Effect of COVID-19 Curriculum Changes on Medical Student Exam Performance: A Case Series.

BACKGROUND: The COVID-19 pandemic caused medical schools to convert to an online format, necessitating a swift change in medical education delivery. New teaching methods were adapted, with some schools having greater success than others. Kirk Kerkorian School of Medicine (KSOM) employed a small-group interactive learning style that consists of eight or fewer medical students and one faculty mentor engaging in group problem-based learning (PBL) twice weekly. This style had clear signs of struggle with a significant decrease in exam performance. Rocky Vista University College of Osteopathic Medicine (RVUCOM) employed a large-group didactic lecture style that consisted of one faculty mentor lecturing hundreds of medical students in a pre-recorded setting five times weekly. This style had greater success with its curriculum adaptation leading to minimal effect on their exam performance. This study aims to investigate whether the type of medical school curriculum (small-group interactive vs. large-group didactic) impacts student exam performance during online learning transitions forced by the COVID-19 pandemic. METHODOLOGY: KSOM and RVUCOM students were grouped into above-expectations and below-expectations categories based on each institution's standardized exam performance metrics. Independently sampled t-tests were performed to compare groups. KSOM was classified as a small-group interactive curriculum through its heavy reliance on student-led PBL, whereas RVUCOM was classified as a large-group didactic curriculum through its extensive proctor-led slideshow lectures. RESULTS: KSOM's transition to online PBL resulted in fewer students scoring above the national average on the National Board of Medical Examiners (NBME) exams compared to previous cohorts (55% vs. 77%, respectively; N = 47 and 78; P < 0.01). RVUCOM's transition to online large-group lectures yielded no significant differences between students who performed above expectations and students who performed below expectations between their cohorts (63% vs. 65%, respectively; N = 305 and 300; P > 0.05). CONCLUSIONS: KSOM's COVID-19 cohort performed significantly worse than RVUCOM's COVID-19 cohort during their medical school organ-system exams. We believe that the small-group learning at KSOM is less resilient for online curricula compared to the large-group didactics seen at RVUCOM. Understanding which didactic methods can transition to online learning more effectively than others is vital in guiding effective curriculum adjustments as online delivery becomes more prominent.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine.

BACKGROUND: Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce. METHODS: Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05. RESULTS: First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures. CONCLUSION: Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

The Timing, Factors, and Impact of USMLE Step 1 Becoming Pass/Fail on the Process of Choosing a Specialty.

Background  Choosing a medical specialty is an important decision. A combination of factors influenced this decision. Student characteristics and examination performances can influence this decision. With the transition of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, it is important to analyze the specialty decision process. Objective The purpose of this multimethod study is to assess when in the curriculum students choose a specialty, what factors influence their decision, and the impact of USMLE Step 1 scores on a student's assessment of competitiveness. Methods In February 2022, a survey was prepared and approved by the University of Nevada, Las Vegas (UNLV) Institutional Review Board (IRB). The survey contained multiple-choice questions and a free-response section. The survey was sent to the Class of 2022 and 2023 students at Kirk Kerkorian School of Medicine who follow a Longitudinal Integrated Clerkship. Descriptive statistics and one-sample t-tests were calculated. Results A total of 89 students completed the survey: 42 out of 60 students (70%) from the Class of 2022 and 47 out of 61 students (77%) from the Class of 2023. This study found that 78.8% of longitudinal interleaved clerkship (LInC) students committed to their specialty during the second half of the clinical year. The effects of positive and negative experiences during clerkships were most significantly different (p < 0.001). Conclusion The majority of LInC students arrive at their decision by the latter half of the clinical year. A variety of factors help students arrive at their decision. Our findings suggest that the pass/fail grading system will make it more difficult for students to assess their personal competitiveness.

Disadvantaged Students Utilize School Campus and Its Resources More Than Non-disadvantaged Students.

