A Virtual Wellness and Learning Communities Program for Medical Students during the COVID-19 Pandemic.

OBJECTIVES: Numerous studies have demonstrated the high risk for burnout and mental illness in medical students. Because of the coronavirus disease 2019 (COVID-19) pandemic, our medical school transitioned to an all-virtual learning environment from March to June 2020, which raised concerns among student leaders and administrators, as reduced interpersonal attachments have known associations with decreased mental health. In an effort to facilitate student well-being during the pandemic, the Virtual Wellness and Learning Communities (VWLC) program was established. VWLC consisted of hour-long events that offered students the opportunity to engage with their peers online. METHODS: More than 20 events and workshops were conducted from March to June 2020, including trivia nights, song and guitar performances, sketching, video editing tutorials, chess lessons, yoga, and personal investing tips. An institutional review board-approved survey to assess the efficacy of the VWLC program was sent to medical student participants and nonparticipants. RESULTS: The overall response rate of this study was 43% (53/123). The response rate for students who attended a VWLC event was 51% (33/65), and the response rate for students who did not attend a VWLC event was 34% (20/58). Of all of the respondents, 85% (45/53) reported a decreased sense of connectivity with peers because of the pandemic, and 40% (21/53) reported a decrease in their sense of wellness. After attending a VWLC event, 79% (26/33) reported an increased sense of peer connectivity, 61% (20/33) reported improved wellness, and 55% (18/33) believed that these events should continue postpandemic to supplement in-person programming. Those who did not attend a virtual event stated that the main barriers to attending were unfamiliarity with attendees and screen fatigue. CONCLUSIONS: The COVID-19 pandemic has worsened medical student well-being and sense of community. VWLC programming may be an effective strategy for promoting medical student wellness and community while social distancing during the COVID-19 pandemic. To our knowledge, this is the first virtual wellness program for promotion of medical student mental health during the COVID-19 pandemic to be described in the literature.

Does Delaying the United States Medical Licensing Examination Step 1 to After Clerkships Affect Student Performance on Clerkship Subject Examinations?

Phenomenon: Schools are considering the optimal timing of Step 1 of the United States Medical Licensing Examination (USMLE). Two primary reasons for moving Step 1 after the core clerkships are to promote deeper, more integrated basic science learning in clinical contexts and to better prepare students for the increasingly clinical focus of Step 1. Positioning Step 1 after the core clerkships leverages a major national assessment to drive learning, encouraging students to deepen their basic science knowledge while in the clinical setting. Previous studies demonstrated small increases in Step 1 scores, reductions in failure rates, and similar Step 2 Clinical Knowledge scores when Step 1 was after the clerkships. Some schools that have moved Step 1 reported declines in clinical subject examination (CSE) performance. This may be due to shortened pre-clerkship curricula, the absence of the Step 1 study period for knowledge consolidation, or exposure to fewer National Board of Medical Examiners type questions prior to taking CSEs. This multi-institutional study aimed to determine whether student performance on CSEs was affected by moving Step 1 after the core clerkships. Approach: CSE scores for students from eight schools that moved Step 1 after core clerkships between 2012 and 2016 were analyzed in a pre-post format. Hierarchical linear modeling was used to quantify the effect of the curriculum on CSE performance. Additional analysis determined if clerkship order impacted clinical subject exam performance and whether the curriculum change resulted in more students scoring in the lowest percentiles (as defined as below the national fifth percentile) before and after the curricular change. Findings: After moving Step 1 to after the clerkships, collectively these eight schools demonstrated statistically significant lower performance on four CSEs (Medicine, Neurology, Pediatrics, and Surgery) but not Obstetrics/Gynecology or Psychiatry. Comparing performance within the three years pre and post Step 1 change, differences across all clerkships ranged from 0.3 to -2.0 points, with an average difference of -1.1. CSE performance in clerkships taken early in the sequence was more affected by the curricular change, and differences gradually disappeared with subsequent examinations. Medicine and Neurology showed the largest average differences between curricular-group when taken early in the clinical year. Finally, there was a slightly higher chance of scoring below the national fifth percentile in four of the clinical subject exams (Medicine, Neurology, Pediatrics, and Psychiatry) for the cohort with Step 1 after the clerkships. Insights: Moving Step 1 after core clerkships had a small impact on CSE scores overall, with decreased scores for exams early in the clerkship sequence and an increased number of students below the fifth percentile. Score differences have minor effects on clerkship grades, but overall the size of the effect is unlikely to be educationally meaningful. Schools can use a variety of mitigation strategies to address CSE performance and Step 1 preparation in the clerkship phase.

