Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application.

Chronic pain (CP) affects over 50 million Americans daily and represents a unique challenge for healthcare professionals due to its complexity. Across all health professions, only a small percentage of the curriculum is devoted to treating patients with CP. Unfortunately, much of the content is delivered passively via lecture without giving students an opportunity to practice the communication skills to effectively treat patients in the clinic. An interprofessional team of health educators identified 5 essential messages that students frequently struggle to convey to patients with CP. Those messages were based on interprofessional and profession-specific competencies to treat patients with CP from the International Association for the Study of Pain. The 5 messages highlighted the importance of (1) therapeutic alliance, (2) consistent interdisciplinary language, (3) patient prognosis, (4) evidence for pain medicine, surgery, and imaging, and (5) early referral to the interprofessional team. For each message, the team summarized relevant research supporting the importance of each individual message that could serve as a foundation for didactic content. The team then developed active learning educational activities that educators could use to have students practice the skills tied to each message. Each learning activity was designed to be delivered in an interprofessional manner.

Motivational Interviewing Education in North American Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: Many health conditions are preventable or modifiable through behavioral changes. Motivational interviewing (MI) is an evidence-based communication technique that explores a patient's reasons for behavioral changes. This study assesses the current landscape of MI training in North American Family Medicine (FM) clerkships. METHODS: We analyzed data gathered as part of the 2022 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of FM clerkship directors (CDs). The survey was distributed via email invitation to 159 US and Canadian FM CDs in June 2022. RESULTS: Of the 94 responses received, 61% indicated that MI training is provided in their FM clerkship. Medical school type, class size, and location were associated with MI training priority, offerings, and duration in the clerkship, respectively. CD experience correlated with MI training duration; student MI skill training level was associated with MI training duration and priority; the rigor of student MI skills evaluation was correlated with MI teaching methods and training duration; self-reported student MI competency was associated with the length of time students spent with FM community preceptors as well as MI training priority and teaching methods; and several items emerged as predictors of student, CD, and FM faculty MI training expansion. CONCLUSIONS: Opportunities exist to enhance the volume, content, and rigor of MI training in North American FM clerkships as well as to improve self-reported student MI competency within those clerkships.

Building reliable and generalizable clerkship competency assessments: Impact of 'hawk-dove' correction.

PURPOSE: Systematic differences among raters' approaches to student assessment may result in leniency or stringency of assessment scores. This study examines the generalizability of medical student workplace-based competency assessments including the impact of rater-adjusted scores for leniency and stringency. METHODS: Data were collected from summative clerkship assessments completed for 204 students during 2017-2018 the clerkship at a single institution. Generalizability theory was used to explore variance attributed to different facets (rater, learner, item, and competency domain) through three unbalanced random-effects models by clerkship including applying assessor stringency-leniency adjustments. RESULTS: In the original assessments, only 4-8% of the variance was attributed to the student with the remainder being rater variance and error. Aggregating items to create a composite score increased variability attributable to the student (5-13% of variance). Applying a stringency-leniency ('hawk-dove') correction substantially increased the variance attributed to the student (14.8-17.8%) and reliability. Controlling for assessor leniency/stringency reduced measurement error, decreasing the number of assessments required for generalizability from 16-50 to 11-14. CONCLUSIONS: Similar to prior research, most of the variance in competency assessment scores was attributable to raters, with only a small proportion attributed to the student. Making stringency-leniency corrections using rater-adjusted scores improved the psychometric characteristics of assessment scores.

Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review.

PURPOSE: The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research. METHOD: The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies' quality. RESULTS: The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5-15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students' educational outcomes related to SUDs and/or interprofessionalism. CONCLUSIONS: Interprofessional SUD educational interventions improved health professions students' knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students' behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.

Improving Passage Rate on USMLE Step 2 Clinical Skills: Results from a Pilot Program.

