Leveraging Telehealth and Medical Student Volunteers to Bridge Gaps in Education Access for Providers in Limited-Resource Settings.

PROBLEM: High-quality training opportunities for providers in limited-resource settings are often scarce or nonexistent. This can lead to a dearth of boots-on-the-ground workers capable of translating knowledge into effective action. The tested telehealth education model of Project ECHO (Extension for Community Healthcare Outcomes) can help address this disparity. However, the planning and logistical coordination required can be limiting. APPROACH: Medical student volunteers interested in health disparities and global health can be leveraged to reduce the costs of administration for Project ECHO programs. From mid-2018 to present (2020), student organizations have been formed at Vanderbilt University School of Medicine, University of California, San Francisco, School of Medicine, and Albert Einstein College of Medicine. These organizations have recruited and trained volunteers, who play an active role in assessing the needs of local clinics and providers, developing curricula, and coordinating the logistical aspects of programs. OUTCOMES: In the first 4 student-coordinated Project ECHO cohorts (2019-2020), 25 clinics in 14 countries participated, with a potential impact on over 20,000 cancer patients annually. Satisfaction with the telehealth education programs was high among local clinicians and expert educators. Students' perceived ability to conduct activities important to successfully orchestrating a telehealth education program was significantly greater among students who had coordinated one or more Project ECHO programs than among students who had yet to participate for 7 of 9 competencies. There also appears to be an additive effect of participating in additional Project ECHO programs on perceived confidence and career path intentions. NEXT STEPS: The student-led model of coordinating telehealth education programs described here can be readily expanded to medical schools across the nation and beyond. With continued expansion, efforts are needed to develop assessments that provide insights into participants' learning, track changes in patient outcomes, and provide continuing medical education credits to local clinicians.

Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic.

In light of the evolving COVID-19 pandemic, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) released a joint statement in March 2020 recommending an immediate suspension of medical student participation in direct patient contact. As graduating medical students who will soon begin residency, the authors fully support this recommendation. Though paid health care workers, like residents, nurses, and environmental services staff, are essential to the management of COVID-19 patients, medical students are not. Students' continued involvement in direct patient care will contribute to SARS-CoV-2 exposures and transmissions and will waste already limited personal protective equipment. By decreasing nonessential personnel in health care settings, including medical students, medical schools will contribute to national and global efforts to "flatten the curve."The authors also assert that medical schools are responsible for ensuring medical student safety. Without the protections provided to paid health care workers, students are uniquely disadvantaged within the medical hierarchy; these inequalities must be addressed before medical students are safely reintegrated into clinical roles. Although graduating medical students and institutional leadership may worry that suspending clinical rotations might prevent students from completing graduation requirements, the authors argue the ethical obligation to "flatten the curve" supersedes usual teaching responsibilities. Therefore, the authors request further guidance from the LCME and AAMC regarding curricular exemptions/alternatives and adjusted graduation timelines. The pool of graduating medical students affected by this pause in direct patient contact represents a powerful reserve, which may soon need to be used as the COVID-19 pandemic continues to challenge the U.S. health care infrastructure.

Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel.

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient-physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.

Effects of Moving the United States Medical Licensing Examination Step 1 After Core Clerkships on Step 2 Clinical Knowledge Performance.

PURPOSE: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.

Attrition among New Zealand medical students completing research degrees: A 20-year analysis.

INTRODUCTION: Not all medical students who intercalate research degrees go on to completion. No study to date has investigated the specific reasons. Understanding this minority would fill an important research gap. METHODS: A list was obtained of intercalating medical students who enrolled at our institution between 1995 and 2014. Students who withdrew from an intercalated research degree were then invited to complete an online survey via email. RESULTS: Over the study period, 178 medical students commenced an intercalated honours or PhD degree with their medical degree, and 13 students withdrew from that program, giving an overall attrition rate of 7.3%. Students who withdrew from the intercalated degree were also more likely to withdraw from their medical degree (40%); this is compared with 3.6% of students who completed the intercalated degree, but eventually withdrew from their medical degree. DISCUSSION: Demographics of this cohort were not dissimilar to those of completing students. Although withdrawing students had a higher exit rate from the medical degree, the rate of research involvement remained similar pre- and post-intercalation. The most commonly cited reasons for withdrawal were decreased satisfaction with research, and conflict with supervisors.

Early internationalization of students in a German medical school in the former German Democratic Republic.

The growing influence and importance of internationalization in higher education, especially in medical education, inspired anatomists at Columbia University New York, USA and at the Martin Luther University Halle-Wittenberg, Germany, to start a novel international preclinical collaboration project. As part of the anatomy dissection course a group of volunteer medical students from Halle dissected selected areas of the human body with the help of an English, illustrated, iPad-run dissection script (American Dissector). Meanwhile the rest of the students worked with a traditional German text-based dissector. Additionally, participating German students were matched with US students, with whom they connected via video-conferencing and discussed subjects like differences between their health care systems, structure and content of the anatomy course and the differences in their medical education systems. Questionnaires were sent for feedback and checklists confirmed dissection findings. Results indicated that the American Dissector was successfully shared internationally. The majority (62%) found it easier to find structures using the American Dissector compared to the standard dissector and also 62% needed the atlas two times less when using the American Dissector. Furthermore, students enjoyed their interaction with their international peers and the vast majority (77%) wished there were more interactions like this in the medical curriculum. This publication describes an approach to embed internationalization in the preclinical medical curriculum based in the gross anatomy course in a German Medical school, located in East Germany. Considering its history as a former German Democratic Republic faculty this is a meaningful step towardglobalization of medical education in this part of Germany.

[Analysis of the discrimination of the final marks after the first computerized national ranking exam in Medicine in June 2016 in France]. / Analyse de la discrimination des notes aux ECN informatisées de 2016.

INTRODUCTION: The first computerised national ranking exam (cNRE) in Medicine was introduced in June 2016 for 8214 students. It was made of 18 progressive clinical cases (PCCs) with multiple choice questions (MCQs), 120 independent MCQs and 2 scientific articles to criticize. A lack of mark discrimination grounded the cNRE reform. We aimed to assess the discrimination of the final marks after this first cNRE. METHODS: A national Excel® file gathering overall statistics and marks were transmitted to the medical faculties after the cNRE. The mean points deviation between two papers and the percentage of points ranking 75% of students allowed us to analyse marks' discrimination. RESULTS: The national distribution sigmoid curve of the marks is superimposable with previous NRE in 2015. In PCCs, 72% of students were ranked in 1090 points out of 7560 (14%). In independents MCQs, 73% of students were ranked in 434 points out of 2160 (20%). In critical analysis of articles, 75% of students were ranked in 225 points out of 1080 (21%). The above percentages of students are on the plateau of each discrimination curve for PCCs, independent MCQs and critical analysis of scientific articles. CONCLUSION: The cNRE reduced equally-ranked students compared to 2015, with a mean deviation between two papers of 0.28 in 2016 vs 0.04 in 2015. Despite the new format introduced by the cNRE, 75% of students are still ranked in a low proportion of points that is equivalent to previous NRE in 2015 (between 15 et 20% of points).

Avaliação das atitudes de colaboração entre estudantes de graduação dos cursos de Farmácia e Medicina na Universidade de São Paulo / Evaluation of collaboration attitudes among undergraduate students of Pharmacy and Medicine courses at the University of São Paulo

A prática farmacêutica vem, ao longo dos anos, mudando o seu foco, uma vez que as mudanças de perfil epidemiológico, como a elevação da expectativa de vida, a diversidade de enfermidades crônicas, bem como a morbimortalidade associada ao uso de medicamentos e o aumento dos gastos com saúde, requerem acompanhamento prolongado de pacientes e abordagem integral que contemple as múltiplas dimensões da assistência à saúde dos usuários e da população em geral, com ênfase em prevenção e educação em saúde. Atributos importantes dos profissionais de saúde incluem, mas não estão limitados, à empatia cognitiva, a colaboração interprofissional e as orientações centradas no paciente. Instrumentos de pesquisa para medir cada um desses atributos foram projetados e validados em diferentes graus. O objetivo deste trabalho foi avaliar o grau de cooperação entre estudantes de graduação dos cursos de Farmácia e de Medicina da Universidade de São Paulo, Campus da Capital. Trata-se de um estudo do tipo transversal, quantitativo, com aplicação de questionário online construído e validado especificamente para avaliar o grau de cooperação entre estudantes de todos os anos de graduação dos cursos de Farmácia e de Medicina. Os dados foram coletados por meio do envio do questionário aos estudantes dos dois cursos, o qual contempla dados sócio-demográficos, contato prévio com a prática interprofissional e a versão validada para o português do instrumento "Scale of Attitudes Toward Pharmacist-Physician Collaboration". Foi realizada análise estatística empregandose métodos descritivos (média, mediana e desvio padrão) e inferenciais (Software R - teste t de Student e ANOVA). Com o presente estudo, observou-se que, de maneira geral, os estudantes dos dois cursos são favoráveis às práticas interprofissionais, porém, os dados apontam que os estudantes de Farmácia se mostram mais favoráveis a estas práticas quando comparados aos de Medicina. São necessários mais estudos para aprofundar as causas das diferenças encontradas entre os dois grupos e no que diz respeito à relação das atividades de educação interprofissional e a percepção dos estudantes quanto à colaboração médicofarmacêutico

