Capacity for wonder among medical students: Assessment and educational implications.

OBJECTIVE: The capacity for wonder (CfW) is a personal disposition related to lifelong learning and moral character development, two highly valued characteristics of health professionals. We previously developed and validated a CfW measure among college students. Here we describe how the scale performs among medical students. METHODS: We invited all students at a top-tier U.S. medical school (N = 477) to participate in an online survey including the CfW measure, year in medical school, and demographics. We performed confirmatory factor analysis on the CfW measure and reassessed its reliability. RESULTS: 276 students completed the survey for an overall response rate of 58%. Factor analysis resulted in a 10-item scale with an alpha of 0.79 and an eigen value of 3.57. Factor loadings ranged from 0.43 to 0.77. The mean total score was 39.3 (SD = 8.9) out of a possible high score of 60. Total scores varied by year in school with significantly lower scores among 2nd year students (32.9 vs. 41.5; p < 0.001). CONCLUSION: We confirmed the reliability of a 10-item CfW scale in 4 cohorts of medical students. Results suggest that the 2nd year of medical school poses the greatest risk to students' capacity for wonder. Efforts should be made to understand this phenomenon and develop interventions to mitigate it. Future research should explore the validity of the CfW scale, its utility in evaluating interventions designed to cultivate the capacity for wonder, its applicability to other groups of health professionals, and its association with ethical decision-making and practice.

Student curriculum review team, 8 years later: Where we stand and opportunities for growth.

BACKGROUND: The Student Curriculum Review Team (SCRT) was founded at the Johns Hopkins University School of Medicine (JHUSOM) in 2012 to refine pre-clinical courses. Since then, SCRT has provided a voice for student feedback - offering forums for discussion through 'Town Hall meetings' and confidential avenues for peer-to-peer comments. Here, we assess the perceived efficacy and utility of SCRT among the student body and faculty course directors. METHODS: A cross-sectional analysis was conducted in 2019 using an anonymous survey distributed to second- (MS2) and third-year (MS3) medical students as well as faculty course directors at JHUSOM. RESULTS: A total of 113 student surveys and 13 faculty surveys were returned. The majority of students (97%) endorsed SCRT as effective in enabling them to express their concerns. Most faculty (69%) reported SCRT's impact on their respective course as positive and found SCRT suggestions to be 'realistic and actionable.' Students (84%) and faculty (62%) alike considered SCRT to meet needs not met by other curricular organizations at JHUSOM. CONCLUSION: Students and faculty find that SCRT satisfies an unfilled position in the landscape of curricular feedback at JHUSOM. This study may be beneficial for other academic institutions considering ways to better engage students in curricular reform.

Do questions help? The impact of audience response systems on medical student learning: a randomised controlled trial.

BACKGROUND: Audience response systems (ARSs) are electronic devices that allow educators to pose questions during lectures and receive immediate feedback on student knowledge. The current literature on the effectiveness of ARSs is contradictory, and their impact on student learning remains unclear. OBJECTIVES: This randomised controlled trial was designed to isolate the impact of ARSs on student learning and students' perception of ARSs during a lecture. METHODS: First-year medical student volunteers at Johns Hopkins were randomly assigned to either (i) watch a recorded lecture on an unfamiliar topic in which three ARS questions were embedded or (ii) watch the same lecture without the ARS questions. Immediately after the lecture on 5 June 2012, and again 2 weeks later, both groups were asked to complete a questionnaire to assess their knowledge of the lecture content and satisfaction with the learning experience. RESULTS: 92 students participated. The mean (95% CI) initial knowledge assessment score was 7.63 (7.17 to 8.09) for the ARS group (N=45) and 6.39 (5.81 to 6.97) for the control group (N=47), p=0.001. Similarly, the second knowledge assessment mean score was 6.95 (6.38 to 7.52) for the ARS group and 5.88 (5.29 to 6.47) for the control group, p=0.001. The ARS group also reported higher levels of engagement and enjoyment. CONCLUSIONS: Embedding three ARS questions within a 30 min lecture increased students' knowledge immediately after the lecture and 2 weeks later. We hypothesise that this increase was due to forced information retrieval by students during the learning process, a form of the testing effect.

