Student Teaching in the Family Medicine Clerkship: Opportunities for Interactive Virtual Learning.

OBJECTIVES: It often is challenging to deliver clerkship didactic sessions in a time-effective and engaging manner for learners. The flipped classroom approach, which fosters independent learning before applying knowledge in group settings, is an evidence-based way to enhance engagement and learning. Electronic learning methodologies were used widely during the coronavirus disease 2019 pandemic to ensure student safety while continuing didactics remotely. Student teaching of didactics delivers key content in innovative ways while also providing students with the opportunity to teach their peers. METHODS: During the Family Medicine clerkship at Florida International University Herbert Wertheim College of Medicine, students deliver an interactive, 15-minute presentation on a core Society of Teachers of Family Medicine National Clerkship Curriculum topic. During the first year of the pandemic (2020), this assignment was transitioned to be conducted remotely via Zoom. For the 2020-2021 academic year, students completed an anonymous, optional, computer-based, postactivity survey to assess their satisfaction with and perceptions of the assignment. RESULTS: The majority (80%) of respondents reported that they enjoyed teaching in the online format. In addition, students reported that this assignment made them feel confident in their teaching abilities, that they learned from their peers, and that teaching helped clarify their understanding of the topic. CONCLUSIONS: Student-led teaching is beneficial to learners because it enhances engagement. It can be easily implemented and help reduce faculty burden for curricular development. In a distributed, community-based clinical model such as ours, electronic learning allows for coordinated teaching efforts across geographical boundaries.

Medical Students' Perspectives on Opportunities to Engage in the Clinical Care of COVID-19 Patients during the Pandemic.

OBJECTIVES: Recent disease modeling suggests that pandemics are likely to increase in frequency and severity. As such, medical educators must learn from their experiences with coronavirus disease 2019 (COVID-19) to develop systematic strategies for ensuring that medical students receive hands-on training in the management of emerging diseases. Here, we outline the process by which the Florida International University Herbert Wertheim College of Medicine developed and updated guidelines for student participation in the care of patients with COVID-19 and report on students' experiences. METHODS: During the 2020-2021 academic year, Florida International University Herbert Wertheim College of Medicine students were not permitted to care for patients with COVID-19; however, academic year 2021-2022 guidelines did permit fourth-year students on subinternships or Emergency Medicine rotations to voluntarily care for patients with COVID-19. At the end of the 2021-2022 academic year, students completed an anonymous survey about their experience caring for patients with COVID-19. Likert-type and multiple-choice questions were analyzed using descriptive statistics and the short-answer responses were analyzed qualitatively. RESULTS: One hundred two students (84%) responded to the survey. Sixty-four percent of respondents opted to provide care for patients with COVID-19. Most students (63%) cared for patients with COVID-19 during their required Emergency Medicine Selective. Twenty-eight percent of students wished they had more COVID-19 patient care opportunities, and 29% did not feel prepared to care for patients with COVID-19 on their first day of residency. CONCLUSIONS: Many graduating students felt unprepared to care for patients with COVID-19 during residency and many wished they had had more opportunities to care for patients with COVID-19 during medical school. Curricular policies must evolve to allow students to gain competency in the care of patients with COVID-19 so that they are prepared for day one of residency.

Facilitating the Advance Care Planning Conversation with Patients: An Interactive Virtual 1.5-Hour Session.

