Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review.

PHENOMENON: Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation. APPROACH: This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees. FINDINGS: The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy. INSIGHTS: Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.

Use of Sociodemographic Information in Clinical Vignettes of Multiple-Choice Questions for Preclinical Medical Students.

Purpose: This paper aims to characterize the use of demographic data in multiple-choice questions from a commercial preclinical question bank and determine if there is appropriate use of different distractors. Background: Multiple-choice questions for medical students often include vignettes describing a patient's presentation to help guide students to a diagnosis, but overall patterns of usage between different types of nonmedical patient information in question stems have yet to be determined. Methods: Three hundred eighty of 453 randomly selected questions were included for analysis after determining they contained a clinical vignette and required a diagnosis. The vignettes and following explanations were then examined for the presence/absence of 11 types of demographic information, including age, sex/gender, and socioeconomic status. We compared both the usage frequency and relevance between the 11 information types. Results: Most information types were present in less than 10% of clinical vignettes, but age and sex/gender were present in over 95% of question stems. Over 50% of questions included irrelevant information about age and sex/gender, but 75% of questions did not include any irrelevant information of other types. Patient weight and environmental exposures were significantly more likely to be relevant than age or sex/gender. Discussion: Students using the questions in this study will frequently gain practice incorporating age and sex/gender into their clinical reasoning while receiving little exposure to other demographic information. Based on our findings, we posit that questions could include more irrelevant information, outside age and sex/gender, to better approximate real clinical scenarios and ensure students do not overvalue certain demographic data. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01778-z.

The Effectiveness of a Virtual Anatomy Curriculum Versus Traditional Cadaveric Dissection in UNC SOM's First-Year Class.

Even prior to the COVID pandemic, the push for medical schools to adopt virtual anatomy curricula in lieu of human cadaveric dissection was growing. In this study, musculoskeletal and gastrointestinal anatomy examination scores of first-year medical students at the UNC School of Medicine were compared across three consecutive years. These classes experienced in-person, virtual, and hybridized anatomy curriculum, respectively. There was not a single instance noted where in-person curriculum produced higher examination scores than virtual or hybridized models. By incorporating virtual or hybridized models of anatomy, medical education programs can effectively reach and educate students far beyond the traditional cadaver laboratory.

Race, ethnicity, and gender representation in clinical case vignettes: a 20-year comparison between two institutions.

BACKGROUND: The medical case vignette has long been used in medical student education and frequently includes demographic variables such as race, ethnicity and gender. However, inclusion of demographic variables without context may reinforce assumptions and biases. Yet, the absence of race, sexual orientation, and social determinants of health may reinforce a hidden curriculum that reflects cultural blindness. This replication study compared proportions of race, ethnicity, and gender with University of Minnesota (UMN) findings. This study sought to determine if there has been progress in the representation of demographic characteristics in case vignettes. METHODS: University of North Carolina (UNC) case vignettes from 2015-2016 were analyzed and compared to UMN case vignettes from 1996-1998. Data included mentions of race, ethnicity, gender and social determinants of health. RESULTS: In the 278 UNC vignettes, white race was noted in 19.7% of cases, black race was in 7.9% cases, and 76.6% of cases were unspecified. In the 983 UMN vignettes, white race was recorded in 2.85% cases, and black race in 0.41% cases. The institutions were significantly different in the proportion of their cases depicting race (0.20; 95% CI (0.15, 0.25)). Males were represented in the majority of vignettes. DISCUSSION: Comparing case vignettes results from two medical schools suggests that reporting explicit demographic diversity was not significantly different. The findings illustrate that sex was the demographic characteristic consistently described, where males were over-represented. Based on these findings, greater cultural diversity as it intersects with social determinants of health is needed in medical student education.

Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy.

BACKGROUND: There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students. METHODS: The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork. Through offerings across a medical school curriculum, the LI introduced leadership principles and provided an opportunity to apply them in an interactive activity or simulation. We utilized the existing SOM evaluation platform to collect data on program outcomes that included satisfaction, fidelity to the learning model, and impact. RESULTS: From 2017 to 2020, over 70% of first-year medical students participated in LI course offerings while a smaller percentage of fourth-year students engaged in the curriculum. Most students had no prior awareness of LI course material and were equivocal about their ability to apply lessons learned to their medical school experience. Students reported that the LI offerings provided opportunities to practice the skills and competencies of self-awareness, communication, and collaboration/teamwork. DISCUSSION: Adding new activities to an already crowded medical curriculum was the greatest logistical challenge. The LI was successful in introducing leadership principles but faced obstacles in having participants apply and practice these principles. Most students reported that the LI offerings were aligned with the foundational competencies.

Differences in medical student performance on examinations: exploring score variance between Kolb's Learning Style Inventory classifications.

BACKGROUND: Kolb's Cycle of Learning Theory acts as a foundational framework for the evolution of knowledge gained by learners throughout their education. Through Kolb's cycle of experiential learning, one's preferred way of learning could impact academic achievement in the pre-clinical years of medical education. METHODS: The medical student classes of 2020 and 2021 at a public university in the southeastern U.S. were invited to complete Kolb's Learning Style Inventory (LSI). For those participants completing the LSI, examination results for their pre-clinical blocks were obtained and matched to the LSI results. Examination scores (locally-developed examinations and customized National Board of Medical Examiners (NBME) final examinations) were compared by LSI classification for each examination using Kruskal-Wallis Test. RESULTS: Out of 360 possible participants, 314 (87.2%) completed the Learning Style Inventory. Convergers and Assimilators made up 84.1% [Convergers (n = 177, 56.4%), Assimilators (n = 87, 27.7%)]. Accommodators (n = 25, 7.9%) and Divergers (n = 25, 7.9%) made up the remaining sample. Accomodators' scores were significantly lower on locally-developed examinations in Principles of Medicine, Hematology, and Gastrointestinal System. The only NBME examination that demonstrated a significant difference across learning styles was from the Cardiovascular block. CONCLUSIONS: Upon reviewing Kolb's LSI, our study indicated that performance on the customized NBME examinations minimized the variance in performance compared to locally-developed examinations. The lack of variance across learning styles for all but one NBME final examination appears to provide a more equitable assessment strategy.

Novel mitochondrial derived Nuclear Excisosome degrades nuclei during differentiation of prosimian Galago (bush baby) monkey lenses.

The unique cellular organization and transparent function of the ocular lens depend on the continuous differentiation of immature epithelial cells on the lens anterior surface into mature elongated fiber cells within the lens core. A ubiquitous event during lens differentiation is the complete elimination of organelles required for mature lens fiber cell structure and transparency. Distinct pathways have been identified to mediate the elimination of non-nuclear organelles and nuclei. Recently, we reported the discovery of a unique structure in developing fiber cells of the chick embryo lens, called the Nuclear Excisosome, that is intractably associated with degrading nuclei during lens fiber cell differentiation. In the chick lens, the Nuclear Excisosome is derived from projections of adjacent cells contacting the nuclear envelope during nuclear elimination. Here, we demonstrate that, in contrast to the avian model, Nuclear Excisosomes in a primate model, Galago (bush baby) monkeys, are derived through the recruitment of mitochondria to form unique linear assemblies that define a novel primate Nuclear Excisosome. Four lenses from three monkeys aged 2-5 years were fixed in formalin, followed by paraformaldehyde, then processed for Airyscan confocal microscopy or transmission electron microscopy. For confocal imaging, fluorescent dyes labelled membranes, carbohydrate in the extracellular space, filamentous actin and nuclei. Fiber cells from Galago lenses typically displayed prominent linear structures within the cytoplasm with a distinctive cross-section of four membranes and lengths up to 30 µm. The outer membranes of these linear structures were observed to attach to the outer nuclear envelope membrane to initiate degradation near the organelle-free zone. The origin of these unique structures was mitochondria in the equatorial epithelium (not from plasma membranes of adjacent cells as in the chick embryo model). Early changes in mitochondria appeared to be the collapse of the cristae and modification of one side of the mitochondrial outer membrane to promote accumulation of protein in a dense cluster. As a mitochondrion surrounded the dense protein cluster, an outer mitochondrial membrane enclosed the protein to form a core and another outer mitochondrial membrane formed the outermost layer. The paired membranes of irregular texture between the inner core membrane and the outer limiting membrane appeared to be derived from modified mitochondrial cristae. Several mitochondria were involved in the formation and maturation of these unique complexes that apparently migrated around the fulcrum into the cytoplasm of nascent fiber cells where they were stabilized until the nuclear degradation was initiated. Thus, unlike in the chick embryo, the Galago lenses degraded nuclear envelopes with a Nuclear Excisosome derived from multiple mitochondria in the epithelium that formed novel linear assemblies in developing fiber cells. These findings suggest that recruitment of distinct structures is required for Nuclear Excisosome formation in different species.

