The Effectiveness of Different Teaching Modalities for the Detection of Heart Murmurs in Undergraduate Medical Education: A Review.

One of the many physical exam skills introduced to medical students during their pre-clerkship education is cardiac auscultation, one purpose of which is to teach the detection and identification of heart murmurs. Cardiac auscultation with a stethoscope has been the standard method of teaching. Another method, point-of-care ultrasound (POCUS), has been recently introduced as another modality by which students learn to detect and identify murmurs. The emerging popularity of POCUS in undergraduate medical curricula has led many institutions to include it in their curricula; however, doing so is challenging. Not only is cost a major factor, but reorganizing curricula to allow sufficient time for POCUS training has proven to be difficult. Additionally, the presence of notable gaps in the literature regarding the efficacy of POCUS for teaching the detection and identification of heart murmur has increased scrutiny of its value. Studies that assessed teaching cardiac auscultation to medical students in their pre-clinical years via stethoscope have used different teaching methods. However, evaluation of these studies identified numerous limitations, one being little long-term retention of cardiac auscultation knowledge. Furthermore, several barriers to integration of POCUS in undergraduate medical education were identified. The purpose of this review is to synthesize the literature comparing the effectiveness of these different tools of a cardiac exam for detection of heart murmurs in undergraduate medical education and identify gaps in literature requiring future exploration.

Improving and Sustaining Resident Physician Handover.

Background Handoffs serve a critical patient safety function in the transition between caregivers. In 2006, the Joint Commission on Accreditation of Healthcare Organizations strongly recommended the implementation of "a standardized approach to 'handoff' communications, including an opportunity to ask and respond to questions." Numerous studies have investigated the quality and efficacy of patient handoffs and the utility of structured handoff curriculums, particularly in the context of patient safety and outcomes. Objective The pediatric residents at Penn State Health (PSH) did not utilize a formal written or verbal handoff tool. Our study facilitated the design of a comprehensive handoff curriculum, including verbal and written components, and the implementation of faculty and multidisciplinary care team involvement coupled with resident training and observations. We investigate the impact of this curriculum longitudinally utilizing validated tools completed by external observers as well as the residents themselves. Methods Prior to SAFETIPS being implemented, residents at a mid-sized Pediatric program were observed giving handovers at various intervals to understand baseline habits. Residents were then educated with the SAFETIPS curriculum and again observed. Trained observers of the handover process completed a validated evaluation form concentrating on seven key domains necessary for effective handover and communication; residents involved in the handover also completed a validated evaluation form. Consent for the project was implied with the observer's presence during the process and our study was exempt from full IRB consideration given its quality improvement design. A mix of summary statistics, stacked dot plots, mixed effects regression, and joint F tests were used to analyze data. Results Mean values on all sections of the handover evaluation Likert scale completed by trained observers tended to increase over time; the variance in responses was likewise much smaller at later time periods. Similarly, all sections of the evaluation tools completed by the resident physicians themselves showed significantly increased scores from pre- to post-implementation of our curriculum. Data revealed a plateauing of results toward later time points suggestive of skills mastery and sustained improvements. Conclusion Our findings suggest that the introduction of a structured handoff curriculum correlated with improved communication among residents, and such improvements were sustained over time.

Navigating Undergraduate Medical Education: The Impact of Enhanced Mentorship Pairing at a New Medical School.

Introduction Transitioning into medical school is challenging, particularly in the first year, with a notable support gap. This study aimed to evaluate a mentorship program at a new medical school. Methods Initiated in 2017 at the University of Texas Rio Grande Valley School of Medicine, the mentorship program had two iterations: initial random pairings and subsequent formative pairings based on matching criteria. A mixed-methods approach assessed its effectiveness in supporting first-year students. Results Of 109 first-year students, 76% completed a 6-month survey. Both classes primarily had male mentees with varied interests in primary or specialty care. No significant demographic differences or benefits between 1:1 and 2:1 mentor-mentee pairings were found, though in-person communication was preferred in 1:1 pairings (p=0.036). While enhanced matching criteria improved perceived transitions (p=0.47) and academic performance (p=0.84), these did not reach statistical significance. However, it increased the frequency of communication (p=0.038). Conclusion The implementation of a peer-mentorship program at a new medical school demonstrates high engagement among first- and second-year medical students with perceived improvement in transition and academic performance. Although enhanced matching criteria led to more frequent communication, highlighting the significance of careful mentor-mentee pairings, they did not correlate with better transitions or academic outcomes. This indicates that while these criteria are valuable, they are less crucial than simply having a mentorship program in place.

Improvements in Interdisciplinary Communication Following the Implementation of a Standardized Handoff Curriculum: SAFETIPS (Statistics, Assessment, Focused Plan, Pertinent Exam findings, to Dos, If/Thens, Pointers/Pitfalls, and Severity of Illness).

