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.

Medical Students' Knowledge and Perceptions of Mpox in a High Incidence Region: Implications for Clinical Preparedness.

Introduction: In August 2022, mpox (formerly "monkeypox") was declared a public health emergency in the United States, yet there has been little published on medical providers' knowledge or perceptions of the disease. With one of the highest incidence rates in the United States being in South Florida, our Miami-based medical school aimed to assess students' perceived levels of knowledge and attitudes regarding mpox. Methods: An optional, anonymous survey consisting of multiple choice and Likert-type questions was emailed to all medical students. The first survey was sent out September 1, 2022, after which students received reminders on October 3, 8, and 31, 2022. We analyzed respondents' perceived knowledge and risk of contracting mpox by comparing responses between heterosexual and LGBTQ+ groups and preclinical and clinical groups. We used Mann-Whitney U or Kruskal Wallis tests for inferential statistical analysis. Results: Of 480 medical students, 168 (35.0%) responded to the survey. Most respondents (88.1%) were not concerned about mpox; 95.2% perceived their personal risk to be moderate or low. LGBTQ+ students were significantly more likely than others to report feeling at risk from mpox. The majority (72.0%) of respondents reported poor perceived knowledge of mpox. There was no significant difference between preclinical and clinical students' reported level of perceived knowledge (P=.0621); 76.2% of respondents were not confident in their ability to recognize mpox symptoms. LGBTQ+ students were significantly more confident in identifying symptoms than others (P=.0201). Conclusion: Medical students feel they lack critical knowledge of mpox and report being unprepared to recognize disease symptoms. The higher level of perceived risk and knowledge among LGBTQ+ students may stem from biases perpetuated by public messaging regarding mpox. These findings highlight the need for integrating education on emerging epidemics into undergraduate medical education to enable students to safely provide high-quality patient care.

Writing an External Letter of Review for Promotion.

Academic promotion, representing achievement of a level of distinction in one's body of work, is an honorable accomplishment in a faculty member's career. External letters of review written by faculty at higher ranks are a critical component of the promotion portfolio. We discuss key considerations for writing external letters. These considerations can be used to mentor this skill for less experienced letter writers. We also highlight how professional societies can aid faculty in developing and strengthening writing and mentoring capabilities for this vital task.

From East to West: A Narrative Review of Healthcare Models in India and the United States.

The global healthcare landscape is fraught with quality, cost, equity, and innovation challenges. Despite this, successful healthcare interventions have emerged from unexpected locations. In India, the eradication of certain communicable diseases, the expansion of access to primary care, and the implementation of innovative methods such as telemedicine have demonstrated the potential for community-centered care. In the United States (US), improvements in healthcare quality, accessibility, and the utilization of medical technology, such as the incorporation of telehealth and artificial intelligence, have highlighted opportunities for technological innovation in healthcare delivery. This manuscript reviews the history and development of healthcare systems in India and the US, highlighting each system's strengths, weaknesses, lessons learned, and opportunities for improvement. By examining both systems, we strive to promote a healthcare model that incorporates lessons from each country to improve community-centered care and ultimately provide equitable access to all.

Lessons From India: A Narrative Review of Integrating Yoga Within the US Healthcare System.

The ancient practice of yoga has gained worldwide popularity as a way for people to improve their overall health and well-being. This manuscript reviews and examines the history of yoga, its physical and mental health benefits, its incorporation into the Indian healthcare system, and the public perception of yoga in India. Many initiatives for yoga exist, including promoting research on yoga, providing education and information on its benefits, and developing evidence-based standardized yoga therapy guidelines. With this in mind, this narrative review article explores the potential benefits of incorporating yoga into the United States (US) healthcare system and the possible challenges of doing so. It also provides valuable insights for policymakers and healthcare professionals.

Student Teaching in the Family Medicine Clerkship: Opportunities for Interactive Virtual Learning.