In the United States (US), successful passage of United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (Step 2 CS) is required to enter into residency training. In 2017, the USMLE announced an increase in performance standards for Step 2 CS. As a consequence, it is anticipated that the passage rate for the examination will decrease significantly for both US and international students. While many US institutions offer a cumulative clinical skills examination, their effect on Step 2 CS passage rates has not been studied. The authors developed a six-case, standardized patient (SP)-based examination to mirror Step 2 CS and measured impact on subsequent Step 2 CS passage rates. Students were provided structured quantitative and qualitative feedback and were given a final designation of "pass" or "fail" for the practice examination. A total of 173 out of 184 (94.5%) students participated in the examination. Twenty SPs and $26,000 in direct costs were required. The local failure rate for Step 2 CS declined from 4.5% in the year proceeding the intervention to 2.1% following the intervention. In the same timeframe, the US failure rate for Step 2 CS increased from 3.8 to 5.1%, though the difference between local and national groups was not significantly different (P = .07). Based on the initial success of the intervention, educational leaders may consider developing a similar innovation to optimize passage rates at their institutions.

Effective Learning in an Ambulatory Family Medicine Clerkship: A Qualitative Study of Medical Student Midpoint Feedback.

BACKGROUND AND OBJECTIVES: There is substantial research on the effectiveness of ambulatory medical preceptors' teaching skills, but less is known about the student perspective on what contributes most to effective learning in a busy clinical practice. METHODS: As part of a formative midpoint assessment during the third-year clerkship in family medicine, students were asked to respond to the following open-ended reflective prompt: "My preceptor contributed to my learning by..." A qualitative assessment of student responses was conducted to identify themes describing effective learning in the ambulatory setting. Responses for all clerkship students from the years 2012-2014 were examined (N=314). RESULTS: The most common characteristic of effective learning identified by respondents was Autonomy in Practice. Other prominent themes included Stimulating Critical Thinking and Feedback. CONCLUSIONS: Understanding student perceptions of the critical components of learning in ambulatory settings will allow medical educators to design meaningful student learning experiences and coach community teachers on effective teaching practices.

Are Scores From NBME Subject Examinations Valid Measures of Knowledge Acquired During Clinical Clerkships?

PURPOSE: The National Board of Medical Examiners' Clinical Science Subject Examinations are a component used by most U.S. medical schools to determine clerkship grades. The purpose of this study was to examine the validity of this practice. METHOD: This was a retrospective cohort study of medical students at the Virginia Commonwealth University School of Medicine who completed clerkships in 2012 through 2014. Linear regression was used to determine how well United States Medical Licensing Examination Step 1 scores predicted Subject Examination scores in seven clerkships. The authors then substituted each student's Subject Examination standard scores with his or her Step 1 standard score. Clerkship grades based on the Step 1 substitution were compared with actual grades with the Wilcoxon rank test. RESULTS: A total of 2,777 Subject Examination scores from 432 students were included in the analysis. Step 1 scores significantly predicted between 23% and 44% of the variance in Subject Examination scores, P < .001 for all clerkship regression equations. Mean differences between expected and actual Subject Examination scores were small (≤ 0.2 points). There was a match between 73% of Step 1 substituted final clerkship grades and actual final clerkship grades. CONCLUSIONS: The results of this study suggest that performance on Step 1 can be used to identify and counsel students at risk for poor performance on the Subject Examinations. In addition, these findings call into the question the validity of using scores from Subject Examinations as a high-stakes assessment of learning in individual clerkships.

'Don't play the butter notes': jazz in medical education.

Jazz has influenced world music and culture globally - attesting to its universal truths of surviving, enduring, and triumphing over tragedy. This begs the question, what can we glean in medical education from this philosophy of jazz mentoring? Despite our training to understand disease and illness in branching logic diagrams, the human experience of illness is still best understood when told as a story. Stories like music have tempos, pauses, and silences. Often they are not linear but wrap around the past, future, and back to the present, frustrating the novice and the experienced clinician in documenting the history of present illness. The first mentoring lesson Hancock discusses is from a time he felt stuck with his playing - his sound was routine. Miles Davis told him in a low husky murmur, 'Don't play the butter notes'. In medical education, 'don't play the butter notes' suggests not undervaluing the metacognition and reflective aspects of medical training that need to be fostered during the early years of clinical teaching years.

Health disparities and underserved populations: a potential solution, medical school partnerships with free clinics to improve curriculum.

