, race, ethnicity, and presence of affiliated RO department. <h3>Results</h3> 197 students from 13 institutions attended a lecture, and 114 responded to the survey (response rate 58%). Students' demographics included: 68% 1^st years, 59% female, 42% white, 32% Asian, 13% Black, 15% Hispanic, and 61% from a school without a RO department. When coordinated by an UIM student group, 60% of respondents were UIM, as compared to 16% UIM respondents when promoted to all medical students (<i>p</i> < 0.01). The mean overall UIM student enrollment at the participating schools was 14% (SD 9%). 92 students (81%) were aware of the specialty of RO before the lecture; however, UIM students were significantly less likely to be aware of RO than all others (69% vs. 87%, <i>p</i> = 0.05). Only 19 students (17%) reported previously hearing a RO lecture. 98 students (86%) expressed more interest in pursuing a career in RO after the lecture. There was no significant difference in interest in RO for any demographic subgroups of participants. 18 students (16%) contacted the speaker afterwards for guidance on research or mentorship opportunities locally or nationally. <h3>Conclusion</h3> Virtual RO exposure was feasible to deliver to students less likely to be exposed, and successfully stimulated interest in the specialty among most students regardless of their gender, race, or ethnicity. Sustainable pathways are needed to link these students to RO departments with mentors and sponsors who can help facilitate a more diverse RO workforce.

Perceptions of US Medical Students on Artificial Intelligence in Medicine: Mixed Methods Survey Study.

Given the rapidity with which artificial intelligence is gaining momentum in clinical medicine, current physician leaders have called for more incorporation of artificial intelligence topics into undergraduate medical education. This is to prepare future physicians to better work together with artificial intelligence technology. However, the first step in curriculum development is to survey the needs of end users. There has not been a study to determine which media and which topics are most preferred by US medical students to learn about the topic of artificial intelligence in medicine. We aimed to survey US medical students on the need to incorporate artificial intelligence in undergraduate medical education and their preferred means to do so to assist with future education initiatives. A mixed methods survey comprising both specific questions and a write-in response section was sent through Qualtrics to US medical students in May 2021. Likert scale questions were used to first assess various perceptions of artificial intelligence in medicine. Specific questions were posed regarding learning format and topics in artificial intelligence. We surveyed 390 US medical students with an average age of 26 (SD 3) years from 17 different medical programs (the estimated response rate was 3.5%). A majority (355/388, 91.5%) of respondents agreed that training in artificial intelligence concepts during medical school would be useful for their future. While 79.4% (308/388) were excited to use artificial intelligence technologies, 91.2% (353/387) either reported that their medical schools did not offer resources or were unsure if they did so. Short lectures (264/378, 69.8%), formal electives (180/378, 47.6%), and Q and A panels (167/378, 44.2%) were identified as preferred formats, while fundamental concepts of artificial intelligence (247/379, 65.2%), when to use artificial intelligence in medicine (227/379, 59.9%), and pros and cons of using artificial intelligence (224/379, 59.1%) were the most preferred topics for enhancing their training. The results of this study indicate that current US medical students recognize the importance of artificial intelligence in medicine and acknowledge that current formal education and resources to study artificial intelligence-related topics are limited in most US medical schools. Respondents also indicated that a hybrid formal/flexible format would be most appropriate for incorporating artificial intelligence as a topic in US medical schools. Based on these data, we conclude that there is a definitive knowledge gap in artificial intelligence education within current medical education in the US. Further, the results suggest there is a disparity in opinions on the specific format and topics to be introduced.

Continued underrepresentation of historically excluded groups in the neurosurgery pipeline: an analysis of racial and ethnic trends across stages of medical training from 2012 to 2020.

