Hackensack Meridian School of Medicine | Nutley, NJ | Student Abstracts
View the abstracts written by recent students in the Medical Education Curriculum Development and Research Electives.
Medical Education Research Student Abstracts
Medical Education Curriculum Development Student Abstracts
Medical Education Research Student Abstracts
2023 Student Research Abstracts
Virtual Reality in Medical Education
There is a demand to enhance/streamline medical education. There are numerous necessary learning experiences during medical training and not enough time/resources. Medical students often come to medical school lacking clinical experience, anatomy knowledge, and medical procedures. There has been a push towards virtual/flexible training since the Covid 19 pandemic. Virtual reality (VR) offers a cost-effective solution, low stress environment, repeatable experiences, a flexible schedule, and truly standardized experiences.
Virtual Reality (VR) is a computer-generated world to give a user a simulated environment for an experience. There are three forms of virtual reality: non-immersive, semi-immersive, and fully immersive. Non-immersive is the most widely used form of virtual reality and is not actively thought of as a form of virtual reality. Things that rely on a monitor and controller such as video games are prime examples. Semi-versive is a hybrid form of non-immersive and fully immersive. It uses more advanced technology that makes the user feel more in tune with the experience without fully immersing themselves in virtual reality. An example of this would be pilot training where the pilot functions and surroundings feel more like the cockpit than a monitor and controller would. Immersive VR is what is commonly thought of as VR. Immersive involves full sight and sound to be experienced through the VR usually using a headset. This paper preliminary focuses on immersive VR.
Methods A literature review was conducted on Jan 1, 2023, using PubMed. The search terms used were “medical education” AND “virtual reality”. Only publications from 2018-present were used.
The article types were Meta-Analysis, Randomized Control Trials, Literature Reviews, and Systematic Reviews. There were 183 results on PubMed. An emphasis was placed on head-mounted displays in the form of VR. Consulted with VR experts from Oxford Simulation and Tipping Point.
A meta-analysis of anatomy knowledge through VR showed positive results. 15 randomized controlled trials with VR (experimental) and traditional controls. VR has shown that it is an effective and efficient way to improve a learner’s level of anatomy knowledge. The primary outcomes were the examination scores of the students.
Meta-analysis of 27 studies comprising 956 healthcare professionals (including medical students and residents) on the effects of VR. Results showed training with VR was perceived as motivating and engaging. 63% showed that interventions of VR were found effective for education purposes. Only 4/27 showed the head-mounted display was only viable as a supplemental teaching tool. 2 studies showed no effect. Many of the studies were based on surgical procedures.
Another study showed after simulations students experience less anxiety and more confidence compared to students without simulation experience.
Not enough quantitative studies have been done on VR-standardized patients. However, the literature seems to postulate even without quantitative data that VR is in the realm of virtual standardized patients for clinical experience.
Studies have shown the effectiveness of VR in teaching anatomy. It is often difficult for students studying anatomy to grasp 3-dimensional concepts from 2-dimensional constructs (anatomy books). Anatomy is commonly presented in transverse, coronal, and sagittal. To understand anatomy through a textbook a student needs to combine these orientations in his/her head.
Virtual reality also allows students to understand 3-dimensional concepts in their spatial orientation. Virtual reality allows students to manipulate the space and look at any orientations to use. Students can control the VR in 360 degrees. Allowing students to view any orientation or blend of orientations. Studying 3d concepts in 3d is more intuitive.
The purpose of the body of anatomy is to understand 3-dimensional concepts and organs’ spatial orientation. A well-developed anatomy program will be able to do that plus more. There are many disadvantages of the anatomy body. The initial procurement of the body is resource intensive. As well as maintaining the body in a lab and preserving the body. Preserving the body leads to the destruction of anatomical structures. Anatomy bodies are variable to damage. Inexperienced students can improperly dissect important structures. Virtual Reality will allow the student to understand similar principles through the dissection of the body without having a body. Students will be able to dissect to the heart’s content, while traditional bodies can be dissected once. VR doesn’t require bodies, labs, or the level of maintenance in a traditional anatomy lab.
2d radiologic images have been constructed into 3d in a virtual reality model.
Studying radiology images in 3d allows students to understand the importance of certain anatomy in a clinical context and enhances their motivation to learn. Traditional models have many difficulties procuring bodies and lab maintenance.
Virtual Reality Standardized Patients
There has not been much quantitative research on the use of VR for standardized patients. However, the literature points out that simulation has been proven to be effective in medical education. Virtual reality can provide immediate feedback and provides analysis compared to a professional approach. Virtual reality is flexible in scheduling and repeatable. Reduction in standardized patient variability. Reduction of cost. In a safe environment free to learn at own pace, Traditional SP encounters add anxiety and pressure to students. VSPs are unlimited. Traditional SP encounters are finitely based on resources
The surgery field is most involved in research/investment in Virtual Reality. Since learning by doing has become less acceptable due to patient, legal, and budgetary (time, resources, or faculty) pressures, it is important to find other ways of teaching. Virtual Reality allows for teaching surgical procedures at one’s own pace without the fear of causing harm to the patient.
Can learn procedures regardless of geographical area. Better access to rural areas and developing countries. Knot tying, virtual operating room, hip arthroplasty, needle decompressions, and many more procedures
Virtual Reality has many pros to its application. VR allows for flexible schedules. VR can be done at any time as long as the hardware and software are available. VR allows students to repeat simulations and experiences. Learning by continuous practice hones skills until they can be replicated effortlessly. Virtual reality offers a safe learning environment where students can learn from mistakes and learn at their own pace. Vr allows for gamification which leads students to be more engaged in their learning and want to learn more. VR has the potential to be more cost-effective than traditional methods. Has the potential to be cost-effective in the future compared to traditional methods because it requires fewer resources.
While VR has many advantages, it does pose some issues. Side effects of using VR include headaches, nausea, dizziness, and loss of balance. This poses a risk for long-term use and the amount of use. Any new technology acquires faculty and students to become accustomed to new technologies. It has been shown older generations have trouble with VR and might pose a problem with older faculty. While VR has the potential to be cost-effective, that while requires full integration of VR into a medical curriculum. At this point in time, no curriculum has done that. Initial acquisition of VR is expensive with the hardware and software. Hardware costs are coming down. However, the software is still expensive and still needs more improvement. As more competition comes into the market this will be less of a problem. VR does can’t teach emotion/compassion. However, artificial intelligence has shown marked improvement and shown the possibility for emotion/compassion. Some literature expressed concern that procedures are too technical for the controllers on VR. Other literature says VR provides an accurate experience at a technical standard.
Virtual reality has shown its effectiveness in many studies pertaining to anatomy and procedures. However, there are significantly fewer quantitative studies on virtual reality standardized patients. More studies need to show the effectiveness of virtual reality in medical education. However, despite this, the literature points out the effectiveness of virtual reality in medical education. VR allows for flexibility in schedules, repeatability, a stress-free learning environment, and gratification of learning through gamification. VR has the potential to alter the medical education space. VR has some unpredictability with the cost of hardware and software and the development of future software. However, as VR becomes more mainstream it will be folded into more curriculums. Medical curriculums should start thinking about a soft integration of VR to gauge the educational value and student interest.
The impact of the pass/fail grading system on student well being and academic success
The pass/fail grading system has seen used in the pre-clerkship years of med school since the 1960s. According to the AAMC, over the last decade, there has been an increase to about 100 medical schools that use the pass/fail system for pre-clerkship years. The original argument for this change was the concern that students were just focusing on grades and not actually learning for general knowledge. In recent years, the argument has focused on improving student wellness, with benefits such as a less competitive learning environment, more free time, and a greater focus on learning. With all these benefits, there would be no change in future academic success, which was the concern about making the change to pass/fail. Prior literature from the 2011 systematic review showed student well-being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system (Spring et al. 2011). The systematic review was limited by a lack of data in the literature and old studies from the 1980s. In this literature review, I will be examining the literature for more recent data as well as examining the potential role of the change to P/F for Step 1.
A literature review was conducted in Feb 2023 through Pubmed. The search terms used for Pubmed were: “(“Educational Measurement/methods”[MAJR] AND pass-fail NOT (USMLE OR step 1)) AND ((Medical school OR undergraduate medical education OR medical students)). Databases were last searched on Feb 16th, 2023. The database searches returned a total of 88 results. A total of 8 studies were selected based on relevancy and viable data.
The data remains limited as not many studies have been published on this topic since the 2011 systematic review. The consensus from the 8 studies found is in agreement with the 2011 systematic review that the pass/fail grading system for pre-clerkship enhances student well-being and has no effect on future academic performance or success. Although one study from 2004 did show the predictive validity of Year 1 grades on future academic success. Additionally, while limited, the initial data from the pass/fail change for Step 1 shows that residency programs will focus on Step 2 and other areas which may not have the attended effect of reducing stress and improving well-being.