The pharmaceutical practice has, over the years, changing its focus, since the epidemiological profile changes, such as increased life expectancy, the diversity of chronic diseases, as well as the morbidity and mortality associated with the use of drugs and the increase in health spending, require prolonged follow-up of patients and require comprehensive approach that addresses the multiple dimensions of health care users and the general population, with emphasis on prevention and health education. Important health professionals attributes include, but are not limited to cognitive empathy, interprofessional collaboration, and guidance centered on the patient. Research tools to measure each of these attributes have been designed and validated to varying degrees. The objective of this study is to measure and evaluate the level of cooperation among undergraduate students of Pharmacy and Medicine courses at the University of São Paulo, Campus Capital. It is a transversal, quantitative study with online application of online questionnaire developed and validated specifically to evaluate the level of cooperation between students from all undergraduate years of Pharmacy and Medicine courses. Data will be collected by sending the questionnaire to students from both courses. The questionnaire will be prepared on the basis of the Federal University of Sergipe tool and every student can respond to even just once. It will be performed the statistical analysis employing descriptive methods (mean, median and standard deviation) and inferential (Software R - Student's t-test and ANOVA). With the present study, it was observed that, in general, the students of the two courses are favorable to interprofessional practices, however the data indicate that the students of pharmacy are more favorable when compared to those of medicine. Further studies are necessary to look into the causes of the differences found between the two groups and also regarding the relation of the activities of interprofessional education and the students' perception regarding the physician-pharmacist collaboration

Results of Student-Generated 'Unique Characteristics' on the Medical Student Performance Evaluation.

IMPORTANCE: The Medical Student Performance Evaluation (MSPE)--formerly called the dean's letter--is an important tool for residency program directors to use in assessing student qualifications for both invitation to interview and construction of their rank order list. Many institutions are now allowing students to construct their own Unique Characteristics (UC) section for the MSPE. This study addresses the results of allowing students to construct their own UC. OBJECTIVES: The goal of this study was to allow students to voice their thoughts regarding their participation in the construction of the UC section of the MSPE. The survey evaluated student attitude toward, value of, and support for the UC section. METHOD: We conducted a cross-sectional survey of all fourth-year medical students at the Medical College of Wisconsin during the 2014-2015 academic year. Responses were received from 66% of students (133 out of 199). We developed a question bank to cover the aims of the study--to assess student perceived value, experience writing, and support for the UC section. RESULTS: There was agreement among students that their participation will positively affect their candidacy for interview selection and success in the match. Overall significance of regression model P = .001, R2. = .60. Additionally, students believed they had an advantage over applicants at other schools without the opportunity to draft their UC. Other findings included that men found the task more challenging, psychiatry applicants were least satisfied with the character count, and emergency medicine applicants voiced the lowest value for the UC section. CONCLUSIONS: The present study supports, in general terms, the utility and value of students drafting their own UC section of the MSPE. Future investigations should focus on expanding to other schools, comparing public to private institutions, and refining the interspecialty comparisons.

What Are You Measuring? Dimensionality and Reliability Analysis of Ability and Speed in Medical School Didactic Examinations.

Summative didactic evaluation often involves multiple choice questions which are then aggregated into exam scores, course scores, and cumulative grade point averages. To be valid, each of these levels should have some relationship to the topic tested (dimensionality) and be sufficiently reproducible between persons (reliability) to justify student ranking. Evaluation of dimensionality is difficult and is complicated by the classic observation that didactic performance involves a generalized component (g) in addition to subtest specific factors. In this work, 183 students were analyzed over two academic years in 13 courses with 44 exams and 3352 questions for both accuracy and speed. Reliability at all levels was good (>0.95). Assessed by bifactor analysis, g effects dominated most levels resulting in essential unidimensionality. Effect sizes on predicted accuracy and speed due to nesting in exams and courses was small. There was little relationship between person ability and person speed. Thus, the hierarchical grading system appears warrented because of its g-dependence.

SELECTION OF ENDOCRINOLOGY SUBSPECIALTY TRAINEES: WHICH APPLICANT CHARACTERISTICS ARE ASSOCIATED WITH PERFORMANCE DURING FELLOWSHIP TRAINING?

