"Near Miss": A Mixed-Methods Analysis of Medical Student Assignments in Patient Safety.

The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to identify a patient safety event and indicate if the event required an incident report. Assignments were reviewed and coded based on Joint Commission incident definitions. Qualitative analysis was performed to evaluate incident report justification. There were 473 student assignments included in the analysis. Assignments reported incidents regarding communication, medical judgment, medication errors, and coordination of care. Students indicated only 18.0% (85/473) would warrant an incident report. Justification for not filing an incident report included lack of harm to the patient or that it was previously reported. Students were able to identify system issues but infrequently felt an incident report was required. Justifications for not filing an incident report suggest a need for a curriculum focused on the value of reporting near misses and hazardous conditions.

Four-year longitudinal culinary and lifestyle medicine track for undergraduate medical students: development and implementation.

The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.

Collaborative Development and Implementation of a Hybrid Virtual Surgery Clerkship Curriculum in a Vietnamese Medical School.

OBJECTIVE: To collaboratively develop a hybrid virtual curriculum for a medical school surgery clerkship within an emerging medical university in Vietnam. DESIGN: A hybrid virtual surgery clerkship curriculum was collaboratively developed by Vietnamese and American surgeons as part of an international partnership between their respective universities. A set of 25 virtual lectures with associated materials were created and deployed in tandem with live, in-person review and skills sessions. Student quantitative and qualitative evaluation methods were developed and deployed to allow continuous iteration. A 6-month course was deployed to develop surgical faculty into effective teachers. SETTING: The curriculum was deployed at VinUniversity College of Health Sciences, the youngest medical university in Vietnam. It was developed in collaboration with the University of Pennsylvania Perelman School of Medicine. Each cohort of 12 students in the surgical clerkship will participate in the curriculum. CONCLUSIONS: The development of this hybrid surgical clerkship in Vietnam leveraged local resources and expertise with those available remotely. Lessons learned are directly applicable to future collaborative curriculum development efforts at other emerging medical schools.

Undergraduate Medical Education Curriculum Reforms in Pakistan: A Mixed Methods Study of Academic Leadership Perspectives.

PURPOSE: Periodic revision of undergraduate medical education (UGME) curricula is an essential part of evidence-based educational practices. Pakistan's national UGME curriculum, last updated in 2005, was reviewed, and recommended updates were made in 2022. The authors explore academic medical school leaders' perspectives about the proposed reforms, gaps within the existing curriculum, and how to ensure the reform implementation is effective, collaborative, and feedback-driven. METHOD: Using a mixed methods approach, data were collected from April to July 2022. Academic leadership (principals, who could designate vice principals or medical educators) at all medical schools across Pakistan (n = 117) were invited. Agreement with each of 20 proposed reforms was measured via a survey employing a Likert scale. A semistructured interview guide expanded on the survey questions with probes. RESULTS: Eighty-eight survey responses, from private (59; 67.0%) and public (29; 33.0%) institutions, were obtained (75.2% response rate). Participants recommended most of the proposed reforms. The 3 reforms that received the highest agreement were teaching professionalism as an integral part of the curriculum (83; 94.3%), mandating bedside procedural skills training (80; 90.9%), and including patient safety in the UGME curriculum (79; 89.8%). Including multidisciplinary tumor boards and surgical oncology had the lowest agreement (26; 29.5%). Fifteen interviews were conducted, which revealed 3 major themes: perceptions about changes to the curricular content, limitation of human and financial resources as barriers to reform implementation, and recommendations for effective implementation of an updated curriculum. CONCLUSIONS: The findings reflect an overall positive attitude of academic medical school leadership toward the 20 proposed UGME curriculum reforms, which could aid with on-the-ground implementation. However, major limitations, such as a lack of trained faculty and financial resources, must be addressed. The authors propose future research on the resources required for implementing UGME reforms and the reforms' impact after national implementation.

Student advanced trauma management and skills (SATMAS): a validation study.

