2017 Meeting Posters – Curriculum

200 – THE SQUEAKY WHEEL GETS THE GREASE? INSIGHTS AND IMPACTS DURING RESOURCE-CHALLENGED CURRICULAR TRANSFORMATION
Max Anderson, Linda Love, Abbas Hyderi, and Sandra Yingling
University of Illinois College of Medicine at Chicago and University of Nebraska Medical Center

PURPOSE: Medical and health professions schools across the country are embarking on curriculum change/redesign or have recently completed a significant curriculum overhaul. The forces of change in modern academic medicine often clash with pressures of time for performance improvement, ingenuity and creativity in teaching. These real constraints tempt faculty and organizations to resort to familiar teaching traditions, not a viable ongoing solution. Likewise, administrators and leaders are faced with where to place resources for the biggest impact. In past decades, it may have been appropriate to merely monitor and develop the small fraction of poorly evaluated teachers – to grease the squeaky wheel. In modern day, with widespread change, expanded strategies to assure teaching quality more make sense. Two universities in the Midwest examined a variety of approaches to help organizations best calibrate how to sustain a high performing medical education enterprise by providing feedback to its most important mission-based impact factor—its teachers.

METHODS: At the University of Illinois College of Medicine – Chicago (UICOM-C) and the University of Nebraska Medical Center (UNMC), evaluation and direct observation data indicated weak points for faculty. Some of these included their use of curricular materials, use of educational technology, or facilitation skills. A quality improvement for faculty became a priority.

RESULTS: This is a work-in-progress. This poster features how two universities provide relevant, actionable feedback to faculty members regarding their teaching effectiveness. These quality improvement investments required a synergy between many stakeholders including faculty, administrators, instructional designers, and faculty developers to develop strategies for feedback and coaching. Early indicators from faculty suggest that teaching feedback has helped to increased confidence in change.

CONCLUSIONS: It is important to ensure that faculty and department heads are given appropriate feedback in a timely manner, with which to improve their teaching effectiveness. However, feedback alone may not result in the desired outcomes. Experiences at UICOM-C and UNMC have shown that the type and frequency of feedback is important and necessary for ongoing teaching effectiveness.

201 – Using mindfulness to promote feedback receptivity in third year medical students
Megan Wetzel, Lee Rosen, Elise Everett, Jesse Moore, and Alison Howe
University of South Dakota and Robert K. Larner MD College of Medicine, University of Vermont

PURPOSE: Accepting and integrating feedback is necessary for professional growth during clerkship training. The capacity to receive feedback can be challenging for clerkship students. We assessed the efficacy of a mindfulness-based intervention to create receptivity in clerkship students during feedback.

METHODS: We compared third year medical students enrolled in obstetrics and gynecology (OBGYN; N=16) with their peers enrolled in surgery (N=16). OBGYN clerks were given a brief presentation on the feedback process and mindfulness in addition to participating in a simulation exercise using the intervention (Figure 1). Surgery clerks acted as the control group, and did not receive any additional training on feedback. Both groups completed several measures including a demographic survey, the Sensitivity to Criticism Scale, the trait Mindful Attention Awareness Scale, Mindfulness and Feedback Survey, and Response to Feedback Survey.

RESULTS: At baseline, OBGYN clerks reported more overall mindfulness (p =.03) and greater amounts of sensitivity to criticism than Surgery clerks (p=.01). After the intervention, the majority of OBGYN clerks reported practicing mindfulness at least once during their rotation (87.5%), and found mindfulness to be helpful for creating an open mindset for receiving feedback. OBGYN clerks were more likely to agree that feedback that was given was nonjudgmental (p=.03) and constructive (p=.02).

CONCLUSIONS: This study provides preliminary evidence for the value of incorporating mindfulness practice into clerkship curriculum. OBGYN clerks reported improved openness to feedback, reduced negative emotions associated with feedback, and increased positive responses to feedback, which may be related to their use of mindfulness. Given the results of this study, it is reasonable to consider teaching mindfulness to clerks.

202 – An innovative way of teaching lifestyle medicine in undergraduate medical education: medical students teaching student athletes
Magdalena Pasarica and Ashley Franklin
University of Central Florida College of Medicine

PURPOSE: Studies report that providers often do not provide lifestyle medicine recommendations, due to lack of confidence, knowledge, and appreciation of lifestyle medicine, therefore outside-of-the-box teaching in this area is needed.

METHODS: We used an innovative approach to increase medical students’ knowledge, confidence, and appreciation of lifestyle medicine, by offering pre-clinical medical students the opportunity to serve as teaching assistants for a nutrition and lifestyle educational program delivered to our University football student athletic team. Each session included a teaching part and a corresponding counseling part. The objectives of the sessions were to discuss food composition and calorie content, meal timing, sleep quantity and quality, body composition, weight loss/gain strategies and safe nutritional supplementation needed for achievement of peak athletic performance. The effectiveness of these sessions was assessed by a post-program, voluntary survey.

RESULTS: Students reported that participating in the program increased their confidence in 1) discussing nutrition advice with athletes (100%) and with patients (90%), 2) obtaining patient history (40%), and 3) motivating patients to change their lifestyle (80%). Importantly, most students (90%) agreed that lifestyle management recommendations are a valuable use of patient-doctor time and that participation in this program was a valuable use of their time. Interestingly, 60% agreed that this program should be added to the required medical school curriculum.

DISCUSSION/CONCLUSION: Teaching and counseling peer student athletes on making proper lifestyle choices for peak athletic performance was beneficial to the medical students’ knowledge, confidence, and appreciation of lifestyle medicine and moved students to the highest level “Does” on the Miller’s pyramid of clinical competence. This is the first time medical students were paired with peer student athletes for educational purposes. Other institutions interested in innovative ways to teach nutrition and/or lifestyle medicine may consider this approach, which could be extended to involved athletes from other sports.

203 – INTEGRATING ENVIRONMENTAL HEALTH SCIENCE INTO MEDICAL SCHOOL CURRICULUM
Anisha Garg and Karen B. Mulloy
Case Western Reserve University School of Medicine

PURPOSE: More than 25% of global disease burden is attributable to environmental health (EH) risk factors. Institute of Medicine (IOM) reports indicate no or minimal inclusion of EH in US medical school curriculum and made recommendations for EH competency goals. A pilot project was developed to enhance student knowledge and perceptions of EH.

