Medical Education Research
This section includes Class of 2023 Embark Projects within the Medical Education field. These include educational research projects designed to improve the undergraduate and/or graduate medical education areas, as well as other areas of health education.
The Impact of Early Clinical Experiences on Undergraduate Medical Education
Mark Baniqued, B.S.1, Misa Mi, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Clinical experience is an essential aspect of undergraduate medical education. Schools have a variety of teaching methods that impact how they prepare students for their clinical years. There is no correct way to provide clinical experience, but comparing how schools do so could provide data showing the trend of how these experiences are being provided and the outcomes of these changes.
METHODS
Data regarding outcomes, timing, and methods of early clinical experience distribution are being collected from various sources. AAMC Snapshot provides reports on how LCME-accredited Medical Schools provide clinical experience. This data was used to look at overall trends in assessments and curriculum content. Furthermore, published literature on clinical experiences in undergraduate medical education was searched, analyzed, and synthesized to provide the current status of how clinical experiences were developed, implemented, and evaluated.
RESULTS
In most studies reviewed, clinical education was introduced in the 1st year curriculum (53.8%). The two most common forms of clinical experience presented were case-based lectures (13.9%) and skill-learning sessions (13.9%). Students’ perceptions and satisfaction with early clinical experience revealed four areas of benefits: Improved Preparedness for Clerkships, Better Understanding of Clinical Content, Improved Knowledge and Quiz Scores, and Specialty Experience. The AAMC Snapshot showed that 84% of the medical schools listed were either recently completed, planned or in the middle of a curriculum change.
CONCLUSIONS
Undergraduate Medical Education is trending towards including more clinical experience before starting clerkships. Common ways of introducing clinical education include skills practice, case-based learning, and direct interaction with patients. Introducing clinical experience early showed four areas of benefit for students that could positively affect their experience in the clinical portion of their education. Further studies could measure quantifiable outcomes, such as clinical shelf scores, board exam scores, and residency match results, compared before and after curriculum changes to obtain measurable outcomes.
Medical Student Knowledge of Physician Involvement in the Holocaust and the Importance of Incorporating Holocaust Studies and Ethics into Medical School Curricula
Megan Bricely, B.A.1, Jason Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
A 2019 Claims Conference study demonstrated an alarming lack of knowledge about the Holocaust in the United States general population. There is currently no specific data on medical student knowledge of the Holocaust and the role that the medical community played. The goal of this study was to gather baseline data on medical student knowledge of the Holocaust and medicine’s involvement to demonstrate the need for Holocaust teaching in medical school.
METHODS
An online survey was created on Qualtrics assessing general Holocaust knowledge using questions from the 2019 Claims study. This study was adapted and questions focused on medical personnel and events were added. All participants in this study were medical students attending Oakland University William Beaumont School of Medicine and included M1 through M4 students. The survey was distributed via the OUWB student listserv. 54 participants completed the survey.
RESULTS
Medical students were more likely to be able to name a single concentration camp (91%, z=5.279 ; p<0.001) than the general population (55%). Of the participants, 50.9% (n=27) strongly agreed and 34% (n=18) agreed that it’s important for medical students to study physicians that participated in the Holocaust. The students sampled were less likely to agree that fewer people seem to care about the Holocaust today (54.7%, z=-2.428 ; p > 0.05) than the general population (70%). Medical students were more likely to have visited a Holocaust Museum (51%, z=5.632; p<0.001) than the general population (20%).
CONCLUSIONS
The results affirm that medical students would have more general Holocaust knowledge than the general population, most likely owing to the education standards for admission. It is also clear that medical students think it’s important to study physicians involved in the Holocaust. There are valuable ethical lessons that can be drawn from this dark time to help strengthen students’ professional identities.
Beyond COVID-19: The Impact of Recent Pandemics on Medical Students and their Education: A Scoping Review
Moneb Bughrara, B.A.1, Stephanie Swanberg, MSI2, Victoria Lucia, Ph.D.3, Keaton Schmitz1, Dawn Jung, M.D.4, Tracy Wunderlich-Barillas, Ph.D.1
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2The Michigan School of Psychology, Farmington Hills, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
4Department of Emergency Medicine, Beaumont Health System
INTRODUCTION
Over the past two years, COVID-19 has greatly altered undergraduate medical education (UME) as well as daily life. Medical schools across the world were disrupted and had to immediately adapt the educational experience to the online environment in order to continue the delivery of quality UME. However, COVID-19 was not the only recent pandemic. This posed the question, were similar disruptions and adaptations also seen in recent past pandemics such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) that could have prepared UME for COVID-19? This scoping review investigated the educational and personal impact of recent pandemics on UME and medical students.
METHODS
This review followed the PRISMA guidelines for scoping reviews. Nine databases including PubMed, ERIC, and EMBASE were systematically searched using keywords and subject headings related to medical students/UME and SARS, Ebola, H1N1, MERS, and COVID-19. Articles were limited to research studies published between 2000-2020 and in English. Based on exclusion and inclusion criteria, all articles were independently screened by two reviewers first by the title/abstract and then via full text. Data was extracted from the included studies and analyzed qualitatively using thematic analysis.
RESULTS
A total of 172 studies fit the criteria. Seven major themes emerged from those studies: educational adaptations and online modifications, knowledge and attitudes of students, mental wellness of students, student involvement and use of telehealth, student vaccination uptake and attitudes, physical wellness of students, and stigma.
