Interactive Patient Safety and Quality Improvement capstone during transition-to-residency program: virtual and in-person focused workshop for EPA 13.

Identifying systems failures and contributing to a safety culture is the Association of American Colleges (AAMC's) thirteenth Entrustable Professional Activity (EPA). While most curricula teach Patient Safety (PS) and Quality Improvement (QI) principles, student participation in live QI/PS activities remains limited. This workshop enabled late Clerkship phase students to apply these Health Systems Science (HSS) principles to real adverse patient event cases through team-based simulation.This 3-h capstone included both a didactic review of QI, PS, and TeamSTEPPS® tools and an experiential component where student-led interactive small group discussions were augmented by resident and faculty preceptors. Collaboratively, students composed an adverse patient event report, conducted a Root Cause Analysis (RCA) during role-play, and proposed error prevention ideas after identifying systems problems. In April 2020, the in-person workshop became fully virtual due to the COVID-19 pandemic.A statistically significant increase in ability to identify Serious Safety Events, Escalation Chain of Command, and define a Plan-Do-Study-Act (PDSA) cycle was observed. Comfort with RCA increased from 48 to 87% and comfort with TeamSTEPPS® principles increased from 68% to 85.5%This novel capstone provided students with the tools to synthesize HSS concepts through problem-solving processes and recognize EPA 13's importance. Their increased capability to identify appropriate chain of command, escalate concerns, and recognize serious adverse patient events also has training and practice readiness implications.

Educating the community about the opioid epidemic and medications for opioid use disorder.

BACKGROUND AND OBJECTIVES: Despite overwhelming evidence of benefit, medications for opioid use disorder (MOUD) remain stigmatizing and more efforts are needed to educate health care professionals and the general public. METHODS: We developed and evaluated an educational program for graduate students studying health sciences, teaching them to deliver 1 h presentations to the community on the opioid crisis and the usefulness of MOUD. RESULTS: To date, 120 graduate students have participated in this training experience on substance use disorders and delivered 59 presentations to more than 1065 community members. We found a significant increase in knowledge among students following the training. In addition, although attitudes and beliefs were generally positive at baseline, we also found significant increases in positives attitudes about the treatment of addiction and working with patients with addictions. Almost all students believed the course enhanced their professional expertise and would recommend it to others. We compared our students' baseline knowledge and attitudes to a large sample of other graduate students and did not find significant differences indicating good external validity of our results. Finally, we evaluated change in community members' knowledge and attitudes (N = 315) following student presentations and found significant increases in knowledge and positive attitude change toward MOUD. DISCUSSION AND CONCLUSIONS: Overall our program was feasible, enjoyable, and effective in meeting its goals of increasing knowledge acquisition and improving attitudes among students and the greater community. SCIENTIFIC SIGNIFICANCE: Graduate students in health sciences can be trained to successfully teach the public about the opioid crisis and the usefulness of MOUD.

Teaching end-of-life decision-making "Newlywed style".

Teaching strategies for topics related to death and dying are often journaling, reflection, and group discussions. This study describes an innovative demonstration in which pairs of students made hypothetical medical decisions using a technique similar to the one used on the American game show, "The Newlywed Game." One hundred students at a private mid-Atlantic University participated in a study evaluating the impact of this demonstration on raising students' awareness of issues surrounding medical decision-making and the need to clearly communicate one's desires to others. This active demonstration helps students learn about difficult issues in a meaningful way.

Brief Teaching Intervention Improves Medical Students' Dermatology Diagnostic Skills and Comfort in Performing Dermatology Exams.