The Student Curriculum Review Team: How we catalyze curricular changes through a student-centered approach.

Student feedback is a valuable asset in curriculum evaluation and improvement, but many institutions have faced challenges implementing it in a meaningful way. In this article, we report the rationale, process and impact of the Student Curriculum Review Team (SCRT), a student-led and faculty-supported organization at the Johns Hopkins University School of Medicine. SCRT's evaluation of each pre-clinical course is composed of a comprehensive three-step process: a review of course evaluation data, a Town Hall Meeting and online survey to generate and assess potential solutions, and a thoughtful discussion with course directors. Over the past two years, SCRT has demonstrated the strength of its approach by playing a substantial role in improving medical education, as reported by students and faculty. Furthermore, SCRT's uniquely student-centered, collaborative model has strengthened relationships between students and faculty and is one that could be readily adapted to other medical schools or academic institutions.

Recognizing Reflection: Computer-Assisted Analysis of First Year Medical Students' Reflective Writing.

BACKGROUND: Reflective writing is used throughout medical education to help students navigate their transformation into medical professionals. Assessment of reflective writing, however, is challenging; each available methodology of assessment has distinct advantages and disadvantages. We tested if combining two independent assessment mechanisms-a faculty-designed rubric and Academic Writing Analytics (AWA), an automated technique-could be used together to form a more robust form of evaluation. METHODS: We obtained reflective essays written by first year medical students as part of a clinical skills course. Faculty scored essays using a rubric designed to evaluate Integration, Depth, and Writing. The same essays were subjected to AWA analysis, which counted the number of reflective phrases indicative of Context, Challenge, or Change. RESULTS: Faculty scored the essays uniformly high, indicating that most students met the standard for reflection as described by the rubric. AWA identified over 1400 instances of reflective behavior within the essays, and there was significant variability in how often different types of reflective phrases were used by individual students. CONCLUSIONS: While data from faculty assessment or AWA alone is sufficient to evaluate reflective essays, combining these methods offer a richer and more valuable understanding of the student's reflection.

Tracking reflective practice-based learning by medical students during an ambulatory clerkship.

OBJECTIVE: To explore the use of web and palm digital assistant (PDA)-based patient logs to facilitate reflective learning in an ambulatory medicine clerkship. DESIGN: Thematic analysis of convenience sample of three successive rotations of medical students' patient log entries. SETTING: Johns Hopkins University School of Medicine. PARTICIPANTS: MS3 and MS4 students rotating through a required block ambulatory medicine clerkship. INTERVENTIONS: Students are required to enter patient encounters into a web-based log system during the clerkship. Patient-linked entries included an open text field entitled, "Learning Need." Students were encouraged to use this field to enter goals for future study or teaching points related to the encounter. MEASUREMENT AND MAIN RESULTS: The logs of 59 students were examined. These students entered 3,051 patient encounters, and 51 students entered 1,347 learning need entries (44.1% of encounters). The use of the "Learning Need" field was not correlated with MS year, gender or end-of-clerkship knowledge test performance. There were strong correlations between the use of diagnostic thinking comments and observations of therapeutic relationships (Pearson's r=.42, p<0.001), and between diagnostic thinking and primary interpretation skills (Pearson's r=.60, p<0.001), but not between diagnostic thinking and factual knowledge (Pearson's r =.10, p=.46). CONCLUSIONS: We found that when clerkship students were cued to reflect on each patient encounter with the electronic log system, student entries grouped into categories that suggested different levels of reflective thinking. Future efforts should explore the use of such entries to encourage and track habits of reflective practice in the clinical curriculum.

The positive impact of team-based virtual microscopy on student learning in physiology and histology.

Team-based virtual microscopy and on-line learning were used to transform the first-year Physiology/Histology course at The Johns Hopkins School of Medicine into a student-centered learning environment. Prior to each laboratory session, students were required to view prelaboratory virtual lectures and examine digital slides that had been enhanced with annotations and 2-min microlectures. The laboratory classroom was then used for team-based learning exercises including student presentations and small-group discussions designed to integrate histology and physiology. The results of quantitative assessments indicated an 8- to 14-point increase over the identical final exams given over the past 5 yr. Means (+/-SD) of percent correct answers on the final exam were found to be 75.2% (11.1%), 72.5% (12.6%), 70.5% (12.6%), 73.6% (11.3%), 73.1% (12.2%), and 84.1% (9.1%) for years 2001-2006, respectively. The mean test scores for all other years were statistically lower compared with 2006, as determined by the Bonferroni post hoc multiple-comparison test (P < 0.001 for all years).