CONCLUSIONS
This review provided insights into how medical students were affected by recent pandemics and their perceptions of pivoting to online education, mental health, and knowledge of the diseases. Additionally, this review showcases the various educational adaptations that emerged uniquely during COVID-19, such as telehealth services or video conferencing tools, that can be utilized in a post-pandemic environment.
Cognitive Reappraisal and Self-Reinforcement Improve Academic Performance: The Role of Emotional Suppression as a Mediator
Erica Burkett, 1, Changiz Mohiyeddini, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Predicting and improving student academic performance is a main aim of medical education. Previous research suggests that using positively reinforcing self-talk and cognitive reappraisal as an emotion regulation (ER) strategy have a beneficial impact on various aspects of cognitive performance whereas using expressive suppression as an ER strategy is known to be detrimental to cognitive performance. The aim of the present research was to establish whether decreasing emotional suppression is a mechanism through which cognitive reappraisal and self-reinforcement enhance academic performance of medical students. We hypothesized that using cognitive reappraisal and self-reinforcement will be negatively associated with emotional suppression, resulting in enhanced academic performance.
METHODS
Using a cross-sectional survey-based design, 50 students (75% female) from three different medical schools, were recruited to participate in the study. The Emotion Regulation Questionnaire, Cognitive Emotion Regulation Questionnaire, and Self-Talk Scale were used to assess ER strategies and self-talk patterns of participants. Academic performance was measured using an average of three self-reported exam scores.
RESULTS
The results of a mediation analysis using hierarchical regression analysis showed that positive reappraisal was negatively associated with expressive suppression [ (48) = -.285, p =.027], as was self-reinforcement [ 48) = -.348, p = .006]. A low level of expressive suppression was associated with higher academic performance, [ (48) = -.304, p = .032.]
CONCLUSIONS
The results from this study reflect that students who use self-reinforcement and cognitive reappraisal are less likely to engage in emotional suppression as an emotion regulation strategy. Furthermore, those students who suppress their emotional experiences are less likely to demonstrate high academic performance. These results suggest that decreasing emotional suppression is a mechanism through which self-reinforcement and positive reappraisal enhance academic performance. Interventions to promote healthy emotion regulation and positive self-talk could be beneficial to both students’ health and their ability to succeed in medical school.
Causal Mechanisms In Basic Science Education – Do They Aid In Recall And Application Performance?
George Cholack, M.S.1, Kristina Lisk, Ph.D.2, Zach Sundin, Ph.D.3, Judith Venuti, Ph.D.4, Stefanie Attardi, Ph.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2University of Toronto, Toronto, Ontario, Canada; Humber College, Toronto, Ontario, Canada
3University of Kansas School of Medicine, Kansas City, Kansas USA
4Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Research has shown that learners receiving instruction with basic-science oriented causal mechanisms, statements describing underlying rationale for clinical manifestations, display improved clinical application performance upon delay (one week after instruction). However, no study has examined if instruction of a basic science using causal mechanisms from another basic science improves learning of those disciplines. The purpose of this study was to determine the effect of basic science-oriented causal mechanisms on pre-clinical medical students’ immediate and delayed recall and application of the basic science concepts.
METHODS
Second year medical students (N=123) were recruited to participate in a randomized controlled study. Participants viewed an instructional video about pituitary histology and embryology that either utilized basic science causal mechanisms or did not. Multiple-choice post tests were completed at both the immediate and delayed times to assess recall and application performance of the content. Two-way ANOVAs were used to assess the effect of learning condition and time on overall test, recall, and application performance.
RESULTS
Fifty-two second year medical students completed the study. Time was a significant influence on recall and application performance regardless of learning condition (p<0.001). There was no significant interaction between learning condition and time on overall test performance [F(1, 98) =0.024, p=0.876]. Nonsignificant results were obtained for recall and application performance with respect to learning condition.
CONCLUSIONS
Although no significant differences in recall and application performance between the groups were observed at the immediate and delayed time points, the instruction that used causal mechanisms may prove beneficial for future learning. Further research is warranted to examine the effect of basic science instruction that uses causal mechanisms on preparing students for future learning tasks, as well as the instruction of basic sciences using different basic science discipline combinations, organ systems, video-based learning structures, and varying amounts of causal mechanisms.
Disentangling the link between Burnout, Resilience, and Emotional Regulation Among Medical Students: The role of gap years
Jordan Ensz, B.S.1, Changiz Mohiyeddini, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
US medical schools confer a doctoral degree, typically requiring a bachelor’s degree to enroll. While students can start medical school directly after graduation, some delay this, taking a “gap year(s)”. This is increasingly common, with the percentage of medical students taking gap year rising from 57.9%(2014) to 65.2%(2019). Unfortunately, burnout, or multifaceted exhaustion from stress, is a worsening problem for doctors, and detrimental to their health and patient care. Currently, little research has been done into the effect of gap years on medical students. The study’s aim was twofold: establish if gaps years increase the resiliency of medical students against burnout and whether difficulties with emotion regulation is a mechanism through which resiliency decreases burnout.