Health-care educators share the social responsibility to teach medical students about social determinants of health and health-care disparities and subsequently to encourage medical students to pursue residencies in primary care and medical practice in underserved communities. Free clinics provide care to underserved communities, yet collaborative partnerships with such organizations remain largely untapped by medical schools. Free clinics and medical schools in 10 US states demonstrate that such partnerships are geographically feasible and have the potential to mutually benefit both organizational types. As supported by prior research, students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.

Beyond diagnoses: family medicine core themes in student reflective writing.

BACKGROUND AND OBJECTIVES: We share qualitative study results of third-year medical student writings during their family medicine clerkship utilizing a reflective writing exercise from 2005 and 2013. METHODS: For this paper, 50 student writings were randomly selected from the 2005 cohort in addition to 50 student writings completed by the 2013 cohort. Deductive thematic analysis utilizing Atlas.ti software was completed utilizing the Future of Family Medicine core attributes of family physicians as the a priori coding template. RESULTS: Student writings actively reflect key attributes of family physicians as described by the Future of Family Medicine Report: a deep understanding of the dynamics of the whole person, a generative impact on patients' lives, a talent for humanizing the health care experience, and a natural command of complexity and multidimensional access to care. CONCLUSIONS: We discuss how to lead the writing exercise and provide suggestions for facilitating the discussion to bring out these important aspects of family medicine care.

Residency faculty opinions about medical student advising: a national survey.

BACKGROUND AND OBJECTIVES: Medical student faculty advisors are charged with providing students the best possible information and advice regarding residency selection and how to increase their likelihood of matching into the program of their choice. Given the lack of clear and consistent processes for ranking residency applicants, medical student advisors will benefit from better insight into the perspectives of family medicine residency (FMR) faculty. METHODS: This study was designed to increase understanding of the perceptions of FMR faculty in evaluating and ranking medical student applicants. We surveyed all FMR programs in the United States and Puerto Rico. Program directors, or their designees, were asked to provide basic program characteristics and then to either agree or disagree with various advising statements medical school faculty might say to students applying to FMR programs. RESULTS: Of the 24 items in the survey, consensus among programs was reached for only seven. CONCLUSIONS: These results, especially given the current climate of an increasing number of applicants for a nearly stable number of residency training slots, clearly support the need for enhanced communication and collaboration between family medicine student advisors and residency educators.

Improving public health through student-led interprofessional extracurricular education and collaboration: a conceptual framework.

In the US, health care professionals are trained predominantly in uniprofessional settings independent of interprofessional education and collaboration. Yet, these professionals are tasked to work collaboratively as part of an interprofessional team in the practice environment to provide comprehensive care to complex patient populations. Although many advantages of interprofessional education have been cited in the literature, interprofessional education and collaboration present unique barriers that have challenged educators and practitioners for years. In spite of these impediments, one student-led organization has successfully implemented interprofessional education and cross-disciplinary collaboration. The purpose of this paper is to provide a conceptual framework for successful implementation of interprofessional education and collaboration for other student organizations, as well as for faculty and administrators. Each member of the interprofessional team brings discipline-specific expertise, allowing for a diverse team to attend to the multidimensional health needs of individual patients. The interprofessional team must organize around a common goal and work collaboratively to optimize patient outcomes. Successful interdisciplinary endeavors must address issues related to role clarity and skills regarding teamwork, communication, and conflict resolution. This conceptual framework can serve as a guide for student and health care organizations, in addition to academic institutions to produce health care professionals equipped with interdisciplinary teamwork skills to meet the changing health care demands of the 21st century.

Career advising in family medicine: a theoretical framework for structuring the medical student/faculty advisor interview.

BACKGROUND: There are unique challenges to recruiting students into the specialty of family medicine within academic medical centers. METHODS: At Virginia Commonwealth University, we developed an advising framework to help students address institutional and personal obstacles to choosing family medicine as a career. RESULTS: The role of a faculty advisor is not to direct the student to a career choice but rather to foster a mentor relationship and help the student come to his or her own realizations regarding career choice. The faculty advisor/medical student interview is conceptualized as five discussion topics: self-knowledge, perception, organizational voice, cognitive dissonance, and anticipatory counseling. CONCLUSION: This framework is intended to assist faculty in their efforts to encourage students to consider a career in family medicine.