METHODS: This study introduced EH learning objectives into existing problem-based cases for first year medical students at Case Western Reserve University. The authors developed learning objectives based on IOM recommendations for three cases in Block 1 of first year curriculum. Weekly multiple choice and short essay questions were developed by the authors to reinforce learning objectives. EH topics were incorporated as summative short essay questions on final exam. Multiple choice questions were graded on percent of students choosing the correct answer. Short essay and final exam questions were graded on a defined five-point scale developed by the authors. To analyze student perceptions of EH topics, three question survey was distributed to randomized group of students regarding confidence in eliciting an EH history and influence of EH factors on patient health.

RESULTS: 184 first year students completed multiple choice and final exam questions. 46 students completed short essay questions. A generalized linear model with binomial distribution adjusted for question variability indicated performance on final exam questions was significantly improved compared to short essay questions. 46 students completed end of block survey. 84.8% reporting EH factors influence patient health. 78.2% reporting confidence in eliciting EH risk factors in patient history.

CONCLUSIONS: Results indicate students gained knowledge about EH topics using the case-based approach and perceived EH to be relevant to patient health. The integration of EH topics into case-based medical school curriculum was successful and should be expanded to the full two-year pre-clinical curriculum.

204 – THE CADAVER MEMORIAL: AN AVENUE FOR THE INCORPORATION OF MEDICAL HUMANITIES IN THE UNDERGRADUATE MEDICAL SCHOOL ANATOMY CURRICULUM
Wendy Lackey-Cornelison
Western Michigan University (WMed), Homer Stryker M.D. School of Medicine

PURPOSE: The body donor memorial is a tradition at many medical schools and takes a variety and forms, ranging from small intimate affairs limited to students and faculty to large public ceremonies. This presentation describes how the cadaver memorial provides opportunities to integrate medical humanities into the anatomy curriculum.

METHODS: Incorporation of medical humanities as it pertains to anatomy and the body donor memorial are structured longitudinally over M1 and M2 years at WMed. The memorial occurs in the fall and attendance is required for M2 students. However, components of the medical humanities are introduced during the M1 year. M1 students receive instruction on creative reflective writing with specific examples taken from the anatomy experience before entering the anatomy lab for the first time. Included in these exemplar reflections are student artwork and poetry specific to anatomy. As M2 students, they are responsible for creating and performing the visual and musical components of the ceremony. The anatomy faculty works with representatives from the medical humanities interest group to develop student contributions. Additionally, M2 students are required to write a personal reflection about the donor gift and what it has meant to their education.

RESULTS: Students have created the artistic portion of the cadaver memorial at WMed for the last two years. Students have expressed significant satisfaction reflecting on the anatomy experience, communicating their gratitude to donor families, and collaborating to create memorable artistic representations of gratitude to share with the community.

CONCLUSIONS: The donor memorial offers a concrete avenue for students to embrace components of the medical humanities, particularly visual arts, creative writing, and music into their professional development. These aspects of the medical humanities can be easily integrated into the anatomy curriculum. This integration enhances both disciplines and highlights their importance for dealing with future patients and patient families.

205 – We Need to Talk: Teaching Provider to Provider Communication in a Health Care Setting
Alison Chetlen, Jeanine Beatty-Chadha, Elizabeth Werley
Penn State Milton S. Hershey Medical Center, Penn State Health, Penn State College of Medicine

PURPOSE: Failures in effective communication among the health care team is a common cause of errors that lead to patient harm. Interpersonal communication skills are one of six general competencies identified by the ACGME and ABMS of a competent physician. Since many health care providers are not formally trained in provider-to-provider communication, a new curriculum was implemented to improve communication between members of the health care team. We pursued a novel strategy, mixing resident trainees from two residency programs (Diagnostic Radiology and Emergency Medicine) for two interactive workshops. This abstract describes the project and its outcomes.

METHODS: 42 residents in total from the Diagnostic Radiology department and Emergency Medicine department, participated in this two part- interactive workshop, separated in time by one month. Faculty involved in the design and implementation of the curriculum included two radiology faculty members, an educational curriculum design specialist, and quality-and-safety officer. Themes for the two workshops included SBAR (Situation, Background, Assessment, and Recommendation) communication technique, barriers to effective communication, techniques to manage interprofessional conflict, and provider-to-provider handoffs. During the initial workshop, participants observed and critiqued effective provider-to-provider communication skills and practiced methods used improve communication between health care providers in the Emergency Department and Radiology using the SBAR framework (Institute for Healthcare Improvement). Additionally, evidence-based didactic components were included in each workshop.

RESULTS: 42 residents completed the new provider-to-provider communication curriculum. Involvement of two residency programs with participants that deal with fast paced, high stakes circumstances daily allowed inter-professional learning. Post workshop surveys were uniformly positive.

CONCLUSION: Lessons learned from post-workshop surveys included: Adding more spontaneous, non-rehearsed provider-to-provider practice encounters so learners could practice real-time communication techniques. Mixing diverse resident participants encourages broadmindedness in discussion, improved awareness of each other’s role in providing patient care, and facilitates improved patient safety across the continuum of care.

206 – A NEW APPROACH TO INITIATE AWARENESS AND PRIMARY EXPERTISE IN EVIDENCE-BASED MEDICINE AND CLINICAL OUTCOMES RESEARCH, EARLY IN MEDICAL SCHOOL
Aleric Soans, Rasheed Agboola, James Villaneuva, Naveen Babu Kandavalli, Stephen Katz, Nancy Kheck, and Patrick J Gannon
International American University College of Medicine

PURPOSE: Many medical schools have committed to having primary clinical skills attained earlier. In this setting, it is important that Evidence Based Medicine and Clinical Outcomes Research (EBMCOR) pursue understanding of best available evidence for decision-making under uncertainty as a foundation of healthcare. The goal of this program is to have entry-level medical students understand the basic and clinical science research foundations that promote critical thinking.

METHODS: Over a 12-week course, five key themes represent widespread healthcare issues. Each theme (cancer, diabetes, glymphatics, obesity, gut microbiome) is considered over two separate 2hr learning sessions, then collectively to reflect on relations. The first session involves exercises in literature searching and discussion of reports on how to read a research article. For each theme, students read a relatively easy-read report for the initial session, followed by a research article (review or meta-analysis) for the second session. Learning objectives guide focal issues. Students are prompted in-class by Socratic Questioning to assess contributed oral overviews. Standardized patients have students address their questions by literature review. The final session has small groups identify relations between themes. Students conduct course assessment surveys (n=2) to capture opinions of design, approach and perceived learning value. All assessments (n= 19, 20) use a validated hybrid Visual Analog/Likert Scale rating instrument.

