"What's Next in My Arc of Development?": An Exploratory Study of What Medical Students Need to Care for Patients of Different Backgrounds.

PHENOMENON: Medical schools must equip future physicians to provide equitable patient care. The best approach, however, is mainly dependent on a medical school's context. Graduating students from our institution have reported feeling ill-equipped to care for patients from "different backgrounds" on the Association of American Medical Colleges' Graduation Questionnaire. We explored how medical students interpret "different patient backgrounds" and what they need to feel prepared to care for diverse patients. APPROACH: We conducted an exploratory qualitative case study using focus groups with 11, Year 2 (MS2) and Year 4 (MS4) medical students at our institution. Focus groups were recorded, transcribed, and coded using thematic analysis. We used Bobbie Harro's cycles of socialization and liberation to understand how the entire medical school experience, not solely the curriculum, informs how medical students learn to interact with all patients. FINDINGS: We organized our findings into four major themes to characterize students' medical education experience when learning to care for patients of different backgrounds: (1) Understandings of different backgrounds (prior to medical school); (2) Admissions process; (3) Curricular socialization; and (4) Co-curricular (or environmental) socialization. We further divided themes 2, 3, and 4 into two subthemes when learning how to care for patients of different backgrounds: (a) the current state and (b) proposed changes. We anticipate that following the proposed changes will help students feel more prepared to care for patients of differing backgrounds. INSIGHTS: Our findings show that preparing medical students to care for diverse patient populations requires a multitude of intentional changes throughout medical students' education. Using Harro's cycles of socialization and liberation as an analytic lens, we identified multiple places throughout medical students' educational experience that are barriers to learning how to care for diverse populations. We propose changes within medical students' education that build upon each other to adequately prepare students to care for patients of diverse backgrounds. Each proposed change culminates into a systemic shift within an academic institution and requires an intentional commitment by administration, faculty, admissions, curriculum, and student affairs.

Times of Medical Education Crisis Require New Evaluation Approaches: Proof of Concept of a System-Based Program Evaluation Model.

There are no program evaluation approaches designed for a crisis, such as the COVID-19 pandemic. It is critical to evaluate the educational impact of COVID-19 to keep administrators informed and guide decision-making. The authors used systems thinking to design an evaluation model. The evaluation results suggest complex interactions between individuals and course level changes due to COVID-19. Specifically, year 1-2 students found more education metrics lacking relative to year 3-4 students, faculty, and course directors. There was no consensus for the value of similar instructional/assessment adaptations. The evaluation model can be adapted by other medical schools to fit systems-based needs.

A Process and Rubric for a Group to Review the Quality of a Medical Education Course/Clerkship.

Introduction: Reviewing elements of a curriculum, such as courses and clerkships in medical school, is an essential part of the quality improvement process. Yet there is a gap in the literature in terms of actual rubrics for evaluating course quality in medical schools. Methods: This resource describes a course review process and rubric to evaluate course quality: A subcommittee of faculty members and students evaluates goals, content and delivery, assessment, feedback to students, grading, and student feedback for each course with the rubric. Course directors, Curriculum Committee members, and Curriculum Evaluation Subcommittee members were surveyed on their perception of the process. Results: A large majority of Curriculum Committee and Curriculum Evaluation Subcommittee members agreed that the review process was objective (100%), provided an evaluation of course quality (>95%), helped identify areas of improvement/strengths (>91%) and issues/concerns in the curriculum (>95%), helped them become more familiar with the curriculum (>90%), and was a catalyst for changes in a course (>77%). Course/clerkship directors had less agreement that the course review process was a catalyst for curriculum changes (46%) and that the process helped identify areas of improvement for a course (62%). Discussion: This curriculum evaluation process provides a resource for other institutions to use and/or modify for their own course evaluation process. All stakeholders in the review process agreed that the evaluation process was successful in identifying areas that worked and did not work in courses.