This review, although it is comprehensive and based on existing literature, reveals limited resources regarding the impact of pass/fail grading on student well-being and academic outcomes since Spring et al. 2011 systematic review. The overall consensus from the literature states that student well-being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system. Although there is some merit in having a tier grading system. With the majority of medical schools having a P/F system in preclinical, the focus of more studies needs to be on the impact of Step 1 P/F on student wellness and future academic outcomes.
A review of the benefits of high-fidelity simulations in the preclinical medical school curriculum
The transition from a preclinical-based education to a clerkship-based education can be a challenge for many medical students. One method of easing this transition and bridging the perceived knowledge and skills gap in the preclinical student population is the use of high-fidelity simulations. Many of the studies on this topic in this population have been limited pilot studies. Thus, the aim of this review is to evaluate the benefits of including high fidelity simulations in the preclinical curriculum in preparing students for clerkships.
Electronic databases (PubMed, MedEdPortal, Cochrane Library) were searched without restriction and secondary searching of reference lists of included studies was also conducted. Studies that were included assessed the use of high fidelity simulations in the preclinical medical student population with clear assessment methodology. Common themes between studies were identified.
The initial search identified 97 papers. After removing duplicates and assessing abstracts and full articles against the inclusion criteria, 23 articles were included in the review. The variables assessed in the preclinical medical student population can broadly be categorized into three categories: competency, confidence, and specialty interest.
High-fidelity simulations are a useful tool to begin early in the undergraduate medical education as it aids in bridging the gap between the preclinical and clinical years with higher performance scores, provides a safe environment for students to practice in, improves student confidence, and increases specialty interest in the field of simulation.
2021-2022 Student Research Abstracts
Flipped classroom learning is a pedagogical approach in which direct instruction moves from the group learning space to the individual learning space, and the resulting group space is transformed into a dynamic, interactive learning environment where the educator guides students as they apply concepts and engage creatively in the subject matter. Over the past 10 years, there has been a 32% rise in the number of educational institutions that are incorporating a flipped classroom teaching style into medical students’ pre-clinical phase. There are a variety of benefits to the flipped classroom including the fact that it frees up in-class time to make room for a more interactive session (i.e. more collaboration, inquiry-based learning, peer instruction, and contact time between students and teachers). Additionally, it encourages students to be responsible/active participants in their own learning and encourages students to engage more with the material. It has also been shown to have higher rates of retention compared to traditional lecture styles. Flipped classroom learning, however, inherently puts more stress on the student as he or she is responsible for doing a majority of the work outside the classroom prior to the session. In fact, this means that the quality of the interactive in class session is heavily dependent on student preparation prior to the actual session. This creates unique issues that are associated with the flipped classroom learning model. For instance, the most frequently cited issue from the student’s perspective is that there is inconsistency between the assigned pre-work and the in-class discussion. Students often cite that the reason they had a poor experience in an in-class session is because the pre-work was not relevant to that particular session. This in turn leads to knowledge deficits and dissatisfaction with the curriculum.
In order to address this issue, this project entails close collaboration between the faculty designing the in-class session and the 4th year medical student. At its core, this project revolves around the 4th year medical student pre-viewing the faculty’s in-class session and creating highly specific pre-work for that session thereby ensuring relevant pre-work is available to the student. This has several benefits: 1) the 4th year medical student reinforces the content for themselves for the purposes of residency and future board exams, 2) 4th year medical students have an opportunity to collaborate with a senior physician in an area of their interest thereby solidifying professional relationships, 3) first year students have a more relevant pre-work and in-class sessions are enhanced.
My methods for this project included the following: I performed a comprehensive review of topics covered in the homeostasis/allostasis (HA) course as my prior research led me to conclude that the cardiovascular system was one of the highest yield topics that students might need further academic support in. This conclusion stems from the fact that cardiology consistently makes up 10-15% of the content tested on Step 1, Step 2, Step 3, and the internal medicine NBME exam. After obtaining a calendar for HA I previewed the list of sessions scheduled in that course. I pinpointed cardiac dysrhythmias as a key topic for student learning. I then was put in contact with Dr. Simmon’s, an electrophysiologist at HUMC, to coordinate creation of pre-work for his upcoming cardiac dysrhythmias lecture.
There were 3 main final products that resulted from this project. After reaching out to Dr. Simmons, I designed from the ground up 3 seperate pre-work modules specific to Dr. Simmons’ session. Module 1 was complete by the beginning of week 3 of this elective and Dr. Simmons was able to give me highly positive feedback on the module and made 3 minor edits which are being amended currently. Modules 2 and 3 are currently being developed and build upon the principles taught in module 1. In addition, modules 2 and 3 introduce topics that Dr Simmons will elaborate on during his in class session. Therefore, these modules set the stage for the clinical discussions that Dr. Simmons will have with the students and allow students multiple opportunities to solidify their understanding of the material. One final product that will be created in the future is a student feedback survey on all 3 modules as well as a formal faculty feedback form so that I can acquire appropriate feedback on my modules.
Does using concept mapping in a modified problem-based learning curriculum aid in providing clinical relevance and integration and application of the basic science curriculum?
During the first 18 months to a year of medical school, students are learning basic science material that is often difficult to relate to clinical scenarios. As medical education is evolving, so too are the learning tools that are available to students. Concept mapping is a proven strategy that can aid students in making linkages between new and old concepts. The aim of this project is to conduct a literature review to analyze the available literature pertaining to the use of concept mapping in medical education.
The literature in this review was obtained by searching databases including PubMed. This is a narrative literature review and a summary of published literature pertaining to the use of concept mapping in medical education.
The studies reviewed appeared to have three common themes: (i) the use of concept mapping as a learning tool for medical students, (ii) concept mapping to improve critical thinking skills, and (iii) the use of concept mapping as a feedback tool for faculty.
The review contains literature that can be helpful for both students and faculty when building a problem-based-learning curriculum. Ways in which concept mapping can be utilized are identified in the literature. Since according to the literature, some methods are more successful than others, those involved in medical education can use the literature review to construct a problem-based-learning curriculum that is evidence-based and more likely to succeed. Next steps in future research would include the use of concept mapping as an assessment tool in medical education, concept mapping as a predictor of performance on medical licensing exams and longitudinal studies on the benefits of concept mapping in medical education.
Effect of Early Exposure to Radiology on Medical Student Perceptions and Attitudes
Radiology is not a major part of most medical school curricula. Only 16% of American medical schools require a radiology clerkship as part of their clinical years.1 This is down from a high of 24% in the 2013-2014 academic year. Medical students enter medical school with preconceptions of the field of radiology based on stereotypes, and these are only reinforced by interactions with faculty and other attending physicians.2 This leads to common misconceptions of radiology being propagated amongst medical students. Some of the common misconceptions held by medical students include: Radiologists have little or no patient interaction; Radiologists do not treat patients; Radiology is dangerous to your health; among others.
Negative misconceptions are formed early in a medical student’s career and only reinforced through further interaction with other physicians in later years. How can medical school curricula impact the way a medical student perceives a certain medical specialty?
A literature review was conducted in March, 2022. Three databases were searched, including Pubmed, Education Resources Information Center (ERIC), and Cochrane. The search terms used for Pubmed were: “(Medical School Curriculum) AND (Diagnostic Radiology) AND (Attitudes OR Perceptions) AND (United States or Canada)”. Search terms were modified for ERIC and Cochrane, but included the key components relevant to the topic of the literature review (e.g. Radiology, Attitudes, Medical Students). Databases were last searched on March 16th, 2022. The database searches returned a total of 341 results.
Studies were included in the literature review if they implemented a curricular intervention and/or assessed attitudes or perceptions of Radiology with qualitative and/or quantitative methods. Studies were excluded from the review if they focused on Interventional Radiology or took place outside the United States and Canada medical school systems.
Titles and abstracts were reviewed for inclusion and exclusion criteria and citations were compiled in Zotero. Studies were grouped by intervention or assessment type: preclinical/clinical intervention, national survey, or radiology interest group. Included studies were read in full and reviewed qualitatively for themes and key takeaways.
A total of 12 studies were included in the literature review. Seven studies trialed a curricular intervention, three surveyed medical students nationally, and two assessed the impact of interest groups. Ten studies took place within the United States and two studies in Canada. Six of the seven curricular intervention studies found statistically significant changes in medical student attitudes and perceptions following the interventional. The three national surveys identified key trends amongst medical students in regard to radiology attitudes, perceptions and knowledge. Both studies involving interest groups, showed increased interest in radiology.
Discussion and Conclusion
Early curricular intervention, either through a required radiology course or enhanced radiology interest group activity, has been shown to improve medical student attitudes and perceptions. Increased recruitment in the field should not be the ultimate goal, but rather, as has been shown by national surveys, increasing the knowledge and perceptions of future utilizers of radiology services.
How do medical educators select learning methods?