RESULTS: Assessment quality of in-class oral contributions showed consistently high performance levels (91 +/- 6%, 82 +/- 8%). Both course surveys showed high levels of student approval for design, approach and perceived learning value (74 +/- 3.3%; 72 +/- 3.5%).

CONCLUSION: This approach demonstrated the value of having students understand the value and basic principles of EBMCOR and to apply them. We are applying this approach to subsequent courses across the curriculum in order to have students entering clinical years well versed with high-level EBMCOR skills.

207 – BUILDING A FOUNDATION FOR EVIDENCE BASED PRACTICE: IMPLEMENTATION OF CRITICAL APPRAISAL EXERCISES INTO A PROBLEM BASED LEARNING CURRICULUM
Jessica O’Neil and Colleen Croniger
Case Western Reserve University School of Medicine

PURPOSE: Since medical students matriculate with a diversity of backgrounds, there can exist a disparity in student ability to critically appraise health science literature. To address this, we developed and integrated a critical appraisal exercise into the first year problem-based learning (PBL) curriculum at Case Western Reserve University School of Medicine (CWRU SOM).

METHODS: For 9 weeks, first year medical students were assigned a weekly preselected health science article relating to the content of their PBL curriculum and completed a critical appraisal worksheet regarding study design and result interpretation. Students discussed the article and worksheet within PBL small groups each week. Faculty facilitators were given the critical appraisal worksheet answer keys that students gained access to after the discussion. To measure changes in critical appraisal skills, a voluntary questionnaire was administered before and after the intervention based on the Berlin Questionnaire, a validated tool for measuring knowledge and skills in evidence-based medicine. Results were analyzed using a paired Student’s t-test.

RESULTS: Students who completed both questionnaires (n=57) showed an average score improvement of 4% (P=0.03). Students who scored at or below the 50th percentile on the pre-intervention questionnaire showed an average improvement of 12% (P=0.002).

CONCLUSION: Critical appraisal is a foundational skills that may promote evidence based practice in students’ future careers. This integrated exercise is an effective tool for improving critical appraisal skills particularly in students with limited critical appraisal ability at the onset of the curriculum. Efforts to extend this exercise into a longitudinal curriculum are in progress. This curriculum will include additional evidence-based practice skills such as developing patient-centered research questions.

Poster Award Nominee
208 – “UNCOMFORTABLE, YET INCREDIBLY IMPORTANT:” A METHOD FOR CREATING CONVERSATIONS ABOUT RACE AND BIAS AMONG FIRST-YEAR MEDICAL STUDENTS
Lee Rosen, Jayne Manigrasso, Aaron Hurwitz, and Joanna Streck
Larner College of Medicine at the University of Vermont and University of Vermont Department of Psychological Science

PURPOSE: Racial bias unconscious and otherwise is a critically important issue in medicine. This study examined a curricular method, carried out in early in the first year of medical school, designed to help students increase awareness of their biases and reflect on them in facilitated small groups. This method, combining students Implicit Association Test results with small-group discussion has not appeared in the literature to date.

METHODS: 120 first year medical students at the University of Vermont are enrolled in a year-long, small-group course designed to create reflective discussion about professionalism and emotionally-complex topics in medicine. To prepare for discussion, students were instructed to take the Implicit Association Test (IAT) and read several pertinent articles. In their small groups, students then engaged in a semi-structured discussion facilitated by their faculty preceptor. After the session, all students completed an anonymous evaluation, which included Likert survey questions about session objectives and an opportunity for open-ended comments. Comments were subjected to thematic analysis, and a coding scheme was developed to capture themes.

RESULTS: 86% of the students indicated that this session encouraged them to think about their own unconscious biases, and 80% indicated that it prompted them to have a discussion that they would not have otherwise had with classmates. 64% reported that the IAT played a crucial role in the discussion. Results of thematic analyses elaborate on Likert results, demonstrating sophisticated student engagement in this activity. Themes and exemplars will be presented.

CONCLUSION: Use of the IAT combined with facilitated small-group discussion encouraged students to contemplate and discuss race and bias with peers. This method for promoting exploration of racial bias early in medical school appears useful and lays the groundwork for continued dialogue, hopefully cultivating a just and patient-centered approach in the clinical sphere.

209 – Anatomical Knowledge Retention in Changing Curricula
Alexa Lean, Juliet Lee, Ellen Goldman, Gisela Butera, Kirsten Brown, and Rosalyn Jurjus
The George Washington School of Medicine, Department of Surgery and Department of Human and Organizational Learning

PURPOSE: Traditionally anatomy is one of the first subjects taught in medical school. Practicing physicians have commented on medical students’ poor anatomical knowledge in surgically oriented clerkships. With major medical school curricular changes happening across the nation, quantitative data confirming this correlation is needed. This abstract describes a study of students trained with different medical school curricula and their pre-clinical anatomical knowledge retention.

METHODS: In 2013, The George Washington University School of Medicine students trained in the traditional, discipline based medical school curriculum completed a 27 question test before beginning the general surgery and obstetrics and gynecology (OB/Gyn) rotations. This same examination was then administered to the class of 2018, the first class trained with the new, system-based curriculum at the GWU School of Medicine.

RESULTS: Scores for anatomy categories related to general surgery and OB/Gyn were analyzed, shown in Table 1. Comparing the 2013 and 2016 cohorts showed an overall decrease in retention from 65.69% to 63.64%. Item analysis per topic revealed a 2.53% decrease in surgical anatomy retention and 1.58% decline in OB/Gyn anatomy retention. There was a 21.6% increase in inguinal canal anatomy retention and 17.33% increase in appendix related questions. The drop in fallopian tube anatomy retention was 12.02%. The change in retention is apparent and multifactorial. Analyzing subject matter, curriculum structure, and focus should be evaluated.

CONCLUSION: Comparing the 2013 to the 2016 data, overall retention of general surgery and OB/Gyn anatomy decreased but improvements were noted in a topic specific way. The particular decrease in surgical anatomy retention versus OB/Gyn anatomy may be related to the way the subject matter was organized and presented or how the anatomic foundational knowledge was integrated with clinical relevance. Although integrative learning has been associated with better retention, more studies will have to be conducted to prove this statement true.