METHODS
Using a survey based cross-sectional design, information was gathered from 79 medical students(mean age=25.2, 35.4% male) regarding whether they took a gap year(s), along with inventories for burnout(Oldenburg Burnout Inventory), emotion regulation(Difficulties in Emotional Regulation Scale), and resiliency(Brief Resilience Scale). Multiple regression analysis and ANCOVA were then conducted.
RESULTS
This study showed no significant differences in burnout, emotion regulation or resiliency(ps0.37) between medical students who took gap year and those who did not. But, difficulties with emotion regulation mediated the link between resiliency and burnout (β=.44,p=.01).
CONCLUSIONS
Emotion regulation is a learned skill that affects physical and mental well-being and performance. The results of this study suggest educational interventions on emotion regulation may be beneficial to protect medical students against burnout. Key limitations of this study are small sample size and lack of longitudinal design. While this study did not establish any impact of the gap years, they may still have an effect if students who elect to take time off have differing baseline levels of burnout, emotion regulation, and resiliency than those who progress immediately and further research is needed.
Leadership Training in Undergraduate Medical Education: A Systematic Review
Mallory Evans, B.S.1, Eric James, B.A.1, Misa Mi, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
This review seeks to characterize existing curricular interventions implemented to develop leadership skills in undergraduate medical students at LCME accredited medical schools and elucidate best practices for leadership curriculum development.
METHODS
PRISMA guidelines were used to guide the review. Comprehensive literature searches of five databases retrieved peer-reviewed journal articles with empirical data published in English. Two phases of screening were conducted to identify studies describing leadership development curricular interventions followed by data extraction and synthesis.
RESULTS
Comprehensive literature searching and hand searching identified 977 articles potentially eligible for inclusion in the review with a final set of 16 articles selected for the review. A majority of leadership development programs targeted preclinical students, while others spanned the entire curriculum. "Mixed settings," including both classroom, clinical and community components, were common. There was a wide array of cohort sizes spanning from over 100 students to fewer than 10. Using the competencies defined by Mangrulkar et al we determined that all of the programs described developed leadership skills, including conflict management and emotional intelligence. Out of the 16 selected studies, curricula emphasized development of skills in evidence-based medicine and practice, and 6 curricula targeted interprofessionalism.
CONCLUSIONS
Leadership development needs to be standardized in undergraduate medical education, ideally using a competency-based framework to develop these standards. Longitudinal programs that have a didactic and project-based component received consistently high quality and effectiveness scores, as did programs with smaller cohort sizes that received more consistent mentorship and monetary investment from institutions.
A Survey of Medical Student Experiences During the COVID-19 Pandemic
Stephanie Gappy, B.S.1, Girish Nair, M.D.2, Dwayne Baxa, Ph.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Royal Oak, Michigan
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
During the COVID-19 pandemic, medical students switched from an in-person to virtual curriculum. This shift placed stress on medical schools to find alternatives to train students. Students relied on recorded lectures, emails, and video-conferencing to stay up-to-date with schoolwork. Understanding student experiences during the pandemic will help prepare students and administrators for repeat lockdown events. The goal of this study is to understand the experiences of medical students during the pandemic.
METHODS
A 5-point Likert Qualtrics survey was used to identify common experiences medical students faced during the pandemic. It was distributed electronically to all medical students at OUWB. Questions were organized into three categories: communication, medical school preparedness, and individual experiences. Answer choices ranged from strongly agree (5) to strongly disagree (1), with a corresponding numerical value according to the 5-point scale. Data was aggregated to provide means and standard deviations for each question and category.
RESULTS
32 completed surveys were collected. Questions in the communication category received a mean of 3.5, corresponding to an above-average opinion with regard to the school’s communication. Questions in the medical school preparedness category received a mean of 3.6, corresponding to an above-average opinion with regard to the school’s adaptations. Questions in the individual experience category received a mean of 3.2, indicating a small degree of agreement with regard to the negative impact of the pandemic on student performance and well-being.
CONCLUSIONS
All categories scored positively in student response. In the communication category, students felt well-informed on decisions/changes that were being made in real time. In the medical school preparation category, students felt the structural changes to adapt to the virtual platform were appropriate and felt comfortable entering their next term. In the individual experiences category, students felt the pandemic negatively impacted their mental and physical wellbeing.
The Factors that Influence a Surgical Resident's Subspecialty Decision
Nicole Haggerty, B.S.1, Stefanie M. Attardi, Ph.D.2, Victoria Roach, Ph.D.3
1Oakland University William Beuamont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
3Division of Healthcare Simulation Science, UW Medicine, University of Washington, Seattle, WA
INTRODUCTION
Resident interest across surgical subspecialties is non-uniform; some subspecialties experience a short supply of trainees. A variety of factors may underpin a resident’s interest in a subspecialty. Little is known about the process behind a resident's subspecialty choice. The few studies that have attempted to explore this decision-making process were limited through the use of close-ended surveys. Qualitative methods may provide rich data to better understand the factors. This study aims to use qualitative inquiry to describe the factors influencing a surgical resident’s subspecialty decision.
METHODS
We conducted individual semi-structured interviews with Beaumont Royal Oak general surgery residents (PGYs 4-6; n=7) to explore reasons behind their subspecialty decision using Zoom video conferencing. Using Nvivo qualitative analysis software, the authors coded interview transcripts individually using descriptive and in-vivo codes. Discrepancies were resolved through author meetings after the codes were consolidated into a final code book. Based on the categories, the team synthesized themes representing factors that influence decision-making.