Introduction Disadvantaged populations were disproportionately affected by the COVID-19 pandemic, both in the medical and educational settings. Lower-income families often do not have a laptop/desktop computer, adequate internet connection, or a dedicated study space. This unfortunately contributed to poorer academic performance during distance learning. To combat this, the Kirk Kerkorian School of Medicine (KKSOM) did not close down campus during the pandemic. This study analyzes the utilization of campus and live Zoom lectures by KKSOM students and its impact on educational outcomes. Methods We sent an Institutional Review Board (IRB)-approved survey to KKSOM students and asked about study locations, Zoom lecture attendance, and relationship quality during the pandemic. The class of 2024 had a unique experience as they were first-year students during the start of the COVID-19 pandemic and the transition to online learning. However, they always had access to campus and technological resources. We compared the survey scores from a Qualtrics electronic survey and the National Board of Medical Examiners (NBME) scores of students who self-indicated disadvantaged status, first-generation, underrepresented minority, and lower socioeconomic status to those who did not meet these criteria. Data analysis was done using SPSS software version 28.0.1.1 (IBM Corp., Armonk, NY). Results  First-generation students studied on campus more frequently than their counterparts (31% versus 20%, p < 0.05) and less at home in general (55.4% versus 67.5%, p < 0.05). Lower socioeconomic status (SES) students attended live Zoom lectures more often as well (56.6% versus 43.1%, p < 0.05). Lastly, no significant differences were found between disadvantaged and non-disadvantaged groups for the class of 2024 in the NBME exam scores or relationship quality scores. Conclusion Our results suggest that students from disadvantaged backgrounds spend more time studying on campus than at home. Additionally, during the COVID-19 pandemic, they attended live Zoom lectures more often than their non-disadvantaged counterparts. Access to campus was not restricted for KKSOM students during the pandemic. This may be one explanation for the lack of disparity between disadvantaged and non-disadvantaged students with regard to academic performance and relationship quality. This makes a strong argument for the importance of campus accessibility for the success of students, especially those from disadvantaged backgrounds.

Exploring Anki Usage Among First-Year Medical Students During an Anatomy & Physiology Course: A Pilot Study.

Objectives: As medical schools worldwide condense the preclinical phase of medical education, it is increasingly important to identify resources that help medical students retain and employ the medical information. One popular tool among medical students is an application called Anki, a free and open-source flashcard program utilizing spaced repetition for quick and durable memorization. The purpose of this study is to determine how variable Anki usage among first-year medical students throughout a standardized anatomy and physiology course correlates with performance. Methods: We designed a novel Anki add-on called "Anki Stat Scraper" to collect data on first-year medical students at Kirk Kerkorian School of Medicine during their 8-week anatomy and physiology course. Anki users (N = 45) were separated into four groups: Heavy (N = 5), intermediate (N = 5), light (N = 16), and limited-Anki (N = 19) users, based on the time each student spent on the flashcard app, how many flashcards they studied per day, and how many days they used the app prior to their anatomy and physiology exam. A 14-question Likert scale questionnaire was administered to each participant to gauge their understanding of Anki and how they used the app to study. Results: Heavy and intermediate Anki users had higher average exam scores than their counterparts who did not use Anki as a study method. Average exam scores were 90.34%, 91.74%, 85.86%, and 87.75% for heavy, intermediate, light, and limited-Anki users respectively (p > 0.05). Our survey demonstrated that Anki users spent an average of 73.86% of their study time using Anki, compared to an average of 36.53% for limited-Anki users (p < 0.001). Conclusion: Anki users did not score significantly higher compared to limited-Anki users. However, survey responses from students believe that Anki may still be a useful educational tool for future medical students.

Medical Students' Socioeconomic Status and Academic Performance in Medical School.

Background Students from lower socioeconomic groups tend to underestimate their chances of acceptance to medical school and their likelihood of success once admitted. Objective The objective of this study is to determine if socioeconomic disadvantage status is linked to lower medical college admission test (MCAT) scores and academic performance in medical school. Methods Using the Association of American Medical Colleges (AAMC) education/occupation (EO) indicator, we compared economically disadvantaged students to students with no financial disadvantage on the MCAT, Phase 1 National Board of Medical Examiners (NBME), United States Medical Licensing Examination (USMLE) Step 1, Phase 2 NBME, and USMLE Step 2 test scores. Results Medical students in the disadvantaged group scored significantly lower on the MCAT than students with no financial disadvantage. The disadvantaged group showed a non-significant lower trend in performance until USMLE Step 2. Conclusions Applicants from lower socioeconomic backgrounds may perform lower on their MCAT and early medical school benchmark exams, but they appear to catch up with and even surpass their peers on their USMLE Step 2 examination.

Teaching Skills Training for Pre-clinical Medical Students Through Weekly Problem-Based Learning Teaching Topic Presentations and Directed Feedback.