The Costs of Applying to Residency: One Institution's Efforts to Increase Transparency.

OBJECTIVES: To provide students at our own institution with more accurate and granular data regarding the costs associated with applying for residency. METHODS: We created an electronic survey with >28 different fields delineating the costs associated with applying for residency. Demographic data, costs broken down by type of expenditure, and how these costs were financed were measured. Each year, graduating students at our institution took the survey in 2015, 2016, 2017, and 2018 before The Match. We then created a dynamic, user-friendly, and interactive Web-based application to display these data numerically and graphically for students to use while planning and preparing for The Match. RESULTS: There was a response rate of 48.9% (194/397). Overall, students completed an away rotation at a median of 1.0 (interquartile range [IQR] 0-2.0) programs and spent $1000 (IQR $292-$1606) per away rotation. They applied to a median of 30.0 (IQR 20.0-47.8) categorical programs and attended 12.0 (IQR 10.0-16.0) interviews. The cost per interview was $282 (IQR $192-$407). The total expenditures for preparing for residency were $4992 (IQR $3034-$8,274). These numbers varied significantly by intended specialty. Differences were noted between our data and those from both a regional and recent national cohort. CONCLUSIONS: The costs associated with applying for residency are relatively unknown and can be significant for some. Institutionally led efforts may allow students to more appropriately plan and budget for The Match. Other institutions may benefit from a similar program.

Competency milestones for medical students: Design, implementation, and analysis at one medical school.

Competency-based assessment seeks to align measures of performance directly with desired learning outcomes based upon the needs of patients and the healthcare system. Recognizing that assessment methods profoundly influence student motivation and effort, it is critical to measure all desired aspects of performance throughout an individual's medical training. The Accreditation Council for Graduate Medical Education (ACGME) defined domains of competency for residency; the subsequent Milestones Project seeks to describe each learner's progress toward competence within each domain. Because the various clinical disciplines defined unique competencies and milestones within each domain, it is difficult for undergraduate medical education to adopt existing GME milestones language. This paper outlines the process undertaken by one medical school to design, implement and improve competency milestones for medical students. A team of assessment experts developed milestones for a set of focus competencies; these have now been monitored in medical students over two years. A unique digital dashboard enables individual, aggregate and longitudinal views of student progress by domain. Validation and continuous quality improvement cycles are based upon expert review, user feedback, and analysis of variation between students and between assessors. Experience to date indicates that milestone-based assessment has significant potential to guide the development of medical students.

Rechallenging With Intrathecal Methotrexate After Developing Subacute Neurotoxicity in Children With Hematologic Malignancies.

Methotrexate is associated with neurologic side effects. It is recommended that patients who developed neurotoxicity be rechallenged with methotrexate, but little is known about the safety of this approach. We performed a chart review to identify patients who received high-dose or intrathecal (IT) methotrexate. Twenty-one of 298 patients (7%) experienced neurologic symptoms attributed to methotrexate treatment in the premaintenance phase. Seventeen of these patients were rechallenged with IT methotrexate and 13 (76%) had no further neurotoxic events. No patients rechallenged during maintenance (n = 9) experienced recurrence of neurotoxic events. It is safe to rechallenge with IT methotrexate in maintenance.

Status of portfolios in undergraduate medical education in the LCME accredited US medical school.

AIM: We sought to investigate the number of US medical schools utilizing portfolios, the format of portfolios, information technology (IT) innovations, purpose of portfolios and their ability to engage faculty and students. METHODS: A 21-question survey regarding portfolios was sent to the 141 LCME-accredited, US medical schools. The response rate was 50% (71/141); 47% of respondents (33/71) reported that their medical school used portfolios in some form. Of those, 7% reported the use of paper-based portfolios and 76% use electronic portfolios. Forty-five percent reported portfolio use for formative evaluation only; 48% for both formative and summative evaluation, and 3% for summative evaluation alone. RESULTS: Seventy-two percent developed a longitudinal, competency-based portfolio. The most common feature of portfolios was reflective writing (79%). Seventy-three percent allow access to the portfolio off-campus, 58% allow usage of tablets and mobile devices, and 9% involve social media within the portfolio. Eighty percent and 69% agreed that the portfolio engaged students and faculty, respectively. Ninety-seven percent reported that the portfolios used at their institution have room for improvement. CONCLUSION: While there is significant variation in the purpose and structure of portfolios in the medical schools surveyed, most schools using portfolios reported a high level of engagement with students and faculty.

Benefits to faculty involved in medical school learning communities.