Background Handoffs between medical providers serve a crucial patient safety function. While most published literature on the topic studies the handover process among physicians, robust literature is available on interdisciplinary medical communication. Little is known about the downstream effects of effective physician handover on subsequent physician and nursing interactions. Objective Our objective was to implement a handoff curriculum, SAFETIPS (Statistics, Assessment, Focused plan, pertinent Exam findings, To dos, If/thens, Pointers/pitfalls, and Severity of illness), for pediatric residents and to investigate its impact on nurses' perceptions of resident preparedness, efficiency, and competency. Methods Nurses were asked to score residents in five domains and describe the frequency of nurse-to-resident and resident-to-nurse interruptions. The survey was distributed before and after the SAFETIPS introduction. Results Statistical analysis revealed significant post-intervention mean score increases of one full point in four categories, namely organization and efficiency, communication, content, and clinical judgment. The percentage of nurses using the term "reasonable/relevant" to describe interactions with residents significantly increased from 45% to 76% (p = 0.004). The percentage of nurses reporting that residents gave "unsure response[s]," made decisions that differed from nurses' decisions, and made decisions without family/parental interests significantly decreased by 31 (p = 0.004), 22 (p = 0.034), and 30 (p = 0.002) percentage points, respectively. Conclusion The introduction of a structured handoff curriculum significantly improves communication among residents. This is then associated with improved interactions between residents and nurses.

The Echo Report Understood: Improving Education in Echocardiography for Junior Doctors.

With echocardiography standing as the most widely used cardiac imaging modality, echocardiography report interpretation is a core responsibility of junior doctors. The literature, however, reveals a deficit in echocardiography education. The implications of this for patient care should not be ignored. To address this need, a hybrid teaching session was developed for junior (intern and resident grade) doctors, with the aim to increase understanding of echocardiography and increase confidence in report interpretation. Pre- and post-session data were analysed. Results revealed that the vast majority of respondents received less than an hour of echocardiography teaching at medical school, with over two-thirds receiving less than an hour in the postgraduate setting. A total of 80% of doctors interpreted echocardiography reports weekly, with almost all doctors perceiving this skill as important. Despite this, an overwhelming majority of doctors did not feel confident interpreting reports. The educational intervention achieved significant increases in perceived understanding of echocardiography and confidence with report interpretation. Participants were better able to identify cardiac pathology and understand report terminology. This intervention has the scope to improve patient safety through better management of cardiac patients and recognition of pathology from echocardiography. This work also identifies a need for more echocardiography education, having uncovered a concerning lack of confidence amongst junior doctors and an appetite for further teaching on this important topic.

Instructional Design and Its Usability for Branching Model as an Educational Strategy.

INTRODUCTION: Serious Games (SG) are an educational strategy used in the health professions with positive results in teaching diagnosis and facilitating the application of concepts and knowledge transfer. A type of SG is the branching scenario, which has the potential for a linear story or multiple options to achieve learning goals. There must be evidence for this type of SG's instructional design (InD) and usability. OBJECTIVE: Propose an InD for the branching scenario and rate its usability. MATERIALS AND METHODS: We conducted a two-phase study. In the first phase, we drafted an InD based on the literature review, and then, we applied an expert validation process through a modified Delphi technique. With the consent of InD, we built five branching scenarios. In the second phase, we apply an instrument to measure the SG usability of the branching scenarios in a cross-sectional study with 216 undergraduate medical students. RESULTS: A proposal for an InD for branching scenarios was elaborated. This InD has five dimensions with steps and definitions that help the designer fulfill the requirements for the SG. With the InD, we developed five branching scenarios for undergraduate medical students. Finally, the rates for the usability of the branchings had high scores. The branching SG with multiple options offers different outcomes for the same clinical problem in a single activity. DISCUSSION: The proposal of a specific InD for branching scenarios considered SG theory and was tested, at least in user usability. The steps proposed include the specificity of the requirements of an SG, such as levels, checkpoints, avatars, and gameplay characteristics, among others, in contrast to the other InD that do not explicitly consider them. One of the limitations of this study is that we applied it only using the H5P software to develop branching scenarios with no other evidence of the performance of the InD in different contexts or platforms. CONCLUSIONS: We propose using an InD to construct branching scenarios. This kind of SG has specific characteristics for its correct operation. Using structured steps in developing SG improves the probability of developing decision-making skills. Using an instrument to assess the usability of at least one dimension of the SG is also recommended to identify opportunity areas.

Telehealth Curricula in the Pediatric Core Clerkship: Results From a Survey of Clerkship Directors.

OBJECTIVE: Given the increasing prevalence of telehealth, medical students require dedicated instruction in the practice of high-quality telehealth. This study characterizes telehealth practices and curricula in pediatric core clerkships across the United States and Canada. METHODS: We surveyed pediatric core clerkship directors and site directors through the 2020 Council on Medical Student Education in Pediatrics (COMSEP) annual member survey. We analyzed the results using descriptive statistics. RESULTS: Of 104 medical schools represented, 28 responded (26.9%). Directors reported students spent little time on telehealth during their pediatric core clerkships (average 8.2% of clerkship; SD 10.4). Only 10.7% (n=3) of clerkships had dedicated telehealth curricula. The instructional methods, content, and modes of evaluation varied across the clerkships' curricula. Barriers to implementation of telehealth curricula included lack of dedicated time in the existing curriculum (64.0%), lack of faculty time to teach (44.0%), lack of curricular materials (44.0%), students not participating in telehealth activities (40.0%) and lack of faculty expertise (36.0%). CONCLUSIONS: Most pediatric core clerkships do not include dedicated telehealth curricula, and the characteristics of existing curricula vary. Considering the rapid adoption of telemedicine, pediatric core clerkships merit additional support and guidance for the training of medical students in telehealth practice.