210 – Changing Perspectives on Peer Instruction at the Boonshoft School of Medicine
Larrilyn Yelton, Brenda Roman, Mary Jo Trout, Alban Holyoke, and Aaron Smith
Wright State University Boonshoft School of Medicine

PURPOSE: Peer instruction (PI) is a “flipped classroom” strategy that utilizes class time to solve problems. He found that PI improved student learning, conceptual mastery, and quantitative problem solving. A recent study revealed that PI increased student satisfaction and exam scores, and increased faculty satisfaction and engagement. Faculty at BSOM reported an 8.2% increase in the cumulative exam score in participants that attended at least 1 PI session in pharmacology in 2014. The objectives of this study included: 1) evaluate student and faculty perspectives of PI, and 2) to ascertain differences between PI that is done well versus PI that does not challenge students.

METHODS: The BSOM graduating class of 2018 (107 students) and the faculty using PI (39 faculty members) were invited to participate in the study via an electronic survey. The survey examined attitudes of students and faculty towards PI and differences that might exist when PI is done well versus done poorly.

RESULTS: Seventy-six (71.0%) students and 16 (41.0%) faculty completed surveys. Among students, only 14.4% had positive/very positive attitudes towards PI in AY 2014-15; this increased to 82.9% in AY 2015-16 after a number of administrative changes were made. Faculty attitudes of positive/very positive improved from 62.6% to 81.3%. When PI was done well in a course 93.4% of students agreed/strongly agreed that correct answers were well explained whereas 60.5% of students agreed/strongly agreed for other courses.

CONCLUSIONS: Our results suggest that the procedure changes made between the 2014-2015 and 2015-2016 academic year resulted in a positive change in attitude from the perspectives of both students and faculty. As hypothesized, the changes that were most strongly agreed with by students were the changes in grading. Not surprisingly students did not find the sessions done poorly as useful to their learning as those done well.

211 – A NOVEL ACTIVITY IN THE GROSS ANATOMY COURSE TO ENGAGE FIRST-YEAR MEDICAL STUDENTS IN THINKING ABOUT POPULATION HEALTH THROUGH THEIR CADAVER EXPERIENCE.
Anthony J Weinhaus, David V Power, Angela McArthur, and Robert Englander
University of Minnesota Medical School

PURPOSE: Graduates’ abilities to care for populations is a focus of our medical school. Toward this goal, we added consideration of the population of cadavers to the first year student Gross Anatomy course. We sought to teach and demonstrate the following competencies: obtaining and utilizing information about populations of patients, or communities; and application of principles of epidemiological sciences for patients and populations.

METHODS: Students entered data from the “population” of 44 donors into a registry. There were 46 variables, with a resultant 2100 entries. Part of each dissection period was devoted to student presentations of data from the registry. By the end of the course, all 172 students had at least one opportunity to mine the data set, calculate statistics, and present to the rest of the class. Students had freedom to choose their own topics for analysis.

RESULTS: Examples of student presentations included 1) the comparison of the donor population “Causes of Death” with US “Causes of death” and 2) the association between Diabetes Mellitus and BMI.

Pre- and post-surveys on knowledge of and attitude toward population health were completed by 169/ 172 student. The vast majority of students had previous exposure to entering, querying, and/ or interpreting data in a data set. Overall the mean measures on confidence increased following the intervention on these same measures. In addition, the response to the statement “It is important that physicians know how to manage population health data” had scores that were high both before and after (3.79/4.0 +/- 0.49 S.D. pre- to 3.56/4.0 +/- 0.55 S.D. post-intervention, P=0.001).

CONCLUSIONS: Creating a registry of cadaver data in Gross Anatomy engages students to demonstrate critical competencies in information management and population health, both requisite for physicians in the 21st century.

212 – Finding Our Common Ground: A Framework for Cultural Competency in Medical Education
Tiffany Delaney, Aaron Hurwitz, Diane Jaworski, Michael Upton, and Margaret Tandoh
The Robert Larner M.D. College of Medicine at the University of Vermont

PURPOSE: Ongoing cultural competency development is imperative for physicians. As populations grow more diverse, physicians must continuously develop the knowledge, skills, and attitudes to provide effective care to a wide range of patients, with the ultimate goal of reducing health disparities. The Association for American Medical Colleges (AAMC) created the Tool for Assessing Cultural Competency Training (TACCT), which identifies 52 components to longitudinally integrate throughout a medical curriculum.

METHODS: LCOM’s Finding Our Common Ground (FOCG) pre-matriculation and orientation curriculum focused on fifteen TACCT components. The curriculum began on interview days and not only introduced prospective students to the unique features of the FOCG curriculum, but also described institutional commitment to cultural competency development as a driver of academic excellence. Prior to matriculation, students completed both a set of seven e-modules and the Intercultural Development Inventory® (IDI®), a cross-culturally validated assessment of intercultural competence. Finally, at orientation, students engaged in multiple reflective activities that focused on identifying characteristics of their own personal and social identities and those of their peers.

RESULTS: Participants evaluated each component of the FOCG curriculum via questionnaires. The interview day presentation received positive responses (93% rated excellent/good). Encouragingly, the IDI® was voluntarily completed by 93% of the class. Upon completion of orientation, 94% of students believed that completing the e-modules enhanced their cultural awareness, and overall 93% of students agreed they achieved FOCG’s objectives. Based on the post-intervention questionnaire, students viewed their classmates as more diverse after the activities than they did beforehand.

CONCLUSION: These results demonstrate that the tripartite curricular approach effectively enhanced student’s knowledge of cultural competence terminology, the relevance of cultural sensitivity in patient care, and their ability to recognize dimensions of diversity in themselves and others. Based on feedback, revisions to the orientation curriculum are planned, including additional post-activity reflection and more in-depth data collection and analysis.

213 – PEERS-TEACHING-PEERS: CURRICULUM QUALITY IMPROVEMENT USING PRINCIPLES FROM SIX SIGMA
Bruce Giffin
University of Cincinnati College of Medicine

PURPOSE: Lectures typically have a PowerPoint with required reading or lecture handouts. Faculty who create these documents know the course content so well that they often present the material in a way that is difficult for the naive learner to initially comprehend. Students who complete a course often have insight into how course material can be presented more efficiently to facilitate student learning. We developed a process similar to a wiki site in order to (1) create a cooperative system between medical students and faculty for medical curriculum editing and review; (2) engage students in developing an integrated presentation format to communicate medical informatics; (3) improve learning efficiency.

