Medical student non-modifiable risk factors and USMLE Step 1 exam score.

For diversity to exist in the medical graduate workforce, students from all backgrounds should have equitable opportunities of employment. Specialties have utilized a minimal threshold for USMLE Step 1 score when screening applicants for residency interviews. The OHSU SOM class of 2021 completed a 14-question voluntary survey on their Step 1 score and the following non-modifiable risk factors: Adverse Childhood Experience score (ACEs), sex, gender, Underrepresented in Medicine status (URiM), family income during adolescence, highest degree held by a guardian, discrimination experience during medical school, federal/state assistance use, and rural versus urban primary home. Descriptive statistics and unadjusted risk ratios were applied to study the relation between Step 1 score and non-modifiable risk factors as well as certain non-modifiable risk factors and ACEs ≥ 3. The mean Step 1 score was 230 (213, 247). Of the students, 28.2% identified ACEs ≥ 3, 13.6% were considered URiM, and 65.4% were female. URiM were 2.34 (1.30, 4.23),females were 2.77 (1.06-7.29), and those who experienced discrimination in medical school were 4.25 (1.85, 9.77) times more likely to have ACEs ≥ 3. Students who had ACEs ≥ 3 were 3.58 (1.75, 7.29) times less likely to meet a minimal threshold for residency interviews of 220. These are the first results to demonstrate a relationship between Step 1 score and ACEs. Those who identified as URiM, females, and those who experienced discrimination in medical school were at a higher risk of ACEs of ≥ 3. Step 1 transitioned to pass/fail in January 2022. However, the first application cycle that residencies will see pass/fail scoring is 2023-2024, and fellowships will continue to see scored Step 1 until, at the earliest, the 2026-2027 application cycle. These data contribute to a foundation of research that could apply to Step 2CK testing scores, and help to inform decisions about the diversity and equity of the residency interview process.

An Exploratory Study of a Novel Approach to Improve Readiness for a Rural Family Medicine Residency.

BACKGROUND AND OBJECTIVES: Transitioning from medical school to residency is challenging, especially in rural training programs where a comprehensive scope of practice is needed to address rural health disparities. Oregon Health & Science University partnered with Cascades East Family Medicine Residency in Klamath Falls, Oregon to create an integrated fourth-year medical student experience (Oregon Family medicine Integrated Rural Student Training (Oregon FIRST). Participants may then enter this residency to complete their training with the intention to practice in rural underresourced settings. METHODS: In this exploratory study, we conducted key informant interviews with 9 of ten Oregon FIRST participants to determine how Oregon FIRST contributed both to their readiness for residency training and their choice to practice in rural underserved locations. Interviews were conducted between June 10, 2020 and July 8, 2020. We analyzed field notes taken during interviews for emergent themes using classical content analysis. RESULTS: Emergent themes included logistical ease, relationship development, key curricular elements, and commitment to rural practice. Overwhelmingly, Oregon FIRST participants reported the experience had many challenging and demanding components because they served as subinterns for their entire fourth year of medical school, but this prepared them very well for internship. When asked if they would choose to enroll in Oregon FIRST again, given what they now know about physician training and patient care, all nine (100%) said they would. CONCLUSIONS: This study demonstrated that Oregon FIRST students felt better prepared for the rigors of residency and are committed to practicing in rural areas.

Rapid Mobilization of Medical Students to Provide Health Care Workers With Emergency Childcare During the COVID-19 Pandemic.

PROBLEM: In March 2020, the novel coronavirus 2019 (COVID-19) pandemic spread rapidly within the United States and began overwhelming the health care system. To conserve personal protective equipment, reduce the spread of the virus, and keep student learners safe, leaders of medical schools across the country made the difficult decision to suspend in-person clinical experiences. As medical students were sent home and hospital systems ramped up their response to the virus, many essential health care workers (HCWs) faced an immediate challenge. As "nonessential" services such as schools and daycare centers abruptly closed, HCWs serving on the frontlines in inpatient settings needed a way to both fight the pandemic and care for their children. APPROACH: Medical students at Oregon Health & Science University were able to rapidly OR organize to provide childcare for essential HCWs. For roughly 8 weeks following the state of emergency (March 13 through May 15, 2020), students used Twitter and emerging technology to match families in need of childcare with a trainee volunteer. OUTCOMES: By May 15th, the service had successfully fulfilled 181 of the 202 requests for childcare (90%) over the course of 8 weeks. Of the 181 completed childcare requests, 172 (95%) were fulfilled by an individual (1:1 volunteer-to-household pairing), and 9 (5%) were fulfilled by 2 or more volunteers. NEXT STEPS: The trainees who provided childcare will apply the skills learned (e.g., clear communication, grassroots organizing, triaging, leveraging new technology) to patient care. Broader applications for this system include organizing volunteers to conduct contract tracing or to provide public health information in languages other than English. Future research includes examining the effect of the service on the productivity, morale, and mental health of both those who provided and received childcare.