OBJECTIVE: To determine which residency characteristics are associated with performance during endocrinology fellowship training as measured by competency-based faculty evaluation scores and faculty global ratings of trainee performance. METHODS: We performed a retrospective review of interview applications from endocrinology fellows who graduated from a single academic institution between 2006 and 2013. Performance measures included competency-based faculty evaluation scores and faculty global ratings. The association between applicant characteristics and measures of performance during fellowship was examined by linear regression. RESULTS: The presence of a laudatory comparative statement in the residency program director's letter of recommendation (LoR) or experience as a chief resident was significantly associated with competency-based faculty evaluation scores (ß = 0.22, P = .001; and ß = 0.24, P = .009, respectively) and faculty global ratings (ß = 0.85, P = .006; and ß = 0.96, P = .015, respectively). CONCLUSION: The presence of a laudatory comparative statement in the residency program director's LoR or experience as a chief resident were significantly associated with overall performance during subspecialty fellowship training. Future studies are needed in other cohorts to determine the broader implications of these findings in the application and selection process.

Characteristics of Japanese medical students associated with their intention for rural practice.

INTRODUCTION: In Japan, the maldistribution of physicians between urban and rural areas is increasing. It is important to know the practice location expectations of future physicians. METHODS: The study was designed as a cross-sectional survey. In 2009-2013, students at a medical school in Japan completed a questionnaire containing 50 items with four-point Likert scales. The students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to state their intention to practice in a rural area. RESULTS: The study sample consisted of 368 students (88.2% response rate). Significant variables that were associated with a positively motivated intent for rural practice were 'presence of a role model' (odds ratio (OR), 5.42; 95% confidence interval (CI), 1.58-18.5), 'admission by school recommendation' (OR, 7.68; 95%CI, 2.14-27.6), 'growing up in a rural area' (OR, 6.16; 95%CI, 1.01-37.6), 'general medicine/family medicine as the first career choice' (OR, 5.88; 95%CI, 2.43-14.2), 'interest in the targeted population' (OR, 16.7; 95%CI, 3.97-69.9), 'memorable experience at a class or clinical rotation' (OR, 3.94; 95%CI, 3.73-416), and 'location of their medical school' (OR, 11.4; 95%CI, 2.79-46.2). CONCLUSIONS: The present study suggests that medical schools might recruit students with characteristics associated with intention for rural practice.

A program director's guide to the Medical Student Performance Evaluation (former dean's letter) with a database.

PURPOSE: The value of the Medical Student Performance Evaluation (MSPE) for a program director is in the information it contains comparing how a student performed in medical school relative to his or her classmates. The Association of American Medical Colleges has recommended that a student's class ranking be included in the summary paragraph of the MSPE and that this information be repeated in a supplementary appendix. METHODS: The authors reviewed the MSPEs from 1,479 applications for residency training positions. The aim was to determine to what extent and in what manner individual schools reveal how their students perform relative to their peers. The authors then set out to create a database containing this information. RESULTS: Working from a list of 141 US members of the Association of American Medical Colleges, complete information for 107 schools (76%) and partial information for the remaining 34 schools (24%) was gathered. Only 12 schools (9%) included complete comparative information in the summary section in accordance with the guidelines of the Association of American Medical Colleges. Other schools were in partial compliance or did not comply at all. The database the authors constructed will inform users if comparative information is available, guide users to its location in the MSPE, and explain the meaning of the language different schools use to rank or classify their students. CONCLUSIONS: The authors recognize that this database is incomplete and that the individual institutions will alter their ranking system from time to time. But this database is offered in an open format so that it can be continuously updated by users.

Utility of a writing station in the multiple mini-interview.

The multiple mini-interview (MMI) is a reliable and valid method of selecting applicants for admission to health professional schools on the basis of non-cognitive traits. Because the MMI is a series of short interview stations that applicants rotate through in coordinated sequence, it can potentially be resource intensive. However, the MMI design has room for innovation and efficiency. At the University of Manitoba Faculty of Medicine, a 10-minute unsupervised writing station (WS) was incorporated into the MMI to obtain a writing sample from each applicant, to increase the number of independent scores per applicant, and to increase the number of applicants interviewed per circuit without increasing interviewer numbers. One assessor evaluated all the writing samples and assigned a score ranging from 1 to 7. With the inclusion of a WS into an 11-station MMI, the faculty's capacity to interview applicants increased by 9% (from 297 to 324) without substantially increasing interviewer hours needed per day. For 1,257 applicants interviewed in 2008-2011, the mean WS score was 4.03 (SD=1.36), whereas applicants' mean of 10 oral station (OS) scores was 4.62 (SD=0.69). Correlations between WS score and mean OS score ranged from .16 to .27 (p<.01) over the four years. Because inter-station correlations for OS ranged from .01 to .37, the correlation of .21 between WS and mean OS scores for all four years combined appears reasonable. Institutions that want to effectively increase the capacity of their MMI process might consider adding a WS.