Dataset: Knowledge and attitude retention following an implicit bias classroom workshop.

Background: Baylor College of Medicine provides a classroom-based implicit bias workshop to all third-year medical students to increase students' awareness of their unconscious bias and develop strategies for reducing health care disparities. The workshop meets our immediate goals and objectives. However, we are unsure if the benefit would be long-term or diminish over time. Methods: To examine the concept retention from the implicit bias classroom workshop, we administered a self-developed seven-item seven-point Likert-scale survey to our medical students at pre-, post-, and one-year post-workshop attendance. Results: The data set was comprised of survey results from two cohorts of our third and fourth-year medical students from 2018 to 2020 and included 289 completed records at three measurement points. The data included: Student Identifiers, Sex, Race/Ethnicity, Student Enrollment Type, Cohort, and three repeated measures results for each of the seven items, which were documented in wide format. The data may be of interest to those who wish to examine how factors including elapsed time, race, and sex may associate with attitudes and understandings of implicit bias following related training, and those interested in analytical methods on longitudinal research in general.

Longitudinal outcomes one year following implicit bias training in medical students.

PURPOSE: Training in implicit bias is broadly recognized as important in medical education and is mandated by some accrediting bodies. This study examined medical students' retention of concepts immediately following and one-year post participation in an implicit bias workshop. METHODS: Study subjects were 272 third-year medical students who participated in workshops held between 2018-2020 that used the Implicit Associations Test (IAT) as a trigger for discussions in small groups. We developed a survey and administered it to students to capture their awareness of implicit bias pre-, post-, and one-year post-workshop attendance. Repeated Measures Analyses and independent-samples t-tests were used to examine for differences in responses on each of the seven survey items and a tabulated 7-item average of these seven items. RESULTS: Six of seven survey items and the tabulated 7-item average examined by Repeated Measures Analyses showed statistically significant increases between the pre-, post-, and one-year post-surveys (ps range: 0.01-0.07), with a small to moderate effect sizes (ƞp2s range: 0.01-0.07). Pairwise comparisons among these three surveys' results indicated statistically significant improvements between the pre- and the post-workshop surveys (ps range: 0.01-0.03) but no statistically significant differences between the post- and the one-year post-workshop surveys (ps range: 0.57-0.99). A separate sample of 17 off-cycle students who took the one-year post- workshop survey two years after the workshop did not differ statistically on the level of awareness of bias compared to those taking the same survey one year later, as examined by the two-group independent t-tests for the seven one-year post-workshop survey items (ps range: 0.56-0.99). CONCLUSIONS: The findings support one-year retention of knowledge and attitudes gained from an implicit bias workshop and suggest similar retention at two years. Future educational interventions that train learners to recognize and manage implicit and explicit behaviors in clinical practice are needed.

The Performance and Trajectory of Medical Students With Disabilities: Results From a Multisite, Multicohort Study.

PURPOSE: To conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs). METHOD: From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care. RESULTS: A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08). CONCLUSIONS: Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

No place like home redesign: home-based clinical care as an interprofessional training model for medical and pharmacy students.

Proper program assessment is necessary to ensure the delivered curriculum aligns with the intended curriculum. No Place Like Home (NPLH) is an interprofessional experience in which a healthcare team provides clinical services to patients in a home environment. Following review of program evaluation data, we determined the original design of NPLH was not meeting the intended objectives, and NPLH was redesigned in January 2018. Changes include lengthening the experience, decreasing the team size, improving assessment tools and additional training for the preceptors. The revised curriculum includes a care team with a preceptor, a medical, and a pharmacy student who visit four to six patients on an assigned day. From May 1, 2018 to April 30, 2019, there were 320 students who participated in NPLH. The preceptor assessments of students across the five objectives had mean scores of 3.4-3.7 on a 4 point scale indicating that on average preceptors placed students between Demonstrates Competence and Demonstrates Excellence for all objectives. When students were asked to compare their ability to collaborate interprofessionally after NPLH to the time before, 79% stated Somewhat Better Now or Much Better Now. It is not sufficient to create interprofessional learning activities and assume learning objectives are being met. Ongoing performance assessment and curricular evaluation are essential to ensure such goals are achieved. When intended objectives are not being met, it is possible to make deliberate and purposeful changes to redirect interprofessional learning experiences while maintaining the integrity, novelty and uniqueness of the experience.