Development and evaluation of a simulation-based transition to clerkship course.

BACKGROUND: Transition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course. APPROACH: Beginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. EVALUATION: Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. REFLECTION: This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.

Assessing learning in the adaptive curriculum.

BACKGROUND: Medical education is a dynamic process that will continuously evolve to respond to changes in the foundations of medicine, the clinical practice of medicine and in health systems science. PURPOSE: In this paper, we review how assessing learning in such a dynamic environment requires comprehensive flexible and adaptable methodological approaches designed to assess knowledge attainment and transfer, clinical skills/competency development, and ethical/professional behavior. Adaptive assessments should measure the learner's ability to observe where changes in health care delivery are needed and how to implement them. Balancing formative and summative assessments will promote reflective learning so that each student will reach her/his highest potential. From the programmatic perspective, measuring the design and delivery of instruction in relation to students? efforts to achieve competency will improve learning and foster continuous professional development of faculty and advance the science of learning. APPROACH: We describe how two medical schools are approaching adaptive assessment, including using portfolio systems that encompass teaching and learning experiences while offering real-time longitudinal tracking of digital data toward improving learning and provide curricula continuous improvement cycles. Using latest technologies, portfolios produce actionable data displays with precise guidance for learning and program development.

Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum.

Oregon Health & Science University School of Medicine launched a completely new undergraduate medical education curriculum in 2014. This initiative dramatically transformed the MD degree program, changing the instructional content taught, the pedagogical methods used by the faculty, and the methods of assessment, and it added new elements such as academic coaching and programmatic entrustment to the program. One of the most exciting and impactful aspects to date of this curricular transformation has been the deliberate implementation of a competency-based framework that incorporates frequent assessment, tracking of student progression using an electronic portfolio, and academic coaching to optimize learning and customize curricular elements for each student. The next major step in this process-the implementation of time-variable progression-is currently ongoing as a planning group at the school works through the conceptual, logistical, legal, and regulatory issues related to implementing such a system. When implementation is complete, MD students will graduate only once they have earned entrustment for all 13 Core Entrustable Professional Activities for Entering Residency. This article describes the school's progress to date in its curricular transformation and articulates lessons learned thus far in driving substantive and dramatic institutional changes that profoundly impact students, faculty, and administrators in one academic health center.

Considerations for Medical Students and Advisors After an Unsuccessful Match.

Increasing numbers of graduating U.S. medical students are not securing a graduate medical education (GME) position, even after participating in the National Resident Matching Program (also known as "the Match") and the Supplemental Offer and Acceptance Program. The reasons for an unsuccessful Match include increasing numbers of applicants compared with nearly unchanging numbers of available GME positions, academic problems or professionalism lapses, and a poor fit between applicants and their first-choice specialty.In this Perspective, the authors (1) examine the current Match landscape; (2) discuss the environmental factors that affect that Match landscape such as increasing medical school enrollment without a corresponding increase in GME positions; (3) review historical data on unmatched MD students; (4) discuss medical schools' responsibilities to unmatched students and to society; (5) explore controversial issues related to unmatched students, including graduation delays and altering the Medical Student Performance Evaluation for subsequent Match applications; and (6) outline various pathways for unmatched students to secure a GME position in the future or to pursue an alternative, nonclinical position. Finally, they share guidelines for advising unmatched students in the weeks and months following an unsuccessful Match. These recommendations aim to clarify what options exist, and are practical, for unmatched students, with the hope that further study will enable the development of best practices in this area.

Long-Term Effects of a Health Literacy Curriculum for Medical Students.

BACKGROUND AND OBJECTIVES: Although there are reports of short-term benefits of health literacy curricula for improving health care professionals' communication with patients, no studies have included long-term follow-up. We sought to determine (1) whether a pre-clerkship health literacy training can improve medical students' perceived knowledge and intended behaviors vis-á-vis communication with patients who have low health literacy, (2) the longevity of any such impact at 12 months, and (3) the impact of a follow-up training 1 year later. METHODS: We conducted pre- and post-training assessments of self-perceived knowledge and perceived and planned behavior following a health literacy training for first-year medical students, with a 12-month follow-up training and repeat pre/post assessment. RESULTS: Among 48 pre-clerkship students, improvement was reported on 10 of 12 items following the Year 1 training. At 12-month follow-up, prior to the Year 2 training, ratings on 8 of 10 items had regressed to baseline levels. Nine of these items again improved significantly after the Year 2 training. Students were asked after both trainings if they felt they had overestimated their understanding of health literacy; significantly more students agreed with this statement following the Year 2 training than the Year 1 training. CONCLUSIONS: Among a cohort of pre-clerkship medical students, improvements in perceived knowledge and planned behavior vis-á-vis health literacy training largely did not persist at 12-month follow-up. Efforts to teach medical students about health literacy principles and practices should include a longitudinal or integrated format, rather than a one-time lecture format.