Medical education is unique as it exists not only to teach students, but also to create an individual who is ready and able to join the workforce. With such a large amount of information to learn, students must take what they already know and build on it, as medical educators support this (1,2). Adult learning theory is important to understand, as many aspects in medical education are based on its principals. Connecting learning theory and the phases of learning to the actuality of the classroom can be tricky. Learning objectives are the most important aspect of developing a course, and relate to the learning in the cognitive, affective, and psychomotor domains and identify a specific and measurable outcome. There is a large move in medical education to focus on active learning rather than passive learning.
With a lot of data that suggests what learning methods are most effective based on objectives and a lot of data that suggests active learning is better than passive learning, choosing what educational methods to use in the classroom should, in theory, be relatively straightforward. However, passive and other learning methods used in the classroom are frequently selected without considering learning theory or the learning objectives. So, how are medical educators actually selecting learning methods? In order to answer this question, background information must be gathered to answer the question; what are medical educators doing? It was found that those who were aware of course learning objectives, were significantly more likely to use student centered learning approaches. Additionally, those who were most aware of course learning objectives were more likely to have completed formal faculty development workshops (7). Conceptions of teaching is another very important factor that contributes to what learning methods are used (10). Conceptions of teaching are “largely unspoken composite of individual teachers’ assumptions, knowledge, and beliefs about teaching and learning (8).” These conceptions can influence how an educator teaches in the classroom. Finally, formal training in medical education appears to be very important in determining what medical educators are doing (11). Without formal pedagogical training, teachers are more likely to revert to teaching as they were taught in undergraduate and graduate schools (13). Perhaps one of the most important parts of having formal training in medical education is appreciating how important learning objectives are a catalyst for learning. Knowledge of learning objectives, conceptions of teaching, formal training in medical education all appear to play a significant role in what medical educators are doing. This review is the first step in answering the question, how do medical educators select learning methods? A unifying theme appears to be faculty development is vital, as it makes educators more aware of the importance of learning objectives, addresses various conceptions of teaching and learning and ultimately provides educators with the tools to appreciate and engage in active learning.
Implicit Bias in Academic Medicine: A Scoping Literature Review of Interventions
Implicit bias, otherwise described as the attitudes one has towards others outside of their awareness plays a critical role in the field of medicine. The Association of American Medical Colleges recognizes the negative and positive effects of implicit bias and is actively seeking solutions to the current issue at hand (Gliksman). In order to create solutions it is necessary to understand where implicit bias roots from, and the issues that it creates in the field of medicine, specifically to clinical decision making and patient outcomes. The National Institutes of Health (NIH) defines bias as attitudes, behaviors, and actions that are prejudiced in favor of or against one person or group compared to others. Furthermore, it is necessary to understand that implicit bias is a form of bias that occurs as a mental shortcut and occurs without the person’s awareness – further complicating the issue at hand. These mental shortcuts have been shown to be created from outside experiences one has including childhood experiences and social media. A recent systematic review on the perspective of patients on racism found that implicit bias is “exacerbating health disparities in minorities’” (Sim), further demonstrating the need to identify effective interventions to combat implicit bias as it pertains to academic medicine.
Moreover, most medical school curriculum lack a formal method for reducing implicit bias despite Standard 7.6 provided by the Liaison Committee on Medical Education (LCME) – stating that medical schools must provide curricular opportunities for students to “learn to recognize and appropriately address gender and cultural biases in themselves, in others and in the healthcare delivery process”. Addressing implicit biases early in medical education is critical as it has been shown to interfree with clinical assessment, decision-making, and provider-patient relationships (Blair IV). It is also imperative to compare and contrast implicit bias and explicit bias. While implicit bias occurs outside of one’s awareness and can unconsciously impact one’s behavior towards others, explicit bias is processed at a conscious level. Implicit bias may manifest itself as, described previously, through impaired clinical assessments while explicit bias may present through more overt obvious manifestations such as physical or verbal harassment.
Unequal Treatment: Confronting Racial and Ethnic Disparities In Healthcare, published in 2003, was the first published report to present evidence of healthcare disparities and to attribute these disparities to implicit bias. However, we have not been able to agree on the best way to combat suggested disparities. While implicit bias may be difficult to combat provided that it stems from one’s own past experiences, there are several strategies that have been effective in combating the effects of implicit bias. Studies have shown that addressing and bringing awareness to the issue can help reduce implicit bias. While multiple institutions in academic medicine from the level of undergraduate to graduate education have implemented various interventions to reduce implicit bias, there is no consensus regarding the best strategy. In this review, we will analyze various institutions and how they went about combating implicit bias. While comparing outcomes is a challenge when measuring an unquantifiable variable such as bias – we will review the outcomes of each intervention with the hopes of identifying the strengths and limitations of each intervention. This study will include added value to the literature as we will compare various interventions that aim to combat implicit bias in academic medicine and its outcomes regarding implicit bias regarding race, ethnicity, gender, and sexual orientation. We plan to answer the question:
– What interventions have been implemented and what have been their outcomes in addressing implicit bias in academic medicine?
This study is a literature review, specifically a scoping review given the clear research question stated above, the specific search criteria and the implications for future practice or policy we hope this review will provide. We used PubMed and MedEdPortal to search for published interventions. All studies published prior to 1992 were omitted from the search.
Included studies were found using the following search; ((((“Bias, Implicit”[Mesh] OR “subconscious bias”[tiab] OR “implicit bias”[tiab] OR “Hidden bias”[tiab] OR “unconscious bias”[tiab]) OR (“Cultural Diversity”[Mesh] OR “cultural diversity”[tiab])) OR (cultural competency)) AND (medical education OR medical school OR academic medicine)) AND (intervention OR curriculum OR training OR workshop OR module).
Ultimately, 5 studies were selected in this scoping literature review: 3 were classified as 1-day interventions 2 were classified as longitudinal interventions. The results of these studies showed that interventions whether 1-day or longitudinal were effective and yielded positive outcomes regarding implicit bias education and bringing awareness of one’s own implicit bias. Not all results were statistically significant, however, did show promising results.
Discussion & Conclusion
This study showed a number of methods to combat implicit bias in academic bias. While this study was limited by a number of factors, it did show that interventions as short as one day interventions and as long as one year interventions may lead to positive outcomes and may be effective tools to combat implicit bias.
Our review shed light on possible improvements to implicit bias training. We believe that addressing implicit bias awareness is a necessary first step in combating the issue. Once bias awareness training is complete then it would be appropriate to discuss one’s own bias and ways to manage them through a multitude of interventions including large and small group sessions.
Peer Evaluation in TBL, Literature Review and Abstract
Graduating medical students today require effective collaboration skills, communication, and problem-solving abilities in order to provide optimal patient care. Likewise, medical educators are challenged with teaching an ever-growing body of basic medical science while also ensuring preparedness for multi-professional and interdisciplinary team-working skills. As a result, many medical schools have employed Team Based Learning (TBL), a structured, group-based active learning strategy in order to satisfy both of these needs. Data from systematic reviews over the last 15 years suggest that TBL is as or more effective than comparator learning strategies including traditional lectures, small group sessions, and case-based learning.1 However, despite these clear benefits, many experts have cited that TBL in the context of health professional education is still in its infancy and therefore multiple dimensions of this learning modality remain unexplored and deserve greater attention.1 Furthermore, many key areas still need significant improvement. One such area is the effective incorporation of peer evaluation into TBL. It is generally accepted that peer evaluation leads to better maintenance of teams, builds accountability, and ensures growth and professional identity development for the medical student2. Therefore, it is critical to implement an effective peer evaluation process into TBL and to do so without compromising the collaborative learning fabric that is inherent to TBL and likely responsible for much of its success.
The purpose of this literature review is to describe the various existing methods of peer evaluation. This review will also discuss the various benefits and drawbacks of each method in turn allowing medical educators to carefully weigh the options when selecting a peer evaluation method for their classroom. Finally, this review summarizes the current best practices regarding peer evaluation within the context of TBL in medical education.
The extent of dermatology inclusion in medical education curriculum
The majority of medical schools designate very few curriculum hours to dedicated dermatology teaching and exposure, contrasted by the relatively significant quantity of skin diseases evaluated by physicians.1 Increased exposure to dermatology during medical school is critical, as dermatology as a field requires significant prior exposure, pattern recognition, and the development of perceptual skills.
This literature review gathered information on the current status of dermatology education across international medical schools.
The PubMed database was searched using the term “dermatology/education”[MeSH Terms] AND “Curriculum”[MeSH Terms] AND “education, medical, undergraduate”[MeSH Terms]. Initial search yielded 92 articles. Conference abstracts, articles not published in English, and articles without full- text availability were excluded from analysis. Articles not pertaining to dermatology education in medical school were excluded from review. A total of 10 articles met the criteria for review.