Using a Resuscitation-Based Simulation Activity to Create an Interprofessional Education Activity for Medical, Nursing, and Pharmacy Students.

Introduction: To achieve high-quality, patient-centered care, teaching programs across health professions must prepare their learners to work in effective teams. We created a simulation activity to formatively assess interprofessional objectives in graduating medical, nursing, and pharmacy students. This simulation also gave learners an opportunity to practice clinical airway resuscitation skills. Methods: The simulation featured a decompensating adult asthmatic with a chief complaint of shortness of breath and a final diagnosis of severe asthma exacerbation and respiratory failure. Students completed a prebrief to formulate a plan and then interacted with a mannequin. Faculty led a debriefing and completed assessments of the team's performance. The students completed a questionnaire assessing their own and the team's performance. Results: Four sessions were held over a 2-year period. A total of 91 graduating students participated in the activity: 33 from Baylor College of Medicine, 26 from University of Houston College of Pharmacy, and 28 from Texas Woman's University Nelda C. Stark College of Nursing. Postsession questionnaire data demonstrated very good overall team performance and good individual performance. Student comments demonstrated an understanding of the importance of teamwork and thoughtful reflection on their own areas for improvement. All students rated the activity as valuable and effective. Multirater assessments of the students found that most met three of the four objectives. Discussion: This activity allows for real-time formative assessment with a focus on roles, communication, and managing difficult situations. The debriefing demonstrates the students' understanding of interprofessional goals in providing effective patient-centered care.

Family Medicine Clerkship Directors' Handling of Student Mistreatment: Results From a CERA Survey.

BACKGROUND AND OBJECTIVES: Little is known about how family medicine clerkship directors (FMCDs) handle reports of student mistreatment. We investigated FMCDs' involvement in handling and resolving these reports. METHODS: We collected data as part of the 2019 CERA survey of FMCDs. FMCDs provided responses on how they handled student mistreatment reports and their comfort level in resolving these reports. RESULTS: Ninety-nine out of 142 FMCDs (69.7%) responded to the survey. Regarding mistreatment reports, 24.2% of FMCDs had received at least one report of student mistreatment about full-time faculty in the past 3 years, compared to 64.6% of FMCDs receiving at least one report about community preceptors (P<.001). Regarding who determined the response to the mistreatment, 13.1% of FMCDs were the highest level of leadership responsible for stopping use of a full-time faculty member for mistreatment concerns, while 42.4% of FMCDs were the highest level of leadership responsible for stopping use of a community preceptor. Regarding their comfort level in resolving mistreatment reports, 59.1% of FMCDs were either somewhat or very comfortable resolving a mistreatment report about a community preceptor, while only 48.9% reported those comfort levels for full-time faculty. FMCDs who had previously stopped using full-time faculty and/or community preceptors due to mistreatment reports were less likely to feel comfortable with resolving reports about full-time faculty compared to those who had no such experience (P=.03). CONCLUSIONS: FMCDs more frequently receive mistreatment reports about community preceptors than full-time faculty and are more likely to be the highest decision maker to stop using a community preceptor for mistreatment concerns. Further study is needed to elucidate factors that affect FMCDs' comfort in handling student mistreatment reports.

Teaching Laboratory Stewardship in the Medical Student Core Clerkships Pathology-Teaches.