METHODS: Students who completed the neuroscience course participated in a peers-teaching-peers project guided by the core principles of Six Sigma (invented by Motorola in 1986) for process improvement. Lecture PowerPoints and handouts were placed on a wiki website. This allowed students to edit the content to correct errors, enhance explanations, suggest a more logical development of content, and add figures and diagrams. Course handouts were converted into a dynamic wiki digital document hyperlinked to itself, other UCCOM medical curricula, relevant internet sources, diagrams, photomicrographs, gross specimens, video, and embedded audio. These documents were maintained as web-based wiki documents, which allowed for continuous editing and modification of the content using specific formats and protocols.

RESULTS: Student feedback was positive for all the components of the digital course handouts. Faculty appreciated the suggestions that students made for improving both the lecture handout and PowerPoint presentation and the opportunity to collaborate with students.

CONCLUSION: The application of Six Sigma core principles for quality improvement can be used to develop and deliver better learning experiences for the student. It enables the development of an architecture for a participation-learning collaborative between students and faculty resulting in timely modification of course content.

214 – INTEGRATING FOUNDATIONAL SCIENCE IN A MEANINGFUL CLINICAL CONTEXT IN THE POST-CLERKSHIP CURRICULUM
Kimberly Brown Dahlman, Matthew B. Weinger, Kimberly D Lomis, Lillian Nanney, Neil Osheroff, Donald E. Moore, Jr., Lourdes Estrada, and William B. Cutrer
Vanderbilt University School of Medicine

PURPOSE: Traditional medical curricula generally place the majority of foundational science learning into the pre-clerkship years. Practical solutions are needed to incorporate foundational sciences into the clinical years of undergraduate medical education. This abstract describes an innovative approach to integrating foundational sciences with clinical experiences in the post-clerkship curriculum at Vanderbilt University School of Medicine (VUSM).

METHODS: In AY15-16, VUSM formally implemented “Integrated Science Courses” (ISCs) that combine rigorous training in the foundational sciences with meaningful clinical experiences. These courses were designed and led by clinical and foundational science experts and underwent a rigorous evaluation process. Immediately after finishing each course, students completed an anonymous evaluation regarding course satisfaction, foundational science learning, use of knowledge gained in future training and practice, clinical relevance, and integration of the foundational sciences and clinical experiences. Furthermore, course enrollment data were evaluated.

RESULTS: Eleven ISCs were delivered to 173 students in AY15-16. Many students (81) took more than one ISC (range 1-4 ISCs). Immediately after completing each course, 93% (n=222) of students who enrolled in an ISC completed a course evaluation. Students who completed the survey (91%; n=201) ‘agreed’ or ‘strongly agreed’ that foundational science learning informed and enriched the clinical experiences. Furthermore, 94% (n=209) of students thought that the clinical experiences informed and enriched the foundational science learning. The majority of students who took an ISC (94%; n=209) anticipated using the foundational science knowledge acquired in future clinical training and practice.

CONCLUSION: The teaching of foundational sciences in the clinical workplace in the post-clerkship medical curriculum is challenging and resource-intensive, yet feasible. Results from the course evaluation process indicate that most ISCs will benefit from ongoing refinement. Additional experience with the model will inform what mix of courses is necessary to foster scientifically-founded clinical reasoning skills in each student.

215 – Evaluation of Interprofessional Culinary Medicine Curriculum Within Patient-Centered Medicine Course
Emine Ercikan Abali, Lee Ann Schein, Liesel H. Copeland, Alyse Van Liew, Barbara Tangel, Joshua Miller, Barbara Dutra, Jane Hand, and Annie Truss
Rutgers Robert Wood Johnson Medical School and Rutgers Nutritional Sciences

PURPOSE: To address complex problems such as obesity, a hands-on nutrition approach with interprofessional (IP) education is warranted. The efficacy of healthcare improves when health professionals work together for a patient’s health. The role of the Registered Dietitian (RD) includes educating patients and administering nutrition therapy. Physicians and RDs must understand and appreciate early in their training each other’s roles. RWJMS collaborated with the Nutritional Sciences Department to introduce a unique educational experience in the Patient Centered Medicine (PCM) course by combining IP and culinary education.

METHODS: Teams of 1 Nutritional Sciences and 2 M1 students (N=152) completed the Culinary Medicine session as part of the PCM course. Pre-post surveys measured interprofessional teamwork, level of comfort with nutritional habits, and comfort discussing nutrition with patients. Afterwards, students submitted a reflective essay. Quantitative data was analyzed using descriptive statistics and paired t-test. Student comments were analyzed qualitatively assessing emergent themes. Inter-rater reliability was 100%.

RESULTS: Students’ confidence in changing their own diet (t=3.66, p <.001) and being able to guide patients with their diet changes (t=5.19, p <.001) significantly improved pre to post. The interprofessional teamwork measure did not significantly change pre to post. Emerging topics from the reflections on IP were: developing mutual respect; increased benefits of collaboration; appreciating different perspectives relating to patients. Students recognized that by improving their own nutrition, they can identify with and educate patients to enhance health through better nutrition. Students valued making small, inexpensive substitutions to patients’ diets to help facilitate compliance.

CONCLUSION: Discrepancy between qualitative and quantitative data may be explained by the ceiling effect (means=4 in both pre/post surveys). Students increased their confidence in improving their diet and counseling patients. Our results demonstrated that IP improves communication skills, understanding other’s responsibilities, and developing positive attitudes towards partnership.

216 – PERSONAL DISSECTION VERSUS PLATOON-STYLE DISSECTION: WHICH DO STUDENTS PREFER?
Sean Herrin and Logan Bale
University of Western States

PURPOSE: How students proceed through human dissection labs vary between professional programs often with little change within a program due to faculty preference and curricular inertia. The level of student involvement in dissections labs experiences vary from completely pre-dissected cadavers, platoon-style dissections where teams of students work on one cadaver, to personal dissection where one group of students perform every dissection. A recent loss of lab time due to a facilities issue necessitated switching methods from personal dissection to platoon-style midway through a term in order to complete the dissections. This created a unique opportunity to assess student satisfaction and preferences.

METHODS: A first quarter of class of 108 chiropractic students where surveyed to determine their level of satisfaction with each method using a 5 point Likert Scale. They were also asked which method they preferred and given the opportunity to comment on the reasons for their choice. The survey was administered during finals week of the first quarter of the program.