INTRODUCTION: Despite trauma accounting 9% of global mortality, it has been demonstrated that undergraduate trauma teaching is inadequate nationally and worldwide. With COVID-19 exacerbating this situation, a scalable, accessible, and cost-effective undergraduate trauma teaching is required. METHODS: Our Continual Professional Development United Kingdom (CPUDK)-accredited University Hospitals Birmingham (UHB) Major Trauma Service (MTS) affiliated programme consisted of seven biweekly pre-recorded sessions that were delivered online through the Moodle educational platform to University of Birmingham students. Pre- and post-randomised session-specific multiple-choice questions (MCQs) and anonymous feedback forms were administered. RESULTS: There were 489 student responses, with 63 students completing all seven sessions. On an 8-point scale, students' objective knowledge scores increased by a mean of 1.2 (p < 0.001). Using a 5-point Likert scale, students also showed improvement in subjective outcomes including their confidence in assessing trauma patient (absolute difference (AD) 1.38, p < 0.001), advising initial investigations and formulating initial management plans (AD 1.78, p < 0.001) and thereby their confidence to manage a trauma patient overall (AD 1.98, p < 0.001). A total of 410 student responses endorsed the online delivery of SATMAS through Moodle and recommended SATMAS to future medical students. CONCLUSION: SATMAS has demonstrated positive student feedback and extensive recruitment from only one centre, demonstrating that our programme can be an indispensable low-cost learning resource that prepares undergraduate medical students for their trauma exams and informs the implementation of clinical skills required by all doctors. We publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities nationally and internationally, to synergistically benefit students, tutors, and ultimately patients, on a larger scale.

Third year medical student knowledge gaps after a virtual surgical rotation.

INTRODUCTION: This study describes perceived knowledge gaps of third-year medical students after participating in a virtual surgical didactic rotation (EMLR) and shortened in-person surgery rotation during the COVID-19 Pandemic. METHODS: Open-ended and Likert questions were administered at the end of the virtual rotation and inperson-surgical rotation to medical students. Three blinded coders identified themes by semantic analysis. RESULTS: 82 students (51% of all MS3s) participated in the EMLR. Semantic analysis revealed gaps in perioperative management (Post-EMLR:18.4%, Post-Inpatient:26.5%), anatomy (Post-EMLR:8.2%, PostInpatient:26.5%). and surgical skills (Post-EMLR: 43.0%, Post-Inpatient: 44.1%). Students also described gaps related to OR etiquette (Post-EMLR: 12.2%, Post-Inpatient: 8.8%) and team dynamics/the hidden curriculum (Post- Inpatient:26.6%). There was a significant improvement in perceived confidence to perform inpatient tasks after completing the inpatient clinical experience (p ≤ 0.01). CONCLUSION: Virtual interactive didactics for cognitive skills development cannot replace a full clinical surgical experience for third-year medical students. Future curricula should address perceived gaps.

Effect of a surgical observership on the perceptions and career choices of preclinical medical students: a mixed-methods study.

BACKGROUND: Medical students are increasingly choosing nonsurgical specialties; observership programs can address factors influencing them toward surgical careers by allowing preclerkship exposure and mentorship, and correcting misconceptions. The aims of this study were to assess the influence of a peer-led observership program at the Université de Montréal on the career choices of preclinical medical students and to determine the factors associated with a positive observership experience. METHODS: We used a quasi-experimental convergent mixed-methods questionnaire design. From Nov. 19 to Dec. 31, 2018, and Mar. 1 to Apr. 4, 2019, all medical students participating in the observership program were eligible for the study; there were no ineligibility criteria. Using a prospective purposive sampling method, we recruited students via the email sent to confirm their observership. In the week after their observership, we invited the students by email to complete a postintervention survey. We used nonparametric tests to evaluate the impact of the observership on participants' career choices and an inductive data-driven thematic analysis to analyze their responses. RESULTS: Of the 204 students who participated, 157 provided consent, of whom 85 (54.1%) completed questionnaires both before and after the observership. The majority of participants were interested in a surgical specialty before (72 [85%]) and after (68 [84%]) the observership. There was no significant change in the students' choices of surgical specialties after the observership. However, most (68 [81%]) reported being more interested in a surgical career as a result of the observership, which allowed them to see that the type of practice they considered was congruent with a surgical career. Their perceptions of the field of surgery became positive, particularly regarding its pace and atmosphere and the humanistic patient-doctor relationship it required. The experience was influenced by surgeons' and teams' attitudes toward students, knowledge-sharing and quality of exposure. Participants mentioned that their willingness to participate was in part responsible for the success of their experience. CONCLUSION: This observership program allowed an early, positive introduction of students to surgery while challenging stereotypes. It provided a better understanding of surgery, enabling participants to consider this field and potentially influencing their residency application.

Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training.

BACKGROUND: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers' abilities to provide quality care to patients of color.In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. OBJECTIVES: We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. METHODS: Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. RESULTS: PALMs training produced statistically significant (P < .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. CONCLUSIONS: Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.