Redefining classroom instruction.

In this study, the role of the classroom instructor was redefined from a "lecturer" responsible for delivering the core curriculum to a "facilitator" at the center of an active learning environment. Web-based lectures were used to provide foundation content to students outside of the classroom, which made it possible to improve the quality of student-faculty contact time in the classroom. Students reported that this hybrid format of instruction afforded them a better understanding of the content, a higher probability of retaining the content, and the opportunity to spend more time thinking about the application of the content compared with more traditional lecture-based methods of instruction.

A mobile app for measuring the surface area of a burn in three dimensions: comparison to the Lund and Browder assessment.

The aim of this study was to compare the ease and accuracy of measuring the surface area of a severe burn through the use of a mobile software application (BurnMed) to the traditional method of assessment, the Lund and Browder chart. BurnMed calculates the surface area of a burn by enabling the user to first manipulate a three-dimensional model on a mobile device and then by touching the model at the locations representing the patient's injury. The surface area of the burn is calculated in real time. Using a cohort of 18 first-year medical students with no experience in burn care, the surface area of a simulated burn on a mannequin was made using BurnMed and compared to estimates derived from the Lund and Browder chart. At the completion of this study, students were asked to complete a questionnaire designed to assess the ease of use of BurnMed. Users were able to easily and accurately measure the surface area of a simulated burn using the BurnMed application. In addition, there was less variability in surface area measurements with the application compared to the results obtained using the Lund and Browder chart. Users also reported that BurnMed was easier to use than the Lund and Browder chart. A software application, BurnMed, has been developed for a mobile device that easily and accurately determines the surface area of a burn. This system uses a three-dimensional model that can be rotated, enlarged, and transposed by the health care provider to easily determine the extent of a burn. Results show that the variability of measurements using BurnMed is lower than the measurements obtained using the Lund and Browder chart. BurnMed is available at no charge in the Apple™ Store.

Quantitative and qualitative evaluation of a web-based, interactive approach for teaching the management of angle-closure glaucoma.

PURPOSE: To construct a validated Internet-based teaching system that improves diagnostic and therapeutic skills related to glaucoma diagnosis. DESIGN: Nonrandomized clinical trial. PARTICIPANTS AND/OR CONTROLS: Thirty-four glaucoma specialists and 21 ophthalmologists-in-training. METHODS: An interactive program was designed to improve the recognition of gonioscopic findings and to manage angle-closure glaucoma (ACG) patients, including technical information in performing gonioscopy, ability to recognize angle structures, and treatment choices. The behavior of participants permitted the assessment of degree of improvement related to the interaction. The program content was validated by 5 academic glaucoma subspecialists. Then, 34 fellowship-trained glaucoma specialists and 21 ophthalmology residents accessed the program. Results were evaluated using paired and nonpaired t tests and analysis of variance. MAIN OUTCOME MEASURES: Comparison of pretest and posttest scores of residents and glaucoma specialists on measures of gonioscopy recognition and questions related to ACG management. RESULTS: Residents improved their recognition of gonioscopic findings after viewing the program (P<0.0001), scoring significantly worse than glaucoma specialists before interacting with the program (P<0.0001), but scoring at equivalent levels to specialists after viewing the program (P=0.34). The time necessary to improve knowledge by interacting with the program was significantly related to year of residency training (P<0.0001, analysis of variance). The rate of correct answers to management questions related to ACG increased with increasing years of experience in ophthalmology, validating the education methodology (P<0.0001). CONCLUSIONS: A web-based teaching approach for diagnosis and management of ACG evaluated the knowledge of ophthalmologists in a manner consistent with their expected expertize. Statistically significant improvements in validated knowledge of ACG were demonstrated for this educational method.