RESULTS
Four prominent themes were synthesized: (1) ability to maintain a predictable day-to-day schedule while practicing the subspecialty; (2) ability to envision themselves practicing in the subspecialty, long-term (longevity); (3) desire to practice in a subspecialty where complex patient physiology is common; and (4) desire to practice in a subspecialty which avoids a “tough lifestyle” (i.e. a heavy call schedule, unpredictable day-to-day schedule).
CONCLUSIONS
Thematic analysis of interviews with surgical residents PGY 4-6 revealed that the residents prioritized reasonable work hours as an attending physician, a long-term interest in the subspecialty, and a work-life balance that supports longevity in the subspecialty. Subspecialties that want to attract more applicants may want to highlight aspects of their program that appeal to these priorities, and, if possible, may want to change aspects of their program to better meet the goals of their applicants.
Evaluating the Impact of Medical School Diversity Initiatives on Student Perceptions of Inclusion in Preclinical Curriculum
Katherine E. Hole, B.S.1, Stefanie M. Attardi, Ph.D.2, Deirdre G. Pitts, Ph.D.2,3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
3Faculty & Staff Affairs & Professional Development, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
In July 2020, Oakland University William Beaumont School of Medicine (OUWB) students sent administrators a Call-to-Action letter urging for reform in preclinical education. Several diversity, equity, and inclusion (DEI) initiatives were implemented to address racial disparities in lectures, such as faculty training and redesigned curriculum guidelines. Studies have identified the attitudes and implicit biases of physicians as one factor that contributes to health disparities, thus, the goal of this research was to evaluate changes in student perceptions of racial inclusion in preclinical curriculum following intentional DEI modifications.
METHODS
Medical students in the class of 2023 (N=112) and class of 2024 (N=125) were emailed a survey at the end of their M2 year. The survey contained a demographic section and five four-point Likert scale questions that assessed agreement (where 1 = strongly agree and 4 = strongly disagree) of curricular inclusion of different races with respect to image variety, cases, physical exam skills, barriers towards care, and risk factors for disease. Independent samples T-test and chi-squared were used to compare demographics between cohorts and Mann-Whitney U testing compared Likert responses. Alpha=0.05.
RESULTS
Response rates for the class of 2023 and 2024 were 30% and 14%, respectively. There were no significant differences (p>0.05) in age, gender, or ethnicity between the cohorts, suggesting demographic equivalency. Following the intervention, significantly more students agreed the curriculum included racially diverse images in lectures (p<0.001), ethnically diverse clinical cases (p=0.004), and physical examination skills on diverse skin tones (p=.008). All other Likert scale comparisons between cohorts were insignificant (p>0.05).
CONCLUSIONS
The results demonstrated that instituting diversity initiatives provided improvements in medical student perceptions of racial inclusion in the M2 curriculum. Notable areas of improvement included racial diversity of images, case presentations, and training on physical exam skills.
Physicians' Knowledge and Attitudes of Disordered Eating Behaviors Among Patients with Diabetes
Nayiri Khatchadourian, MPH1, Lowell Schmeltz, M.D.2, Michael Brennan, D.O.2, Virginia Uhley, Ph.D., R.D.3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Endocrinology, Beaumont Health System
3Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Family Medicine and Community Health, Beaumont Health System
INTRODUCTION
Patients diagnosed with type 1 and type 2 Diabetes Mellitus (DM) are at increased risk for developing clinical disordered eating behaviors (DEBs). Although research supports this higher incidence and the impact on health outcomes, few studies have assessed physicians’ knowledge, attitudes and training to identify and treat these conditions. The American Diabetes Associations’ 2021 Standards of Care included a new section about DEB, further highlighting the importance of addressing this issue. Our goal was to assess physicians’ level of training, comfort and attitudes towards providing clinical care to patients diagnosed with DM and their experience in assessing, identifying, and treating DEBs in this patient population.
METHODS
The cross-sectional study was a 17-question online survey through Qualtrics, developed by modifying questionnaires from the Michigan Diabetes Research Center, which was emailed to participants. The response size was 34 physicians or medical residents that provide care for patients diagnosed with DM.
RESULTS
Among the 34 responses, 97% of physicians were endocrinologists with years of experience ranging from 6-35 years. 58.8% reported not having received any education about identifying or assessing for DEBs among patients diagnosed with DM during or after their professional training. 67.6% identified that they did not believe they have the tools or resources available to assist a patient with DEB; requested suggestions included an online learning course or resource, screening questionnaires and specialty training.
CONCLUSIONS
These research results highlight possible gaps in medical education programs regarding training around DEB. Our future plans are to address this by creating continuing medical education training modules for endocrinologists and endocrinology residents focused on the evaluation, diagnosis, and treatment of DEB in patients diagnosed with DM. We anticipate that this will help to enhance the knowledge and skills of physicians and residents in the clinical care and support of patients diagnosed with DM.