Three studies assessed the amount of time dedicated to dermatology teaching during medical school through the distribution of electronic surveys. Reported values for the average number of hours dedicated to dermatology education ranged from a mean of 20.5 hours +/- 17.2 hours, a mean of 25.6 +/- 17.2 hours, and a median of 10 hours.1,3,4 Though there has been a trend towards increasing the number of faculty members teaching dermatology across Canadian medical schools, the average is still relatively low at average of 9.5 +/- 7, ranging from 1-25 faculty members.
Not only do these data points suggest a deficiency in dermatology teaching in medical education from an objective, curricular level, but this deficiency is reflected by student sentiments as well. In assessing medical students’ attitudes’ towards their dermatology education, Ulman et al found that 87.6% of students felt that their dermatology education was insufficient.
Reported teaching methods across all studies included small group learning, clinical skills, e- modules, anatomy sessions, clinical exposure, didactic lectures, tutorials, and problem- based learning.1,4-6 In a survey study conducted by Ulman et al assessing student satisfaction with their dermatology education, interestingly, the majority of students (61.7%) preferred interactive lectures as a main teaching modality, while 24.7% preferred online case- based modules, 21.0% preferred team- based learning, and 19.8% preferred online powerpoint presentations.6 This student preference for didactic lecture teaching was commended by Kirshen et al’s finding that didactic teaching is the most common method of dermatology teaching across all Canadian medical schools.
Furthermore, in a comparative study assessing student satisfaction with supplemental online video or in- class dermatology lectures with formal instruction in anatomy lab, supplementation with pre- session instruction (either online or in- person) resulted in an increase in student understanding of various types of skin lesions.7 Interestingly, in- person lecture was found to be a more effective teaching modality than online video, as 81% of respondents reported that the online video helped them understand the skin lesions they saw in their cadaver, compared to 94% in the lecture group (P=0.015).7 In addition to Blakely et al found that implementation of a half- day dermatology clinical skills session for first- year medical students was highly effective, as 99.5% of students agreed or strongly agreed that the session facilitated learning consolidation.
Reported assessment methods for comprehension of dermatology material across all studies included via multiple choice questions, written answers, and OSCEs.
Though the era of the COVID-19 pandemic has dramatically altered medical education, addressing deficiencies in dermatology teaching specifically during this era can be done via the inclusion of students into teledermatology visits, virtual conferences, and virtual resident lectures.9 Nic Dhonncha and Murphy described their experience in using Microsoft Teams to deliver interactive video lectures, tutorials, and student- led presentations, with active student participation.10 Similarly, Trinh et al implemented a virtual dermatology elective for 3rd and 4th year students with all participating students noting that the online course improved their dermatology clinical knowledge, reflected also objectively by an average score increase of 67% on a pre and post- course dermatopathology quiz.11 Incorporation of virtual approaches to teaching dermatology are thus not only convenient and practical, but also effective.
Current medical school pre- clinical dermatology education is insufficient in terms of dedicated teaching hours, dedicated faculty members, and student satisfaction. In- person lectures are the most highly regarded method for teaching dermatology, especially by students. However, during the era of the COVID-19 pandemic, implementing virtual didactic sessions, teledermatology visits, and online courses are also effective in increasing medical student dermatology clinical knowledge and satisfaction.
Anki, a Powerful Tool in Medical Education, But Where Does it Fit in?
The software program, Anki, is an opensource and free to use platform that enables users to create digital flashcards. The application, which is quickly gaining popularity among medical students allows students to take advantage of two key concepts that have been thoroughly studied in cognitive psychology: the testing effect and the spacing effect. However, as Anki continues to grow in popularity, with this popularity comes more questions. Specifically, how effective is Anki at helping students improve their performance? What makes Anki an effective tool? And in what phase of complex learning does Anki best fit? The goal of this literature review will be to take a more in depth look at the methodology behind Anki and to answer some of these questions about the role of Anki in medical education.
A narrative literature review was performed using various web-based tools and databases like Google Scholar and PubMed. The literature was searched using keywords like “Anki” or “spaced repetition” or “spacing effect” or “testing effect” or “cognitive load theory” or “complex learning” or “medical education.” Articles were screened based on a review of the full text for relevancy, and quality of results.
With respect to the effectiveness of Anki there were few articles identified. In a study carried out at the University of North Carolina School of Medicine a survey of 201 medical students showed Anki usage was associated with higher USMLE Step 1 scores. In 2015, Deng at al. reported that for every 1,700 unique Anki cards students used students showed a one-point increase on their USMLE Step 1 exams. The underlying principles of Anki are founded in the spacing and testing effect. Studies comparing massed versus spaced practice have consistently shown that spaced practice produces improved retention. Additionally, according to Roedinger et al. there is substantial evidence that shows actively recalling information through questions or testing improves retention.
Overall, there is a small amount of published literature supporting the effectiveness of Anki. However, the data that is published supports the use of Anki, specifically with respect to improving USMLE Step 1 scores. Despite the minimal amount of data specifically reporting on Anki, there is a vast amount of literature supporting the underlying principles of Anki such as the spacing and testing effect. Spaced repetition has proven to be one of the most effective study methods to improve retention of material. The use of Anki among medical students is becoming more common and has proven to be an effective study tool when used correctly. The evidence supporting Anki, and the spacing effect suggests that spaced repetition should be more formally incorporated into medical education curriculum.
Review of Peer-Lead OSCEs Benefits and Utility in Medical Education Curriculum
Objective Structured Clinical Examinations (OSCEs) can be a stressful event for medical students. Running the OSCE itself can be tasking and time consuming for faculty and resources. This review will aim to analyze the benefits and utility of peer-led OSCEs in the medical school setting. Multiple studies have been referenced to assess the benefits of peer led OSCEs, as well as, peer led education initiatives in medical school. Methods of finding studied included database research involving PubMed, IHS Library, and Google Scholar. Keywords included (peer teaching OR peer-led) AND (OSCE OR “objective structured clinical examination”) AND (undergraduate medical education OR medical school). It was found through literature review that peer-led OSCEs benefit student performance and attitude when approaching summative exams. A common benefit found throughout the studies has been the increase in student confidence and positive student perceptions of a peer-led model. In addition, it has been demonstrated that implication of peer-led OSCEs pose low risk as they are a useful tool for summative assessment preparation. They provide relief to the administrative and financial burden of OSCEs as they are with low cost and low administrative load. In the end, the peer-led OSCE can be a valuable tool for medical school programs. Future research can bridge the gap between formative, peer-led OSCE scores with summative examination scores. The case for peer-led OSCE utilization in the medical school setting would be strengthened if a clear, objective improvement in student scores is visualized and documented.
Medical Education Curriculum Development Student Abstracts 2021 – 2023
2023 Student Curriculum Development Abstracts
Focus on POCUS?
POCUS or Point-of care-ultrasound was first introduced to the clinical setting in the 2000s. It has allowed for the bedside use of portable ultrasound devices to diagnose and manage patients. Flash forward 20 years and now we have POCUS curriculums integrated into medical schools and residencies. However, with such a new and advanced technology comes its own challenges. The primary aim of this study was to evaluate the barriers to the implementation of a POCUS curriculum and therefore propose solutions.
In 2023, we reached out to several faculty members at the HMSOM to assess the barriers and current state of POCUS in the curriculum. Questions put forward consisted of: How do you feel about the incorporation of POCUS into the curriculum? What are current barriers to the incorporation of POCUS into the curriculum? Are there any solutions in mind? How do you see the implementation of the POCUS curriculum occurring? What do you believe the impact of POCUS being integrated into the curriculum would be? The response was analyzed and a survey was created based on this analysis. A presentation was given to the Medical Education committee of the HMSOM who also had feedback that was used to create this survey. The survey consisted of 14 questions asking about the perceptions and attitudes towards POCUS, barriers to POCUS, and possible solutions.
Faculty responded with variable responses. In response to “How do you feel about the incorporation of POCUS into the curriculum?” The response ranged from “Fully in support and developed a brief curriculum of 5 sessions which was delivered for the 2018 cohort with good reviews.” to “POCUS is currently taught to fellows in Nephrology. I don’t see a role in the medical school curriculum.” In response to “What are current barriers to the incorporation of POCUS into the curriculum? Are there any solutions in mind?” It was said that, “Biggest issue is we need equipment which is pretty expensive, then we need the curricular time to deliver the content. We would also need funds to compensate the specialized faculty who will teach it during the sessions.” In response to, “How do you see the implementation of the POCUS curriculum occurring?” Faculty responded “previously the content was introduced during SP (Anatomy course) as a component of the physical exam component and student feedback was it helped with both the anatomy and the physical examination skills. We are not sure there is time during that course to teach it during this time at this point.” While exploring “What do you believe the impact of POCUS being integrated into the curriculum would be?” It was found that “The biggest advantage for pre-clerkship students is to reinforce anatomy & surface anatomy, then later in phase 2, it reinforces physical diagnosis and diagnostic skills.” Further some faculty believed it was not a matter of when POCUS should be introduced to the curriculum but how. Faculty also voiced their concern for the practice of Evidence-Based Medicine via POCUS.