CONTEXT.­: Current health care spending is unsustainable, and there is a need to teach high-value care principles to future physicians. Pathology-Teaches is an educational intervention designed to teach laboratory stewardship early in clinical training, at the level of the medical student in their core clinical clerkships. OBJECTIVE.­: To assess the pilot implementation of case-based educational modules in 5 required core clerkships at our institution. DESIGN.­: The online cases were developed by using a multidisciplinary approach. In the Pathology-Teaches educational module, students make decisions regarding the ordering or interpretation of laboratory testing within the context of a clinical scenario and receive immediate feedback during the case. The intervention was assessed by using pretest and posttest. Student feedback was also collected from end-of-rotation evaluations. RESULTS.­: A total of 203 students completed the Pathology-Teaches pilot, including 72 in Family Medicine, 72 in Emergency Medicine, 24 in Internal Medicine, 24 in Neurology, and 11 in Obstetrics-Gynecology (OB-GYN). Pathology-Teaches utility was demonstrated by significantly increased improvement between pretest and posttest scores (mean, 63.1% versus 83.5%; P < .001; Hedge g effect size = 0.93). Of the 494 students who completed the Pathology-Teaches questions on the end-of-rotation evaluation, 251 provided specific feedback, with 38.6% (97 of 251) rating the activity as "extremely valuable" or "very valuable," and 41.4% (104 of 251) as "some/moderate value." Qualitative feedback included 17 positive comments with 6 requests to scale up or include more cases, 16 constructive comments for improvement mainly regarding the technical aspects, and 5 negative comments. CONCLUSIONS.­: Pathology-Teaches effectively teaches stewardship concepts, and most students perceived value in this educational intervention.

Variability in student perceptions of mistreatment.

BACKGROUND: As medical schools strive to improve the learning environment, it is important to understand medical students' perceptions of mistreatment. The purpose of this study was to explore student interpretations of previously reported mistreatment incidents to better understand how they conceptualise the interactions. METHODS: Medical students were presented with case scenarios of previously reported instances of mistreatment and asked to indicate their agreement as to whether the scenarios demonstrated mistreatment, using a five-point Likert scale (1, strongly disagree; 5, strongly agree). It is important to understand medical student's perceptions of mistreatment RESULTS: One hundred and twenty-seven third-year medical students gave feedback on 21 mistreatment cases. There was variability in the categorisation of the scenarios as mistreatment. The highest degree of consensus (96% agreement) was for a scenario in which a resident claimed a student made statements about a patient's status that the student did not make. There was also relative consensus on three additional scenarios: (1) a patient making disparaging remarks about a student's role in health care in relation to the student's ethnicity (88% agreement); (2) a resident asking a student to run personal errands (86% agreement); and (3) a nurse calling a student an expletive in front of others (77% agreement). For the majority of the cases, there was no consensus amongst students as to whether mistreatment had occurred. Students self-identifying as minorities and students who had previously reported mistreatment were more likely to perceive mistreatment in the scenarios. CONCLUSIONS: There is remarkable variability, and in many cases a lack of agreement, in medical student perceptions of mistreatment. This inconsistency needs to be considered in order to effectively address and mitigate the issue.

Medical Students' Use of Different Coping Strategies and Relationship With Academic Performance in Preclinical and Clinical Years.

Phenomenon: Medical students' coping abilities are important for academic success and emotional health. The authors explored differences in students' use of active, problem-solving strategies and emotional, inwardly directed approaches; the change in coping strategies used during medical school; and coping strategy impact on performance. APPROACH: One hundred eighty-three students completed the Ways of Coping Scale at matriculation and end of the 2nd and 3rd years. Frequency of each of 8 ways of coping, changes in coping strategy use over time, and relationship of coping method with preclinical and clinical scores were calculated. FINDINGS: Students varied widely in use of coping mechanisms. Over time, students shifted to using emotional strategies more frequently while decreasing their use of active strategies. Coping strategies were unrelated to preclinical academic performance (R2 = .09, adjusted R2 = .04, ns) but were related to clinical performance (R2 = .23, adjusted R2 = .18, p < .0001), with active coping associated with higher performance and emotional methods associated with lower performance. Insights: Students decreased use of active coping strategies and increased use of emotional coping strategies over time, but emotional strategies were associated with poorer clinical academic performance. These shifts in coping methods may be detrimental to student performance and learning. Improving students' ability to cope should be an educational priority.