Impact of Earlier Ophthalmology Clerkships on Medical Student Match Rates in Ophthalmology
Andrew Lee, B.S.1, Steven Joseph, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Emergency Medicine, Beaumont Health, Royal Oak, Michigan
INTRODUCTION
The purpose of this study is to analyze the association between earlier clerkship exposure and match success, specifically in ophthalmology. Medical schools are constantly changing their clinical curriculums to provide a stronger foundational education to their students. The structure of each medical school’s clerkship curriculum varies in timing, length and availability of certain core and elective rotations. Gaining a better understanding of the factors that affect student match rates in certain specialties can influence changes in clinical curricula to maximize future match success.
METHODS
A list of all accredited allopathic medical schools from the Association of American Medical Colleges (AAMC) website was obtained. Publicly accessible information on medical school curriculums were reviewed and information on elective and mandatory ophthalmology clerkships, length, year offered and associated ophthalmology residency programs were collected. Public match data of each school between 2017 to 2019 was also obtained. A statistician performed two sample T-tests to assess the relationship of ophthalmology clerkship availability and timing on student match rates in ophthalmology.
RESULTS
A total of 151 US-medical schools were found on the AAMC website. Of these schools, we found 93 with publicly available curriculum and match data for analysis between the years 2017-2019. There was no correlation between medical schools that offered an earlier ophthalmology clerkship to an increased number of students (P<0.61), or percentage (P<0.12), matching into ophthalmology. There was a correlation between an increased number of students matching into ophthalmology with an associated residency program.
CONCLUSIONS
An earlier clinical exposure to ophthalmology did not correlate with increased match rates into ophthalmology. Match rates are multifactorial and should be further explored for students pursuing a career in ophthalmology. This information may be valuable to medical schools as an opportunity to modify the timing and length of their current curriculums to meet specific institutional goals.
Analyzing Medical Student Call To Action Letters Following 2020 Black Lives Matter Protests
Nick McMillen, B.S.1, Jason Adam Wasserman, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
The Flexner Report, written in 1910, may have revolutionized medical education, but it also recommended and led to the closure of all but two Black medical schools. While recent decades have lead to increased attention to diversity and inclusion, representation of historically marginalized groups among students and faculty has been slow to materialize.
Black Lives Matter protests encouraged a national dialogue over the need for more effective DEI initiatives and increased antiracist material in medical school curricula. Organizations such as White Coats 4 Black Lives developed “Call to Action” letters to medical school administrations across the country.
METHODS
15 student letters that had been sent to medical school administrations were collected an analyzed. A line-by-line coding strategy was used to classify letters into codes, categories, and themes. Each item was analyzed for prevalence and inclusion. A mind map was created to visually describe these clearer.
RESULTS
Six major themes were elucidated from these. Some examples included a desire for transparent and responsive communication with administration, a longitudinal curriculum to promote diversity and cultural competency, and measures to improve the diversity of the medical school body.
CONCLUSIONS
There were a variety of concerns such as campus policing and mental health of minority students reflected across multiple letters. These results reflect a broad need for increased diversity, mental health and safety for minority students in the U.S. In the future, it is hoped that strategies for increasing funding for diversity initiatives and greater elaboration of these patterns can occur.
Impact of Imposter Phenomenon on Medical Learners and Clinicians: A Scoping Review
Claire M. McNary, B.S.1,2, Edward J. Rohn, Ph.D.2,3
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
3Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan.
INTRODUCTION
Imposter phenomenon is the belief that one does not deserve their success. Medical students, residents, and physicians experience IP at significant rates, often due to the stress of mastering the extensive diagnostic information and treatment modalities and the competitive nature of medicine. We aimed to identify the main factors of imposter phenomenon in medical students, residents, and physicians in the available literature in order to increase awareness of imposter phenomenon in medical education.
METHODS
In this scoping review various databases were systematically searched for relevant studies published before June 2020. Articles that clearly examined imposter phenomenon in medical students, residents, and attending physicians were retained. References were hand-searched following the PRISMA approach. Extracted data was tabulated to summarize characteristics and main findings from each study. Content analysis of this table identified major themes in the available literature.
RESULTS
24 journal articles published between 1978 and 2020 were included. Three main themes were identified, including specific demographic characteristics of imposter phenomenon (n=14), professional impact (n=10), and psychological impact (n=17) of imposter phenomenon. For demographic characteristics, imposter phenomenon was higher in older individuals (n=3), racial/ethnic minorities (n=2), and women (n=12). Married individuals experienced less imposter phenomenon (n=2). For professional impact, imposter phenomenon increased during career transitions or professional challenges (n=8). For psychological impact, imposter phenomenon was associated with reduced self-esteem (n=7), a negative self-concept (n=2), increased self-doubt (n=3), and perfectionism (n=3). Depression, anxiety (n=3), and burnout (n=6) were also heightened with imposter phenomenon.
CONCLUSIONS
Results revealed a multitude of factors influencing imposter phenomenon. Increased awareness of the presence, impact, and severity of imposter phenomenon can assist medical educators to combat its negative effects. Further research is needed to improve treatments for imposter phenomenon in this population and to better understand the impact of imposter phenomenon on diversity, career trajectory, and career satisfaction in medicine.
Motivation in Medical Education: Effects of a Clinical Skills Course on Motivation
Mary Nowlen, B.S.1, Gregory R. Thrasher, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2School of Business Administration, Oakland University, Rochester, Michigan
INTRODUCTION
Medical student intrinsic motivation has important implications for indicators of student success. A person’s needs for autonomy, relatedness, and competence are considered primary indicators of their intrinsic motivation. As early clinical education in medical school could affect intrinsic motivation – understanding the factors that contribute to this process are critical. The primary goal of this study is to determine if a clinical skills course affects medical students’ feelings of autonomy, competence, and relatedness and therefore their intrinsic motivation.
