Adapting Surgical Clerkship Curricula in Response to the COVID-19 Pandemic.

BACKGROUND: Coronavirus disease-19 (COVID-19) impacted medical education and led to the significant modification or suspension of clinical clerkships and rotations. OBJECTIVES: To describe a revised surgery clerkship curriculum, in which we divided in-person clinical teaching into smaller groups of students and adopted online-based learning to foster student and patient safety while upholding program standards. METHODS: The third-year surgery core clerkship of a 4-year international English-language program at the Medical School for International Health at Ben Gurion University of the Negev, Beer Sheva, Israel, was adapted by dividing students into smaller capsules for in-person learning and incorporating online learning tools. Specifically, students were divided evenly throughout three surgical departments, each of which followed a different clinical schedule. RESULTS: National Board of Medical Examiners clerkship scores of third-year medical students who were returning to in-person clinical clerkships after transitioning from 8 weeks of online-based learning showed no significant difference from the previous 2 years. CONCLUSIONS: To manage with the restrictions caused by COVID-19 pandemic, we designed an alternative approach to a traditional surgical clerkship that minimized the risk of exposure and used online learning tools to navigate scheduling challenges. This curriculum enabled students to complete their clinical rotation objectives and outcomes while maintaining program standards. Furthermore, this approach provided a number of benefits, which medical schools should consider adopting the model into practice even in a post-pandemic setting.

Gender Disparity in Evaluation of Internal Medicine Clerkship Performance.

Importance: Women studying medicine currently equal men in number, but evidence suggests that men and women might not be evaluated equally throughout their education. Objective: To examine whether there are differences associated with gender in either objective or subjective evaluations of medical students in an internal medicine clerkship. Design, Setting, and Participants: This single-center retrospective cohort study evaluated data from 277 third-year medical students completing internal medicine clerkships in the 2017 to 2018 academic year at an academic hospital and its affiliates in Pennsylvania. Data were analyzed from September to November 2020. Exposure: Gender, presumed based on pronouns used in evaluations. Main Outcomes and Measures: Likert scale evaluations of clinical skills, standardized examination scores, and written evaluations were analyzed. Univariate and multivariate linear regression were used to observe trends in measures. Word embeddings were analyzed for narrative evaluations. Results: Analyses of 277 third-year medical students completing an internal medicine clerkship (140 women [51%] with a mean [SD] age of 25.5 [2.3] years and 137 [49%] presumed men with a mean [SD] age of 25.9 [2.7] years) detected no difference in final grade distribution. However, women outperformed men in 5 of 8 domains of clinical performance, including patient interaction (difference, 0.07 [95% CI, 0.04-0.13]), growth mindset (difference, 0.08 [95% CI, 0.01-0.11]), communication (difference, 0.05 [95% CI, 0-0.12]), compassion (difference, 0.125 [95% CI, 0.03-0.11]), and professionalism (difference, 0.07 [95% CI, 0-0.11]). With no difference in examination scores or subjective knowledge evaluation, there was a positive correlation between these variables for both genders (women: r = 0.35; men: r = 0.26) but different elevations for the line of best fit (P < .001). Multivariate regression analyses revealed associations between final grade and patient interaction (women: coefficient, 6.64 [95% CI, 2.16-11.12]; P = .004; men: coefficient, 7.11 [95% CI, 2.94-11.28]; P < .001), subjective knowledge evaluation (women: coefficient, 6.66 [95% CI, 3.87-9.45]; P < .001; men: coefficient, 5.45 [95% CI, 2.43-8.43]; P < .001), reported time spent with the student (women: coefficient, 5.35 [95% CI, 2.62-8.08]; P < .001; men: coefficient, 3.65 [95% CI, 0.83-6.47]; P = .01), and communication (women: coefficient, 6.32 [95% CI, 3.12-9.51]; P < .001; men: coefficient, 4.21 [95% CI, 0.92-7.49]; P = .01). The model based on the men's data also included growth mindset as a significant variable (coefficient, 4.09 [95% CI, 0.67-7.50]; P = .02). For narrative evaluations, words in context with "he or him" and "she or her" differed, with agentic terms used in descriptions of men and personality descriptors used more often for women. Conclusions and Relevance: Despite no difference in final grade, women scored higher than men on various domains of clinical performance, and performance in these domains was associated with evaluators' suggested final grade. The content of narrative evaluations significantly differed by student gender. This work supports the hypothesis that how students are evaluated in clinical clerkships is associated with gender.

Attracting the Best Students to a Surgical Career.

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.

Necessity is the mother of invention: how the COVID-19 pandemic could change medical student placements for the better.