OBJECTIVES: The Liaison Committee on Medical Education requires that the curriculum of medical schools includes end-of-life care. Most medical students feel reluctant to discuss end-of-life issues with their patients, but would like to learn more. METHODS: We created an educational session on using Five Wishes to facilitate the advance care planning conversation. Third- and fourth-year students were given a brief PowerPoint lecture detailing the importance of advance directives, barriers to advance care planning conversations, approaches for the conversation, and two brief video sample conversations. Students discussed their experiences related to advance directives and role-played a part of an advance care planning conversation. RESULTS: A total of 97 medical students participated in the didactic on advance care planning conversations from May 4, 2020 to October 24, 2020. Eighty-six (88.7%) of 97 students responded to the postcourse evaluation survey. Most of the respondents (96%) agreed or strongly agreed that the session was pertinent to learning needs and that the goals and objectives of the session were met. Ninety-two percent of respondents felt confident about having a conversation with a patient about advance directives and 88% of respondents felt comfortable starting and completing advance directives conversations. CONCLUSIONS: The brief didactic presented here on facilitating advance directives conversations constitutes an easily implemented and well-received session for medical students. Students reported high levels of confidence and comfort around having advance directive conversations after participating in this didactic session.

Attending an Alcoholics Anonymous Meeting: A Pilot Study of an Experiential Learning Activity on the Family Medicine Clerkship.

OBJECTIVES: Physicians frequently treat patients struggling with addiction, including alcohol abuse. The Society of Teachers of Family Medicine's National Clerkship Curriculum lists necessary learning for all future physicians and includes several core objectives related to identifying community resources, the role of support groups in treating patients, and identifying and managing substance abuse. METHODS: During the family medicine clerkship at the Florida International University Herbert Wertheim College of Medicine, students learn about resources for treating alcohol abuse by attending a 12-step Alcoholics Anonymous (AA) meeting and answering brief reflective questions about the experience. For the 2018-2019 academic year, students completed an anonymous, optional, computer-based, pre-/postactivity survey to assess the students' perceived impact of attending an AA meeting. RESULTS: After the AA meeting, there was an increase in the percentage of students who agreed or strongly agreed that AA meetings are a useful resource. Students perceived that they would be likely to refer a patient with alcohol abuse to AA in the future, were confident in their ability to explain AA to a patient, were knowledgeable about community resources for patients with alcohol addiction, and were confident in their ability to assess patients for alcohol abuse. CONCLUSIONS: Attendance at a single AA meeting increased students' awareness of community resources, including AA, for patients who abuse or misuse alcohol. Because students also reported increased perceived self-confidence regarding explaining AA to patients and assessing patients for alcohol addiction, attendance at an AA meeting has the potential to affect future patient care.

Understanding Successful Mentor-Mentee Relationships in New Faculty Scholars Program.

Background and Objectives: Mentorship is critical for the career development of health care professionals and educators. Facilitating successful mentorship is valuable in supporting future leaders and educators in family medicine. Since 1988, the Society of Teachers of Family Medicine's New Faculty Scholars (NFS) program has provided 1-year mentorship opportunities for new faculty. This qualitative study used group concept mapping to identify the characteristics of successful mentorship relationships within the NFS program. Methods: Eight New Faculty Scholars (five mentors, three mentees) from 2015 to 2021 participated in a virtual 90-minute group concept-mapping and pattern-matching session. Participants generated statements in response to a prompt about successful features of mentorship relationships. Participants categorized responses by similarity and rated each statement on a numerical scale from 1 to 5 (1 indicating lowest, 5 indicating highest) according to importance, current presence within the program, and feasibility. Results: Statements generated by participants were grouped into seven common themes. Categories rated most important included interpersonal skills, mentor soft skills, and mentor preparation. Structured processes and goal setting, mentor soft skills, and mentor preparation were rated most feasible in terms of future improvement. Conclusions: Interpersonal skills, mentor soft skills, and mentor preparation were the most highly rated by participants, but also displayed the largest disparity when compared to ratings on current presence. Future efforts to improve interpersonal communication and mentor training can potentially lead to greater satisfaction with the NFS program. The most highly rated categories indicated the primary benefit of the relational components of mentorship.

Next steps for workplace-based assessments of entrustable professional activities.