METHODS
An experience sampling methodology was used to examine motivation and changes in intrinsic motivation over the course of multiple clinical skills sessions. Beginning in August 2020, first- and second-year students were emailed a pre- and post-survey containing the Work-Related Basic Need Satisfaction Scale adapted to medical students prior to and immediately following select clinical skills classes. A sample of 33 participants completed 65 pre-surveys and 87 post-surveys across three classes. Paired t-tests and a lagged endogenous change model were used to analyze the findings.
RESULTS
Tests of specific sessions showed that the second had a significant, positive relationship with autonomy (t(16) = 2.52, p < 0.05, [0.47, 0.04]). Across the semester, class sessions had a significant (p < 0.10) and positive compounding effect on post-ratings of competence (b = 0.76, SE = 0.40, p = 0.056).
CONCLUSIONS
Class sessions in a clinical skills course have both a distinct and compounding effect on medical student motivation – specifically autonomy and competence. Supplemental analysis showed the effect on medical students’ post-ratings of competence is especially influenced by pre-ratings of competence. This study highlights the importance of clinical education during the didactic years of medical school and the impact it can have on motivation in general and when coursework is delivered online.
Assessing intercoder reliability of skin tones in medical textbook imagery
Kaitlin Pataroque, B.A.1, Ryan Wu, B.S.1, Malli Barremkala, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
As an independent risk factor for health outcomes and as a marker of disease presentation, an important consideration for physicians is skin tone representation in medical textbooks. However, substantiating colorism in these resources is contingent on the degree of reliability of the skin tone measure. Our goal is to assess intercoder reliability of one of the most widely used skin tone measures in social surveys – the Massey-Martin (MM) scale, in context of rating skin tones seen in medical textbook imagery.
METHODS
M1 and M2 students attending OUWBSOM were invited to complete an electronic survey. 78 responded, filling out a self-identification questionnaire detailing racial/ethnic group and self-identified skin tone. They were then asked to code 20 images selected from the most recent editions of popular preclinical anatomy textbooks, including Atlas, Bates’, Clinically, and Gray’s using the MM scale. We assessed intercoder reliability including measures such as average pairwise percent agreement and Krippendorff’s alpha – stratified across respondent race and self-identified skin tone.
RESULTS
The use of the MM scale in rating skin tones seen in medical textbook imagery fails to pass acceptability standards for intercoder reliability. The aggregate average pairwise percent agreement was 36.8%. No group of coders, regardless of race or self-identified skin tones had an agreement above 45%. Furthermore, none all the associated Krippendorff’s alphas passed the threshold of 0.8, falling <0.3 for each group.
CONCLUSIONS
While sample sizes were small for these analyses, especially in Black respondents, the study provides evidence for low reliability of the MM scale in rating skin tones in medical textbook imagery – regardless of the coder’s race or self-identified skin tone.
Development and Evaluation of a Peer Education-Based Ultrasound Curriculum with Emphasis on Clinical Reasoning
Nisha Patel, B.S.1, Arati Kelekar, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Beaumont Health System, Royal Oak, Michigan
INTRODUCTION
Point-of-care ultrasonography (POCUS) is being increasingly incorporated in pre-clerkship physical diagnosis courses. However, the development of such a curriculum at many medical schools is limited by financial constraints, the availability of trained faculty, and the recent COVID-19 pandemic. Here, we describe an optional POCUS curriculum that circumvents these barriers while still providing basic image acquisition skills and pathophysiological correlations.
METHODS
16 M2 volunteer students participated in this 2-month curriculum which consisted of a virtual lecture, hands-on practice sessions, portfolio compilation with a debriefing session, post-curriculum knowledge test, and a post-curriculum survey.
RESULTS
On average, students scored 83% on the post-curriculum knowledge test. All 16 students satisfactorily completed the portfolio. On the post-curriculum survey, the majority strongly agreed on all questions evaluating their satisfaction with the content and the need for including it as part of the mandatory curriculum.
CONCLUSIONS
Students were able to apply what they learned during this POCUS curriculum to the clinical questions on the knowledge test and were interested in the idea of incorporating this education into our medical school’s curriculum. A single trained faculty with access to only two ultrasound devices who was working within pandemic restrictions was able to achieve these results. Future direction would include extending the POCUS curriculum to the entire M2 class, incorporating more organ system exams, and promoting the 16 students who completed the curriculum to serve as peer tutors.
Evaluating the effect of the COVID-19 pandemic on the use and impact of social media in the urology residency match: A review of the literature
Shivam Patel, B.S.1, Brent Yelton, B.S.1, Andrew Shanholtzer, B.S.1, Brianna Walter, B.S.1,
Syed Mohammad Jafri, M.D.1,2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
INTRODUCTION
Social media (SoMe) use within healthcare has changed significantly since the start of the COVID-19 pandemic. This project highlights recent changes in SoMe use within the field of urology and summarizes how they have impacted the urology residency application and match process.