Medical student perceptions of an initial collaborative immersion experience.

Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration. Students attend 14 sessions at one of 18 different clinical sites. They work directly with different health professionals from among 17 possible professions, including nurses, pharmacists, social workers, and respiratory, occupational, and physical therapists. Between 2015 and 2016, 167 students completed the course, and 81 completed the end-of-course evaluation. Students agreed or strongly agreed that ICE meaningfully contributed to their understanding of healthcare teams and different professional roles (86%), improved their understanding of healthcare systems (84%), improved their ability to communicate with healthcare professionals (61%), and improved their ability to work on interprofessional teams (65%). Select themes from narrative comments suggest that clinical immersion improves understanding of professional roles, helps students understand their own future roles in healthcare teams, and increases awareness of and respect for other professionals, with the potential to change future practice. ICE may be a template for other schools wishing to expand their current educational offerings, by engaging learners in more authentic, longitudinal clinical experiences with practicing healthcare professionals.

The interrupted learner: How distractions during live and video lectures influence learning outcomes.

New instructional technologies have been increasingly incorporated into the medical school learning environment, including lecture video recordings as a substitute for live lecture attendance. The literature presents varying conclusions regarding how this alternative experience impacts students' academic success. Previously, a multi-year study of the first-year medical histology component at the University of Michigan found that live lecture attendance was positively correlated with learning success, while lecture video use was negatively correlated. Here, three cohorts of first-year medical students (N = 439 respondents, 86.6% response rate) were surveyed in greater detail regarding lecture attendance and video usage, focusing on study behaviors that may influence histology learning outcomes. Students who reported always attending lectures or viewing lecture videos had higher average histology scores than students who employed an inconsistent strategy (i.e., mixing live attendance and video lectures). Several behaviors were negatively associated with histology performance. Students who engaged in "non-lecture activities" (e.g., social media use), students who reported being interrupted while watching the lecture video, or feeling sleepy/losing focus had lower scores than their counterparts not engaging in these behaviors. This study suggests that interruptions and distractions during medical learning activities-whether live or recorded-can have an important impact on learning outcomes. Anat Sci Educ 11: 366-376. © 2017 American Association of Anatomists.

Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum.

PURPOSE: To determine medical students' study behaviors when preparing for the United States Medical Licensing Examination (USMLE) Step 1, and how these behaviors are associated with Step 1 scores when controlling for likely covariates. METHOD: The authors distributed a study-behaviors survey in 2014 and 2015 at their institution to two cohorts of medical students who had recently taken Step 1. Demographic and academic data were linked to responses. Descriptive statistics, bivariate correlations, and multiple linear regression analyses were performed. RESULTS: Of 332 medical students, 274 (82.5%) participated. Most students (n = 211; 77.0%) began studying for Step 1 during their preclinical curriculum, increasing their intensity during a protected study period during which they averaged 11.0 hours studying per day (standard deviation [SD] 2.1) over a period of 35.3 days (SD 6.2). Students used numerous third-party resources, including reading an exam-specific 700-page review book on average 2.1 times (SD 0.8) and completing an average of 3,597 practice multiple-choice questions (SD 1,611). Initiating study prior to the designated study period, increased review book usage, and attempting more practice questions were all associated with higher Step 1 scores, even when controlling for Medical College Admission Test scores, preclinical exam performance, and self-identified score goal (adjusted R = 0.56, P < .001). CONCLUSIONS: Medical students at one public institution engaged in a self-directed, "parallel" Step 1 curriculum using third-party study resources. Several study behaviors were associated with improved USMLE Step 1 performance, informing both institutional- and student-directed preparation for this high-stakes exam.