BACKGROUND: Florida International University Herbert Wertheim College of Medicine (FIU-HWCOM) participated in the AAMC Core Entrustable Professional Activities (EPA) implementation pilot. Entrustment decision processes based on data from workplace-based assessments (WBAs) were piloted. Outcomes illustrated challenges including variability across EPAs with regards to learner level alignment and feasibility of data collection in the form of WBAs. In addition, students reported discomfort requesting WBA completion by preceptors and dissatisfaction with associated feedback. APPROACH: To guide future directions, we conducted a survey of third-year students to better understand their experience with and perceptions of WBAs used to evaluate EPAs at FIU-HWCOM. EVALUATION: Survey response was 96% (n = 107/112). Most (84%) reported that WBAs were not valuable to their development and that preceptors often did not complete WBAs in a timely fashion. Many (47%) reported not receiving verbal feedback. Most students (78%) used language in written responses demonstrating confusion between the EPAs and the WBAs used to assess them. IMPLICATIONS: The use of WBAs to assess EPAs did not have its intended impact at FIU-HWCOM. For future classes, WBA forms will consist of paper cards with questions directly assessing performance of skills aligned with EPAs 1, 5 and 6 only. To continue to promote feedback, students will be required to collect WBAs on all clerkships, but the number of required WBAs will be less than prior and no entrustment decisions will be made.

Silent Myocardial Infarction: A Case Report.

Silent myocardial infarction (SMI) is a type of myocardial infarction (MI) that is asymptomatic or demonstrates mild symptoms; therefore, patients often do not seek medical treatment. SMI cases are often incidentally detected later by electrocardiogram (ECG). We present a case of a 59-year-old overweight woman with prediabetes, primary hypertension, and hypercholesterolemia who presented for herpes zoster (HZ) follow-up; she reported having skipped heartbeats and heart rate fluctuations during the review of systems. On further workup, ECG revealed low voltage QRS complexes, flat QRS complexes, flat T waves, and pathological Q waves, suggesting the diagnosis of SMI. Based on the identified risk factors, including high BMI, prediabetes, primary hypertension, hypercholesterolemia, HZ, and newly diagnosed SMI, the patient was advised to continue with lisinopril 20 mg daily, prescribed atorvastatin 80 mg daily, and was educated about maintaining a healthy diet, exercise, and receiving the shingles vaccination. To prevent the possible risks of poor outcomes such as those following MI, stroke, heart failure, arrhythmias, angina, and shortness of breath (SOB), the patient was referred to the cardiologist for a stress test and further treatment plan.

Professional Development Needs of Clerkship Directors.

BACKGROUND AND OBJECTIVES: Successful clerkship directors (CDs) must exhibit a variety of leadership, administrative, educational, and interpersonal skills. This study investigates the professional development needs for family medicine CDs to be successful in their role, in relation to career stage, institutional support, and needed resources. METHODS: A cross-sectional survey of CDs at qualifying United States and Canadian medical schools was performed between April 29, 2021 and May 28, 2021. Questions addressed specific training when beginning CD position, professional development activities that have contributed to success, additional professional development skills required to be a successful CD, and planned future development activities. We utilized χ2 square and Mann-Whitney U tests for comparisons. RESULTS: Surveys were completed by 75 CDs, for a response rate of 48.8%. Only 33.3% of respondents reported receiving training specific to their role as CD. The majority of respondents cited informal mentoring and conference attendance as important to their professional development, but none identified graduate degrees as the most important method of professional development. CONCLUSIONS: These findings demonstrate the lack of formal training provided to CDs and highlight the importance of informal training and conference attendance for professional development.

Writing an External Letter of Review for Promotion.

Academic promotion, representing achievement of a level of distinction in one's body of work, is an honorable accomplishment in a faculty member's career. External letters of review written by faculty at higher ranks are a critical component of the promotion portfolio. We discuss key considerations for writing external letters. These considerations can be used to mentor this skill for less experienced letter writers. We also highlight how professional societies can aid faculty in developing and strengthening writing and mentoring capabilities for this vital task.

Writing Collaboratively in Medical Education.