In my analysis of POCUS curriculums across the country, I have found that they are very variable not only in implementation but content. In terms of buy-in, it seems there is also a variable response. Some faculty believe it would be effective in bolstering anatomical and physiological concepts while others believe it is too complex and should only be taught at the postgraduate level. In terms of the largest barrier to POCUS, curricular time is already hard to come by in an already expedited curriculum. A possible solution would be to consider exposing students on their own time or working it into didactic sessions already in place. Another significant barrier is the cost of POCUS equipment. Cost can be combated by strategically instilling days where equipment is shared and this may even contribute to the peer teaching aspect of POCUS. It may seem idealistic but several studies have shown that POCUS has led to lower healthcare costs. Begging the question, could this be a solution to expensive diagnostic testing? It seems that an online platform for POCUS would be a great solution to the barriers of cost and accessibility. It may be of note to investigate how students and faculty would feel about an online platform and its effectiveness. Next steps would also include discovering how to motivate faculty to get involved and evaluate an online platform that would be suitable for students. Based on the survey put forward, it could address concerns for a POCUS curriculum and how to best instill one. A brief workshop could be designed based on results and held in order to address attitudes, feasibility, and POCUS’s importance in medical education.
Developing Tip Sheet for Pre-Work Videos
Medical education is the groundwork that is created to nurture and develop future physicians. In a world that is continuously advancing in methodology, research and technology, efforts are being made in medical education to evolve at a similar pace. In such an area, pre-work has become a necessary development to prepare students for each session. Pre-work videos have helped to bridge the gap and accommodate a majority of student’s learning styles. While much research is done on why such videos and tools are effective and useful, little exists in terms of a concise reference for educators to utilize on how to make such videos. Therefore the purpose of this project is to create a tool for educators that guide them in creating valuable pre-work videos. This one page tip sheet will ultimately target students’ learning as well by aiding them in better understanding their lectures and session content.
In order to create a consolidated reference sheet, data had to be gathered on what students need in their videos to keep them engaged. Additionally, it was important to understand the utility of videos, as well as other such learning tools and strategies in medical education. This background can help to tease out the most important qualities to include in development of the tip sheet for educators to use. Research led to a multiple of articles, studies, and essays that have collected data on these topics. Consolidating this information allowed for the creation of a concise list of recommendations to be incorporated into it. This sheet, in theory, would be the only tool needed to make an effective video. It would be easy to use, easy to understand, and universally available.
Various studies reached conclusions that allow for the development of the recommendations. In particular, a study concluded that students find accelerated, video recorded lectures equally or more valuable than live attendance8. Additionally, a study highlighted that more students completed assignments in a non mandatory, asynchronous, fully online learning module versus the traditional type7. Showing evidence for the utility of the videos. In terms of what is important in the video, another essay reviewed literature to suggest practical ways for instructors to apply three core principles when using videos as educational tools; cognitive load, elements that impact engagement, and elements that promote active learning.6 The tip sheet was developed taking into consideration these recommendations and those gathered from other articles such as tips to reducing production time and increasing long-term reusability of videos, making effective educational videos for clinical teaching, and tips for effective use of videos in medical education (i.e. high-yield videos)
Educational videos are tools that have been utilized throughout multiple disciplines. Based on the research, students, and faculty opinions a list of concise recommendations were created. First, organize the content. In this arena, it is important to include a title page and make sure at least one slide states the learning objectives clearly. Additionally, include a table of contents and a summary slide at the conclusion of the video. Second, create a script. This should be an outline of what to say in each slide and can be later used/available as a transcript to the students. Third, avoid overloading video content. Do not include necessary details not aligned with objectives. It should be a general overview of upcoming sessions, not a substitute for the session. Fourth, verify easy accessibility of video. Upload to youtube and the school’s learning platform such as LEO or blackboard. Fifth, choose a platform to create the narrated video slides such as powerpoint or google slides, powerpoint is recommended. Sixth, limit the video length to 15-20 minutes and if it exceeds that, separate into 15-20 min sections, no more than three. Seventh, integrate features to help learners follow along such as lecturers perspective video and captions. Lastly, include interactive elements such as questions and quizzes throughout the video for continued engagement. Include only necessary graphics such as labeled images and diagrams and not more than one per slide. Overall, with these recommendations will be the development of a tip sheet to create effective pre-work videos.
Effectively communicating with patients with developmental disabilities
Patients with developmental disabilities (DD) are a growing population. Within New Jersey, the prevalence of autism spectrum disorder (ASD) is 2.8%, higher than the national average of 2.3%.1 People with DD experience health inequalities such as shorter life expectancy, with negative attitudes among healthcare staff being a likely contributing factor.
A majority of medical students do not feel comfortable in their ability to provide care for patients with DD.3 This is an under-represented area in medical school curricula; an audit of Australian medical school curricula showed only 2.5 hours dedicated to this population.4 Communication education improves students’ attitudes and feelings of preparedness to provide care to this population.3 This project designs a curriculum to educate medical students at the Hackensack Meridian School of Medicine on strategies to communicate with this underserved population.
Informal needs assessment was conducted amongst preclerkship and phase 3 students. Common themes among preclerkship students were uncertainty about communication approaches with this patient population, with varying exposure levels from extracurricular activities prior to medical school. Common themes among phase 3 students were having some exposure to these patients during clerkship, but without formal training and considering this a weaker clinical skill area. Literature review revealed existing medical curricula project designs based on existing best practices models such as Communicate CARE.5 Augmentative and alternative communication (AAC) methods were identified as an emerging field with clinical utility for these patients.6 Educational strategies selected for this curriculum were text-based resources, lectures, and roleplay. These were based on reflective, experiential, and constructivist learning theories.
Learning objectives are
Describe and reflect on one’s pre-existing attitudes towards patients with DD Recognize communication challenges faced by patients with DD in the healthcare setting Identify augmentative communication strategies that may be useful for patients with DD Use a communication exercise to distinguish challenges that may be faced by both practitioners and patients in encounters where the patient has limited verbal ability Prework includes a review paper on medical student attitudes towards patients with DD and impacts of communication training, a video on Communicate CARE, and a review paper on AAC. Session design includes a clicker quiz, lecture, communication simulation activity where students play a person with communication impairments and their clinician, and a debrief.
This curriculum can be incorporated into a Human Dimension session during the Neuroscience and Behavior course. The project mentor, Dr. Leslie Bagay, could potentially deliver the session. Evaluation would include a standardized HD session Leo evaluation, performance statistics for exam questions. Next steps include content reinforcement in the clerkship curriculum and providing students with a communication tips sheet for use in their clerkships.
Medical Student Communication with Patients with Limited English Proficiency
Evidence that suggests that patients with limited English proficiency (LEP) have worse access to care and experience worse outcomes. Interpreter use for patients with LEP has been shown to improve communication and care between patients and providers. It is also important to note that improved training with translation services has been shown to improve medical students’ ability to use interpreters.
A needs assessment was performed in the form of a student survey and a curriculum analysis. The survey was sent to the current students (N=60). 41.7% felt they did not get training on how to effectively use interpreters in a clinical setting. The challenges indicated were: phrasing questions (56.7%), accounting for time (61.7%), and forming connections (60%). The solutions recommended were: training for interpreter use in clinical settings (56.7%), information about available interpreter services (71.7%), and increased access (80%). Finally, 90% (54) felt that there was a difference in how patients with LEP are treated compared to patients who speak English.
Curriculum analysis revealed two sessions that currently touch on this topic. The first is part of the Clinical Skills Approach to Cultural Humility discussion session that occurs in July of first year. There is also a session early in first year in the Human Dimensions course where students practice using the language line in small groups to prepare for VPs.
The goal of the session developed is to fill this gap identified and for students to feel more prepared and confident using an interpreter in a clinical setting.
Using the interpreter line in a clinical setting is a psychomotor skill. Therefore, the educational strategies that best support learning this skill include demonstration, role-plays, simulated clinical scenarios, and standardized patients. The learning theories that influenced this session plan were deliberate practice and social learning theories.
A pilot session was developed for the ongoing round of transitional clerkship. Objectives for the session are: describe strategies to implement best practices of interpreter use in a clinical setting, demonstrate best practices of interpreter use via fishbowl standardized patient activity, and reflect on challenges associated with interpreter use. The session begins with a student discussion of experiences with interpreters so far, reflection on their prior knowledge, and discussion of goals. Then there would be a review of best practices. Next they would use the language line for fishbowl activity with a standardized patient. Finally, a debrief to discuss their experience and how to improve going forward.
Based on the literature review and needs assessment performed, students would benefit from expanded education on this topic. Feedback from this session would include the Leo session evaluation immediately after the session and another evaluation one month after beginning clerkships. Following the feedback from this pilot session, the session could be adapted for the curriculum on a larger scale. This session was not able to be conducted for the current group of students in transitional clerkship, so next steps include finding a time for this session.