BACKGROUND: Skin disease is a significant contributor to the global disease burden, with dermatologic health disparities adding to this burden. Internists, general practitioners, and other medical professionals often manage skin disease with limited exposure to dermatologic education in medical school. OBJECTIVE: This study evaluated a brief educational intervention for medical students to improve dermatologic knowledge, diagnostic and communication skills, and comfort in performing dermatology-focused physical exams. A secondary focus of the intervention was to promote awareness of skin disease, detection, and prevention for patients with a variety of skin tones. METHODS: Sixty-five first through fourth-year students at Rutgers RWJMS participated in a pre-test-post-test within-subject study. Students described images using open-ended responses followed by multiple-choice identification questions. Students watched a one-hour self-paced module created by a licensed dermatologist and completed a follow-up assessment. RESULTS: At pre-test, descriptions were brief and often inaccurate but significantly improved post-intervention to include descriptors such as primary morphology and demarcation. Accuracy on diagnostic and management questions significantly improved and comfort in advising patients and performing dermatologic exams significantly increased. CONCLUSIONS: A low-cost, brief, self-paced module can augment dermatologic education for medical students while increasing exposure to multiple skin tone presentations of lesions.

A Pre-Clerkship Medical Education Elective as Catalyst for Student Learning, Faculty Teaching, and Curricular Improvement.

Recent reviews of student-as-teacher programs call for early, longitudinal, and timely training in both learning principles and applied teaching skills. We describe a longitudinal elective for pre-clerkship students that includes interactive meetings addressing a range of theoretical and practical teaching topics and the tools needed to conduct medical education research.

Development of a Novel Peer-sharing Application to Supplement Learning from Cadaveric Dissection.

Gross anatomy dissection in contemporary medical education must balance the traditional value of learning from the cadaver with the possibilities created by the use of digital tools as supplemental resources that personalize and deepen the student learning experience. This study broadly examined the design, implementation, and use of AnatomyShare, a novel iPad application employing learner-generated content that allows students to securely share annotated images of their dissections with each other and take faculty-generated image-based quizzes during their first-year medical school gross anatomy course. Almost all students enrolled in the course used the application (N = 176; 91% use based on analytics). Seventy-five students responded to a survey asking how and when they used the application, along with their perceptions of its usefulness and contribution to learning. More students reported using the application outside of laboratory (97.3%) than during laboratory (85.3%), despite only in-laboratory use being required. Taking quizzes using the "Exam" feature was the highest rated use of AnatomyShare, and students cited that the application exposed them to anatomical variation and motivated them to correctly identify structures during dissection. While steps need to be taken to combat low-quality learner-generated content and to enhance meaningful student interaction and collaboration, AnatomyShare was a feasible and highly rated supplement to dissection that provided valuable assessment opportunities for students. Future research will examine the impact of use on course grades and engagement in gross anatomy dissection.

Three Decades Later: A Scoping Review of the Literature Related to the United States Medical Licensing Examination.

PURPOSE: To conduct a scoping review of the timing, scope, and purpose of literature related to the United States Medical Licensing Examination (USMLE) given the recent impetus to revise USMLE scoring. METHOD: The authors searched PubMed, PsycInfo, and ERIC for relevant articles published from 1990 to 2019. Articles selected for review were labeled as research or commentaries and coded by USMLE Step level, sample characteristics (e.g., year(s), single/multiple institutions), how scores were used (e.g., predictor/outcome/descriptor), and purpose (e.g., clarification/justification/description). RESULTS: Of the 741 articles meeting inclusion criteria, 636 were research and 105 were commentaries. Publication totals in the past 5 years exceeded those of the first 20 years.Step 1 was the sole focus of 38%, and included in 84%, of all publications. Approximately half of all research articles used scores as a predictor or outcome measure related to other curricular/assessment efforts, with a marked increase in the use of scores as predictors in the past 10 years. The overwhelming majority of studies were classified as descriptive in purpose. CONCLUSIONS: Nearly 30 years after the inception of the USMLE, aspirations for its predictive utility are rising faster than evidence supporting the manner in which the scores are used. A closer look is warranted to systematically review and analyze the contexts and purposes for which USMLE scores can productively be used. Future research should explore cognitive and noncognitive factors that can be used in conjunction with constrained use of USMLE results to inform evaluation of medical students and schools and to support the residency selection process.

Stability of older adults' preferences for life-sustaining medical treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.