Climbing Bloom's taxonomy pyramid: Lessons from a graduate histology course.

Bloom's taxonomy was adopted to create a subject-specific scoring tool for histology multiple-choice questions (MCQs). This Bloom's Taxonomy Histology Tool (BTHT) was used to analyze teacher- and student-generated quiz and examination questions from a graduate level histology course. Multiple-choice questions using histological images were generally assigned a higher BTHT level than simple text questions. The type of microscopy technique (light or electron microscopy) used for these image-based questions did not result in any significant differences in their Bloom's taxonomy scores. The BTHT levels for teacher-generated MCQs correlated positively with higher discrimination indices and inversely with the percent of students answering these questions correctly (difficulty index), suggesting that higher-level Bloom's taxonomy questions differentiate well between higher- and lower-performing students. When examining BTHT scores for MCQs that were written by students in a Multiple-Choice Item Development Assignment (MCIDA) there was no significant correlation between these scores and the students' ability to answer teacher-generated MCQs. This suggests that the ability to answer histology MCQs relies on a different skill set than the aptitude to construct higher-level Bloom's taxonomy questions. However, students significantly improved their average BTHT scores from the midterm to the final MCIDA task, which indicates that practice, experience and feedback increased their MCQ writing proficiency. Anat Sci Educ 10: 456-464. © 2017 American Association of Anatomists.

Teaching across the continuum: variations in rankings and valued teaching components between surgery residents and medical students.

BACKGROUND: Surgical faculty teach medical students and residents within the same environment; however, each group may require different teaching methods. The aim of this study was to identify teaching components valued by these sets of learners. METHODS: Teaching evaluations for 43 surgical faculty members who received yearly evaluations from students and residents were analyzed. Highest and lowest ranked educators in medical student evaluations were traced to corresponding rankings in resident evaluations. Thematic analysis was conducted on written comments. RESULTS: Educators rated the highest in the medical student group were spread out among the residents' rankings, with several educators being rated the lowest. Similar patterns were observed in reverse for faculty rated highly by residents. CONCLUSIONS: Residents and medical students value faculty teaching using different criteria, with residents more focused on operative autonomy and medical students focused on approachability. Using one group to define best teaching methods is insufficient as learners value different optimal attributes.

A Hybrid Interview Model for Medical School Interviews: Combining Traditional and Multisampling Formats.

PROBLEM: Most medical schools have either retained a traditional admissions interview or fully adopted an innovative, multisampling format (e.g., the multiple mini-interview) despite there being advantages and disadvantages associated with each format. APPROACH: The University of Michigan Medical School (UMMS) sought to maximize the strengths associated with both interview formats after recognizing that combining the two approaches had the potential to capture additional, unique information about an applicant. In September 2014, the UMMS implemented a hybrid interview model with six, 6-minute short-form interviews-highly structured scenario-based encounters-and two, 30-minute semistructured long-form interviews. Five core skills were assessed across both interview formats. OUTCOMES: Overall, applicants and admissions committee members reported favorable reactions to the hybrid model, supporting continued use of the model. The generalizability coefficients for the six-station short-form and the two-interview long-form formats were estimated to be 0.470 and 0.176, respectively. Different skills were more reliably assessed by different interview formats. Scores from each format seemed to be operating independently as evidenced through moderate to low correlations (r = 0.100-0.403) for the same skills measured across different interview formats; however, after correcting for attenuation, these correlations were much higher. NEXT STEPS: This hybrid model will be revised and optimized to capture the skills most reliably assessed by each format. Future analysis will examine validity by determining whether short-form and long-form interview scores accurately measure the skills intended to be assessed. Additionally, data collected from both formats will be used to establish baselines for entering students' competencies.

Student Evaluation of Faculty Physicians: Gender Differences in Teaching Evaluations.