2021-2022 Student Curriculum Development Abstracts
A New Elective in Gastrointestinal Radiology at HMSOM Medical Education
At Hackensack Meridian School of Medicine (HMSOM), there is a lack of clinical electives offered in the field of radiology. Out of nearly 80 electives encompassing various medical specialties available to students, only one is offered in radiology. The currently available elective in Diagnostic Radiology takes place virtually and in-person over four weeks and introduces a wide-range of imaging modalities in each imaging sub-specialty. This elective is offered to three students per block, which limits the number of students that can sign-up for the course in any given year. This may be problematic for students pursuing radiology residency or other specialties that rely heavily on individual interpretation of radiographic imaging for diagnosis and management (i.e., surgery, urology, neurosurgery, emergency medicine, etc.). Through advanced electives, medical students can progress their knowledge, seek mentors, and pursue research opportunities. Positive experiences may additionally translate into competitive residency applications with strong letters of recommendation from individuals in a desired field. For these reasons, development of additional electives and learning opportunities in radiology have been proposed. In this project, we focus on the development of a pilot sub-specialty elective in Gastrointestinal (GI) Radiology.
Development of an anesthesiology supplemental module for the surgery clerkship
As a medical student who was interested in anesthesiology, my anecdotal experiences during clerkships were limited with regards to opportunities for advancing my clinical knowledge in this field in an organized or structured manner. Existing literature on the topic of anesthesiology education during the core curriculum of medical school is limited and the subject is not a required course for most medical schools in the United States. The surgery clerkship is often the first experience students will have in the operating room, including anesthesia and perioperative management. Given that context, it seems like a logical time point in clinical education to introduce basic materials on the topic. In order to address this suspected gap, three major questions were formulated: “How is introduction to anesthesiology classically handled in US curriculums?”, “is there a benefit to incorporating anesthesiology training into the medical school curriculum?” and “do medical students prefer to learn about anesthesia in the context of their surgery rotation?” These questions were initially addressed by reviewing existing literature using keyword searches on pubmed including, “anesthesiology medical school curriculum” and “anesthesiology surgery clerkship.” Additionally, the AAMC curriculum toolkit was used to retrieve data on the use of formal anesthesiology clerkships in the United States. After sufficient review of existing data was conducted, an advanced curriculum resource review was conducted utilizing the Hackensack Meridian School of Medicine library services in order to identify the best means of designing and implementing an elective curriculum for students.
The initial literature review revealed two articles on the topic of anesthesiology education during the core clinical years of medical school. One article outlined the data from a survey study conducted at a major US medical school amongst both faculty and 4th year students who had already completed the program’s required anesthesiology clerkship. They found that 10 of the 14 major teaching topics contained within the anesthesia curriculum were deemed to be “somewhat or very important” by more than 70 percent of both faculty irrespective of specialty and students. Additionally, they reported that over 82 percent of this same sample found 7 of the 14 topics to be “very important” to medical education as a whole. While this sample size was not ideal, these results provided a foundation for this project and its relevance to the targeted learners. The second article reviewed the relevance of introducing an anesthesia curriculum within the context of the surgery clerkship. They analyzed survey data across multiple years at a US medical school where there was a transition from a 1 week anesthesia course conducted within the 8 week surgical clerkship into a separate anesthesia clerkship taught in the context of other advanced clinical rotations. This study reported that students felt they learned more about perioperative management and felt it was more favorable when the rotation was paired with the surgery clerkship versus with other advanced rotations. While, again, sample size was limited these results helped guide the following steps of defining learning objectives and identifying tools for implementing an elective anesthesiology curriculum for students to utilize during their surgical clerkship. After an extensive resource review, the Access Anesthesiology CaseFiles tool was identified as an ideal learning material for the previously defined learning objectives. Given that the objectives were cognitive in nature, the independent case review format with associated comprehension questions for reinforcement of concepts was deemed an appropriate method. As a final review, the structured list of cases associated with their proposed learning objectives was reviewed by 5 student peers, and deemed to be “very helpful” to student education in the context of basic clinical rotations. The next steps for this project will be to seek approval from the clerkship director and librarian staff for integration of these elective materials into the student clerkship “phase 2 toolkit” online accompanied by an evaluation form for students to provide basic feedback.
Implementation of OB/GYN Ultrasound Elective at HMSOM
The clinical applications of ultrasonography in the field Obstetrics and Gynecology are immeasurable. Residents and attending physicians across multiple fields of medicine, including Obstetrics and Gynecology, rely on ultrasound imaging to not only diagnose, but to create effective treatment plans for their patients. Currently, there is no consensus regarding the competencies that medical students should achieve prior to starting residency when it comes to ultrasound imaging and ultrasound image recognition. Furthermore, there is a gap in the research regarding implementation of ultrasound curricula in medical education. Studies have shown that the quality of OB/GYN ultrasound can be improved, and that the lack of consistency throughout the United States regarding OB/GYN ultrasound quality is due to the lack of a standardized curriculum in ultrasound teaching (Benacerraf). However, several studies suggest that early exposure to ultrasonography in the field OB/GYN may further prepare students entering residency training programs. In a recent study, medical students were exposed to an additional one week theoretical and hands-on practical course that focused on ultrasound screening in Obstetrics and gynecology. After the course their ability to correctly answer multiple choice questions on their theoretical knowledge and fetal imaging recognition skills improved from (50 to 80%; P < 0.001) (Hamza). In another study, the median correct number of responses in a multiple choice exam that focused on pelvic anatomy and pathology increased from 11/18 to 14/18 after a one-hour OB/GYN ultrasound simulation training session, these students (n=65) also showed a statistically significant increase in comfort level with OB/GYN ultrasound (Cook). Based on adult learning theories, multiple exposures is one of the many ways to develop competencies in the subject at hand. Implementing early exposure training to OB/GYN ultrasound basics and application will allow students applying to the field of OB/GYN to begin residency feeling more confident and prepared. Methods Using the competency-based curriculum course design (fig. 1), kern’s six-step approach to curriculum development, and working with faculty from HUMC, the 2-week course was developed. The course objectives and session objectives for the course were influenced by The American Institute of Ultrasound in Medicine (AIUM). The AIUM aims to create a consensus curriculum and competency assessment for residency training in OB/GYN (Abuhamad). It was this data together with other data from our general needs assessment that we were able to show that there is a gap in medical education regarding ultrasound teaching - particularly those applying to OB/GYN, despite the benefits of such. Our general needs assessment/literature review was conducted by using keywords “transvaginal ultrasound (medical school OR medical students)) AND (competency OR readiness) "Obstetrics/education"[Mesh] AND ultrasound AND (medical school OR undergraduate medical education” Under targeted needs assessment, the OB/GYN interest group has informally stated that they would be interested in taking this course in preparation for their residency. HUMC residents have also stated that this would be a beneficial course prior to starting their intern year. Data from the official survey is currently being collected. We plan on providing both subjective and objective data to gauge interstate in the course and graduating students' subjective comfort level with ultrasound skills. Using the competency-based curriculum and course design, and several studies on adult learning theory the course objectives and teaching methods were created. Results General needs assessment results show that there is a lack of consensus regarding the competencies medical students should acquire prior to graduation when it comes to ultrasound skills. However, studies also show the increasing usage of ultrasound in clinical medicine and the need for medical professions to feel comfortable acquiring and interpreting ultrasound images. This discrepancy is the leading motive to create more OB/GYN US electives in medical education. Targeted needs assessment at HMSOM shows that there is a lack of OB/GYN electives for students pursuing a career in said field. Currently, HMSOM provides only advanced 4-week OB/GYN focused courses. Discussion with the OB/GYN interest group at HUMC confirms student interest in such a course. Official qualitative data is being collected via a survey. Our target assessment also showed that HMSOM offers 2-week ultrasound courses in both emergency medicine and vascular medicine - the lack of an OB/GYN elective is the gap we aim to fill. Discussion Early exposure to necessary skills, and re-exposure, aids in adult learning. Given the importance of ultrasonography skills in multiple fields, including OB/GYN, and student interest at HMSOM - we argue for the implementation of a 2-week OB/GYN course. The course was created using the HMSOM educational program objectives - and the objectives proposed by the AIUM in order to ensure that the skills taught were in line with student expectations. It is also important to discuss the adult learning theory and its influence in the course design. We argue that the course focused primary on the cognitive and psychomotor domains of learning, however, the affective domain of learning is also important to discuss given the nature of patient interaction during the course. The course falls under the humanist theory of learning. Given the nature of the course, and the students who will enroll - the successful student in this course will be one who is self-motivated and who is using the pre-work readings in order to come to in-person sessions prepared where faculty will hold the role of facilitators of learning rather than the main teachers.