Working collaboratively across schools to promote oral health education through interprofessional education.

PURPOSE: The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools. METHODS: First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated. RESULTS: Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline. CONCLUSION: Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.

Dissection Versus Prosection: a Comparison of Laboratory Practical Examinations.

There is insufficient evidence supporting complete dissection as essential for medical student education. Due to physical constraints, we employed a hybrid teaching method. Gross anatomy practical examinations from two medical student classes were analyzed to determine performance on dissected versus student-prosected material. Overall, student performance on questions pertaining to personally dissected material was similar to performance on questions learned by studying student-prosected material. We found dissection time can be reduced without impacting medical student examination performance.

InstaHisto: Utilizing Instagram as a Medium for Disseminating Visual Educational Resources.

BACKGROUND: Applying active recall during studying vexes medical students. The integration of social media into medical education is rapidly expanding; however, there is minimal use of Instagram in medical education. Histology is a visually dominant subject and pairs well with Instagram. We sought to create a standardized process for medical educators to establish Instagram as a study tool for histology. METHODS: An Instagram account accessible to MS1s was created. Histology images in the course syllabus along with questions and explanations for each image were organized and posted to Instagram in a question and answer format. Instagram analytics on student engagement were gathered along with student survey responses. RESULTS: Seventy-four percent (141/190) of the class followed the account. Images had an average of 442 total views. Images had an average of 3.5 views per user (VPUs), ranging from 2.6 to 4.3 VPUs, suggesting that students are viewing images multiple times. Ninety-eight percent of survey responders found the account easy to use. Ninety-five percent said studying the account increased their confidence when answering histology questions on exams, and 75% said the account led to decreased stress when studying histology. DISCUSSION: Instagram is a platform that the majority of our medical students are already using daily. There was strong evidence of student engagement via Instagram analytics. Once a database of images with questions and answers is established, content can readily be posted to Instagram for students to study. Once established, this process can be applied to other visual content, such as anatomy, radiology, pathology, and microbiology.

Cracking the Nut on LCME Standard 8.7: Innovations to Ensure Comparability Across Geographically Distributed Campuses.