US allopathic medical schools have experienced improvements in racial and ethnic diversity among matriculants in the past decade. It is not clear, however, whether better representation of historically excluded racial and ethnic groups at medical school entry impacts subsequent stages of the medical training pipeline leading into a specific field. The aim of this study was to examine these trends as they relate to the neurosurgical medical education pipeline and consider the drivers that sustain barriers for underrepresented groups. Race and ethnicity reports from the American Association of Medical Colleges were obtained on allopathic medical school applicants, acceptees, and graduates and applicants to US neurosurgical residency programs from 2012 to 2020. The representation of groups categorized by self-reported race and ethnicity was compared with their US population counterparts to determine the representation quotient (RQ) for each group. Annual racial composition differences and changes in representation over time at each stage of medical training were evaluated by estimating incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using non-Hispanic Whites as the reference group. On average, Asian and White individuals most frequently applied and were accepted to medical school, had the highest graduation rates, and applied to neurosurgery residency programs more often than other racial groups. The medical school application and acceptance rates for Black individuals increased from 2012 to 2020 relative to Whites by 30% (95% CI 1.23-1.36) and 42% (95% CI 1.31-1.53), respectively. During this same period, however, inequities in neurosurgical residency applications grew across all non-Asian racialized groups relative to Whites. While the incidence of active Black neurosurgery residents increased from 2012 to 2020 (0.6 to 0.7/100,000 Black US inhabitants), the prevalence of White neurosurgery residents grew in the active neurosurgery resident population by 16% more. The increased racial diversity of medical school students in recent years is not yet reflected in racial representation among neurosurgery applicants. Disproportionately fewer Black relative to White US medical students apply to neurosurgery residency, which contributes to declining racial representation among all active neurosurgery resident physicians. Hispanic individuals are becoming increasingly represented in neurosurgery residency but continue to remain underrepresented relative to the US population. Ongoing efforts to recruit medical students into neurosurgery who more accurately reflect the diversity of the general US population are necessary to ensure equitable patient care.

A 10-Year Review of Designated Leadership Positions of the American Orthopaedic Foot & Ankle Society (AOFAS).

In 2019 the majority of US medical students were women (50.5%). However, despite this representation, female representation within orthopaedic surgery remains low when compared to male counterparts. Previously, the American Society for Surgery of the Hand (ASSH) and Pediatric Orthopaedic Society of North America (POSNA) published their gender diversity data. No such study has been conducted in the American Orthopaedic Foot & Ankle Society (AOFAS), which is the largest membership organization for foot and ankle-trained orthopaedic surgeons. This study sought to investigate whether increased female representation in the AOFAS membership roster is reflected in different levels within the organization. The 2012-2022 membership rosters were obtained from the AOFAS and compared by gender. Volunteer, elected, and appointed leadership positions as well as rates of engagement were compared for each of the activities. Leadership positions were defined as committee chair, vice chair, or board of directors (BOD). When available, time for advancement through leadership positions to the presidential role was analyzed by gender. Comparative data were available for 2 other respective subspecialty groups, ASSH and POSNA, from previously published studies. Between 2012 and 2022, the percentage of female membership in the AOFAS has continued to increase from 7.5% (n=76) to 13% (n=163). Engagement in committee membership positions during this time has more than doubled from 11 of 26 (14.4%) to 57 of 163 (34.9%). When participation trends were evaluated by gender, women showed higher rates of committee involvement than their male counterparts. In 2021 compared to 2012, the percentage of female committee members more than doubled compared with their male counterparts (female 34.9% to male 23.2% vs female 14.4% to male 16.8%). This increase in female gender committee composition trend has been seen in the ASSH and POSNA, but it is more pronounced in the AOFAS. Representation of women in committee chair positions and elected positions has not seen this same parallel increase. The female membership of the AOFAS has a similar gender composition to other orthopaedic subspecialities. Female membership within the society has increased over the past 10 years. The rates of female involvement within committee membership positions have seen a parallel increase. It will take time to mature into leadership roles as we continue to increase diversity within our respective subspecialty organizations. Inception of the AOFAS Diversity Equity and Inclusion and Women's Subcommittee demonstrate a continued emphasis on this core value within the society. Level IV, cohort study.