PURPOSE: Job satisfaction plays a large role in enhancing retention and minimizing loss of physicians from careers in academic medicine. The authors explored the effect of learning communities (LCs) on the faculty members' job satisfaction. METHODS: Between October 2011 and May 2012, the authors surveyed 150 academic clinical faculty members serving as LC mentors for students at five US medical schools. Factor analysis was used to explore satisfaction themes and relationships between these themes and other characteristics. RESULTS: Factor analysis revealed two major sources of this satisfaction: a Campus Engagement factor (e.g., feeling happier, improved sense of community, better communication skills, and feeling more productive) and a skills factor (e.g., improved clinical skills, being a better doctor). Higher Campus Engagement factor satisfaction was associated with less desire to leave the learning community (p = 0.01) and more FTE support for role in LC (p = 0.01). Higher skills factor satisfaction was associated with the school that provided more structured faculty development (p = 0.0001). CONCLUSION: Academic clinical faculty members reported serving as a mentor in an LC was a strong source of job satisfaction. LC may be a tool for retaining clinical faculty members in academic careers.

Use of individualized learning plans among fourth-year sub-interns in pediatrics and internal medicine.

BACKGROUND: Individualized Learning Plans (ILPs) are an effective tool for promoting self-directed learning among residents. However, no literature details ILP use among medical students. METHODS: Fifty fourth-year sub-interns in pediatrics and internal medicine created ILPs, including a self-assessment of strengths and weaknesses based on ACGME core competencies and the setting of learning objectives. During weekly follow-up meetings with faculty mentors and peers, students discussed challenges and revised goals. Upon completion of the rotation, students completed a survey of Likert-scale questions addressing satisfaction with and perceived utility of ILP components. RESULTS: Students most often self-identified strengths in the areas of Professionalism and Interpersonal and Communication Skills and weaknesses in Patient Care and Systems-Based Practice. Eighty-two percent set at least one learning objective in an identified area of weakness. Students expressed high confidence in their abilities to create achievable learning objectives and to generate strategies to meet those objectives. Students agreed that discussions during group meetings were meaningful, and they identified the setting learning objectives and weekly meetings as the most important elements of the exercise. CONCLUSIONS: Fourth-year sub-interns reported that ILPs helped them to accomplish rotation goals, with the setting of learning objectives and weekly discussions being the most useful elements.

Becoming Active Bystanders and Advocates: Teaching Medical Students to Respond to Bias in the Clinical Setting.

INTRODUCTION: Incidents of bias and microaggressions are prevalent in the clinical setting and are disproportionately experienced by racial minorities, women, and medical students. These incidents contribute to burnout. Published efforts to address these incidents are growing, but gaps remain regarding the long-term efficacy of these curricular models. We developed and longitudinally evaluated a workshop that taught medical students a framework to respond to incidents of bias or microaggressions. METHODS: In October 2019, 102 Vanderbilt core clerkship medical students participated in an hour-long, interactive, case-based workshop centered around the 3 D's response behavior framework: (1) direct, (2) distract, and (3) delegate. Participants were surveyed before and after the training, and both qualitative and quantitative data were collected. A refresher workshop was offered 8 months later, which added two additional D's: delay and display discomfort. RESULTS: After the workshop, respondents' knowledge of the assessed topics improved significantly, as did their confidence in addressing both personally experienced and witnessed incidents. Respondents initially indicated a high likelihood of using response behaviors to address incidents. The workshop did not consistently modify behavioral responses to experienced or witnessed incidents. Ninety-one percent of respondents agreed the workshop was effective. DISCUSSION: This workshop provided an effective curriculum to sustainably improve participant knowledge and confidence in responding to incidents of bias and microaggressions. This resource can be adopted by educators at other institutions.

Evaluation of Racial Microaggressions Experienced During Medical School Training and the Effect on Medical Student Education and Burnout: A Validation Study.