Problem: A large state university in the southeastern United States and state Area Health Education Centers (AHEC) collaborated to establish branch campuses to increase clinical capacity for medical student education. Prior to formally becoming branch campuses, two AHEC sites had established innovative curricular structures different than the central campus. These sites worked with the central campus as clinical training sites. Upon becoming formal campuses, their unique clinical experiences were maintained. A third campus established a curricular structure identical to the central campus. Little exists in the literature regarding strategies that ensure comparability yet allow campuses to remain unique and innovative. Intervention: We implemented a balanced matrix organizational structure, well-defined communication plan, and newly developed tool to track comparability. A balanced matrix organization model framed the campus relationships. Adopting this model led to identifying reporting structures, developing multidirectional communication strategies, and the Campus Comparability Tool. Context: The UNC School of Medicine central campus is in Chapel Hill. All 192 students complete basic science course work on central campus. For required clinical rotations, approximately 140 students are assigned to the central campus, which includes rotations in Raleigh or Greensboro. The remaining students are assigned to Asheville (25-30), Charlotte (25-30), or Wilmington (5-7). Chapel Hill and Wilmington follow identical rotation structures, 16 weeks each of (a) combined surgery and adult inpatient experiences; (b) combined obstetrics/gynecology, psychiatry, and inpatient pediatrics; and (c) longitudinal clinical experiences in adult and pediatric medicine. Asheville offers an 8-month longitudinal integrated outpatient experience with discreet inpatient experiences in surgery and adult care. Charlotte offers a 6-month longitudinal integrated experiences and 6 months of block inpatient experiences. Aside from Charlotte and Raleigh, the other sites are urban but surrounded by rural counties. Chapel Hill is 221 miles from Asheville, 141 from Charlotte, and 156 from Wilmington. Outcome: Using the balanced matrix organization, various reporting structures and lines of communication ensured the educational objectives for students were clear on all campuses. The communication strategies facilitated developing consistent evaluation metrics across sites to compare educational experiences. Lessons Learned: The complexities of different healthcare systems becoming regional campuses require deliberate planning and understanding the culture of those sites. Recognizing how size and location of the organization affects communication, the central campus took the lead centralizing functions when appropriate. Adopting uniform educational technology has played an essential role in evaluating the comparability of core educational content on campuses delivering content in very distinct ways.

Interprofessional Education: Oral Health in the Medical Curriculum.

Schools of medicine and dentistry on the same geographical campus have an opportunity to promote oral health by training physicians to become more skilled in screening for oral disease in addition to counseling and referring patients to dental health professionals.

Comparison of Medical Student Learning Styles and Exam Performance in an Integrated Curriculum.

BACKGROUND: There has been an emphasis on the implementation of self-directed learning in medical education. Kolb's experiential learning theory could be a useful framework in curriculum development. ACTIVITY: During the 2016-2017 academic year, participants completed the learning styles inventory. Percent time dedicated to lecture, laboratory, small groups, modules, simulations, and exams was collected along with participant academic performance. RESULTS: Findings showed that the curriculum delivery accommodated Assimilators and Convergers, with Convergers primarily outscoring the other categories. DISCUSSION: Although efforts emphasized self-directed learning, the curriculum is still delivered by lectures. Based on Kolb's theory, lecturing benefits Converger and Assimilator learning styles.

Clinical Skills Simulation Complementing Core Content: Development of the Simulation Lab Integrated Curriculum Experience (SLICE).

Simulation is emerging as an essential component of the medical school curriculum. Simulation Lab Integrated Curriculum Experience (SLICE) is a student-organized program at the University of North Carolina School of Medicine (UNC SOM) for medical students that provides skills-based training sessions to augment didactic learning experiences. During its pilot year, SLICE conducted five events with respondents completing pre-and post-surveys evaluating participants' level of comfort with procedures. There was a significant increase in self-reported confidence after each session, with students providing overwhelmingly positive feedback regarding SLICE's ability to contextualize material presented in traditional lectures.

Teaching procedural skills to medical students: A pilot procedural skills lab.