There is a need to provide additional OB/GYN electives at HMSOM. Multiple studies have shown that implementation of such electives yield positive outcomes regarding student objective and subjective knowledge and comfort with ultrasound skills. Moving forward additional information must be presented, including student assessment during the course and faculty members involved in the electrive, prior to official submission in the spring of 2022.
Pilot Podcast Episode on Trauma, Supplemental Material for Surgery Clerkship
Free open access medical education (FOAMed) refers to a wide range of educational sources that include social media, podcast, and blogs for further discussion of various topics. This could be a discussion on recent changes in screening guidelines over Twitter, new methods for awake intubations on a blog, or a podcast on the approach to a patient with chest pain in the Emergency Department. Virtual and in-person communities have grown around these resources and have become incorporated into the Undergraduate Medical Education environment. The rise of podcasts as part of FOAMed has led to the growth of communities around many popular shows. The ACGME now allows Emergency Medicine residents to use 1 hour of podcasts for every 5 hours of lectures. This shift in educational methods shows the impact that podcasts are having on medical education and is leading to further evaluation into how they can be best utilized not only in graduate but also in undergraduate medical education. Medical students see podcasts as an advantageous way of studying due to the relaxed tone of the presenters and the flexibility that comes with listening. With podcasts becoming a growing educational resource we want to focus on the current literature to identify best practices for podcast design and use this to create a pilot podcast episode to give guidance about the role of both internally produced and externally produced podcast can be used.
To gain a better understanding of the process of medical education curriculum design chapters of Curriculum Development for Medical Education: A Six-Step Approach was reviewed and use to create our intervention. This began with the development of learning objects for the course and the pilot podcast episode. Lectures were used to supplement the readings from Kerns and to give a well-rounded introduction to Curriculum Development. Next, a needs assessment was conducted to identify areas of improvement using the surgical clerkship as an example to represent all clerkship at the School of Medicine. After identifying an area of discrepancy between the actual and ideal approaches attention was turned to planning an intervention. As part of this step, stakeholders were identified to gain support for the project. The Primary and Secondary survey in trauma patients was selected as an area where a podcast could be used as a targeted intervention. Using the surgical clerkship resources enabling objectives were created to help facilitate the creation of a pilot podcast and give students clear expectations for what they could learn for the podcast.
A literature review was performed with the help of the IHS library to evaluate the current work being done on podcasts in medical education. Databases used include PubMed and Scopus. With undergraduate medical education, medical education, podcast, and audio lectures were used as keywords for the search. This review led to the identification of several papers that focused on the use of podcasts in both graduate and undergraduate medical education. A number of these articles talked about the increasing role that podcasts were playing in medical education and discussed how they were being used by residents and students.
Included in these articles was a scoping review done by Academic Medicine evaluating the current research educational outcomes, the impact of current evidence on best practices, and gaps in the research for further work. As part of this review, they were able to identify several key components found in high-quality podcasts including the length of episodes, the use of summaries, and review questions at the end of episodes. Also discussed was the fact that many of the current podcasts are designed with a focus on graduate and continuing medical education and how this may cause medical students to be less engaged in certain podcasts. They hypothesize that the reason for medical students’ decreased engagement is the lack of content designed for them. There were two key studies that reference both showed podcasts as an effective teaching method for medical students. As well as showing that students enjoyed having podcasts as a resource to supplement their education and provided feedback similar to that given by residents and attendings.
Other articles were selected that covered tips and recommendations for designing a successful podcast looking at both the process of preparing for an episode as well as the recording and editing process. It was decided that the creation of pilot podcast episodes would allow the SOM to gauge students’ interest in podcasts targeted to them, develop a road map for the creation of future podcast episodes, and the possible creation of tips and tricks guide for podcast design.
A review of the surgical clerkship materials assigned for the trauma lecture and supplemental resources listed in the surgical clerkship tool kit was reviewed. These were used to create and refine the enabling objects for the podcast episode. Outside resources were used to fill in gaps identified between the available prework and common topics covered both on rotations and on various board exams. Using all of these resources an outline was created and reviewed by faculty members. After approval of the outline and enabling objects a podcast script was created and revised before the recording of the podcast. Upon completion of the podcast, it will be available for students to access as part of the surgical clerkship to use both as pre-work and for review before their trauma rotation or shelf exam. This episode will also be helpful to students preparing for their Emergency Medicine rotation and shelf exam.
Currently, we are in the process of finalizing the podcast recording and show notes sheet so that they will be able to be published and used by students on their Surgical Clerkship.
Once the podcast has been created and available to students we will be able to see how they decided to use this resource. Initially, this can be tracked by seeing the number of times that students are accessing it as a resource. After multiple rounds of the surgical clerkship have been completed there could be either a focus group or survey to gain a better understanding of how students are using the podcast. Also to look for areas of improvement if future episodes are going to be produced. It may be possible to add in a few questions related to the podcast at the end of the clerkship rotation evaluation form on Leo.
If there is evidence that students enjoy and would like more podcasts this can be used to help spur a discussion about the role of podcasts at the SOM. There are two different approaches to podcasts that would be worth discussing. The first would be the evaluation of available podcasts focused on undergraduate medical education and how they relate to the content covered at the SOM. These selected podcasts should also undergo an internal review to evaluate how they compare with current best practices and a review of their credibility. This would allow students to have a readily available list of episodes to listen to while commuting or doing other tasks. If no such podcast is found and a topic is deemed to be important by faculty it would represent an unfilled niche that the SOM could fill by the creation of a podcast episode. This combination approach would allow for the efficient creation of podcast episodes covering the unique aspect of the SOM curriculum and the hospitals where students rotate while also taking advantage of already available resources.
With FOAMed having grown from being associated with social media platforms to commonly used and referenced education resources in both undergraduate and graduate medical education. Podcasts as part of FOAMed have seen rapid growth with many targeted at graduate and continuing medical education which often does not provide the background needed for medical students. To fill this niche there is a growing opportunity for the SOM to be involved in making podcasts more adapted to undergraduate medical education both in terms of content creation and reviewing/recommending podcasts as supplemental resources.
Pre-work video for LGAL session on Acid and Base Disorders
Flipped classrooms have become increasingly popular in medical education. Students are assigned work, often in the form of readings or videos, and learning objectives prior to coming to class. They familiarize themselves with the content, and once they arrive at class they engage in application of material through problem solving and discussion which leads to active learning (2). In order for this model to work effectively, students need to ensure they are coming to class prepared, by completing the prework. Readings are a very common form of prework that is assigned to students. While targeted textbook readings can be effective, they are often too long and filled with extraneous details that distract the learner (5). It is vital to provide prework that is convenient to complete and aligns with session learning objectives. Such prework will allow a larger percentage of students to do the prework and come to class prepared. A large group active learning session during preclinical years is a perfect session to design an effective and easy to complete prework assignment – and a video is the perfect way to do this.
To begin it is important to focus on the session learning objectives. Learning objectives guide what content is taught and state what the curriculum hopes to achieve, and also suggest which learning methods will be most effective (1). A video is a great choice as it is an effective education method for cognitive knowledge and cognitive problem solving based learning objectives (1,7). They can really be targeted to learning objectives and much easier to make it through videos than a ton of reading. Finally a video is not resource intensive and it is very easy to distribute after completion.
It is also vital to understand how to make an effective video. First, it is important to be aware of cognitive load, by eliminating extraneous details and keeping things simple. Important information should be highlighted and related topics can be “chunked” together. Videos should be short and finally should promote active learning by interspersing questions or drawing on the screen (3). Constructivist learning theory states that “learners actively build knowledge by imparting meaning to new information that builds on prior knowledge” and creates a conceptual framework (1). The video will focus on building off that prior knowledge and giving a good framework on which to build during the active learning session
Flipped classrooms and active learning have become increasingly popular in medical education, and it requires students do prework come to class ready to engage in application of material through problem solving and discussion. Prework that’s easy to complete and is focused on the session learning objectives is very important, which is why prework videos will be effective.
Student as Teacher: Small Group Facilitation Elective
Residents are expected to teach medical students and other residents as soon as intern year. However, many residents may not have had formal ‘learning how to teach’ courses during medical school. This can leave potential gaps in education going forward into residency. Currently at Hackensack Meridian SOM, a formalized, concentrated ‘learning how to teach’ course. Our aim is to create an elective aimed at teaching students how to become effective small group facilitators. Students will have the opportunity to co-facilitate and facilitate small group discussion sessions.
Several medical schools both within the United States and around the globe have implemented student-teaching through various components of their curriculum. In problem-based learning (PBL) courses, physical exam teaching, and anatomy courses, student facilitation has been shown to not lead to significant differences in objective evaluations of student performance. In fact, these initiatives have shown mutual benefits for student learners and teachers alike. Student learners find student facilitation more relaxed and sometimes more efficient because student facilitators understand common difficulties learners have with content. Student teachers benefit from developing the ability to speak about basic science concepts in a clinical context and convey complex ideas, as well as the skills to identify the needs of learners.