METHODS
A literature review of the PubMed, Embase, Cochrane, Scopus, PsycINFO, and Web of Science databases was performed on March 19th, 2022 for relevant studies regarding the use of SoMe in the American urology residency application and match process. Articles not published in English, published prior to 2019, or focusing on residency matches outside of the United States were excluded.
RESULTS
Studies consistently found that both urology applicants and residency programs increased their SoMe use following the start of the COVID-19 pandemic as the percentage of programs (26-50% to 51-75%) and percentage of applicants (44% to 80%) participating in SoMe for professional purposes increased from 2018-2019 to 2021. Notably, Twitter was the most popular SoMe platform used. Among urology applicants, 43-61% found SoMe to have the greatest utility in providing information about specific programs. There was also consistency between studies in finding that SoMe use played a minimal role in whether or not a student matched, as only 3-6% of program directors reviewed applicants’ SoMe during the application and match process, while as many as 80% reported that SoMe had no role in the assessment of applicants.
CONCLUSIONS
With programs continuing to see SoMe as a method of reaching out to applicants, increases in usage will likely continue even after the COVID-19 pandemic ends. Continuing to analyze and reevaluate the benefits and drawbacks of these SoMe tools will remain important as virtual interactions become increasingly relevant to the field of urology.
Imaging-Based Modules for Musculoskeletal Anatomy & Pathology in Preclinical Medical Education
Ameen Suhrawardy, B.S.1, Tarek Almsaddi, B.S.1, Sarah Fried, B.S.1, Sayf Al-katib, M.D.1,2, Drew Moore, M.D.1,3, Malli Barremkala, M.D.4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Molecular Imaging & Radiology, William Beaumont University Hospital, Royal Oak, MI
3Department of Orthopaedic Surgery, William Beaumont University Hospital, Royal Oak, MI
4Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
Many medical students report a lack of adequate orthopedic and musculoskeletal (MSK) teaching in the preclinical medical curriculum. As gross anatomy is emphasized in pre-clinical education, students may feel a disconnect from clinical anatomy proficiency. This project assesses the efficacy of a preclinical image-based module to teach MSK anatomy and pathology concepts to preclinical medical students.
METHODS
Two image-based modules for the back and upper limb were created for second-year students in the MSK course. The modules integrated the anatomy and MSK imaging with relevant pathology. The modules provided a highly interactive and engaging interface with practice questions, active recall exercises that incorporate high-yield image-based MSK anatomy and orthopedic concepts, radiological imaging, illustrational anatomy, and cross-sectional cadaver images. Voluntary participants were recruited via email. Student performance on each module was collected and compared to performance on course assessments.
RESULTS
76 of 122 (62%) students in the MSK course used the upper limb module and 55 (45%) students utilized the back module, showing a high participation rate. Students who used the upper limb module scored 2.9 points higher on average (p=0.046), in the MSK written assessment, and students who used the back module scored 1.5 points higher (p=0.362).
CONCLUSIONS
A module integrating MSK concepts with cross-sectional imaging is a valuable tool to teach students MSK anatomy and related orthopedic concepts at their own pace. Increasing exposure to cross-sectional anatomy with imaging may help students better transition from preclinical anatomy knowledge to clinical application. While the data reached statistical significance only for the upper limb module, there is a positive trend in assessment performance for all students using the modules. Anecdotal evidence also supports preference for module-based learning over traditional modes of studying MSK material. Other curricula should further explore the integration of image-based module learning into preclinical education.
Veteran Care in Undergraduate Medical Education: A Systematic Review
Adam Wahl, B.S.1, Misa Mi, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Medical Library, Oakland University William Beaumont School of Medicine
INTRODUCTION
Many healthcare providers claim to lack sufficient knowledge of impacts of military service on veteran patient health and of resources available to veteran patients. As more veterans utilize civilian healthcare centers, medical schools are challenged with ensuring integration of veteran care into their curricula. The purpose of this systematic review is to identify veteran care interventions implemented in LCME accredited medical schools and to investigate how learning outcomes were measured, what assessment tools were used, and what impact veteran care interventions had on undergraduate medical education.
METHODS
A systematic review of the literature was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. English-language peer-reviewed articles published between January 2000 and March 2022 were identified using PubMed, Embase, PsychINFO, and Web of Science databases. Search terms included a combination of subject headings and keywords related to veteran health and undergraduate medical education.
RESULTS
Of the 446 citations imported from the four databases, 266 titles and abstracts were screened; 62 full-text articles were assessed for eligibility; and 11 studies were selected for inclusion in the final review. The majority of studies used a mixed method study design, recruited third year medical student participants, and had a Veterans Affairs (VA)-based clinical setting. Interventions for veteran care education varied widely, but three major themes emerged: direct patient encounters, simulated/standardized patient experiences, and didactics/skills sessions. Outcome measures mostly consisted of surveys/questionnaires, student evaluations, and interviews. Reaction and Learning (Levels 1 and 2) were the most commonly observed outcomes based on the Kirkpatrick’s Four-Level Evaluation Model.
CONCLUSIONS
Overall, veteran care educational interventions implemented in medical schools appeared to have positive effects on medical students and veteran patients. Each type of intervention had a unique subset of educational implications that should be considered before implementation within a medical school’s curriculum.