Scholarly writing and working in teams are vital skills for medical education faculty. Collaborative writing brings together team members from varying departments, professions, and universities and, as such, optimizes the resources and skill sets needed to develop high-quality projects and manuscripts. Previous literature discusses a broad perspective on collaborative writing, including writing surveys, submitting for institutional review board, and grant writing. We build on this work by providing detailed guidance for planning the writing process and then writing collaboratively towards a successful medical education submission.

What Do Medical Students Want From a Mentor?

Introduction: The medical education literature lacks a uniform definition of mentoring. Mentoring relationships benefit the mentor and mentee. Mentoring roles include coach, advisor, teacher, counselor, and sponsor in the setting of mutual trust toward impacting psychosocial and career functions for the mentee. Mentoring helps improve underrepresented minority medical student performance. Medical students value mentoring relationships. Student mentees note a positive influence on career planning and research and saw mentors as counselors, idea providers, and role models. Medical students' varied goals and development call for personalized, flexible mentoring. Methods: This study sought to expand the current understanding of medical student mentoring. We emailed a voluntary Qualtrics survey to second-, third-, and fourth-year medical students at the Florida International University (FIU) Herbert Wertheim College of Medicine asking, "What do you want from a mentor (choose all that apply)?" Multiple choice options were constructed based upon literature search. We conducted one-way analysis of variance and Tukey's test to identify whether mentoring preferences differed by student academic year. Results: Of 363 students, 171 responded (47% response rate). Top-rated responses included honest feedback, responsiveness, and professional connections or networking opportunities. Discussion: Student desire for honest feedback from mentors was prioritized, affirming the lack of need for impression management in the mentoring relationship. This investigation will be useful for specific mentoring relationships, helping to trigger discussion regarding specific mentoring hopes and training mentors.

Ectodermal Dysplasia Presenting as Hypodontia in a Nine-Year-Old Female.

Ectodermal dysplasia describes a group of disorders that involve abnormal development of ectodermal tissue, including hair, teeth, and sweat glands. This report presents a case of a child affected by ectodermal dysplasia presenting as abnormal teeth development. Social determinants of health, including recent immigration from an underserved area and lack of funds, have limited this child from an earlier diagnosis and have formed barriers to access proper oral rehabilitation.

Promoting Transfer of Learning to Practice in Online Continuing Professional Development.

ABSTRACT: Leveraging online learning tools and encouraging transfer of learning to practice remains a critical challenge to successful continuing professional development (CPD) offerings. Four sets of factors are essential to the transfer of learning from CPD into practice: learner characteristics, instructional design, content, and environment. Through incorporating elements of educational theories/frameworks into the planning of online CPD activities, educators can maximize opportunities for learning transfer. In this article, we highlight four educational theories/frameworks that provide useful insight to tackle these interrelated factors in online CPD: Self-Determination Theory considers the intrinsic and extrinsic motivation of participants, which can be encouraged through flexibility, customization, and choices available in online formats. Practical Inquiry Model encourages intentionally planning and embedding opportunities for reflection and dialogue in online activities to enhance knowledge application. Virtual Communities of Practice can be used to transcend spatial and temporal boundaries, promoting interactions and relationships where participants learn from peers. Finally, Professional Learning Networks can be fostered through developing interpersonal connections and sharing resources for informal and flexible learning. Online CPD is likely to increase in the future, and educators should consider elements of these educational theories/frameworks in the design and delivery of CPD to support participants' application of newly acquired knowledge.

Faculty Development Advancements-Lessons Learned in a Time of Change.

Faculty development (FD) activities at colleges of medicine shifted to virtual in March 2020 as the coronavirus pandemic limited in-person engagement. Medical schools delivered quality virtual faculty development (VFD) through accessing national and international experts virtually, improving faculty access to FD through recorded sessions, collaborating across institutions, and building on previous success as comfort with virtual platforms grew. Disruptive innovation and Keller's ARCS model, highlighting motivational concepts of attention, relevance, confidence, and satisfaction, guided nine faculty developers' reflections towards continuous quality improvement of VFD offerings. The convenience and low-cost availability of virtual activities mean this format will likely persist.