Problem: Medical students commonly encounter scenarios in which they are charged with teaching medical content, but studies find a paucity of teaching skills training especially in the pre-clerkship phase of undergraduate medical programs. Intervention: Videos lessons were created to instruct on five teaching skills identified as useful for presenting short lessons on medical topics: effective learning objectives, appropriate lesson complexity, audience engagement, relevance to practice, and resource selection. A rubric was generated to assess the performance level of each teaching skill. Context: First-year medical students viewed the video lessons and were instructed to implement these teaching skills for the creation and delivery of weekly learning issue (LI) presentations within a problem-based learning (PBL) course. PBL facilitators assessed students by using the rubric to assign a score of 0-2 corresponding to the level of skill performance. Impact: Scores in every dimension of our LI assessment rubric showed significant improvement above week 1 at the end of the initial 4 weeks of practice and assessment. Follow-up assessment showed durable performance and significant improvement for 3 out of 5 at weeks 8 and 12. Lessons Learned: Our novel framework was effective in fostering the adoption and implementation of five teaching skills among first-year medical students over a 4-week period, with most skills remaining durable over 12 weeks. Furthermore, end-of-course surveys showed that students found feedback received using the framework helpful in improving their LIs, and faculty reported that student LI presentation quality improved overall. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01912-x.

Impact of High School Quality on Academic Performance Throughout Medical School.

INTRODUCTION: Numerous studies currently evaluate medical school success and performance using college Grade Point Average (GPA) and Medical College Admissions Test (MCAT) scores. These studies demonstrate that students who score low on the MCAT will continually perform worse than their peers on medical school exams and board exams. We investigated where a student attended high school and how that factor can affect medical school performance because most studies evaluated performance based on college attendance. METHODS: Our retrospective study evaluated 184 students at Kirk Kerkorian School of Medicine (KSOM) and showed higher-quality high schools, in comparison to lower-quality high schools, affected medical school performance. We categorized two groups for high school quality based on the U.S. News scorecard for programs within Nevada: those students with a high school reading proficiency (HSRP) >50% and those with an HSRP <50%. These two groups were then standardized based on percentile within the school and averaged using HSRP, MCAT, pre-clinical, step 1, clinical, and step 2 scores. A line chart was graphed to demonstrate the difference between the two groups. DATA/RESULTS: As might be expected, our results showed significantly higher MCAT scores from students who attended high-quality versus low-quality high schools. Our results also showed that although students from low-quality high schools performed worse for the first part of medical school, by step 2, students will score similarly in both groups. CONCLUSION: Students who performed poorly on the MCAT and attended lower-quality high schools will score as competitively as their peers by step 2.

Pre-clerkship National Board of Medical Examiners Subject Examinations Versus End-of-Semester Final Examinations: How Well Do They Assess Preparedness for the United States Medical Licensing Examination Step 1?

Background The ability to provide performance insights of various United States Medical Licensing Examination (USMLE) Step 1 assessments is of great importance to medical educators. Two custom pre-clerkship assessments used at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (KSOM) are National Board of Medical Examiners (NBME)-derived end-of-semester final examinations and subject examinations. The authors sought to determine if performance on these custom assessments can provide feedback on a medical student's readiness to undertake the USMLE Step 1 examination. Methodology Deidentified student performance data were provided by institutional databases for the KSOM graduating class of 2023 (N = 60). Pearson correlation analyses were utilized to evaluate the strength of the correlation between USMLE Step 1 performance and NBME subject examinations versus NBME end-of-semester final examinations. Results The results indicated that the NBME end-of-semester final examinations have a statistically higher correlation to the USMLE Step 1 score than the majority of the individual NBME subject examinations. However, the mean NBME subject examination score (Semester 1: r = 0.53, p < 0.05; Semester 2: r = 0.58, p < 0.05) demonstrated significantly higher correlation to the USMLE Step 1 performance than the NBME end-of-semester final examination score for both Semesters 1 and 2 (Semester 1: r = 0.50, p < 0.05; Semester 2: r = 0.48, p < 0.05). Conclusions These results showed that the mean of the NBME subject examination score was a better metric to assess readiness for the USMLE Step 1 than the NBME end-of-semester final examinations. However, each NBME end-of-semester final examination score showed a better correlation than the majority of the NBME subject examinations.

College competitiveness and medical school exam performance.