COVID-19 led to the widespread withdrawal of face-to-face hospital-based clinical placements, with many medical schools switching to online learning. This precipitated concern about potential negative impact on clinical and interprofessional skill acquisition. To overcome this problem, we piloted a 12-week COVID-19 safe face-to-face clinical placement for 16 medical students at the Hospital for Tropical Diseases, London, during the first wave of the COVID-19 pandemic. COVID-19 infection control measures necessitated that students remained in 'social bubbles' for placement duration. This facilitated an apprenticeship-style teaching approach, integrating students into the clinical team for placement duration. Team-based learning was adopted to develop and deliver content. Teaching comprised weekly seminars, experiential ward-based attachments and participation in quality improvement and research projects. The taught content was evaluated through qualitative feedback, reflective practice, and pre-apprenticeship and post-apprenticeship confidence questionnaires across 17 domains. Students' confidence improved in 14 of 17 domains (p<0.05). Reflective practice indicated that students valued the apprenticeship model, preferring the longer clinical attachment to existent shorter, fragmented clinical placements. Students described improved critical thinking, group cohesion, teamwork, self-confidence, self-worth and communication skills. This article describes a framework for the safe and effective delivery of a longer face-to-face apprenticeship-based clinical placement during an infectious disease pandemic. Longer apprenticeship-style attachments have hidden benefits to general professional training, which should be explored by medical schools both during the COVID-19 pandemic and, possibly, for any future clinical placements.

Perspectiva de los alumnos para identificar áreas de mejora en el grado de Medicina / Students' perspective to identify areas for improvement in the Medical Degree

INTRODUCCIÓN: La evaluación del grado de Medicina en la Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU) requiere una revisión constante para poder detectar áreas de mejora y conseguir llegar a la excelencia. MATERIAL Y MÉTODOS: Estudio descriptivo de los resultados de la encuesta realizada a los alumnos del ciclo clínico del grado de Medicina de las cuatro unidades docentes (hospitales universitarios). RESULTADOS: De un total de 945 alumnos, se recogieron 395 respuestas desde el 2 de enero de 2018 hasta el 28 de febrero de 2018, lo que supone una tasa de respuesta del 41,79%. Se obtuvieron los datos referentes a las asignaturas en sus clases teóricas y prácticas, la valoración del material utilizado y las instalaciones disponibles, el personal docente y de administración de la UPV/EHU, así como una valoración del grado. DISCUSIÓN: El estudio se basa en una encuesta de opinión, de la que se destaca la necesidad de tener en cuenta la opinión de docentes y alumnos para identificar las posibles áreas de mejora; de seleccionar a los docentes para la enseñanza clínica por su interés en serlo, no por su currículum académico; de ampliar las prácticas clínicas de cada asignatura; y de revisar las guías docentes de todas las asignaturas para no repetir de forma reiterada la misma materia en distintas asignaturas y año tras año

INTRODUCTION: The evaluation of the medical degree at the UPV-EHU requires a constant review in order to detect areas for improvement, and to achieve the excellence. MATERIAL AND METHODS: A descriptive study of results from the survey carried out with students of the clinical courses from the four teaching units (university hospitals). RESULTS: From 945 students, 395 responses were collected from January the 2nd, 2018 to February 28th, 2018, that represents a response rate of 41,79%. The collected data concern to the subjects in theoretical and practical classes, evaluation of the material, the available facilities, teaching and administrative staff, as well as to a global evaluation of the degree. DISCUSSION: The study is based on an opinion survey. It highlights the relevance of taking into account the opinion of teachers and students to identify possible areas of improvement. Students suggest that selection of clinical teachers be up to professional interests better than up to their academic curricula. Claim for longer periods of clinical practice and propose to review the teaching guides in order to avoid redundant repetitions in different subjects year after year

Valoración por los estudiantes de la formación práctica de grado de Medicina. El caso de la Neumología / Valuation by the students of the practical training of degree of Medicine. The case of pneumology