INTRODUCTION: Microaggressions in the learning environment have been documented at various levels of medical training. However, there is lack of data detailing the prevalence and effects of racial microaggressions in medical school. This limits interventions that might improve the learning environment for underrepresented minority medical students (URMMS). This study describes the creation and validation of a survey instrument characterizing the experience of microaggressions in medical school and their impact on medical student education and burnout. METHODS: An anonymous survey instrument was adapted for medical students from the validated Racial and Ethnic Microaggressions Scale (REMS) and distributed to the national listservs of the Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), and the Asian Pacific American Medical Student Association. Responses were categorized into two cohorts: under-represented minority (URM) and non-URM based on self-reported race or ethnicity. RESULTS: A total of 217 responses were collected from medical students across the United States, with 148 (68.2%) students identifying as URM. URM respondents were significantly (p < 0.05) more likely to report experiencing race-related microaggressions during medical school (55% vs 31%), and to report that these microaggressions contributed to feelings of burnout (62% vs 29%) and compromised learning (64% vs 49%). URM students were significantly less likely to feel that adequate resources were available to address microaggressions (26% vs 39%, p < 0.05). CONCLUSIONS: Our results suggest that microaggressions experienced by URMMS can be evaluated using an adapted REMS. Additionally, the experience of microaggressions negatively impact the learning environment, and students feel the availability of sufficient resources to address microaggressions and their effects are lacking. Further research is needed to evaluate microaggressions and their impact on a larger scale. This should be followed by interventions to minimize the frequency and impact of these microaggressions.

Exploring Careers in Medicine: Implementation and Perceived Value of a Multi-Specialty Elective.

INTRODUCTION: Choosing a medical specialty is one of the most crucial and difficult decisions made during medical school. Given that specialty exposure is among the most important factors in decision-making, the Careers in Medicine (CiM) multi-specialty elective was designed to provide clerkship students an avenue to explore three or more specialties of interest during a single elective. METHODS: A cross-sectional study was conducted at Vanderbilt University School of Medicine using anonymous surveys and de-identified written reflections submitted by students enrolled in the CiM course between August 2015 and June 2018. Data were analyzed using a mixed-methods approach. RESULTS: The majority of students reported the elective guided them in ruling out (80%) and ruling in (65%) specialties. About half (51%) of students decided between the procedural versus critical-thinking dichotomy. Finally, 80% of students reported that they would take the course again rather than a focused elective. Major themes identified from student reflections included course attributes, specialty impacts, and student values. DISCUSSION: Implementation of a multi-specialty elective during the clerkship year was an effective way to help students understand their career values, gain early exposure to specialties not featured in core clinical curriculums, and determine future fields of interest. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01311-0.

Improvements in medical school wellness and career counseling: A comparison of one-on-one advising to an Advisory College Program.

BACKGROUND: Medical students have unmet needs in the areas of career and wellness advising. AIMS: The goal of this study is to describe the development of an Advisory College Program (ACP) and assess its effectiveness compared to a traditional one-on-one faculty advisor system. METHODS: The ACP, consisting of four colleges co-led by Advisory College Directors and supported by key Faculty, was developed to provide structured career and wellness advising. The authors compared the ACP to the former Faculty Advisory Program (FAP) using two parallel questionnaires. RESULTS: Surveys were completed by 74% of first-year students, 60% of second-year students, and 88% of third-year students. Survey data demonstrated a significant increase in the number of students who could identify their advisor, the frequency of student-advisor contacts, and the perceived accessibility of advisors in the ACP compared to the FAP. While an ordinal logistic regression model did not demonstrate a significant effect of the new advising system on overall satisfaction, univariate analysis demonstrated a significant increase in student satisfaction with wellness and career counseling. CONCLUSIONS: The ACP was more effective in promoting student wellness and career counseling than the traditional one-on-one faculty advisor system. Similar college-based programs may be beneficial to students at other medical school programs.

Effects of Moving the United States Medical Licensing Examination Step 1 After Core Clerkships on Step 2 Clinical Knowledge Performance.

PURPOSE: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.

Identifying and Supporting Students to Prevent USMLE Step 1 Failures When Testing Follows Clerkships: Insights From 9 Schools.

Several schools have moved the United States Medical Licensing Examination Step 1 exam after core clerkships, and others are considering this change. Delaying Step 1 may improve Step 1 performance and lower Step 1 failure rates. Schools considering moving Step 1 are particularly concerned about late identification of struggling students and late Step failures, which can be particularly problematic due to reduced time to remediate and accumulated debt if remediation is ultimately unsuccessful. In the literature published to date, little attention has been given to these students. In this article, authors from 9 medical schools with a postclerkship Step 1 exam share their experiences. The authors describe curricular policies, early warning and identification strategies, and interventions to enhance success for all students and struggling students in particular. Such learners can be identified by understanding challenges that place them "at risk" and by tracking performance outcomes, particularly on other standardized assessments. All learners can benefit from early coaching and advising, mechanisms to ensure early feedback on performance, commercial study tools, learning specialists or resources to enhance learning skills, and wellness programs. Some students may need intensive tutoring, neuropsychological testing and exam accommodations, board preparation courses, deceleration pathways, and options to postpone Step 1. In rare instances, a student may need a compassionate off-ramp from medical school. With the National Board of Medical Examiner's announcement that Step 1 scoring will change to pass/fail as early as January 2022, residency program directors might use failing Step 1 scores to screen out candidates. Institutions altering the timing of Step 1 can benefit from practical guidance by those who have made the change, to both prevent Step 1 failures and minimize adverse effects on those who fail.