BACKGROUND: In medical school, students are tested through periodic USMLE Step 1 and 2 examinations before obtaining a medical license. Traditional predictors of medical school performance include MCAT scores, undergraduate grades, and undergraduate institutional selectivity. Prior studies indicate that admissions committees might unfairly discriminate against applicants who graduated from less competitive universities. However, there is limited literature to determine whether those who attended competitive colleges perform better on USMLE Step 1 and 2 examinations. OBJECTIVE: The purpose of our study is to determine if students who attended competitive undergraduate colleges outperform those who did not on medical school benchmarks. METHODS: We defined a Competitive College as having greater than 10% of its student body scoring 1400 or higher (on a 1600 scale) on the SAT. If this criteria was not met, colleges would be categorized as Non-Competitive. Descriptive statistics and unpaired t-tests were calculated to analyze average test scores on the MCAT, Phase 1 NBME, USMLE Step 1, Phase 2 NBME, and USMLE Step 2. RESULTS: Our findings suggest there are no statistically significant differences between students who do or do not attend competitive undergraduate colleges on these medical school benchmark examinations following the MCAT. CONCLUSION: Admissions committees should use this data to aid in their student selection as our research indicates that institutional selectivity accurately predicts MCAT scores, but not performance on standardized medical school examinations once admitted.

Incorporation of Comprehensive Examinations for a Time-Efficient Remediation Method.

Background: Remediation in medical school should be a time-limited, and highly structured process that addresses student deficiencies and allows them to prove content competency before progressing in the curriculum. In this study, we analyze the use of a comprehensive end-of semester final examination in the remediation process for pre-clinical students at Kirk Kerkorian School of Medicine (KSOM). Faculty time utilized is analyzed and compared with the previously employed remediation process. Methods: Administered to all students at the end of each semester is a comprehensive examination consisting of a sufficient number of faculty-selected questions relating to each organ system covered with a 75% passing threshold. A student must also demonstrate competency of any failed system examination content to remediate successfully. The performance of those who did not exhibit competency was analyzed to identify areas of deficiency then an individualized exam would then be administered. The total remediation time spent by faculties and students was then analyzed. Results: KSOM Class of 2024 results showed that faculty were able to yield significant savings in time spent on remediation. Faculty spent 45 total remediation hours for the Class of 2024, compared to 400 hours remediating using the paper-based assignment method for the Class of 2021. With the transition to comprehensive end-of-semester final examinations, a total of 355 hours were saved. Furthermore, faculty used an average 1.07 hours/student with end-of-semester comprehensive examinations. The saved time allows faculty to work on improving the overall curriculum for all students rather than focusing on a limited number of students. Conclusion: Utilizing comprehensive end-of-semester final examinations notably decreased the amount of faculty time spent per semester on remediation. Further evaluation is required to evaluate long-term effectiveness on content competency and would further be strengthened by a multi-institutional comparison.

Exploration of the Role of Relationships and Virtual Learning on Academic Performance and Mental Health.

Background The coronavirus disease 2019 (COVID-19) pandemic caused medical schools to rapidly transition to online/distance learning. Online learning is often associated with poor academic performance, mental health, and student-to-faculty relationships. The purpose of this study is to determine if correlations exist between academic performance, mental health, study location, and student/faculty relationships among medical students. Methodology First-year medical students received a survey asking them to reflect on their study location, mental health, and student/faculty relationships during the COVID-19 pandemic. Second- and third-year medical students received a similar survey asking them to reflect on their experiences from the perspective of their first year of medical school (pre-pandemic). The first five exam scores were gathered for all participants. Pearson's correlation coefficient was calculated between all variables. Results Academic performance was found to be positively correlated with both mental health (R = 0.215, p = 0.016) and relationships among students (R = 0.0259, p = 0.004), while negatively correlated with the percentage of time spent studying at home (R = -0.185, p = 0.039). Mental health was additionally found to be positively correlated with relationships to faculty (R = 0.230, p = 0.01) and relationships to students (R = 0.245, p = 0.006). Conclusions Academic performance and mental health are correlated with relationships and study location. These correlations may explain the negative outcomes associated with online learning in medical education.

To Wait or Two Weeks: The Relationship Between Step 2 CK Scores and the Length of Dedicated Study Time Within a Longitudinal Interleaved Clerkship Curriculum.

INTRODUCTION: Graduate medical education program directors report that United States Medical Licensing Examination (USMLE) Step 2 CK exam scores will likely have greater importance in the future selection of residents due to USMLE Step 1 transitioning to a pass/fail score as early as January 2022. With emphasis moving to the Step 2 exam, it is important to examine factors that maximize student Step 2 CK performance, such as third-year curriculum models and exam timing. This study analyzes whether or not Step 2 performance is affected by a specific length of dedicated study time within a Longitudinal Interleaved Clerkship (LInC) curriculum. METHODS: A regression model was used to predict Step 2 scores for 102 students using previous performance measures. Actual and predicted scores were compared to indicate which students overperformed or underperformed on Step 2. A t-test was used to compare the mean difference between predicted and actual performance of students who had two weeks or less of dedicated study time for Step 2 CK versus students who had a longer dedicated study period.  Results: Students who completed Step 2 with two weeks or less of dedicated study significantly overperformed (t(100)=2.06, p=0.042) on the exam (Mean=1.61, SD=9.21) compared to students who had more than two weeks of dedicated study (Mean=-1.67, SD=6.44) in a LInC curriculum. CONCLUSION: Although studies of Step 2 preparation time have shown the importance of taking Step 2 soon after completion of clinical rotations, this study adds a specific timeframe. Our findings show that a dedicated study period of two weeks or less for Step 2 CK within a LInC curriculum is associated with better performance. This study was limited to a LInC curriculum and may not apply to other clinical year curricula.

The Impact of COVID-19 on Academic Performance and Personal Experience Among First-Year Medical Students.

Background: The COVID-19 pandemic forced medical education to rapidly transition from in-person learning to online learning. This change came with learning difficulties, social isolation, limited student/faculty relationships, and decreased academic performance. Objective: The purpose of this study is to determine if academic performance, study habits, student/faculty relationships, and mental health were different in first-year medical students (class of 2024) during the COVID-19 pandemic compared to pre-COVID cohorts. Methods: In April 2021, a survey was sent to first-year medical students at the Kirk Kerkorian School of Medicine at UNLV asking them to reflect on their experiences during the COVID-19 pandemic including study environment, mental health, and relationships with peers and faculty. A similar survey was sent to second- and third-year medical students (classes of 2023 and 2022) asking them to reflect on similar experiences during their first year of medical school. Exam scores for the first five exams were gathered and compared between first-, second-, and third-year medical students. Results: One hundred twenty-five students responded to the survey (81% of first-year students, 75% of second-year students, and 55% of third-year students). During the COVID-19 pandemic, first semester students did not score above the national average as much as first semester students pre-COVID (55% vs. 77%). Students during the pandemic studied at home more than previous cohorts. Mental health and relationships were all rated significantly lower among first semester students during the COVID-19 pandemic. Conclusions: Significant differences were found in first semester student experience and academic performance during the pandemic compared to pre-COVID cohorts.

Required Longitudinal Service-Learning and Its Effects on Medical Students' Attitudes Toward the Underserved.

Although medical students enter medicine with altruistic motives and seek to serve indigent populations, studies show that medical students' attitudes towards the undeserved tend to worsen significantly as they go through their medical education. This finding emphasizes the need for medical educators to implement activities such as service-learning that may help mitigate this negative trend. All students at the University of Nevada Las Vegas (UNLV) School of Medicine are required to participate in longitudinal service-learning throughout medical school, and a majority of students interact with the underserved at their service-learning sites. Using the previously validated Medical Student Attitudes Towards the Underserved (MSATU), independent sample T-tests showed that students who interact with underserved populations at their sites scored with significantly better attitudes towards the underserved at the end of their preclinical phase. Subjects included 58 medical students with 100% taking the MSATU. This result indicates that longitudinal service-learning, particularly when it includes interaction with the underserved, can be one method to combat the worsening of medical students' attitudes as they complete their medical education.

Predicting United States Medical Licensing Examination Step 2 Clinical Knowledge Scores from Previous Academic Performance Measures within a Longitudinal Interleaved Curriculum.

Background United States Medical Licensing Examination (USMLE) Step 1 is a common metric looked at by residency programs to determine invitations for candidates to interview. However, USMLE Step 2 Clinical Knowledge (CK) has also been an important factor for selecting applicants to interview and plays a significant role during applicant selection. This study aims to identify academic performance measures that correlate with USMLE Step 2 CK scores and to develop a model to predict USMLE Step 2 CK scores using previous academic measures from the first two cohorts in the longitudinal interleaved clerkship (LInC) at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (KSOM). Setting The KSOM is a newly accredited US allopathic medical school that accepted its first class in 2017. At KSOM, a LInC model is used in the primary clinical year. In this model, rotations are two weeks in duration before moving on to the next specialty. Students complete the National Board of Medical Examiners (NBME) subject examinations in all six specialties in one week at the midpoint and the end of the LInC. Students who passed an exam at the midpoint can opt out of that exam at the end as the higher of the two exam scores is recorded. However, most students choose to take all the exams again to improve their scores and prepare for USMLE Step 2 CK. Methodology Academic performance measures were gathered from the class of 2021 and 2022 (n = 101) including undergraduate grade point average (GPA), undergraduate science GPA, medical college admission test score, USMLE Step 1 score, NBME clinical subject exam scores, and USMLE Step 2 CK scores. Pearson correlations were run between the performance variables and USMLE Step 2 CK scores to measure influence variables individually, then a regression model measured impacts of variables together. Results All variables except undergraduate science GPA significantly correlated with USMLE Step 2 CK score. USMLE Step 1 had the strongest correlation (r = 0.752, p < 0.001). The regression model had an R of 0.859 with the internal medicine subject exam showing the highest beta coefficient (0.327, p < 0.001). Conclusions This study determined that USMLE Step 2 CK scores can be effectively predicted using available performance measures. With USMLE Step 1 becoming pass/fail in January 2022, the importance of USMLE Step 2 CK as a screening tool in the residency application process will likely increase. This study was conducted within a LInC curriculum and may have limited value in the prediction of scores within other clinical year curricula.

The Impact of Educational Resources and Perceived Preparedness on Medical Education Performance.

INTRODUCTION: Undergraduate medical education has evolved necessarily with the increasing utilization of technology and the availability of ancillary resources developed for medical students. However, medical educational resources are expensive and there have been few studies validating these resources for their ability to significantly modify student exam performance. METHODS: A post-exam survey was devised to evaluate medical students for resource usage, student-perceived preparedness, and exam performance. RESULTS: Students who felt more prepared for exams performed better than students who felt less prepared (p = .017). Students who watched didactic lectures online and those who utilized peer-to-peer tutoring outperformed students who did not use these resources (p = .035, p = .008). Analyses of the data show that none of the purchased resources utilized significantly improved student exam performance. The majority of students used between six and eight resources for exam preparation. There may be a slightly negative association with the quantity of resources used and exam scores (p = .18). DISCUSSION: Contrary to traditional confidence studies that correlate overconfidence with underperformance, medical students who reported feeling more prepared for exams performed better than students who felt less prepared. CONCLUSION: Medical students may have a more complete grasp of their knowledge base and deficits, which may enable a more accurate match between exam expectations and academic performance. This post-exam survey method can be customized and applied to evaluate resource utility as it pertains to specific undergraduate medical education curricula at individual institutions.

Development and Validation of Simulation-Based Procedural Checklists for Evaluation of Neonatal Nurse Practitioner Performance.

BACKGROUND: Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures. PURPOSE: The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures. METHODS: IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis. FINDINGS/RESULTS: A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists. IMPLICATIONS FOR PRACTICE: Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes.

The Impact of a Rural Training Track on Medical Students Specialty Choice.

BACKGROUND: Compare the expectations and outcomes of students involved in rural medical training versus those of urban trainees. METHODS: Survey items relating to primary care interest were added to program evaluation surveys already being sent at the beginning and end of the primary clinical year. Students from the graduating class of 2016 and the class of 2017 responded to the surveys (N=115). Responses from students trained in rural sites were compared with students trained in medium or large communities. For the purposes of the survey, primary care was not specifically defined and was open to participants' interpretation. Primary care is commonly thought of as the medical care from the doctor who sees a patient first and provides treatment or decides the other specialist care that the patient may need. Primary care specialties can include family medicine, internal medicine, pediatrics and obstetrics and gynecology. RESULTS: Most students enter their primary clinical year undecided about specialty choice and preferred practice location. At the end of the primary clinical year, most students have decided on a specialty and most report wanting to practice in communities similar to where they trained during that year. Before the primary clinical year student attitudes toward primary care are not significantly different based on selected training site. However at the end of the primary clinical year, students who had been trained in small communities were significantly more likely to choose primary care compared with students trained in medium to large communities. CONCLUSIONS: For students who begin the primary clinical year undecided regarding specialty choice, and practice location, the community size of the training site plays a large role in the decisions they will make. A majority of students trained in small communities chose to go into primary care and practice in small communities.