INTRODUCCIÓN: La formación práctica en el grado de Medicina se imparte en los últimos cursos y está determinada por numerosos factores condicionantes, entre ellos, la formación MIR. En general, la evaluación de la formación práctica recibe mucha menos atención que la teórica, su calidad no es evaluada y el profesorado no recibe retroalimentación. El objetivo de nuestro estudio ha sido conocer la valoración que dan los alumnos a la formación práctica de Neumología después de una rotación de 3semanas, con el objetivo de obtener información para el proceso de mejora continua. MÉTODOS: El estudio incluye 2encuestas anónimas realizadas a los alumnos de grado en el mismo curso académico. Una interna, aplicada por el propio Servicio de Neumología y otra externa, por la Unidad de Evaluación de la Calidad Docente de la USAL. RESULTADOS: En la evaluación interna la opinión de los alumnos acerca de la calidad de la formación práctica es alta (8,26) y la utilidad percibida también es elevada (8,23), en una escala de 0 a 10, y no se observan diferencias por el hecho de que tenga lugar en cuarto, quinto o sexto curso. Estos resultados concuerdan con los obtenidos en la evaluación externa, con un valor medio de 4,56 en una escala de 0 a 5. Las preferencias de los alumnos durante su rotación por el servicio son las unidades de hospitalización y consultas, con menor valoración en las áreas técnicas. CONCLUSIONES: La calidad de la docencia práctica es un reto que es necesario evaluar para que los profesores dispongan de la retroalimentación (interna y externa) oportuna. La rotación por los servicios de Neumología constituye una oportunidad para la mejora de la percepción de la especialidad por los alumnos de grado. Es preciso reflexionar acerca de los contenidos de dicha rotación, buscando un equilibrio entre las áreas clínicas y las de técnicas

INTRODUCTION: Practical training for medical students is provided during the final years of study and is determined by several conditioning factors, including the MIR training that students receive simultaneously. In general, practical training evaluation receives much less attention than the theoretical one; its quality is not evaluated, and the professors do not receive feedback. The objective of our study was to determine how students value practical training in pulmonology rated the experience after completing a three-week rotation, in order to apply the information gained toward a process of continual improvement. METHODS: The study included 2anonymous surveys taken by medical students during the same academic year-one internal, prepared by the Department of Pneumology, itself, and another external one, prepared by the Evaluation Unit for Teaching Excellence at the University of Salamanca. RESULTS: On the internal evaluation, student opinions of their practical training ran high (8.26) and the perceived usefulness was also high (8.23), on a scale of 0 to 10 and no differences were noted according to whether the survey was taken during their fourth, fifth, or sixth year of study. These results agree with those obtained in the external evaluation with a mean value of 4.56 on a scale of 0 to 5. Student preferences during their rotation in the department were for hospitalization and consultation units, with the technical areas being lesser valued. CONCLUSIONS: Achieving and maintaining a high quality of practical training is a goal that should be consistently evaluated so that professors may receive feedback (internal and external). Rotations in the Department of Pneumology provide an opportunity to improve the perception that medical students have regarding this specialty. It is imperative to reflect upon the contents of these rotations, seeking a balance between clinical areas and technical areas

Digital health strategies in the war against COVID-19 and beyond.

This editorial explores how technology has helped clinicians during the COVID-19 pandemic, from patient care to education, the changes that have been made and the numerous exciting possibilities of where technology can amalgamate with health care.

Embedding Ethics Education in Clinical Clerkships by Identifying Clinical Ethics Competencies: The Vanderbilt Experience.

The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees' first sustained exposure to the "reality" of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second (clerkship) year to address the unique experience of trainees' first exposure to clinical care. Our embedded curriculum is centered around core "ethics competencies" specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women's autonomy, unborn child's interests, and partner's rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum.

Clerkship Ethics: Unique Ethical Challenges for Physicians-in-Training.

Three ethical conflicts in particular are paradigmatic of what we define as "clerkship ethics." First, a distinction that differentiates the clerkship student from the practicing physician involves the student's principal role as a learner. The clerkship student must skillfully balance her commitment to her own education against her commitment to patient care in a fashion that may compromise patient care. While the practicing physician can often resolve the tension between these two goods when they come into conflict, the clerkship student is left with a more ambiguous set of choices. Second, evaluative scrutiny during clinical clerkships often forces medical students to balance doing what is morally fitting against the perceived expectations of the medical teams in which they work. Third and finally, a deeply entrenched culture of medical hierarchy presents a particular challenge to innovation and improvement in ethics education during the clerkship years. Students regard faculty as exemplars, but are not provided with the tools to assess when technical medical competence is not matched by moral competence; moreover, these faculty are unlikely to have experienced the ethics education in which students are asked to demonstrate mastery.

Rotaciones clínicas / Clinical rotations

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National Radiation Oncology Medical Student Clerkship Trends From 2013 to 2018.