Challenges Associated With Moving the United States Medical Licensing Examination (USMLE) Step 1 to After the Core Clerkships and How to Approach Them.

An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and populations. These curricular reforms often include a shortened preclerkship phase with earlier introduction of learners into clinical environments. This has led schools to reconsider the optimal timing of United States Medical Licensing Examination Step 1. A number of schools have shifted the exam to the period immediately after core clerkships. Although this shift can provide pedagogical advantages, there are potential challenges that must be anticipated and proactively addressed. As more institutions consider making this change, key educational leaders from five schools that repositioned the Step 1 exam after core clerkships share strategies for mitigating some of the potential challenges associated with this approach. The authors describe six possible challenges: lack of readiness without consolidation of basic science knowledge prior to clerkships; risk that weaker students will not be identified and provided academic support early; clerkship or clinical shelf exam performance weaknesses; extension of Step 1 study time; an increase in student anxiety about residency specialty choices; and/or a reduced time frame to take and pass board exams. These potential challenges may be addressed using three main strategies: effective communication with all stakeholders; curricular design and assessments that facilitate integration of basic and clinical sciences; and proactive student coaching and advising.

Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection.

Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.

Defining Learning Communities in Undergraduate Medical Education: A National Study.

BACKGROUND: Learning communities (LCs) are intentionally designed groups that are actively engaged in learning with and from each other. While gaining prominence in US medical schools, LCs show significant variability in their characteristics across institutions, creating uncertainty about how best to measure their effects. OBJECTIVE: The aim of this study is to describe the characteristics of medical school LCs by primary purpose, structures, and processes and lay the groundwork for future outcome studies and benchmarking for best practices. METHODS: Medical school LC directors from programs affiliated with the Learning Communities Institute (LCI) were sent an online survey of program demographics and activities, and asked to upload a program description or summary of the LC's purpose, goals, and how it functions. Descriptive statistics were computed for survey responses and a qualitative content analysis was performed on program descriptions by 3 authors to identify and categorize emergent themes. RESULTS: Of 28 medical school LCs surveyed, 96% (27) responded, and 25 (89%) provided program descriptions for qualitative content analysis. All programs reported longitudinal relationships between students and faculty. Most frequently cited objectives were advising or mentoring (100%), professional development (96%), courses (96%), social activities (85%), and wellness (82%). Primary purpose themes were supporting students' professional development, fostering a sense of community, and creating a sense of wholeness. Structures included a community framework, subdivisions into smaller units, and governance by faculty and students. Process themes included longitudinal relationships, integrating faculty roles, and connecting students across class years. CONCLUSIONS: Medical school LCs represent a collection of high-impact educational practices characterized by community and small-group structures, relational continuity, and collaborative learning as a means to guide and holistically support students in their learning and development as physicians. In describing 27 medical school LCs, this study proposes a unifying framework to facilitate future educational outcomes studies across institutions.

Too Many Hats? Conflicts of Interest in Learning Community Faculty Roles.

PURPOSE: Many US medical schools have adopted learning communities to provide a framework for advising and teaching functions. Faculty who participate in learning communities often have additional educator roles. Defining potential conflicts of interest (COIs) among these roles is an important consideration for schools with existing learning communities and those looking to develop them, both for transparency with students and also to comply with regulatory requirements. METHODS: A survey was sent to the institutional contact for each of the 42 Learning Communities Institute (LCI) member medical schools to assess faculty opinions about what roles potentially conflict. The survey asked the role of learning community faculty in summative and formative assessment of students and whether schools had existing policies around COIs in medical education. RESULTS: In all, 35 (85%) LCI representatives responded; 30 (86%) respondents agreed or strongly agreed that learning community faculty should be permitted to evaluate their students for formative purposes, while 19 (54%) strongly agreed or agreed that learning community faculty should be permitted to evaluate their students in a way that contributes to a grade; 31 (89%) reported awareness of the accreditation standard ensuring "that medical students can obtain academic counseling from individuals who have no role in making assessment or promotion decisions about them," but only 10 (29%) had a school policy about COIs in education. There was a wide range of responses about what roles potentially conflict with being a learning community faculty. CONCLUSION: The potential for COIs between learning community faculty and other educator roles concerns faculty at schools with learning communities, but most schools have not formally addressed these concerns.