Building the Generalist Physician to Support Adolescence and Emerging Adulthood: A Narrative Review.

Undergraduate medical education serves as a foundation for the medical student to develop the skills of a generalist physician. Given the "blurring" of the demarcations between childhood and adulthood and the increased scope of pediatric practice, an extra layer has been added to medical education which seeks to address care across the lifespan. While approaches have been developed to teach this layer, clerkship reform has not focused on advancing the clinical science of adolescence. Furthermore, as we look towards the vanguard of entrustable professional activities (EPA), specific attention to transition care for the adolescent has seen minimal attention. Drawing on prior examples of curriculum integration between specialties as well as solutions to complex care management from clinical reasoning, we suggest that attention to the development of the generalist physician requires attention to the combined medicine-pediatrics specialty.

Flipped Classroom (FCR) as an Effective Teaching-Learning Module for a Large Classroom: A Mixed-Method Approach.

Flipped classroom (FCR) is one of the emerging active teaching-learning methods in the medical profession. Its potential for achieving learning objectives, especially in the scenario of a large classroom, especially in medical schools, has not been convincingly demonstrated. This study was designed to establish FCR model conduction and its overall utility as a teaching-learning methodology for undergraduate medical students in large classroom settings using a mixed-method approach using quantitative (assessment scores) and qualitative criteria (subjective feedback from students and teachers). FCR was conducted for a batch of 170 first-year medical students for a hematology topic. Pre- and post-assessments (based on all the cognitive learning domains) were done to quantify the objective improvement after exposure to the FCR. In addition, subjective feedback from both students and teachers was taken on a validated feedback survey to decipher the qualitative benefits of the FCR. Comparing pre- and post-assessment scores, there was a significant improvement after the FCR session, especially in the low performers. There was optimistic feedback from students and teachers regarding the utility of FCR as a teaching-learning module. FCR as a teaching-learning module was feasible and effective, and the users seemed primarily satisfied. Although there is a higher workload for students and teachers, still FCR is an effective teaching-learning module for a large classroom.

Teaching Quality Improvement: The Use of Education Theories Across the Medical Education Spectrum.

It is well recognized that the principles and practices of patient safety and quality improvement (QI) need to be included in medical education. The implementation of patient safety and QI learning experiences at the undergraduate medical education (UME) and graduate medical education (GME) levels has been variable. Consistent teaching of QI across the UME-GME-continuing medical education (CME) spectrum may result in a systemic change of improved patient care and patient safety in clinical practice. We propose using education theories to frame the development of QI curricula for a longitudinal integration in medical education and clinical practice. The basic principles of four education theories, namely, reflective practice, deliberate practice, social constructivism, and organizational learning, are briefly described, and examples of their applications to QI teaching are discussed. The incorporation of education theory into the design and implementation of a longitudinal QI curriculum threaded across the UME-GME-CME spectrum may empower learners with a comprehensive and lasting understanding of QI principles and training in patient safety practice, which are essential prerequisites for the formation of a physician workforce capable of creating sustainable change in patient care.

Predicting Osteopathic Medical Student Performance on the United States Medical Licensing Examination Step 2 Clinical Knowledge From Results of the Comprehensive Osteopathic Medical Licensing Examination Level 2-Cognitive Evaluation.

Background To improve their standing in residency selection, many osteopathic medical students choose to take the United States Medical Licensing Examination (USMLE). Although scores on USMLE Step 1 and Level 1 of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) are known to be highly correlated, scarce data exist on the association between COMLEX-USA Level 2-Cognitive Evaluation (CE) and USMLE Step 2 Clinical Knowledge (CK) scores. In this study, we aimed to determine the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores and derive an equation to predict performance on USMLE Step 2 CK for applicants who have only taken COMLEX-USA. Methodology We reviewed COMLEX-USA Level 2-CE and USMLE Step 2 CK scores for all students at the Lake Erie College of Osteopathic Medicine from May 2020 to April 2021. Linear regression was used to evaluate the relationship between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores. Results A total of 340 students took both COMLEX-USA Level 2-CE and USMLE Step 2 CK. There was a linear association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores such that every one-point increase in COMLEX-USA was associated with a 0.13-point increase in USMLE Step 2 CK score (standard error = 9.1; model R2 = 0.64). Conclusions Students or programs interested in predicting performance on USMLE Step 2 CK from performance on COMLEX-USA Level 2-CE can do so using the following equation: USMLE Step 2 CK = 0.13(COMLEX-USA Level 2-CE) + 163.5.