Step 2: The New Normal

"Eh, it is just 'Step 2'. I will do fine!" This is a commonsentiment seen in most medical students andgraduates. After all, Step 2 is about what we learn onour clinical rotations. It is mostly about practicalknowledge that is meant to be ingrained in us, thanksto hours of clinical practice. This leaves little need forthe endless cycles of mugging and regurgitation.Besides, Step 1 is the 'real beast' we need to sweatover. That is the one program directors really look at!Well unfortunately the glory days of Step 1 are over.With the recent cancellation of Step 1 scores, it is amere qualification exam and it is finally time for themuch- overlooked Step 2 to shine.Now that all of a sudden Step 1 scores do not matter,medical students and graduates will have to scramble tomake their Step 2 scores exemplary. This is doubly truefor international medical graduates (IMGs). Why isthat? One may wonder!Well, most IMGs come from curriculums which aresomewhat different than the medical schools in theUSA. Hence the transcripts do not hold much value, asit is impossible for the program directors to fairlycompare the grades given by the different medicalschools all over the world to the ones obtained by USmedical students [1]. Letters of recommendation(LORs) tend to be subjective (even from USphysicians). So the only objective data programdirectors can assess now are the STEP 2 scores. So howdo we go about making sure it is outstanding? Bystudying of course! But how?The answer first and foremost still does lie within Step1. The better prepared you are for step 1 the betterprepared you will be for Step 2. There has been in fact,a continuous positive correlation between Step 1 andStep 2 scores [2,3,4]. So even if Step 1 scores do notmatter, even if one just has to pass, it is much moreprudent to read up and get a strong hold on all Step 1concepts, as they are the building blocks on which Step2 questions are based. So, prepare for Step 1 andpretend to aim for a high score even though there isn'tone. This will make you that much more prepared forStep 2, which does give a scored report.When it comes to preparation for Step 2 my go-to hasbeen the U world Q banks. Every single possible detailthat can be asked in the test, tends to be covered in UWorld. But it is not enough just to solve the questions.The real treasure of the U World questions is in theexplanations. It is important to read through every lineof each explanation and take notes of it. These notesshould be your bible. Read it re-read it, understand it,and remember it. And unless you have an eideticmemory, repeat the questions. The more times yourepeat it, the more you will remember and the moreyou will instinctually know what the right answer is.Other than that it is important to sit down and practiceall the 'National Board of Medical Examiners' (NBME)self-assessment tests as they are the best indicator ofreal day test scores time and time again [5].So take a deep breath and remember, at the end of theday this is just an exam. Hundreds of students havebeen giving it and performing well. It is most certainlynot an impossible feat and as long as you areconsistent, good scores are achievable. Lastly good luckand remember you got this!

Establishing a Virtual Global Health Education Partnership: The Cleveland-Cusco Connection.

IntroductionThe Cleveland-Cusco Connection (CCC) elective was created during the COVID-19 pandemic to continue global health (GH) education for Case Western Reserve University (CWRU) and Universidad Nacional de San Antonio Abad del Cusco (UNSAAC) medical students. The CCC elective was held over Zoom and aimed to promote international collaboration, knowledge about health systems, and perspectives in GH with synchronous and asynchronous learning.MethodsPeruvian and US medical students participated in six monthly sessions consisting of student presentations and large and small group discussions. The elective was led collaboratively by CWRU and UNSAAC students. We evaluated students’ experience using pre- and post-course surveys.ResultsNineteen students (76%) completed the post-course survey. The median rating for meeting each course objective was “somewhat effective” on a 5-point scale ranging from “very ineffective” to “very effective.” All respondents would recommend the course to a friend. Common barriers included language challenges, fatigue from other coursework, and technology issues. Seven students’ pre- and post-course surveys could be linked. The number of students who agreed with the statements assessing course objectives increased for all questions between the pre- and post-test, with only the number agreeing that they understood the Peruvian healthcare system increasing significantly (p < 0.05).DiscussionThe CCC elective provides a valuable GH educational opportunity via a virtual platform. Students reported that learning from their peers was effective and enjoyable.ConclusionVirtual GH electives like the CCC may offer benefits in terms of cost, equity, and flexibility and merit further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-022-01626-6.