Next steps for workplace-based assessments of entrustable professional activities.

BACKGROUND: Florida International University Herbert Wertheim College of Medicine (FIU-HWCOM) participated in the AAMC Core Entrustable Professional Activities (EPA) implementation pilot. Entrustment decision processes based on data from workplace-based assessments (WBAs) were piloted. Outcomes illustrated challenges including variability across EPAs with regards to learner level alignment and feasibility of data collection in the form of WBAs. In addition, students reported discomfort requesting WBA completion by preceptors and dissatisfaction with associated feedback. APPROACH: To guide future directions, we conducted a survey of third-year students to better understand their experience with and perceptions of WBAs used to evaluate EPAs at FIU-HWCOM. EVALUATION: Survey response was 96% (n = 107/112). Most (84%) reported that WBAs were not valuable to their development and that preceptors often did not complete WBAs in a timely fashion. Many (47%) reported not receiving verbal feedback. Most students (78%) used language in written responses demonstrating confusion between the EPAs and the WBAs used to assess them. IMPLICATIONS: The use of WBAs to assess EPAs did not have its intended impact at FIU-HWCOM. For future classes, WBA forms will consist of paper cards with questions directly assessing performance of skills aligned with EPAs 1, 5 and 6 only. To continue to promote feedback, students will be required to collect WBAs on all clerkships, but the number of required WBAs will be less than prior and no entrustment decisions will be made.

Professional Development Needs of Clerkship Directors.

BACKGROUND AND OBJECTIVES: Successful clerkship directors (CDs) must exhibit a variety of leadership, administrative, educational, and interpersonal skills. This study investigates the professional development needs for family medicine CDs to be successful in their role, in relation to career stage, institutional support, and needed resources. METHODS: A cross-sectional survey of CDs at qualifying United States and Canadian medical schools was performed between April 29, 2021 and May 28, 2021. Questions addressed specific training when beginning CD position, professional development activities that have contributed to success, additional professional development skills required to be a successful CD, and planned future development activities. We utilized χ2 square and Mann-Whitney U tests for comparisons. RESULTS: Surveys were completed by 75 CDs, for a response rate of 48.8%. Only 33.3% of respondents reported receiving training specific to their role as CD. The majority of respondents cited informal mentoring and conference attendance as important to their professional development, but none identified graduate degrees as the most important method of professional development. CONCLUSIONS: These findings demonstrate the lack of formal training provided to CDs and highlight the importance of informal training and conference attendance for professional development.

Medical Students' Perspectives on Opportunities to Engage in the Clinical Care of COVID-19 Patients during the Pandemic.

OBJECTIVES: Recent disease modeling suggests that pandemics are likely to increase in frequency and severity. As such, medical educators must learn from their experiences with coronavirus disease 2019 (COVID-19) to develop systematic strategies for ensuring that medical students receive hands-on training in the management of emerging diseases. Here, we outline the process by which the Florida International University Herbert Wertheim College of Medicine developed and updated guidelines for student participation in the care of patients with COVID-19 and report on students' experiences. METHODS: During the 2020-2021 academic year, Florida International University Herbert Wertheim College of Medicine students were not permitted to care for patients with COVID-19; however, academic year 2021-2022 guidelines did permit fourth-year students on subinternships or Emergency Medicine rotations to voluntarily care for patients with COVID-19. At the end of the 2021-2022 academic year, students completed an anonymous survey about their experience caring for patients with COVID-19. Likert-type and multiple-choice questions were analyzed using descriptive statistics and the short-answer responses were analyzed qualitatively. RESULTS: One hundred two students (84%) responded to the survey. Sixty-four percent of respondents opted to provide care for patients with COVID-19. Most students (63%) cared for patients with COVID-19 during their required Emergency Medicine Selective. Twenty-eight percent of students wished they had more COVID-19 patient care opportunities, and 29% did not feel prepared to care for patients with COVID-19 on their first day of residency. CONCLUSIONS: Many graduating students felt unprepared to care for patients with COVID-19 during residency and many wished they had had more opportunities to care for patients with COVID-19 during medical school. Curricular policies must evolve to allow students to gain competency in the care of patients with COVID-19 so that they are prepared for day one of residency.

What Do Medical Students Want From a Mentor?