PURPOSE: The purpose of this study was to assess national trends in fourth-year medical student radiation oncology clerkships over the past 6 academic years. Results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the implementation and expansion of the Radiation Oncology Education Collaborative Study Group (ROECSG) clerkship curriculum. However, over half of clerkship experiences continue to lack a structured didactic curriculum. Over the past 6 years, the ROECSG implemented and expanded upon a national standardized curriculum for the fourth-year medical student radiation oncology clerkship. This study hypothesized that this would lead to increased use of structured clerkship educational methods on a national level. METHODS AND MATERIALS: From 2013 to 2018, all applicants to a single United States radiation oncology residency program were sent an anonymous clerkship experience survey. The χ2 test was used for statistical analysis. RESULTS: Of 1183 students, 488 completed the survey (41.3% response rate); 1303 total clerkship experiences were described. From 2013 to 2018, there has been a significant increase in clerkships with lectures designed for medical students, from 28.3% of clerkships in 2013 to 43.2% in 2018 (P = .02). Students who received ≥1 formal lecture perceived greater postclerkship confidence in radiation oncology-related knowledge (P < .01) and overall confidence in their ability to function as a postgraduate year-2 resident (P = .02). CONCLUSIONS: These results demonstrate a national trend toward inclusion of structured didactics in radiation oncology clerkships coinciding with the expansion of the ROECSG curriculum and support the addition of structured didactics to the clerkship experience to provide medical students with foundational radiation oncology knowledge to function as residents.

Rural Medicine Realities: The Impact of Immersion on Urban-Based Medical Students.

PURPOSE: The purpose of our study was to determine what effect a rural-based 8-week surgical clerkship during the third year of medical school in a rural setting has on students' opinions about rural living and practice. METHODS: Thirty-three third-year medical students completed a rural health opinion survey at the beginning and end of their 8-week rural rotation and a survey measuring their interest in rural practice after the rotation. The setting was a rural hospital with an average acute care census of 100 that is a regional referral center for 5 rural counties. FINDINGS: Urban campus-based students had a statistically significant positive change in opinions about rural comfortable living, availability of quality services, community support, and medical resources. The urban campus-based students also showed a significantly increased interest in small town practice after the rotation. CONCLUSIONS: Our hypothesis that urban-based students would report an increased level of rural community support at the end of the rotation was confirmed. These urban-based students also reported positive opinions about rural living and practice. The students primarily based at the urban campus also showed a statistically significant more positive attitude toward pursuing a career in a small town after the 8-week experience. This suggests that brief rural immersion experiences may make the larger student pool at an urban campus available to address rural workforce challenges. Future studies at multiple rural sites with a larger sample size are needed to confirm this possibility.

A dozen years of evolution of neurology clerkships in the United States: Looking up.

OBJECTIVE: To report a 2017 survey of all US medical school neurology clerkship directors (CDs) and to compare the results to similar surveys conducted in 2005 and 2012. METHODS: An American Academy of Neurology (AAN) Consortium of Neurology Clerkship Directors (CNCD) workgroup developed the survey that was sent to all neurology CDs listed in the AAN CNCD database. Comparisons were made to similar 2005 and 2012 surveys. RESULTS: The response rate was 92 of 146 programs (63%). Among the responding institutions, neurology is required in 94% of schools and is 4 weeks in length in 75%. From 2005 to 2017, clerkships shifted out of a fourth-year-only rotation (p = 0.035) to earlier curricular time points. CD protected time averages 0.24 full-time equivalent (FTE), with 31% of CDs reporting 0.26 to 0.50 FTE support, a >4-fold increase from prior surveys (p < 0.001). CD service of >12 years increased from 9% in 2005 to 23% in 2017. Twenty-seven percent also serve as division chief/director, and 22% direct a preclinical neuroscience course. Forty-nine percent of CDs are very satisfied in their role, increased from 34% in 2012 (p = 0.046). The majority of CDs identify as white and male, with none identifying as black/African American. CONCLUSION: Changes since 2005 and 2012 include shifting of the neurology clerkship to earlier in the medical school curriculum and an increase in CD salary support. CDs are more satisfied than reflected in previous surveys and stay in the role longer. There is a lack of racial diversity among neurology CDs.

Cambios en la percepción de los alumnos de medicina sobre la geriatría tras una rotación clínica docente / Changes in the perception of medical students towards Geriatrics after a clinical-teaching rotation

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Dedicated education units as a clinical rotation for nursing students: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to explore the existing literature regarding student nurse and nursing faculty perceived experiences and outcomes of dedicated education units, to examine and conceptually map the evidence, and to identify any gaps in the literature. The question of this review is.

Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships.

BACKGROUND: Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems. AIM: To implement an integrated primary care-psychiatry clerkship for third-year medical students. SETTING: Undergraduate medical education, amid institutional curriculum reform. PARTICIPANTS: Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017. PROGRAM DESCRIPTION: Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines. PROGRAM EVALUATION: Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting. CONCLUSIONS: While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.