Preparing students for residency interviews in the age of COVID: Lessons learned from a standardized video interview preparation program.

Objectives: The COVID-19 pandemic has necessitated the widescale adoption of video-based interviewing for residency applications. Video interviews have previously been used in the residency application process through the pilot program of the American Association of Medical Colleges standardized video interview (SVI). We conducted an SVI preparation program with our students over 3 years that consisted of an instructional lecture, deliberate practice in video interviewing, and targeted feedback by emergency medicine faculty. The aim of this investigation was to summarize the feedback students received on their practice SVIs to provide the guidance they need for preparing for the video interviews that will replace in-person interviews with residency programs. Methods: A retrospective thematic analysis was conducted on faculty feedback provided to students who had completed SVI practice videos in preparation for their application to an EM residency between June 2017 and July 2019. Categorized comments were also sorted by type of faculty feedback: positive reinforcement, constructive criticism, or both. Results: Forty-six medical students received 334 feedback elements from three faculty. Feedback was balanced between positive reinforcement statements and constructive criticism. Students performed well on appearance and attire, creating a proper recording environment, and response content. They needed the most guidance with the delivery of content and the technical quality of the video. Conclusions: Our results demonstrate a need for formal instruction in how to communicate effectively through the video medium. Medical educators will need to formally prepare students for tele-interviews with residency programs, with an emphasis on communication skills and techniques for improving the quality of their video presentation, including lighting and camera placement.

Development of an Assessment for Entrustable Professional Activity (EPA) 10: Emergent Patient Management.

INTRODUCTION: Medical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10. METHODS: First, we wrote five emergent patient case-scenarios that a medical trainee would likely confront in an acute care setting. Furthermore, we developed high-fidelity simulations to realistically portray these patient case scenarios. Finally, we designed a performance assessment instrument to evaluate the medical student's performance on executing critical actions related to EPA-10 competencies. Critical actions included the following: triage skills, mustering the medical team, identifying causes of patient decompensation, and initiating care. Up to four students were involved with each case scenario; however, only the team leader was evaluated using the assessment instruments developed for each case. RESULTS: A total of 114 students participated in the EPA-10 assessment during their final year of medical school. Most students demonstrated competence in recognizing unstable vital signs (97%), engaging the team (93%), and making appropriate dispositions (92%). Almost 87% of the students were rated as having reached entrustment to manage the care of an emergent patient (99 of 114). Inter-rater reliability varied by case scenario, ranging from moderate to near-perfect agreement. Three of five case-scenario assessment instruments contained items that were internally consistent at measuring student performance. Additionally, the individual item scores for these case scenarios were highly correlated with the global entrustment decision. CONCLUSION: High-fidelity simulation showed good potential for effective assessment of medical student entrustment of caring for the emergent patient. Preliminary evidence from this pilot project suggests content validity of most cases and associated checklist items. The assessments also demonstrated moderately strong faculty inter-rater reliability.

A clinical procedures curriculum for undergraduate medical students: the eight-year history of a third-year immersive experience.

BACKGROUND: Procedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine. OBJECTIVES: The primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships. PROGRAM DESIGN: The course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time. IMPACT: Students valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001). CONCLUSION: A dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied.