Evaluation of the public health clinical rotation in medical school: a qualitative case study design.

Public health clinical rotation in the Faculty of Medicine, Universitas Islam Indonesia, was conducted in Puskesmas (community health center). This study aims to evaluate the public health clinical rotation in Puskesmas, part of the clinical clerkship of the Faculty of Medicine, Universitas Islam Indonesia. Several concerns have been highlighted regarding the implementation of clinical rotations in public health in Puskesmas. A briefing session before placement in the village must be coherent with a guidebook. The placement of students in the village was based on community health issues determined by the Puskesmas supervisor. Priority in the curriculum was given to converting the alertness village (Desa Siaga) into a Program Indonesia Sehat-Pendekatan Keluarga (Healthy Indonesia Program-Family Education) program throughout implementation. Moreover, scheduling after four major clinical programs was difficult, and the writing of reports served as a guide for establishing the correct format. Therefore, the objective of the evaluation was to assess knowledge, skill, and psychomotor, and the burden of assignment in Puskesmas was difficult to accomplish a primary task in the community.

The effects of simple graphical and mental visualization of lung sounds in teaching lung auscultation during clinical clerkship: A preliminary study.

INTRODUCTION: The study aimed to evaluate visualization-based training's effects on lung auscultation during clinical clerkship (CC) in the Department of Respiratory Medicine on student skills and confidence. METHODS: The study period was December 2020-November 2021. Overall, 65 students attended a lecture on lung auscultation featuring a simulator (Mr. Lung™). Among them, 35 (visualization group) received additional training wherein they were asked to mentally visualize lung sounds using a graphical visualized lung sounds diagram as an example. All students answered questions on their self-efficacy regarding lung auscultation before and after four weeks of CC. They also took a lung auscultation test with the simulator at the beginning of CC (pre-test) and on the last day of the third week (post-test) (maximum score: 25). We compared the answers in the questionnaire and the test scores between the visualization group and students who only attended the lecture (control group, n = 30). The Wilcoxon signed-rank test and analysis of covariance were used to compare the answers to the questionnaire about confidence in lung auscultation and the scores of the lung auscultation tests before and after the training. RESULTS: Confidence in auscultation of lung sounds significantly increased in both groups (five-point Likert scale, visualization group: pre-questionnaire median 1 [Interquartile range 1] to post-questionnaire 3 [1], p<0.001; control group: 2 [1] to 3 [1], p<0.001) and was significantly higher in the visualization than in the control group. Test scores increased in both groups (visualization group: pre-test 11 [2] to post-test 15 [4], p<0.001; control group: 11 [5] to 14 [4], p<0.001). However, there were no differences between both groups' pre and post-tests scores (p = 0.623). CONCLUSION: Visualizing lung sounds may increase medical students' confidence in their lung auscultation skills; this may reduce their resistance to lung auscultation and encourage the repeated auscultation necessary to further improve their long-term auscultation abilities.

Evaluation and Management of Early Pregnancy: A Flipped Classroom Case for OB/GYN Clerkship Students.

Introduction: Evaluation and management of an early pregnancy diagnosis are clinically pertinent to multiple specialties that will encounter reproductive-age patients. We designed an interactive, small-group, flipped classroom session teaching concepts related to early pregnancy for obstetrics and gynecology clerkship students. Methods: Students received advance preparation materials prior to joining the small group facilitated by clinical educators in the OB/GYN department. Following each 2-hour session, students and facilitators were asked to voluntarily complete a satisfaction survey. Results: Over six clerkships, which occurred across 9 months, 116 students participated. Eighty-three students completed the satisfaction survey, with 98% agreeing that the session was helpful in applying learned principles to patient care. A very high rate of students (average: 93%) self-reported that they achieved the session's learning objectives after completing the prework and interactive small-group teaching. Eleven clinical instructors completed the survey, with 91% agreeing that they were able to facilitate active learning using the materials and 82% agreeing that the curriculum reduced their personal preparation time to teach compared to traditional didactics. Discussion: This interactive flipped classroom session achieves specified learning objectives and helps students apply learned concepts in the evaluation of early pregnancy while standardizing clerkship education and reducing the burden on clinical educators.

Master clinical teachers and personalised learning.

Clinical history taking and physical examination are two of the most important competencies of physicians. In addition to informing diagnoses, these activities build rapport and establish relationships between caregivers and patients. Despite this, emphasis on the assessment of bedside clinical skills is declining. To prepare our students for clinical work, we began a clinical competency, personalised teaching programme in which students perform a history and physical examination in front of a master clinical teacher (MCT) approximately every 2 weeks throughout their core clerkship year. The MCT works with the student in a clinical encounter, providing personalised bedside instruction on all features of being a clinician including bedside manner, history-taking skills, physical examination skills, and clinical reasoning. The MCT then provides an assessment of student's competency development and gives feedback to the student about what they do well and where they have opportunities for growth. Assessment data are collected and tracked longitudinally across the clerkship phase to ensure that each student is progressing developmentally. With over 6000 observations of student performance, we are able to discern competency development and growth over time. We can identify if a student is not improving as expected during their clerkship phase and intervene by providing extra practice and training. This core clerkship teaching programme has been well received by both students and instructors and has led us to pilot this approach during the post-clerkship phase of our medical training.

Beyond Skin Deep: case-based online modules to teach multidisciplinary care in dermatology among clerkship students.

BACKGROUND: Canadian medical schools offer limited clinical dermatology training. In addition, there is a lack of educational resources that are designed specifically for clerkship students that focus on the multidisciplinary nature of dermatology. OBJECTIVES: After developing case-based educational resources to address the lack of clinical exposure and learning of multidisciplinary care in dermatology, this study aimed to evaluate the educational intervention and gather feedback for future module development. METHODS: Ten online interactive dermatology case-based modules involving 14 other disciplines were created. Medical students (n = 89) from two Canadian schools were surveyed regarding perceptions of the existing dermatology curriculum. Among 89 students, 46 voluntarily completed the modules, and a survey (a five-point Likert scale ratings) including narrative feedback was provided to determine an improvement in dermatology knowledge and understanding of multidisciplinary care. RESULTS: Among 89 surveyed students, only 17.1% agreed that their pre-clerkship dermatology education was sufficient and 10.2% felt comfortable managing patients with skin conditions in a clinical setting. Among 46 students, 95.7% of students agreed that the modules fit their learning style (4.17 ± 0.73 on Likert scale) with positive narrative feedback. 91.3% agreed or strongly agreed that the modules enhanced their dermatology knowledge (4.26 ± 0.61). 79.6% of students agreed that the modules helped with understanding the multidisciplinary nature of dermatological cases (3.98 ± 0.81). Student comfort to manage skin conditions increased 7.7 times from 10.2% to 78.3% post-module. CONCLUSIONS: Clerkship students had limited knowledge of dermatologic conditions; the case-based modules were able to successfully address these deficits and assist students in understanding the multidisciplinary nature of dermatology.

Lessons learned through the implementation of a rural longitudinal integrated clerkship at the University of Missouri-Columbia.

INTRODUCTION: Created in 1995, The University of Missouri School of Medicine's Rural Track Pipeline Program was designed to address physician shortages in rural Missouri through medical student participation in a series of clinical and non-clinical programs over the course of their medical training to influence graduates to choose rural practice. METHODS: To increase the likelihood of students choosing rural practice, a 46-week longitudinal integrated clerkship (LIC) was implemented at one of nine existing rural training sites. Over the course of the academic year, quantitative and qualitative data was collected to evaluate effectiveness of the curriculum and for quality improvement purposes. RESULTS: Data collection is in progress and includes student evaluation of the clerkship, faculty evaluations of students, student evaluations of faculty, student aggregate clerkship performance, and qualitative data from student and faculty debrief sessions. DISCUSSION: Based on data collected, changes are being made to the curriculum for the following academic year to enhance the student experience. The LIC will also be offered at an additional rural training site beginning in June of 2022, and then expanded to a third site in June of 2023. As each LIC is unique, our hope is our experience and lessons learned will help others in developing a LIC or improving an existing LIC.

The student experience during a rural clerkship in Brazil.

INTRODUCTION: Universities have the ability to bring science and comprehensive care to remote regions. This can be done through the creation of rural clerkships during the training of health professionals. METHODS: Report of students' experiences during their rural clerkships in Brazil. RESULTS: Rural clerkships made contact possible between students from different areas of health, such as medicine, nutrition, psychology, social assistance, and nursing. This multidisciplinary team expanded the possibilities of care in the region, which often suffers from a shortage of healthcare professionals. DISCUSSION: Students noticed that the use of management and treatment guided by evidence-based medicine was more common in their university than in rural facilities. The relationship between students and local health professionals provided discussions and application of new scientific evidence and updates. Due to the greater number of students and residents of the multi-professional health team, it was possible to initiate health education, integrated case discussions, and territorialization projects. Areas with untreated sewage and a high local concentration of scorpions were identified, which allowed a targeted intervention. The students noticed the numerous differences between the tertiary care they were used to at medical school and the access to health and resources in a rural area. Collaboration between educational institutions and rural areas with scarce resources makes it possible to exchange knowledge between students and local professionals. In addition, these rural clerkships expand the possibilities for care for local patients and make it possible to carry out projects related to health education.

Taking More Society for Academic Emergency Medicine Practice Tests Does Not Lead to Improved National EM-M4 Exam Scores.

INTRODUCTION: Emergency medicine (EM) is a required clerkship for third-year medical students, and an elective EM acting internship (AI) is available to fourth-year students at our institution. The Society for Academic Emergency Medicine's (SAEM) National Emergency Medicine M4 Examination (EM-M4) is administered to students at the end of the EM AI experience. To prepare for the exam, students gain access to 23 practice tests available from SAEM. In this study we investigate the correlation between the number of practice tests taken and EM-M4 performance. METHODS: We collected data for EM-M4 and the US Medical Licensing Exam (USMLE) Step 2 Clinical Knowledge (CK) from students completing a MS4 EM clerkship in consecutive medical school classes from 2014-2017 at a private medical school. In addition, we collected data during the clerkship on the number of practice exams taken and whether a comprehensive practice exam was taken. We analyzed the study population three ways to determine whether the number of practice tests impacted final exam results: a binary distribution (1-11 or 12-23 tests taken); quaternary distribution (1-6, 7-12, 13-18, or 19-23 tests taken); and individual test variability (1,2,3,…22,23 tests taken). Complete data for 147 students was used for data analysis. RESULTS: The EM-M4 showed moderate (r = 0.49) correlations with USMLE Step 2 CK. There was no significant difference in EM-M4 performance in the binary analysis (P ≤ 0.09), the quaternary analysis (P ≤ 0.09), or the continuous variable analysis (P ≤ 0.52). Inclusion of a comprehensive practice test also did not correlate with EM-M4 performance (P ≤ 0.78). CONCLUSION: Degree of utilization of SAEM practice tests did not seem to correlate with performance on the EM-M4 examination at our institution. This could be due to many factors including that the question bank is composed of items that had poor item discrimination, possible inadequate coverage of EM curriculum, and/or use of alternative study methods. While further investigation is needed, if our conclusions prove generalizable, then using the SAEM practice tests is an extraneous cognitive load from a modality without proven benefit.

Revealing the Hidden Clerkship Curriculum: A Qualitative Analysis.

BACKGROUND AND OBJECTIVES: Family medicine (FM) clerkships have learning objectives to define what students should learn by the end of their clerkship, but how do we know what larger lessons students are taking away? This study aimed to explore the FM clerkship explicit and hidden curriculum. METHODS: Students were asked to list their top five take-home points at the end of their FM clerkship at two institutions. A total of 668 written reflections were qualitatively analyzed. RESULTS: Thirteen code categories emerged: scope of practice, health care systems, role of FM in the system, traits of a family doctor, values of FM, cultural competency and social justice, challenges of FM care, evidence-based medicine, clinical skills for a student, personal impact, life skills and tips, patient centeredness, and clinical pearls. Prominent subcategories included prevention, team-based care, doctor-patient relationship, and continuity of care. CONCLUSIONS: When compared to the FM clerkship learning objectives at both institutions, four code categories emerged that were not part of the explicit objectives: traits of a family doctor, challenges in FM care, personal impact, and life skills and tips. Conversely, some nuances of the learning objective of FM in the health care system regarding decreasing cost and improving health outcomes and equity were not represented in the coded categories of student responses. These findings could potentially help FM clerkships nationally define ways to improve messaging around challenges in FM care and help the 25 x 2030 initiative to produce more family physicians in the United States.

Educational Podcast Impact on Student Study Habits and Exam Performance.

BACKGROUND:  Emerging technologies, trainees' proficiency with digital resources, and the COVID-19 pandemic have increased the role of mobile and asynchronous learning methods in medical education. Educational podcasts have gained popularity in both formal curricula and independent learning, but their impact on educational outcomes has not been well studied. METHODS:  We conducted a prospective cohort study of third-year medical students during pediatrics clerkship. An educational podcast series titled "Peds Soup" was introduced to students as a voluntary study resource. We surveyed students at the end of the rotation to assess study habits and perceptions of the podcast. We compared survey responses from podcast users and nonusers, and used standardized pediatrics subject examination scores to measure knowledge differences between groups. RESULTS:  Eighty-three students participated in the study. Peds Soup listeners (n=43) reported spending significantly more time studying during clerkship (M=16.5, SD=9.0 vs M=12.4, SD=9.2 hours/week, P=.009) than nonlisteners. Users expressed positive views toward the podcast's impact on introducing, reinforcing, and helping apply knowledge, and endorsed that Peds Soup made it easier to find time to study. Examination scores did not differ between the two groups. DISCUSSION:  The podcast demonstrated a reaction-level impact, with users reporting positive attitudes toward the podcast's impact and spending more time studying during pediatrics clerkship. Podcasts have strong potential as a supplement to existing curricula, where they can fill a need for interested learners. Future research should focus on the relationship between time spent and knowledge gain or utilize alternative measures of knowledge.

A Mixed-Methods Needs Assessment for a Longitudinal Surgical Preparation Course in Undergraduate Medical Education.

OBJECTIVE: To assess the unmet needs associated with surgical education and skill development during the pre-clerkship years of medical school. DESIGN: A mixed-methods design was employed that leveraged semi-structured interviews and quantitative surveys followed by qualitative analysis. SETTING: A large midwestern academic medical center. PARTICIPANTS: Eighteen participants were enrolled representing second year medical students with an interest in surgery, surgical residents, and attending surgeons from a diverse array of surgical specialties. RESULTS: Unanimous support for the creation of a pre-clerkship surgical skills course emerged due to 2 main themes: (1) gaps in current surgical education offerings and (2) the value of early exposure to surgery and surgical skills followed by longitudinal practice. The components that participants deemed essential to a well-designed course were also revealed. Each stakeholder group (medical students, residents, surgeons) would benefit across all factors uncovered. CONCLUSIONS: There is a significant unmet need across all stakeholder groups for the creation of a longitudinal surgical skills course for pre-clerkship medical students. Future studies should seek to design a curriculum based on these study results and assess a pilot version of the curriculum to understand its feasibility under application.

Educational Podcast Impact on Student Study Habits and Exam Performance.

BACKGROUND:  Emerging technologies, trainees' proficiency with digital resources, and the COVID-19 pandemic have increased the role of mobile and asynchronous learning methods in medical education. Educational podcasts have gained popularity in both formal curricula and independent learning, but their impact on educational outcomes has not been well studied. METHODS:  We conducted a prospective cohort study of third-year medical students during pediatrics clerkship. An educational podcast series titled "Peds Soup" was introduced to students as a voluntary study resource. We surveyed students at the end of the rotation to assess study habits and perceptions of the podcast. We compared survey responses from podcast users and nonusers, and used standardized pediatrics subject examination scores to measure knowledge differences between groups. RESULTS:  Eighty-three students participated in the study. Peds Soup listeners (n=43) reported spending significantly more time studying during clerkship (M=16.5, SD=9.0 vs M=12.4, SD=9.2 hours/week, P=.009) than nonlisteners. Users expressed positive views toward the podcast's impact on introducing, reinforcing, and helping apply knowledge, and endorsed that Peds Soup made it easier to find time to study. Examination scores did not differ between the two groups. DISCUSSION:  The podcast demonstrated a reaction-level impact, with users reporting positive attitudes toward the podcast's impact and spending more time studying during pediatrics clerkship. Podcasts have strong potential as a supplement to existing curricula, where they can fill a need for interested learners. Future research should focus on the relationship between time spent and knowledge gain or utilize alternative measures of knowledge.

Development and evaluation of a pre-clerkship spiral curriculum: data from three medical school classes.

Pre-clerkship curricula of most Liaison Committee on Medical Education (LCME)-accredited medical schools are divided into blocks by organ system, leaving a significant amount of information susceptible to loss due to prolonged nonuse. We describe the implementation of a formal Spiral Curriculum that periodically revisits material from previous blocks. Learners were surveyed on receptivity to the curriculum across three graduating classes at a single medical school. Medical school graduate classes of 2020, 2021, and 2022 were surveyed at the end of their pre-clerkship years (2018-2020). The class of 2022 actually received the Spiraled Curriculum intervention, for which the authors created 500 board exam style multiple-choice questions, periodically administered via mandatory in-class sessions ranging from 10 to 20 questions reviewing content from previous blocks with designated expert faculty. Response rates were 36% (n = 46), 45% (n = 52), and 32% (n = 40) for classes of 2020, 2021, and 2022, respectively. On a Likert scale (1 = strongly disagree, 5 = neutral, 10 = strongly agree), the classes of 2020, 2021, and 2022 provided statistically significant differences in their belief that a Spiraled Curriculum would/did help them retain information as 8.2 (SD 1.7), 8.2 (SD 2.2), and 5.0 (SD 3.0) (n < 0.05). All classes endorsed neutral confidence in the existing pre-clerkship curriculum in themselves to prepare for United Stated Medical Licensing Examination (USMLE) Step 1, and in their retention of previous block material with no statistically significant differences between classes. USMLE Step 1 scores did not differ significantly between classes (n = 0.21). Those who did not receive the Spiral Curriculum were highly receptive to it in theory, while those who actually received the intervention gave a neutral rating. Per survey comments, implementation of a Spiraling Curriculum would ideally be administered as either team-based or self-directed activities, and a Spiraling Curriculum may be difficult to implement in accelerated (18 month) pre-clerkship formats.Practice points Question: What is the receptivity of medical students to a formal Spiral curriculum that uses time-spaced repetition sessions of board exam style questions to revisit previous block content of their pre-clerkship years?Findings: In this single-center, quasi-experimental study, the two control group medical school classes had very positive theoretical reception to a Spiral curriculum proposal (rated 8 out of 10) while the class who actually received the Spiral curriculum provided a statistically significant lower neutral rating (rated 5 out of 10), citing preference for a team-based or self-directed format.Meaning: Medical students are strongly in favor of structured time-spaced repetition with board exam style questions to revisit previous material but prefer a format that does not interfere with time to personalize their medical school experience.

Academic Performance of Clerkship Students Working on a Longitudinal Inpatient Pediatrics Team.

OBJECTIVE: To determine if the academic performance of students who worked on a longitudinal inpatient team in the pediatric clerkship differed from students on traditional teams. We hypothesized that working on the longitudinal team would be associated with improved performance. METHODS: We retrospectively identified students who rotated in the pediatric clerkship at a single institution from 2017 through 2021. We used multiple linear and multiple ordered logistic regression to examine whether working on a longitudinal inpatient team in which the majority of students work with the same senior resident and attending for the entire inpatient block and function without interns was associated with improved academic performance. RESULTS: We included data from 463 students, 316 in the longitudinal team group and 147 in the traditional team group. Working on the longitudinal team was associated with a higher inpatient preceptor rating (adjusted mean rating 3, 95% confidence interval [CI] 2.97 to 3.03 vs 2.85, 95% CI 2.81 to 2.90; P = .02; on a scale of 0 to 4) and an increased probability of achieving a higher final grade in the pediatric clerkship (adjusted probability of achieving honors 22%, 95% CI 17% to 28% vs 11%, 95% CI 6% to 16%; P = .003). These differences did not persist in the clerkship immediately after pediatrics. CONCLUSIONS: Compared with a traditional inpatient team, working on a longitudinal team was associated with achieving a higher preceptor rating and final pediatric clerkship grade. Implementing similar models within clinical clerkships may help foster optimal student performance.

Identifying Meaningful Patterns of Internal Medicine Clerkship Grading Distributions: Application of Data Science Techniques Across 135 U.S. Medical Schools.

PROBLEM: Residency program directors use clerkship grades for high-stakes selection decisions despite substantial variability in grading systems and distributions. The authors apply clustering techniques from data science to identify groups of schools for which grading distributions were statistically similar in the internal medicine clerkship. APPROACH: Grading systems (e.g., honors/pass/fail) and distributions (i.e., percent of students in each grade tier) were tabulated for the internal medicine clerkship at U.S. MD-granting medical schools by manually reviewing Medical Student Performance Evaluations (MSPEs) in the 2019 and 2020 residency application cycles. Grading distributions were analyzed using k-means cluster analysis, with the optimal number of clusters selected using model fit indices. OUTCOMES: Among the 145 medical schools with available MSPE data, 64 distinct grading systems were reported. Among the 135 schools reporting a grading distribution, the median percent of students receiving the highest and lowest tier grade was 32% (range: 2%-66%) and 2% (range: 0%-91%), respectively. Four clusters was the most optimal solution (η 2 = 0.8): cluster 1 (45% [highest grade tier]-45% [middle tier]-10% [lowest tier], n = 64 [47%] schools), cluster 2 (25%-30%-45%, n = 40 [30%] schools), cluster 3 (20%-75%-5%, n = 25 [19%] schools), and cluster 4 (15%-25%-25%-25%-10%, n = 6 [4%] schools). The findings suggest internal medicine clerkship grading systems may be more comparable across institutions than previously thought. NEXT STEPS: The authors will prospectively review reported clerkship grading approaches across additional specialties and are conducting a mixed-methods analysis, incorporating a sequential explanatory model, to interview stakeholder groups on the use of the patterns identified.

Impact of Students' Scheduling Choice on Clerkship Examination Score Performance in a Time-Varying Competency-Based Curriculum.

PURPOSE: Standardized end-of-clerkship examinations typically occur on the last day of the clerkship. However, recent trends toward time-varying competency-based medical education have offered students more test scheduling flexibility, creating an opportunity to study the impact of student-selected examination timing. METHOD: Starting with the graduating class of 2018, students took the required standardized end-of-core clerkship examinations at any available time they chose during their clinical years. Before this change, these examinations were administered to all students on the last day of the clerkship. Students' examination dates relative to clerkship completion were analyzed between 2017 and 2020 (inclusive of before and after flexible exam timing) to assess the impact that student-selected exam timing had on test performance on National Board of Medical Examiners shelf clinical science examinations for required core clerkships. RESULTS: Data on 146 medical students in 2017 (fixed exam timing) and 466 medical students between 2018 and 2020 (flexible exam timing) were included. Among students offered flexible exam timing, between 2.7% (internal medicine) and 14.6% (psychiatry) took their exam before actually taking clerkship, while between 22.7% (psychiatry) and 40.0% (surgery) took their exam more than 90 days after the clerkship ended. Exam scores were statistically higher for those who took the exam at a time of their choosing compared with those who were required to take it at the end of individual rotations and when the exam scores were combined (fixed exam timing mean = 73.9, standard deviation [SD] = 7.8; flexible exam timing mean = 77.4, SD = 6.0, P < .001). The percent of students with passing scores was statistically higher in internal medicine, pediatrics, and psychiatry. CONCLUSIONS: Self-selection of shelf exam timing appears to increase shelf exam scores. As more medical schools transition to competency-based medical education, providing scheduling flexibility appears not to negatively affect student achievement.

Evaluating the Implementation of a Medical Student's Handoff Curriculum During the Surgery Clerkship.

INTRODUCTION: Early introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship. METHODS: A multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship. RESULTS: There were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03). CONCLUSIONS: Medical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.

Roles and Responsibilities of Medicine Subinternship Directors : Medicine Subinternship Director Roles.