Introduction: The medical education literature lacks a uniform definition of mentoring. Mentoring relationships benefit the mentor and mentee. Mentoring roles include coach, advisor, teacher, counselor, and sponsor in the setting of mutual trust toward impacting psychosocial and career functions for the mentee. Mentoring helps improve underrepresented minority medical student performance. Medical students value mentoring relationships. Student mentees note a positive influence on career planning and research and saw mentors as counselors, idea providers, and role models. Medical students' varied goals and development call for personalized, flexible mentoring. Methods: This study sought to expand the current understanding of medical student mentoring. We emailed a voluntary Qualtrics survey to second-, third-, and fourth-year medical students at the Florida International University (FIU) Herbert Wertheim College of Medicine asking, "What do you want from a mentor (choose all that apply)?" Multiple choice options were constructed based upon literature search. We conducted one-way analysis of variance and Tukey's test to identify whether mentoring preferences differed by student academic year. Results: Of 363 students, 171 responded (47% response rate). Top-rated responses included honest feedback, responsiveness, and professional connections or networking opportunities. Discussion: Student desire for honest feedback from mentors was prioritized, affirming the lack of need for impression management in the mentoring relationship. This investigation will be useful for specific mentoring relationships, helping to trigger discussion regarding specific mentoring hopes and training mentors.

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19.

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways. The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time. During this period, students had remote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc., San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year was reduced to five weeks to allow for timely graduation. The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkship has traditionally been an eight-week-long rotation. Other clerkships that varied from six to eight weeks were similarly reduced to five weeks. We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care. A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation. We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68, p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there was limited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship. These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education. If another pandemic were to arise, the duration of different clerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.

Family Medicine Clerkship Assessment Analysis: Application and Implications.

INTRODUCTION: Clerkship assessment structures should consist of a systematic process that includes information from exam and assignment data to legitimize student grades and achievement. Analyzing student performance across assessments, rather than on a single assignment, provides a more accurate picture to identify academically at-risk students. This paper presents the development and implications of a structured approach to assessment analysis for the Family Medicine Clerkship at Florida International University Herbert Wertheim College of Medicine. METHODS: The assessment analysis included a table presenting the distribution of all assessment performance results for 166 clerkship students from April 2018 to June 2019. A correlation table showed linear relationships between performance on all graded activities. We conducted a Pearson analysis (r), coefficient of determination (r 2), multiple regression analysis, and reliability of performance analysis. RESULTS: Performance on one assessment-the core skills quiz-yielded a statistically significant correlation (r=.409, r 2= .16, P<.001) with the final clerkship grade. The reliability of performance analyses showed low performers (<-1.7 SD), had both a low mean quiz score (59.6) and final grade (83). Top performers (>-1.7 SD) had both a high mean quiz score (88.5) and final grade (99.6). This was confirmed by multiple regression analysis. CONCLUSION: The assessment analysis revealed a strong linear relationship between the core skills quiz and final grade; this relationship did not exist for other assignments. In response to the assessment analysis, the clerkship adjusted the grading weight of its assignments to reflect their utility in differentiating academic performance and implemented faculty development regarding grading for multiple assignments.

Abortion Opt-in Experience in Third-Year Clerkship.

INTRODUCTION: Despite the public health imperative that all medical practitioners serving reproductive-aged women know the components of abortion care and attain competency in nondirective pregnancy options counseling, exposure to abortion care in US medical school education remains significantly limited. METHODS: Florida International University Herbert Wertheim College of Medicine offers an opt-in clinical exposure to abortion care during the obstetrics and gynecology clerkship. During clerkship orientation, students watched a recorded presentation reviewing components of abortion care and emphasizing that participating students may increase or decrease involvement at any time without explanation. Students opting in completed a form specifying their desired level of involvement for each component as "yes," "no," or "not sure." RESULTS: Of 350 clerkship students over 23 6-week rotations, 98 (28%) chose to opt in, with opt-in form data available for 90 students. Ninety students chose to observe counseling for first- and second-trimester surgical abortion and medical abortion. Seven students used the option "no" for history taking and examine second trimester fetal parts. Twenty-four students marked "not sure" for participating in evacuation of first-trimester pregnancy. DISCUSSION: This educational intervention proved feasible and offers an opportunity for students to have experiential learning about abortion care in an inclusive, respectful manner. This experience may be incorporated into undergraduate and graduate medical education. Providing learners the opportunity for exposure to abortion care improves their overall medical education and will impact the care they provide as future clinicians.