RESULTS: 108 of the 108 (100%) students enrolled in the class responded to the survey. Levels of satisfactions for personal dissection were 72% very satisfied, 23% satisfied, 5% neutral, <1% dissatisfied, 0% very dissatisfied. Levels of satisfactions for platoon-style dissection were 12% very satisfied, 28% satisfied, 26% neutral, 27% dissatisfied, 8% very dissatisfied. 69% of students preferred personal dissection while 21% preferred platoon-style. 9% had no preference

CONCLUSION: Rarely do anatomy educators get an opportunity to study different dissection methods with the same group of students. While there are limitations to this small cross-sectional study it does provide useful data related to student satisfaction and preferences of these two methods.

217 – TEACHING EXCELLENCE: A YEARLONG PROFESSIONALISM CURRICULUM FOR FIRST YEAR MEDICAL STUDENTS
Matthew T. Rivera-Bloodworth, Shawna McCafferty, Ellen Encisco, Anna Edmondson, and Carol Nichols
The Medical College of Georgia at Augusta University

PURPOSE: Creating a longitudinal medical professionalism curriculum is a challenge for most medical schools. At our institution, professionalism is introduced during the first three days of the Year 1 curriculum. Last year we expanded the curriculum to emphasize professionalism throughout the first year.

METHODS: Second year medical students were selected as Professionalism Coordinators to facilitate the development and delivery of a more robust professionalism curriculum. They developed and led a series of cases tied to core programmatic competencies (Medical Knowledge, Patient Care, Practice Based Learning, Professionalism, Communication, and Systems Based Practice). The cases were based on actual incidents that were relatable to first year medical students. As part of the curriculum, first year students, working in small groups, were given assignment to develop a case about a professionalism incident they witnessed during the year. Cases included a short narrative and analysis, 3-5 discussion questions, and a journal article relevant to their case. They were evaluated using a grading rubric. Finally, students were asked to complete an end of year professionalism survey.

RESULTS: Second year students developed and led professionalism sessions throughout the year that included discussion of cases such as inappropriate social media use, exam behaviors, appropriate attire, and apathy. First year students submitted cases in the spring that ranged from off-campus drinking to sexual harassment. The year-end survey asked about comparable professionalism situations from healthcare and educational environments. Interestingly, students viewed those situations differently.

CONCLUSION: This Year 1 professionalism curriculum provided multiple opportunities for students to discuss relatable professionalism cases with peers and second year mentors in a safe environment. The case writing assignment encouraged students to think about professionalism in the context of everyday activities. Year-end survey results indicate opportunities to better emphasize the translatability of situations in their current medical education and future healthcare working environments.

Poster Award Nominee
218 – PRACTICE MAKES PERFECT: LESSONS IN MEDICAL SCHOOL PROFESSIONALISM
Shawna McCafferty, Matthew Rivera-Bloodworth, and Carol Nichols
Medical College of Georgia – Augusta University

PURPOSE: Professionalism education for medical students is often centered on clinical scenarios that are difficult for students early in their training to relate to or interpret. We designed a student led professionalism curriculum using scenarios relevant to the lives of these medical students.

METHODS: Four Professionalism Case Discussion sessions were added to the Year 1 curriculum to supplement the current professionalism curriculum delivered at the beginning of the academic year. For the first three sessions, Year 2 medical student coordinators developed and led cases based on actual incidents that could be tied to core competencies (Medical Knowledge, Patient Care, Practice Based Learning, Professionalism, Communication, and Systems Based Practice).

Each case included a professionalism scenario, 3-5 short pre/post session survey questions, a relevant article, and discussion questions. Students were asked to complete the pre-survey prior to the session and the post survey right after the session. Another element of this curriculum was a small group assignment for the Year 1 students to write a case based on an assigned core competency about an event they had witnessed during the year. The final session was led by two panels of Year 1 students, whose cases had been selected from class submissions.

RESULTS: Approximately 89% of the class completed the pre-session surveys and 75.5% completed the post-session surveys. Overall there was a 63% decrease in the number of “inappropriate” survey responses and a 9% increase in the number of “appropriate” survey responses after the sessions.

CONCLUSION: First year students have a basic understanding of acceptable professional behaviors. However, they often have difficulty identifying appropriate responses to specific situations. The sessions were useful for helping students understand their roles and responsibilities within the context of specific situations. Providing opportunities for students to discuss relevant professionalism scenarios can be a valuable teaching tool.

219 – Assessment of EPA 7 across the Curriculum
Monica Bailey, David Lebowitz, Nadine Dexter, Magdalena Pasarica, and Laurel Gorman
University of Central Florida College of Medicine

PURPOSE: In 2014, the Association of American Medical Colleges announced 13 core Entrustable Professional Activities (EPAs) for entering Residency. EPAs represent a shift to competency-based medical education (CBME). CBME is a framework for strengthening medical education so that it focuses on abilities and outcomes rather than performances on tests and medical knowledge. The literature on CBME calls for frequent assessment throughout the curriculum. Therefore it is critical that faculty be made aware of how competencies are assessed throughout the curriculum so that faculty can make the necessary adjustments in their development of assessments, in order to provide comprehensive assessment of skills. We aim to describe the process our institution used to identify the assessment of EPA 7: “Form clinical questions and retrieve evidence to advance patient care, across the curriculum and the faculty development that was administered to bolster appropriate assessment methods”.

METHODS: In order to identify gaps in the assessment of EPA 7 in our curriculum, we mapped the current assessment activities associated with EPA 7. The map was shared with faculty involved in teaching and assessing content associated with EPA 7 to confirm current practices and inform faculty. A follow up Faculty Development session was planned to discuss potential gaps in the curriculum and ensure adequate assessment of all sub-domains for EPA 7.

RESULTS: Mapping the assessment activities relevant to EPA 7 revealed that several sub-domains for the competency were not formally assessed at all or only formally assessed once throughout the MD program, even though they have been taught several times.

CONCLUSION: The lack of assessment throughout the curriculum could result in under development of associated clinical skills. Sharing this process can help other institutions consider how they are assessing competencies across their curriculum, in particular EPA 7.

220 – TRANSGENDER MEDICINE CURRICULUM: INTEGRATION INTO AN ORGAN-SYSTEM BASED PRECLINICAL PROGRAM
Aaron Marshall and Sarah Pickle
Department of Medical Education, University of Cincinnati and Department of Family and Community Medicine, University of Cincinnati

PURPOSE: There is a recognized and articulated need for health professionals to understand the definitions, health disparities and medical management of transgender patients. This recognition comes organically from students requesting more information, and top-down from governing bodies such as the AAMC or LCME. Surveys of North American medical schools indicate that training in transgender medicine (and specifically the process of transition) is infrequent and inadequate. One underlying problem to this trend may be the lack of resources to help conceptualize and roll out a transgender medicine curriculum.