University of Toronto's redesigned ophthalmology curriculum and eye dissection lab.

OBJECTIVE: To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning. DESIGN: Curriculum review, validation, and student feedback evaluations. PARTICIPANTS: Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program. METHODS: Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012-2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017-2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test. RESULTS: Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001). CONCLUSIONS: The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.

Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature.

Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.

Diversity in Dermatology? An Assessment of Undergraduate Medical Education.

BACKGROUND: A lack of representation of skin of color (SoC) in dermatology curricula is well-documented across North American medical schools and may present a barrier to equitable and comprehensive undergraduate medical education. OBJECTIVES: This study aims to examine representation in dermatologic educational materials and appreciate a link between bias in dermatologic education and student diagnostic ability and self-rated confidence. DESIGN: The University of Toronto Dermatology Undergraduate Medical Education curriculum was examined for the percentage photographic representation of SoC. A survey of 10 multiple-choice questions was administered to first- and third-year medical students at the University of Toronto to assess diagnostic accuracy and self-rated confidence in diagnosis of 5 common skin lesions in Fitzpatrick skin phototypes (SPT) I-III (white skin) and VI-VI (SoC). RESULTS: The curriculum audit showed that <7% of all images of skin disease were in SoC. Diagnostic accuracy was fair for both first- (77.8% and 85.9%) and third-year (71.3% and 72.4%) cohorts in white skin and SoC, respectively. Students' overall self-rated confidence was significantly greater in white skin when compared to SoC, in both first- (18.75/25 and 17.78/25, respectively) and third-year students (17.75/25 and 15.79/25, respectively) (P = .0002). CONCLUSIONS: This preliminary assessment identified a lack of confidence in diagnosing dermatologic conditions in SoC, a finding which may impact health outcomes of patients with SoC. This project is an important first step in diversifying curricular materials to provide comprehensive medical education.

Radiation oncology education and experience in the undergraduate medical setting.

The goal of this study was to determine the impact and experience of radiation oncology (RO) education in the undergraduate medical experience in the USA. A list of American medical schools was complied from various sources including the Association of American Medical Colleges (AAMC) and American Association of Colleges of Osteopathic Medicine (AACOM) in the summer of 2019. Data was extracted through institution website review, individual phone calls and email distribution. A total of 198 programs (155 allopathic and 43 osteopathic medical schools) were included. Every medical school curriculum had oncology lecture during MS year 1 and 2, although a minimal amount (4%) had a RO-specific lecture during MS year 1 and 2. There were significant differences in the RO education and experience in allopathic (MD) versus osteopathic (DO) programs. Home radiation oncology programs and career advising were associated with a radiation oncology elective during year 3 and 4. Furthermore, RO career advisors and older schools were associated with having one student match into radiation oncology. RO education during the didactic portion of the undergraduate medical experience remains extremely limited. This limitation is even more pronounced in medical schools without RO mentorship and in osteopathic medical schools. This lack of RO exposure perpetuates itself by bringing less students into the field. These issues require attention both on a national and medical-school-specific level.

Fully Integrated Readiness for Service Training (FIRST): An Accelerated Medical Training Program for Rural and Underserved North Carolina.

PROBLEM: The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas. APPROACH: At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC's 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students. OUTCOMES: As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program. NEXT STEPS: The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.

Implementation and evaluation of eight virtual surgical electives for medical students during the COVID-19 pandemic.

BACKGROUND: Eight novel virtual surgery electives (VSEs) were developed and implemented in April-May 2020 for medical students forced to continue their education remotely due to COVID-19. METHODS: Each VSE was 1-2 weeks long, contained specialty-specific course objectives, and included a variety of teaching modalities. Students completed a post-course survey to assess changes in their interest and understanding of the specialty. Quantitative methods were employed to analyze the results. RESULTS: Eighty-three students participated in the electives and 67 (80.7%) completed the post-course survey. Forty-six (68.7%) respondents reported "increased" or "greatly increased" interest in the course specialty completed. Survey respondents' post-course understanding of each specialty increased by a statistically significant amount (p-value = <0.0001). CONCLUSION: This initial effort demonstrated that VSEs can be an effective tool for increasing medical students' interest in and understanding of surgical specialties. They should be studied further with more rigorous methods in a larger population.

Medical Student Education During COVID-19: Electronic Education Does Not Decrease Examination Scores.