Effect of Anatomical Studies Prior to Medical School on Medical School Anatomy Study Success and Residency Choice
Brianna Walter, B.S.1, Rebecca Pratt, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
The purpose of this study is to investigate the outcomes of early exposure to anatomical studies. In this study, two particular outcomes are of interest. The first outcome is medical school anatomy grades. The second outcome of interest is interest in anatomy-focused residencies, especially regarding underrepresented groups in these specialties.
METHODS
A retrospective model was used in which a survey was sent to fourth year medical students at Oakland University William Beaumont School of Medicine (OUWB-SOM). Students were asked whether they took an anatomy course prior to medical school. Students were asked to self-report what percentile grade ranges they got in AFCP 1 and 2. Participants self-reported their STEP 1 score and STEP 2 scores.
RESULTS
The effect of prior anatomy experience on medical school grades had no significant effect on AFCP 1 or AFCP 2 or on STEP 1 or STEP 2 CK grades. Applicants to surgical specialties had higher course grades and STEP scores. One notable finding of this study was that among this sample there was no statistically significant effect of URM status on likelihood of applying to a surgical residency. Thus this particular sample could potentially be not representative of the total pool of students.
CONCLUSIONS
Analysis of first-year medical school anatomy and STEP 1 and 2 CK scores showed that students who took anatomy prior to medical school had no improved performance over those who did not take anatomy prior to medical school. Of the measures taken in this study, only STEP 1 and 2 CK scores had a statistically significant effect on the choice of residency specialty among all students. Thus, an anatomy requirement or recommendation prior to medical school will not be an efficacious intervention for increasing medical school grades, STEP scores, student interest in surgery and radiology, or underrepresented minority interest in these fields.
Medical Student Knowledge About Sexual Assault in Patient Populations
Hayley Walton, B.S.1, Sean Taylor, B.A.2, Michele R. Parkhill, Ph.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Oakland University, Rochester, Michigan
INTRODUCTION
Sexual assault is highly prevalent, has been associated with a variety of medical conditions, and survivors often have higher healthcare utilization than other individuals. Therefore, health care providers will likely encounter survivors in their medical practice. However, there is a dearth of literature surrounding medical student knowledge of sexual violence and interacting with sexual assault survivors. The primary goal of this study is to assess medical student knowledge surrounding sexual violence affecting patient populations.
METHODS
82 current medical students at Oakland University William Beaumont School of Medicine across all four years of study were recruited via email and in the community to complete a cross-sectional survey via Qualtrics to assess their knowledge of sexual assault in patient populations. The survey included both the 18-item Sexual Assault Questionnaire (SAQ) as well as the author-generated 26-item Knowledge and Treatment of Sexual Assault Questionnaire (KTSAQ).
RESULTS
Medical students were split into cohorts of M1/M2 classes (pre-clinical students) versus M3/M4 classes (clinical students) for the purpose of these analyses. For the overall survey results, there was no significant difference in knowledge between these two cohorts. However, when the results were separated into results of the SAQ and results of the KTSAQ, results varied. On the SAQ, which is oriented toward knowledge of rape myths and general information about sexual assault statistics, there was no significant difference between the 2 cohorts. However, on the KSTAQ, which is oriented toward practical information and the physician’s role in clinical care for survivors, the clinical student cohort performed significantly better than the pre-clinical cohort.
CONCLUSIONS
The results support that clinical students acquire practical knowledge about working with sexual assault survivors in the clinical years, however there is still work to be done in advancing medical student knowledge of sexual assault in both the preclinical and clinical years.
Representation of race and skin phenotype medical textbook imagery over time
Ryan Wu , B.S.1, Kaitlin Pataroque, B.A.1, Malli Barremkala, M.D.2
1Oakland University William Beaumont School of Medicine, Rochester, Michigan
2Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan
INTRODUCTION
As an independent risk factor for health outcomes and as a marker of disease presentation, an important consideration for physicians is skin tone representation in medical textbooks. This study seeks to evaluate whether/to what extent the proportion of race and skin tones within medical textbook imagery has changed over time – using one of the most widely employed skin tone measures in social surveys – the Massey-Martin (MM) scale.
METHODS
Electronic copies of multiple editions of Atlas, and Moore were acquired, and all images with visible body parts were coded for race and skin tone based on perceived phenotypic characteristics and the MM scale respectively. Each medical student coded images independently using MacBook Pro laptops issued by the OUWB. Proportions of race and skin tone were calculated for each textbook, and unpaired two tailed t-tests were conducted to evaluate whether differences representation across editions were statistically significant.
RESULTS
The textbooks studied approximated the racial distribution of the US population – 68.25% White, 10.5% Black, 21.25% Persons of Color. However, the skin tones represented – 79.5% light, 19.25% medium, and 1.25% dark, overrepresent light skin tones and underrepresent dark skin tones. In addition, there is no significant difference in representation of race or skin tones across editions of Atlas. While there is significant difference in representation of race in Moore across editions (p=0.046, 0.0098, 0.037 for White, Black and POC respectively), there was no significant difference in representation of skin tones across editions. It is notable that intercoder agreement was low, as Krippendorff's alphas all fell <0.4, below the standard threshold of 0.8.
CONCLUSIONS
While the study is limited by low intercoder reliability, it provides evidence that preclinical anatomy textbooks overrepresent light skin tones and underrepresent dark skin tones – a finding that has not significantly changed across editions.