METHODS: Here we report the results of integrating training in transgender medicine into the organ-system based course, Endocrine-Reproduction. This transgender curriculum includes coverage of basic science, clinical management, ethics, and clinical skills. The curriculum leveraged an already existing, healthcare disparity-focused curriculum, but added (1) a didactic component for dissemination and discussion of basic science principles applied to transgender patients, and (2) a mock initial encounter between a physician and patient with gender dysphoria.

RESULTS: Following the first-time implementation of the transgender curriculum, students were surveyed, with a large majority reporting feeling more prepared to care for transgender patients (62/85, 73%) compared to students who felt neither more or less prepared by this curriculum (22/85, 26%). We next compared the recipients of this curriculum versus upper classmen who only received a healthcare disparity-focused panel discussion with members of LGBT community. Results of Likert-style questions indicate the new curriculum increased the students’ confidence at discussing and managing gender-affirming hormone therapy (1.58 versus 2.32, p <0.01).

CONCLUSIONS: We conclude that including a multi-disciplinary transgender medicine curriculum in medical school advances the goal of creating safe, effective physicians by providing the fundamental knowledge, and exampled application of that knowledge, about an underserved population of patients.

221 – Medical Neuroscience Research Educational Program to enhance diversity and integrate research into medical education
Alberto E.Musto and Mekbib L. Gemeda
Eastern Virginia Medical School

PURPOSE: Addressing culture-specific and patient-centered approaches to improve engaging and retaining minority population in USA health care system. In the field of neuroscience minority groups are significantly underrepresented at both the student and professional levels. Our long term goal is to increase minority representation and greater multicultural understanding of neurological disorders that will ultimately lead to improve treatment outcomes, particularly in the Hispanic and African American populations. This program will train underrepresented medical students in the neuroscience field to increase their probability of long term retention and success in medical neurosciences and health disparities research, and to reduce health disparities.

METHODS: The goals are: a) to implement educational infrastructure combined with a research project in order to integrate medical neuroscience in medical careers; b) reach out and recruit highly qualified underrepresented medical students for the neuroscience research program at EVMS; c) to continuously evaluate and adjust each medical student’s performance during and after the research project, and towards a transition to residency programs.

RESULTS: Assessment focuses on competencies in formulating research hypothesis and research design, presentation and writing skills, ability to search the scientific literature, teamwork and professionalism, and awareness of pathways and professional steps necessary for competitive residency applications and future research careers. Students’ understanding and continued interest in health disparities research in minority populations, particularly in neurological disorders, is also evaluated.

CONCLUSION: Overall, this program will promote critical thinking and creativity, building strategic teamwork, as well as facilitating and promoting communication in medical neuroscience. This educational program will train advanced medical students in neuroscience research and health disparities combining virtual medical neuroscience, research experiences in prevalent neurological disorders.

222 – Thinking Like a Scientist and Thinking Like a Doctor
Stephen Loftus
Oakland University William Beaumont School of Medicine

PURPOSE: Medical education traditionally prepares students in the biomedical sciences before allowing them clinical contact where they are expected to apply their scientific knowledge in the assessment and treatment of patients. Many students struggle with the transition between the scientific thinking of the classroom and the clinical reasoning of the hospital setting. There is a need to support students in reconciling the similarities and differences between scientific thinking and clinical reasoning.

METHODS: Second year medical students were given the opportunity to attend a seminar, “Interpretation in Medicine” held over seven weeks. In the seminar they explored the complexity of clinical reasoning in medicine from different perspectives. Students led discussions following close reading of texts selected to challenge their thinking about clinical reasoning. The complexities as well as the similarities and differences between scientific thinking and clinical reasoning were a recurring theme of the seminar.

RESULTS: Students appreciated the comparison between scientific and clinical reasoning. Modern biomedical knowledge can give the illusion of certainty in medical practice but there can be a disconnect when students confront the realities of clinical practice where uncertainty and complexity can be the norm. They found the seminar gave them a more nuanced view of medical practice and education and felt better prepared to face the clinical years. They also appreciated the opportunity to take a more critical view of their own education and how it connected with many of the wider issues facing the medical profession.

CONCLUSION: Medical students need to understand that scientists and doctors make use of the same knowledge base but think differently. Giving students the chance to explore the commonalities and differences between scientific thinking and clinical reasoning can prepare them for the changes they will need to make as they progress through medical school.

223 – Using a series of simple puzzle phantoms to encourage medical student understanding of ultrasound fundamentals: preliminary results
Lauren Maloney, Christopher Page, Kristen Zach, Neera Tewari, Matthew Tito, and Peggy Seidman
Dept of Emergency Medicine, Dept of Anesthesiology, Stony Brook University School of Medicine, and Dept of Emergency Medicine Eastern Virginia Medical School

PURPOSE: Often, when medical students are introduced to ultrasonography, basic ultrasound physics and machine functionality are discussed, and then students move on to scanning complex phantoms or humans to evaluate organ structure. This approach often skips learning how to manipulate the ultrasound probe in order to evaluate the structure of a three-dimensional object using two-dimensional images. As such, we developed a series of low-cost, homemade, gelatin-based ultrasound puzzles that encourage understanding of rotation, depth, tilt, and alignment, using familiar objects in a clear phantom, thus allowing students to connect the actual shape of an object to its ultrasound representation.

METHODS: In this feasibility study, 28 medical students participated in a 2-hour session. First, they scanned an opaque puzzle phantom and answered questions about its structure. Next, they rotated through four stations, each containing a clear puzzle phantom that targeted a single fundamental with instructions on how to move the probe to obtain the goal image. Additionally, students completed a worksheet that reinforced the objective of each station. They then rescanned the opaque puzzle phantom, and completed a survey. Three months later, they returned to rescan the opaque puzzle phantom and answer a follow-up survey.

RESULTS: Immediately after the session students demonstrated an increased ability to use tilt, alignment, depth, and rotation to answer questions about the structure of an opaque puzzle phantom. Scanning skills were sustained or improved with less time needed to complete the scan in the 15 students that returned for follow-up. Students felt the experience was a productive use of time, believed their new skills were beneficial, and would recommend the experience to others.

CONCLUSIONS: Our preliminary results suggest that a series of puzzle phantoms can be an effective way of helping medical students understand how to manipulate an ultrasound probe when evaluating an unknown structure.