BACKGROUND: Medical students have limited confidence in performing procedural skills. A pilot study was conducted to evaluate the effect of a multifaceted Procedural Skills Lab (PSL) on the confidence of medical students to perform procedural skills. METHODS: Twelve 2nd year medical students were randomly selected to participate in a pilot PSL. The PSL students met with an instructor for 2 h once a week for 4 weeks. Students participated in a flipped classroom and spaced education program before laboratory sessions that included a cadaver laboratory. Procedural skills included a focused assessment with sonography in trauma (FAST) scan, cardiac echocardiogram, lumbar puncture, arthrocentesis, and insertion of intraosseous and intravenous catheters. Students in the PSL were asked to rank their confidence in performing procedural skills before and after completion of the laboratory sessions (Wilcoxon ranked-sum test). A web-based questionnaire was also emailed to all 2nd year medical students to establish a baseline frequency for observing, performing, and confidence performing procedural skills (Mann-Whitney U-test). RESULTS: Fifty-nine percent (n = 106) of 180 2nd year medical students (n = 12 PSL students [treatment group], n = 94 [control group]) completed the survey. Frequency of observation, performance, and confidence in performing procedural skills was similar between the control and treatment groups at baseline. There was an increased confidence level (p < 0.001) for performing all procedural skills for the treatment group after completion of the PSL. DISCUSSION: An innovative PSL may increase students' confidence to perform procedural skills. Future studies will examine competency after a PSL.

Identification and Ultrastructural Characterization of a Novel Nuclear Degradation Complex in Differentiating Lens Fiber Cells.

An unresolved issue in structural biology is how the encapsulated lens removes membranous organelles to carry out its role as a transparent optical element. In this ultrastructural study, we establish a mechanism for nuclear elimination in the developing chick lens during the formation of the organelle-free zone. Day 12-15 chick embryo lenses were examined by high-resolution confocal light microscopy and thin section transmission electron microscopy (TEM) following fixation in 10% formalin and 4% paraformaldehyde, and then processing for confocal or TEM as described previously. Examination of developing fiber cells revealed normal nuclei with dispersed chromatin and clear nucleoli typical of cells in active ribosome production to support protein synthesis. Early signs of nuclear degradation were observed about 300 µm from the lens capsule in Day 15 lenses where the nuclei display irregular nuclear stain and prominent indentations that sometimes contained a previously undescribed macromolecular aggregate attached to the nuclear envelope. We have termed this novel structure the nuclear excisosome. This complex by confocal is closely adherent to the nuclear envelope and by TEM appears to degrade the outer leaflet of the nuclear envelope, then the inner leaflet up to 500 µm depth. The images suggest that the nuclear excisosome separates nuclear membrane proteins from lipids, which then form multilamellar assemblies that stain intensely in confocal and in TEM have 5 nm spacing consistent with pure lipid bilayers. The denuded nucleoplasm then degrades by condensation and loss of structure in the range 600 to 700 µm depth producing pyknotic nuclear remnants. None of these stages display any classic autophagic vesicles or lysosomes associated with nuclei. Uniquely, the origin of the nuclear excisosome is from filopodial-like projections of adjacent lens fiber cells that initially contact, and then appear to fuse with the outer nuclear membrane. These filopodial-like projections appear to be initiated with a clathrin-like coat and driven by an internal actin network. In summary, a specialized cellular organelle, the nuclear excisosome, generated in part by adjacent fiber cells degrades nuclei during fiber cell differentiation and maturation.

Using Rasch measurement to score, evaluate, and improve examinations in an anatomy course.

Any examination that involves moderate to high stakes implications for examinees should be psychometrically sound and legally defensible. Currently, there are two broad and competing families of test theories that are used to score examination data. The majority of instructors outside the high-stakes testing arena rely on classical test theory (CTT) methods. However, advances in item response theory software have made the application of these techniques much more accessible to classroom instructors. The purpose of this research is to analyze a common medical school anatomy examination using both the traditional CTT scoring method and a Rasch measurement scoring method to determine which technique provides more robust findings, and which set of psychometric indicators will be more meaningful and useful for anatomists looking to improve the psychometric quality and functioning of their examinations. Results produced by the more robust and meaningful methodology will undergo a rigorous psychometric validation process to evaluate construct validity. Implications of these techniques and additional possibilities for advanced applications are also discussed.