Utilizing Psychodynamic Principles to Teach Professionalism to Medical Students Through an Innovative Curriculum.

Professionalism is a fundamental expectation of practicing medicine and a core competency in medical education, yet the methods of how to teach and evaluate it are still experimental. Professionalism involves self-reflection, a psychodynamic understanding of the patient's and the doctor's predicament, and conflict resolution, so psychiatrists are uniquely qualified to teach it. This article describes an innovative course that utilizes psychodynamic principles to teach professionalism to medical students. The authors present a novel 2-year curriculum for teaching professionalism to first- and second-year medical students utilizing psychodynamic principles to help develop awareness of others' feelings and motivations, self-reflection, compassion, empathy, and skills in ethical conflict resolution by means of written and oral narrative exercises. Outcomes are evaluated by the student ratings about the course and the faculty, and by using the test for emotional intelligence (EI), administered as a baseline and then at the end of each year. Each subsequent year the students demonstrated a statistically significant increase in EI scores, student evaluations of the course ranked among the highest in the medical school, clerkship supervisors and residency training directors noted the high degree of professionalism of the students, and the number of student applicants to psychiatry residency were consistently higher than the national average. In addition, this course was awarded the 2018 Alpha Omega Alpha Honor Medical Society's Edward B. Harris Medical Professionalism Award for the best professionalism course of U.S. medical schools. Psychodynamic principles are fundamental for teaching medical professionalism at a medical-student level. Professionalism also serves as a way to introduce students to psychiatry early in the curriculum, and psychiatrists and other mental health professionals are uniquely qualified to teach medical professionalism.

Impact of the Introduction of the Clinical Science Mastery Series on Family Medicine NBME Subject Examination Performance.

BACKGROUND AND OBJECTIVES: Many medical schools assess student clinical knowledge using the National Board of Medical Examiners (NBME) subject examinations. The Family Medicine Clinical Science Mastery Series (CSMS) self-assessments, which are made up of former Family Medicine NBME examination questions, became available in September 2017. They provide students with realistic practice questions and immediate performance feedback. To further assess the utility of various study tools available to our students, this study investigated the impact of the CSMS self-assessments for family medicine on the NBME family medicine subject examination performance. METHODS: Data analysis was conducted to compare student performance on the end-of-rotation NBME Family Medicine Clinical Subject Examination before and after the introduction of the CSMS family medicine self-assessments. The effect size was measured using a Cohen d analysis. We conducted an independent t-test analysis to determine the effect the NBME Family Medicine CSMS self-assessments had on end-of-rotation clinical subject examination scores. RESULTS: The analysis revealed statistically significant improvement in students' clinical subject examination scores after the release of the CSMS in September 2017 (n=90) compared to the students' scores prior to the availability of the CSMS (n=95). CONCLUSIONS: Student scores improved with the introduction of the NBME CSMS family medicine self-assessment. These results support recommending student use of the CSMS as a study tool for their end-of-clerkship NBME subject examinations.

Effect of Repeat Examination on Family Medicine NBME Subject Scores.

INTRODUCTION: National Board of Medical Examiners (NBME) subject examinations are used by many schools to assess student clinical knowledge. Studies indicate that mean scores on NBME examinations improve as the clinical year progresses. Literature review revealed no studies investigating changes in individual student scores when end-of-block examinations were repeated at the end of the clinical year. This study investigated NBME family medicine subject examination score changes for students who opted to repeat the examination at the end of the academic year. METHODS: In 2014, students on a 4-week family medicine block clerkship took the NBME subject examination at the end of their clerkship block and were offered the opportunity to repeat this examination at the end of that clinical year; 25 of 80 students voluntarily repeated the examination. Paired t-tests were used to compare performance outcomes between the exam means at the end of the clerkship blocks to the means on the exam administration at the end of the academic year. RESULTS: Results showed a statistically significant improvement in scores between the first and second examination administration. Examinations given immediately after the students' clinical experience yielded scaled scores ranging from 60 to 80 compared to the national mean of 71.9. Examinations given at the end of the clinical year yielded scaled scores ranging from 57 to 90 (t[24]=-2.66, P=0.0006). CONCLUSION: Repeating the NBME subject examination at the end of the year led to slightly increased scores, suggesting that time spent during clerkships influences examination performance.