BACKGROUND: The internal medicine (IM) subinternship (also referred to as acting internship) plays a crucial part in preparing medical students for residency. The roles, responsibilities, and support provided to subinternship directors have not been described. OBJECTIVE: We sought to describe the current role of IM subinternship directors with respect to their responsibilities, salary support, and reporting structure. DESIGN: Nationally representative, annually recurring thematic survey of IM core clerkship directors with membership in an academic professional association as of September 2017. PARTICIPANTS: A total of 129 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited U.S./U.S.-territory-based medical schools. MAIN MEASURES: Responsibilities, salary support, and reporting structure of subinternship directors. KEY RESULTS: The survey response rate was 83.0% (107/129 medical schools). Fifty-one percent (54/107) of respondents reported overseeing both core clerkship inpatient experiences and/or one or more subinternships. For oversight, 49.1% (28/53) of subinternship directors also reported that they were the clerkship director, 26.4% (14/53) that another faculty member directed all medicine subinternships, and 18.9% (10/53) that each subinternship had its own director. The most frequently reported responsibilities for the subinternship directors were administration, including scheduling, and logistics of student schedules (83.0%, 44/53), course evaluation (81.1%, 43/53), and setting grades 79.2% (42/53). The modal response for estimated FTE per course was 10-20% FTE, with 33.3% (16/48) reporting this level of support and 29.2% (14/54) reporting no FTE support. CONCLUSIONS: The role of the IM subinternship director has become increasingly complex. Since the IM subinternship is critical to preparing students for residency, IM subinternship directors require standard expectations and adequate support. Future studies are needed to determine the appropriate level of support for subinternship directors and to define essential roles and responsibilities.

Effects of simulation-based education for neonatal resuscitation on medical students' technical and non-technical skills.

Simulation is a learner-centered practice that helps develop and maintain knowledge, skills, and competencies. This study evaluated the effect of neonatal resuscitation simulation-based education for medical students in the fifth year (part of the regular clinical clerkship program) on the perceived performance of their technical and non-technical skills. In addition, we analyzed the difference between instructor's and learners' evaluations of technical skills after the simulation. A one-group pretest-posttest design was adopted. The simulation-based education of the neonatal resuscitation program (NRP) was conducted for 40 medical students from July to November 2020 at a medical school in South Korea. The simulation-based education comprised 5 minutes of pre-briefing, 10 minutes of running the simulation, and 30 minutes of debriefing (using a recorded video). The perceived performance of students' technical and non-technical skills before and after the simulation was compared by collecting and analyzing the pre- and post-questionnaires. The perceived performance of technical (p = .001) and non-technical skills (p < .001) was found to have significantly increased after the simulation. Particularly, the performance of technical skills, such as diagnostic (p = .007) and therapeutic actions (p < .001) and non-technical skills, such as leadership (p < .001), teamwork (p = .001), and task management (p = .020) improved significantly. There was no significant difference in the evaluations of the technical performance of the instructor and learners after the simulation (p = .953). Simulation-based education can improve technical skills, such as diagnostic and therapeutic actions for neonatal resuscitation. It is also effective in enhancing non-technical skills, such as leadership, teamwork, and task management. Further, after the simulation-based education, students can fully self-evaluate through objective reflection and improve their clinical competency.

Perception of Current Educational Environment, Clinical Competency, and Depression among Malaysian Medical Students in Clinical Clerkship: A Cross-Sectional Study.

The COVID-19 pandemic has altered the educational environment of medical students in clinical clerkship, with potential impacts on clinical competency and reported increased prevalence of depression. This study aimed to determine the relationship between the perception of the educational environment, self-perceived clinical competency, and depression among them. Subjects (N = 196) at the National University of Malaysia participated through convenience sampling in an online survey including sociodemographic data, COVID-19-related stressors, Dundee Ready Education Environment Measure (DREEM), self-perceived clinical competency, and Patient Health Questionnaire (PHQ-9). The cut-off point for depression was a PHQ-9 score ≥ 15. Multiple logistic regression followed bivariate analyses to identify factors for depression. The participants (mean age: 23.2 years, SD ± 0.98 years) were mainly female (71.9%) and Malay (59.2%). The prevalence of depression was 17.4% (95% CI: 12.3-23.4%). Most participants perceived the educational environment positively. In logistic regression, ethnicity (Adjusted OR = 3.1, 95% CI: 1.2-8.1) and DREEM score were significantly associated with depression, whereas self-perceived clinical competency was not. A higher DREEM score indicating a better perception of the educational environment was linked to a lower likelihood of depression (p = 0.046). Besides ethnicity, perception of the educational environment emerged as a factor associated with depression. This relationship between the educational environment and mental well-being warrants further exploration.