PURPOSE: To investigate whether there is a difference in medical student teaching evaluations for male and female clinical physician faculty. METHODS: The authors examined all teaching evaluations completed by clinical students at one North American medical school in the surgery, obstetrics and gynecology, pediatrics, and internal medicine clinical rotations from 2008 to 2012. The authors focused on how students rated physician faculty on their "overall quality of teaching" using a 5-point response scale (1 = Poor to 5 = Excellent). Linear mixed-effects models provided estimated mean differences in evaluation outcomes by faculty gender. RESULTS: There were 14,107 teaching evaluations of 965 physician faculty. Of these evaluations, 7688 (54%) were for male physician faculty and 6419 (46%) were for female physician faculty. Female physicians received significantly lower mean evaluation scores in all four rotations. The discrepancy was largest in the surgery rotation (males = 4.23, females = 4.01, p = 0.003). Pediatrics showed the next greatest difference (males = 4.44, females = 4.29, p = 0.009), followed by obstetrics and gynecology (males = 4.38, females = 4.26, p = 0.026), and internal medicine (males = 4.35, females = 4.27, p = 0.043). CONCLUSIONS: Female physicians received lower teaching evaluations in all four core clinical rotations. This comprehensive examination adds to the medical literature by illuminating subtle differences in evaluations based on physician gender, and provides further evidence of disparities for women in academic medicine.

Correlating students' educational background, study habits, and resource usage with learning success in medical histology.

Histology is a traditional core basic science component of most medical and dental education programs and presents a didactic challenge for many students. Identifying students that are likely to struggle with histology would allow for early intervention to support and encourage their learning success. To identify student characteristics that are associated with learning success in histology, three first-year medical school classes at the University of Michigan (>440 students) were surveyed about their educational background, attitudes toward learning histology, and their use of histology learning strategies and resources. These characteristics were linked with the students' quiz and examination results in histology. Students who reported previous experience in histology or pathology and hold science or biomedical science college degrees usually did well in histology. Learning success in histology was also positively associated with students' perception that histology is important for their professional career. Other positive indicators were in-person participation in teacher-guided learning experiences, specifically lecture and laboratory sessions. In contrast, students who relied on watching histology lectures by video rather than going to lectures in-person performed significantly worse. These characteristics and learning strategies of students who did well in this very visual and challenging study subject should be of help for identifying and advising students early, who might be at risk of failing a histology course or component.

What is appropriate to post on social media? Ratings from students, faculty members and the public.

OBJECTIVES: The purpose of this study was to ascertain what medical students, doctors and the public felt was unprofessional for medical students, as future doctors, to post on a social media site, Facebook(®) . The significance of this is that unprofessional content reflects poorly on a student, which in turn can significantly affect a patient's confidence in that student's clinical abilities. METHODS: An online survey was designed to investigate the perceptions of University of Michigan medical students, attending physicians and non-health care university-wide employees (that serves as a subset of the public) regarding mock medical students' Facebook(®) profile screenshots. For each screenshot, respondents used a 5-point Likert scale to rate 'appropriateness' and whether they would be 'comfortable' having students posting such content as their future doctors. RESULTS: Compared with medical students, faculty members and public groups rated images as significantly less appropriate (p < 0.001) and indicated that they would be less comfortable (p < 0.001) having posting students as future doctors. All three groups rated screenshots containing derogatory or private information about patients, followed by images suggesting marijuana use, as least appropriate. Images conveying intimate heterosexual couples were rated as most appropriate. Overall, the doctor group, females and older individuals were less permissive when compared with employee and student groups, males and younger individuals, respectively. CONCLUSIONS: The most significant conclusion of our study is that faculty members, medical students and the 'public' have different thresholds of what is acceptable on a social networking site. Our findings will prove useful for students to consider the perspectives of patients and faculty members when considering what type of content to post on their social media sites. In this way, we hope that our findings provide insight for discussions, awareness and the development of guidelines related to online professionalism for medical students.