Kern’s model of curricular development as described in Curriculum Development for Medical Education : A Six-Step Approach was used for this project. Problem identification, general needs assessment, and targeted needs assessment were performed. A literature review was conducted to find similar initiatives at other schools as well as any public training materials that came from these endeavors. Meetings were conducted with several medical education faculty to identify important areas of focus. Opinions from several students were elicited regarding potential interest in this course. Learning objectives were developed and relevant educational strategies were identified. A timeline for implementation was developed and methods of evaluation were identified and described. A project proposal outlining these steps was created with intent to be presented.
Project proposal consisting of a formalized curriculum for senior medical students to co-facilitate small group discussion sessions was presented at a medical education scholarship conference. An elective proposal form was completed and submitted to course leads for the Medical Education Curriculum Development elective. The proposal form will undergo a formalized review process by several medical education committees at Hackensack Meridian SOM pending final approval.
The presentation and proposal were met with positive feedback at the medical education scholarship conference. Pending final approval by the Medical Education Committee, the elective will be piloted for the first available offering of the course. Educational resources for potential students of this course have been compiled and materials for sessions are being developed.
Team Based Learning
Introduction and Background
Team Based Learning (TBL) is a learning style that employs the use of small groups to facilitate an active learning environment. TBL is becoming more popular within medical schools across the country because it is teacher-directed, improves team-oriented skillset, and can be used for a variety of topics.
TBL typically includes a few elements to be executed properly. First, students are assigned pre-reading assignments that provide a framework for the TBL session. During the TBL session, students are placed into small groups. Ideally, each group should carefully balance each member’s skill-set so that knowledge bases remain heterogeneous. Each group is assessed with a question set individually and in a group setting. Thereafter, students are given application assignments. These questions should pose a significant challenge for each group, force students to work together to solve the problem, and prompt a specific answer.
This project involved creating new TBL materials for our Structural Principles course such that the content we deliver to students in this session better complies with our school’s TBL standards.
Work on this project included the following: a comprehensive review of the SP course sessions including learning objectives, session materials, and assigned pre-work. After those materials were reviewed, I met regularly with course directors to discuss the greatest needs within each week’s content. Furthermore, we discussed the preferred direction for the TBL in terms of topics.
After those meetings, I compiled assessment questions for the assigned weeks and included learning materials for those questions.
The role of TBL at the HMSOM has evolved over time. During its inception, TBL was originally designed to run two days a week on a single topic. However student feedback during that implementation was mixed. The student body’s concerns included sentiments that TBL sessions resulted in an inconsistent level of learning. For example, if a TBL session covered Myocardial infarction, a student’s takeaway from that TBL might rely upon their performance on tRATs or the competency of their teammates. Whereas content delivered in a lecture format was more likely to be learned at a similar level across sessions. On the other hand, content delivered in a lecture format was less likely to involve active learning principles.
The solution to this problem was for course directors to set aside time for a “review” TBL during each week. In this TBL pre-work was kept to a minimum, and tRATs/application questions were based on content already “covered” in previous sessions. Student responses to these TBL styles were well received. The work made during this project was to develop headway in making two TBL sessions for the SP course during our “new” guidelines.
TBL is a relatively new learning style in medical school curricula. The optimal way to implement TBL sessions in the pre-clerkship setting is still being investigated. At our school, we have pivoted to “review” TBLs which have been met with generally positive feedback from the student body. However, more groundwork is needed to fully implement these new TBL sessions across the entire Phase 1 curriculum. Furthermore, more research is needed to conclude that “review” TBLs are superior to its traditional format.
PPPC Cases in SOM Curriculum – Cultural Humility Subcommittee
Medical education often lacks appropriate and diverse patient representation amongst its curriculum. This misrepresentation can be seen in many patient-based clinical cases and objective-structured clinical exams. Lack of appropriate contextualization of disease burden associated with certain racial, cultural, or ethnic groups starting in the preclinical years can perpetuate harmful stereotypes that contribute to the inequalities seen in medical care. This presents as a missed opportunity to explore the complex structural and socioeconomic conditions early on in medical education. Identification and discussion of these missed opportunities provide a framework for which medical students can recognize the many upstream factors and social determinants of health (SDOH) in caring for a patient as a whole.
We propose a systematic evaluation of our own medical education curriculum within the Cultural Humility Subcommittee that sets out to 1) retroactively apply best practices to our patient-based cases using validated evidence-based tools, and 2) catalog and analyze representation in our patient-based cases. We have identified demographic characteristics in our classification criteria including – name, age, sex, gender, race, culture, education level, occupation, chief complaint, and medical diagnosis. Analysis based on the identified demographics will reveal gaps in patient representation and subsequent actionable items to address such gaps. We will critically analyze and edit our patient-based cases utilizing guidelines published from Krishnan et al to ensure our cases address common fallacies of patient presentation.
Although the sample size of PPPC cases was relatively small (n=11), there were several themes that were observed. On the individual level, cases had common mistakes identified by Krishnan et al describing patient’s appearances or typical portrayal of diseases (n=3 [MCP_Wk1, MCP_Wk3, MCP_Wk5]) that could potentially be diversified (see spreadsheet notes). On a broader level, a common aspect of all PPPC cases mentioned social support, relationship status, or hinted at financial security. Inclusion of social support or marital status in our classification criteria may benefit student discussion about health disparities. Identification of SDOH in PPPC cases however, was not a focal discussion point when compared to developing student’s critical thinking of differential diagnoses. Meaningful discussion of SDOH can be integrated by using PPPC cases as a platform when developing topics to discuss in our Human Dimensions course. Due to the small sample size, further classification of PPPC cases will be needed to have meaningful data in addressing curriculum gaps in patient representation.
This deep dive and analysis of our curriculum provides a basis for curricular changes and a foundation to dialogue about our diverse patient population. It enables contextualization of disease burden, providing an early standard in how we address diversity, and allows students the space to learn about the SDOH in caring for each individual. Classification and retroactive analysis of PPPC cases have identified the addition of social support and/or marital status in our classification system. Typical patient portrayal for certain diseases could benefit from diversifying demographics that are not as well represented (eg – older woman presenting with atypical symptoms of MI instead of middle-aged obese male presenting with typical symptoms of MI). As we continue to classify more PPPC cases, further observations of broader themes in patient representation can be assessed.
Pre-Work Module for Hemostasis and Allostasis
A 2014 survey by OSUCOM showed that learning how to acquire knowledge is one of the five most important aspects of medical education training. At Hackensack Meridian School of Medicine, we use a flipped classroom model of education as a tool for learning how to acquire knowledge. Traditional lecturing tends to lead to passive listening and note taking, so with a flipped classroom model the learning becomes more active. With this model, students are given pre-work where the information is introduced to them for the first time. This way, the classroom time is spent on active learning through cases, practice questions, and team based learning under the guidance of the teacher.
The pre-work for the Hemostasis and Allostasis course currently is predominantly textbook readings. While this is a very effective form of introducing new material to students, adult learners have varying learning preferences. Some learn best from reading while others prefer audio/visual learning or practical exposure through cases and questions. This project is focused on introducing video presentations of new material as an option for pre-work. Verbal feedback from students in the 2018 and 2019 cohorts who have successfully completed the Hemostasis and Allostasis course showed that the video pre-work that was available for some of the physiology lectures in the past were extremely helpful in their learning. They cited reasons such as the time saved, clear explanations of concepts, emphasis on what to focus on, and explanation of figures from the textbook are why video presentations are preferable to reading from the textbook in preparation for large group active learning sessions. With this in mind, this project aims to create more video pre-work modules for physiology lectures in HA. The reasoning behind the focus on physiology lectures are these are the foundational lectures in HA that remain important throughout the course and the rest of medical school. It is essential that multiple resources are presented to students so they may use their preferred learning style to grasp these vital concepts.
A group of collaborators conducted a study in 2014 to measure how video production affects student engagement. They found that shorter videos with informal talking with slides are more engaging than longer video lectures that reassemble pre-recorded classroom lectures. A pre-work video for the microcirculation and control of blood flow was developed using the recommendations from this study as well as incorporating complex learning theory. This topic was selected as it serves as foundational material for other HA lectures. The video includes explanations of important concepts as well as 5 questions that students can use to assess their understanding of material introduced in the video. This way, students have multiple forms of gaining knowledge in an engaging manner. Whether this video style presentation of pre-work is beneficial or not can be assessed by surveying students who watch the video and collecting feedback from them. The barrier to making videos for all lectures is that they require a considerable amount of time. In the future, if video pre-work modules are shown to be beneficial based on student feedback there are several options for how to address the barrier of time. Future M4 students taking medical education electives may continue this project by making similar videos. Additionally, students who are off-cycle and require an activity or students who may need to remediate HA can create videos to supplement their own learning. Finally, the school employs peer tutors. Those who conduct group sessions may elect to create these videos as preparation for their peers. It is important to continue exploring the role videos play in contributing to the educational models our school uses.