BACKGROUND: During the COVID-19 emergency, medical students were mandated to remain home, creating challenges to providing education remotely for third-year clinical rotations. This study aims to assess student reception and investigate objective outcomes to determine if online learning is a suitable alternative. METHODS: Medical students enrolled in the third-year surgical clerkship during COVID-19 were asked to participate in a survey. 19 of 27 (70%) students participated. Content, faculty-led lectures, and resident-led problem-based learning (PBL) sessions were assessed using a ten-point Likert scale. National Board of Medical Examiners (NBME) examination, weekly quiz, and oral examination scores were compared to previous years. Student t-tests compared the groups. RESULTS: The median age was 25 years. Comparing in-person to electronic sessions, there was no difference in effectiveness of faculty sessions preparing students for NBME (6.2 vs. 6.7, P = .46) or oral examinations (6.4 vs. 6.8, P = .58); there was also no difference in resident-led PBL sessions preparing students for NBME (7.2 vs. 7.2, P = .92) or oral examinations (7.4 vs. 7.6, P = .74). Comparing this group to students from the previous academic year, there was no difference in weekly quiz (85.3 vs. 87.8, P = .13), oral examination (89.8 vs. 93.9, P = .07), or NBME examination (75.3 vs. 77.4, P = .33) scores. DISCUSSION: Surgical medical didactic education can effectively be conducted remotely through faculty-led lectures and resident-led PBL sessions. Students did not have a preference between in-person and electronic content in preparation for examinations. As scores did not change, electronic education may be adequate for preparing students for examinations in times of crisis such as COVID-19.

Difficult conversations: Navigating intimate partner violence with standardized patients.

BACKGROUND: One in three women in the US experience intimate partner violence (IPV) in their lifetime. There are minimal opportunities for medical students to learn about responding to IPV. METHODS: Students participated in a learning intervention about recognizing and addressing IPV, followed by a standardized patient session. Students filled out a seven-question survey before and after the session, which assessed comfort addressing IPV, discussing resources, and practicing trauma-informed care. Responses were compared using the Mann-Whitney U test. RESULTS: Sixteen medical students participated, response rate of 100%. The median score for comfort recognizing signs of IPV increased from 2 to 3 (p < 0.01); for asking patients about IPV, from 1 to 3.5 (p < 0.01); in knowledge of IPV resources, from 1 to 3 (p < 0.01); in preparedness to practice trauma informed care, from 2 to 3.5 (ns). Comfort addressing IPV improved from 1 to 3 (p < 0.01). CONCLUSION: After the session, student preparedness and comfort addressing IPV increased. The learning intervention addressed information not in standard medical curricula. This module can be easily adapted to any medical school curricula.

Medical Student Participation in Otolaryngology Telemedicine Clinic During COVID-19: A Hidden Opportunity.

The undergraduate medical student educational experience was greatly altered this year due to coronavirus disease 2019. Many otolaryngology departments increased use of telemedicine technologies to avoid the need for in-person contact. Medical student incorporation into telemedicine clinics is important to increase their comfort with this format of patient care and to continue student exposure to the field of otolaryngology. The technical and logistical aspects of student inclusion in telemedicine clinics at our institution are detailed. While telemedicine is still an evolving tool for experienced practitioners, there are likely advantages to the use of telemedicine patient visits for student learning. These may include closer working relationships between student and preceptor, as well as increased opportunities for student observation and feedback. Medical students should not assume telemedicine experiences are of inferior educational quality to in-person patient interactions. Future research should investigate ways telemedicine could enhance student learning.

"Fighting an uphill battle": A mixed methods exploration of surgeon involvement in medical schools' preclinical curricula.

BACKGROUND: Limited exposure to surgeons early on in medical school may adversely impact students' clerkship experiences and professional development. This explanatory sequential mixed methods study investigates a perceived discrepancy between surgical and nonsurgical instructors in our institution's preclinical curriculum. METHODS: The demographics of preclinical faculty were assessed before and after a curricular reform. Semi-structured interviews with 13 surgical faculty explored barriers and facilitators to surgeon involvement. Responses were inductively coded and thematically analyzed. RESULTS: Surgeons' contributions to preclinical instruction fell from 10% to 5% across the curriculum reform. Barriers both leading to and reinforced by surgeons' limited involvement relate to surgeon, medical school, and student factors. Participants proposed three solutions to barriers in each domain. CONCLUSIONS: Surgeons provide a minority of our preclinical instruction and may be disproportionately impacted by reform efforts. Deliberate efforts are necessary to increase opportunities for surgeons to engage with preclinical medical students.