The Effect of Pass/Fail Exam Grading on Exam Performance in a Pediatric Clerkship.

OBJECTIVE: Clerkship grades are a component of determining a residency candidate's competitiveness. In 2017, the University of Minnesota Medical School's pediatric clerkship transitioned its standardized multiple-choice exam, the Aquifer Pediatrics Examination, to pass/fail with eligibility for honors being determined by clinical performance, not exam performance. We assessed the effect this change had on Aquifer exam performance and evaluated for correlation between Aquifer exam performance and clinical evaluation scores in order to gather insight into the validity of each type of assessment with respect to one another. METHODS: We analyzed de-identified data from 750 medical students between the academic years of 2016 to 2017 and 2019 to 2020. Individual Aquifer exam scores were compared to individual clinical performance scores. Differences in exam performance before and after the transition to pass/fail were investigated with a two-sample t-test and Cohen's d for effect size. RESULTS: No correlation was found between Aquifer exam scores and clinical performance scores. The mean Aquifer exam score prior to the transition to pass/fail was 80.02 ± 7.51 while the mean after the exam was made pass/fail was 77.8 ± 7.42. This difference was statistically significant (P < .001) with a Cohen's d (effect size) of 0.297. CONCLUSIONS: A lack of correlation between the Aquifer exam scores and clinical performance scores was found. There was a small yet statistically significant decrease in Aquifer exam scores after the change to pass/fail; it is not clear if this represents a meaningful decrease in learning by students.

Academic and Wellness Outcomes Associated with use of Anki Spaced Repetition Software in Medical School.

OBJECTIVES: Medical students are increasingly using a spaced repetition software called Anki to study. There are limited studies evaluating the relationship between Anki and learner outcomes. In this study, we describe the history of Anki use in medical school and assess the potential relationships between use of Anki and medical student academic, extracurricular, and wellness outcomes. METHODS: We used cross-sectional data from a 50-item online survey and retrospective academic performance data from our institution's outcomes database. Participants were medical students. The survey assessed the frequency and timing of Anki use, student perceived stress, sleep quality, burnout risk, and involvement in extracurricular activities. Academic success was measured by USMLE Step 1 and Step 2 scores. RESULTS: 165 students responded survey. 92 (56%) identified as daily Anki users. Daily Anki use was correlated with increased Step 1 score (P = .039), but not Step 2 scores. There was an association between Anki use and increased sleep quality (P = .01), but no difference for other measurements of wellness or extracurricular involvement. CONCLUSION: The study demonstrates potential benefits of daily use of Anki but also confirms that a variety of study methods can be used to achieve similar medical school outcomes.

Mindful Medical Education Online.

The COVID-19 pandemic disrupted medical education. In-person classes and clinical rotations were urgently canceled, followed by a historic and unprecedented migration to online teaching. Most medical school courses were not designed to be fully online, and faculty and students are novices in the process. The purpose of this article is to provide recommendations for educators to optimize their approach to online curricular transformation. Mindful teaching online creates presences that set climate and support discourse, establish routines that build practice, model professional expectations, and challenge but support learners.

Medical Student Workshop Improves Student Confidence in Working With Trained Medical Interpreters.

INTRODUCTION: Many physicians care for patients whose primary spoken language is not English, and these interactions present challenges in physician-patient communication. These challenges contribute to the significant health disparities experienced by populations with limited English proficiency (LEP). Using trained medical interpreters is an important step in addressing this problem, as it improves communication outcomes. Despite this, many medical education programs have little formal instruction on how to work effectively with interpreters. METHODS: To address this gap, we created an interactive workshop led by professional trained interpreters and faculty facilitators for medical students in their clinical years. Students were asked to evaluate the session based on relevance to their clinical experiences and helpfulness in preparing them for interactions with patients with LEP. RESULTS: Immediately after the session, students reported that the clinical scenarios presented were similar those seen on their clinical clerkships. They also reported increased confidence in their ability to work with interpreters. On later follow-up, students reported that the instruction helped prepare them for subsequent patient interactions that involved interpreters. CONCLUSION: A workshop is an effective method for improving medical student comfort and confidence when working with interpreters for populations with LEP.

Improving Resident Feedback on Diagnostic Reasoning after Handovers: The LOOP Project.

Appropriate calibration of clinical reasoning is critical to becoming a competent physician. Lack of follow-up after transitions of care can present a barrier to calibration. This study aimed to implement structured feedback about clinical reasoning for residents performing overnight admissions, measure the frequency of diagnostic changes, and determine how feedback impacts learners' self-efficacy. Trainees shared feedback via a structured form within their electronic health record's secure messaging system. Forms were analyzed for diagnostic changes. Surveys evaluated comfort with sharing feedback, self-efficacy in identifying and mitigating cognitive biases' negative effects, and perceived educational value of night admissions-all of which improved after implementation. Analysis of 544 forms revealed a 43.7% diagnostic change rate spanning the transition from night-shift to day-shift providers; of the changes made, 29% (12.7% of cases overall) were major changes. This study suggests that structured feedback on clinical reasoning for overnight admissions is a promising approach to improve residents' diagnostic calibration, particularly given how often diagnostic changes occur.