Abortion Opt-in Experience in Third-Year Clerkship.

INTRODUCTION: Despite the public health imperative that all medical practitioners serving reproductive-aged women know the components of abortion care and attain competency in nondirective pregnancy options counseling, exposure to abortion care in US medical school education remains significantly limited. METHODS: Florida International University Herbert Wertheim College of Medicine offers an opt-in clinical exposure to abortion care during the obstetrics and gynecology clerkship. During clerkship orientation, students watched a recorded presentation reviewing components of abortion care and emphasizing that participating students may increase or decrease involvement at any time without explanation. Students opting in completed a form specifying their desired level of involvement for each component as "yes," "no," or "not sure." RESULTS: Of 350 clerkship students over 23 6-week rotations, 98 (28%) chose to opt in, with opt-in form data available for 90 students. Ninety students chose to observe counseling for first- and second-trimester surgical abortion and medical abortion. Seven students used the option "no" for history taking and examine second trimester fetal parts. Twenty-four students marked "not sure" for participating in evacuation of first-trimester pregnancy. DISCUSSION: This educational intervention proved feasible and offers an opportunity for students to have experiential learning about abortion care in an inclusive, respectful manner. This experience may be incorporated into undergraduate and graduate medical education. Providing learners the opportunity for exposure to abortion care improves their overall medical education and will impact the care they provide as future clinicians.

Chronic Disease Management in Sickle Cell Trait Patients in the Primary Care Setting: A Case Report.

Sickle cell disease (SCD) is a heterogeneous group of inherited hemoglobinopathies associated with mutations in the beta subunit of the hemoglobin protein. Several case reports and scientific reviews of the current literature have been published that indicate individuals having a single copy of the mutant sickle cell allele, known as sickle cell trait (SCT), can experience the same functional asplenia and increased risk of cerebrovascular accidents, kidney disease, cardiovascular effects, and veno-occlusive diseases as SCD patients when they are exposed to extreme conditions and stressful environments such as high-altitude, deep-sea diving, and intense physical activity. SCT also impacts the management of chronic illnesses such as diabetes mellitus. Here, we report a patient presenting for primary care follow-up after an SCT-related splenic infarction in order to emphasize the unique impact of SCT on long-term care and preventive medicine in the primary care setting.

Impact of the Introduction of the Clinical Science Mastery Series on Family Medicine NBME Subject Examination Performance.

BACKGROUND AND OBJECTIVES: Many medical schools assess student clinical knowledge using the National Board of Medical Examiners (NBME) subject examinations. The Family Medicine Clinical Science Mastery Series (CSMS) self-assessments, which are made up of former Family Medicine NBME examination questions, became available in September 2017. They provide students with realistic practice questions and immediate performance feedback. To further assess the utility of various study tools available to our students, this study investigated the impact of the CSMS self-assessments for family medicine on the NBME family medicine subject examination performance. METHODS: Data analysis was conducted to compare student performance on the end-of-rotation NBME Family Medicine Clinical Subject Examination before and after the introduction of the CSMS family medicine self-assessments. The effect size was measured using a Cohen d analysis. We conducted an independent t-test analysis to determine the effect the NBME Family Medicine CSMS self-assessments had on end-of-rotation clinical subject examination scores. RESULTS: The analysis revealed statistically significant improvement in students' clinical subject examination scores after the release of the CSMS in September 2017 (n=90) compared to the students' scores prior to the availability of the CSMS (n=95). CONCLUSIONS: Student scores improved with the introduction of the NBME CSMS family medicine self-assessment. These results support recommending student use of the CSMS as a study tool for their end-of-clerkship NBME subject examinations.