OBJECTIVES: It often is challenging to deliver clerkship didactic sessions in a time-effective and engaging manner for learners. The flipped classroom approach, which fosters independent learning before applying knowledge in group settings, is an evidence-based way to enhance engagement and learning. Electronic learning methodologies were used widely during the coronavirus disease 2019 pandemic to ensure student safety while continuing didactics remotely. Student teaching of didactics delivers key content in innovative ways while also providing students with the opportunity to teach their peers. METHODS: During the Family Medicine clerkship at Florida International University Herbert Wertheim College of Medicine, students deliver an interactive, 15-minute presentation on a core Society of Teachers of Family Medicine National Clerkship Curriculum topic. During the first year of the pandemic (2020), this assignment was transitioned to be conducted remotely via Zoom. For the 2020-2021 academic year, students completed an anonymous, optional, computer-based, postactivity survey to assess their satisfaction with and perceptions of the assignment. RESULTS: The majority (80%) of respondents reported that they enjoyed teaching in the online format. In addition, students reported that this assignment made them feel confident in their teaching abilities, that they learned from their peers, and that teaching helped clarify their understanding of the topic. CONCLUSIONS: Student-led teaching is beneficial to learners because it enhances engagement. It can be easily implemented and help reduce faculty burden for curricular development. In a distributed, community-based clinical model such as ours, electronic learning allows for coordinated teaching efforts across geographical boundaries.

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.

A Letter to the Aunt I Never Met.

In this narrative medicine essay, a family physician writes to her deceased aunt about how their shared genetics connects their histories through which she hopes to create a future unavailable to her aunt in the 1970s.

An Exploratory Study of a Fourth-Year Narrative Medicine Elective: Promoting Strategies for Personal Well-Being and Improved Patient Care.

OBJECTIVES: Narrative medicine promotes the effective practice of medicine by requiring clinicians to listen to, reflect on, and manage not only the physiology of disease but also patient stories. The Florida International University Herbert Wertheim College of Medicine offers a narrative medicine elective to fourth-year students who participate in reading, writing, and discussion activities that focus on processing their medical school experiences. This study evaluated the potential roles of this course in promoting strategies for personal well-being and improved patient care. METHODS: Students completed an anonymous, optional, postcourse survey consisting of Likert-type and short-answer questions. The Likert-type questions assessed students' perceived impact of the curriculum on their knowledge of narrative medicine, likelihood to write about patients in the future, and their understanding of their own patient care experiences. The short-answer questions asked why students took the course and how they would apply their learning to patient care and their own well-being. These responses were analyzed separately by two coders through an inductive approach that grouped responses into themes, which were then agreed upon through an iterative process. RESULTS: All of the students "agreed" or "strongly agreed" that the course encouraged them to write, reflect, and share their experiences. A common theme across short-answer responses was a desire to write about, share, and reflect on experiences, as well as to develop skills regarding demonstrating empathy, processing emotions, and advocating for patients. CONCLUSIONS: Students reported that the narrative medicine elective taught them strategies for improving patient care and personal well-being, which they planned to continue to practice in the future. These findings show how the practice of narrative medicine during medical school may provide opportunities to promote reflection and resilience.

Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults.

The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.

Integration of Sex and Gender Minority Standardized Patients into a Workshop on Gender-Inclusive Patient Care: Exploring Medical Student Perspectives.

OBJECTIVES: Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop. RESULTS: Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session. CONCLUSIONS: Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.

Writing Collaboratively in Medical Education.

Scholarly writing and working in teams are vital skills for medical education faculty. Collaborative writing brings together team members from varying departments, professions, and universities and, as such, optimizes the resources and skill sets needed to develop high-quality projects and manuscripts. Previous literature discusses a broad perspective on collaborative writing, including writing surveys, submitting for institutional review board, and grant writing. We build on this work by providing detailed guidance for planning the writing process and then writing collaboratively towards a successful medical education submission.

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.