224 – A Fourth-Year Bridge to Internship Capstone Course: Student Selection of Online Self-Study Modules and Perceptions of Confidence Gained from the Course
Melissa Hansen, Mary R. Smith, and Imran Ali
The University of Toledo

PURPOSE: A longitudinal Bridge to Internship Capstone Course couples simulation education with online learning to promote confidence and competence, utilizing experiential and self-directed learning to prepare fourth-year medical students for their transition to internship. The purpose of this study is to review student’s selection of online self-study modules, hypothesized as an indicator of student’s perception of relevance to internship. In addition, student perceptions of confidence gained from this course will be explored.

METHODS: Online modules are comprised of (3) groups; General GME topics; Emergency Topics; and Hot Topics. Students are required to complete (10) General GME Modules defined as Core Modules. In addition, students complete their choice of any (5) modules in both Emergency Topics and Hot Topics. Data is collected regarding student selection of online self-study modules.

An opinion survey is provided to students following the course and data related to preparation for residency and increased confidence will be reported for Fall 2015- Spring 2017.

RESULTS: Preliminary data reveals that 86.75% (n=72) of students completing the course in Fall 2015 and 81.25% (n=52) of students completing the course in Spring 2016 strongly agreed or agreed that the course helped them prepare for residency. In addition, investigators will explore student’s selection of topics completed in both Emergency Topics and Hot Topics indicating perceptions of topic significance related to preparation for internship.

CONCLUSIONS: The transition from the fourth-year of medical school into the first year of residency (internship) is known to be associated with anxiety and stress which can ultimately result in the delivery of suboptimal patient care (1). Studies have shown that much of this anxiety and stress results from a junior doctor’s lack of confidence in performing a number of basic tasks (1,2). A course such as the one described can foster increased confidence, providing education and skills training necessary for future residency training.

225 – Checkpoints: Assessment for Learning in Action
Marieke Kruidering, Hanna Burch, Jacob gindi, Jenny Crawford, Rageshree Ramachandran, Susan Wlodarczyk, Karen Hauer, and Tracy Fulton
UCSF, Department of Cellular & Molecular Pharmacology, Deptartment of Pathology, Deptartment of Medicine, and Deptartment of Biochemistry

PURPOSE: Frequent low-stakes assessments have been shown to positively impact subsequent high-stakes examination performance (1). Immediate testing after reading promotes better long-term retention than repeatedly studying the passage (2,3). Other schools, including Case Western Reserve University SOM, have successfully incorporated weekly formative testing into their curriculum. To address principles of testing FOR learning, we incorporated weekly quizzes, termed “Checkpoints,” into the UCSF Bridges Curriculum.

METHOD:MS1 (n=152) enrolled in the initial course of UCSF’s Bridges Curriculum, were oriented to checkpoints in week 1.
Course expectations include completion of 5 out of 6 weekly checkpoints.
Weekly checkpoints included A) 20- 25 multiple-choice questions (MCQs), B) 2 Open ended questions (OEQs) and C) a “reconciliation prompt”; it was open Monday 5 pm through Sunday noon.

MCQs: selected from prior year’s summative exams.

OEQs: writing involved faculty development, peer review and MS2s.

Requirements A) MCQ: at least 50% correct (multiple attempts allowed) B) written completion of one of the two OEQ cases and C) comparison of response to model answer.

RESULTS:

• Time spent per checkpoint: 20 minutes – days.
• MCQ: avg score 85 – 88 % (n=152), 94 % (n=49) reported MCQ “valuable”
• OEQ & reconciliation: Each week 4 – 7 students (different students each week) selected “I missed many key points and/or was confused about how to approach the question”.
• 100% reported OEQ “valuable”
• “I find these extremely helpful and am so glad we have them!”

CONCLUSION:

• Faculty development is needed to construct high value OEQ test items
• MS2 effective team members in writing OEQs
• Timely outreach in response to weekly reconciliation Q where student’s self- identified as struggling to meet expectations was valuable
• Weekly checkpoints that assess students’ understanding of core learning objectives are accepted by leaners and are a valuable tool for learning.

226 – Digital Badging as a operational framework for engaging students in the Entrustable Professional Activities (EPAs)
Paul Ko, Lauren Germain and John Folk
SUNY Upstate Medical University

To examine student confidence on the Core Entrustable Professional Activities for Entering Residency (CEPAERs), members of the fourth year medical student class at SUNY Upstate (N=158) were surveyed prior to and following their 2016 pre-residency bootcamp course. The survey asked students to indicate their level of confidence on each of the 13 CEPAERs. To examine the factors that impacted students’ self-assessments, we held a focus group with a random sample of students. The focus group concentrated on the two lowest ranked EPAs.

Survey data indicated that students felt most confident in EPA 1 (History and Physical), EPA 9 (Interprofessional team member), and EPA 6 (Oral presentation). They felt least confident in EPA 4 (Orders/prescriptions), EPA 12 (Perform procedures), and EPA 8 (Handoffs/transition of care). During the course there were increases in confidence on all EPAs with the largest changes in EPA 12, EPA 10, and EPA 13.

Despite confidence increases, focus group data indicated that there continued to be confusion among the students about the expectations of individual EPAs. For example, students interpreted EPA 12 (perform general procedures of a physician), to include many more procedures than are listed in the documents from the AAMC. After distribution of the AAMC defined tasks and objectives for EPA 12, students felt much more comfortable and confident in their abilities.

The CAEPARs framework is still relatively new and this project identified confusion among students about the components of each activity. Digital badging processes have the potential to impact the CAEPARs movement by engaging educators and learners in meaningful discourse about what it would require to earn a badge in an EPA- what skills or knowledge would a learner have to demonstrate and in what contexts? Our poster will include one example of a faculty-derived badging process that SUNY Upstate is piloting.

227 – Physician and Scientist Collaboration in MS1 Curriculum Building
Thomas Poole, Lauren Germain, Sarah Edwards, and Paul Ko
SUNY Upstate Medical University

PURPOSE: The integration of basic science and clinical content has been shown to support clinical diagnosis in undergraduate medical students . As such, one aim of our MS1 curricular reform effort is to promote increased collaboration among basic scientists and clinicians, as course directors.

METHODS: Intervention: To promote integration of basic and clinical sciences, we established co-director teams for MS1 units. Co-director teams include a clinical faculty member (MD/DO) and a basic science faculty member (PhD, DC). Our hypothesis is that pairing faculty across basic /clinical science lines will result in collaboration that will promote the teaching and testing of basic science knowledge in a clinical context.

Assessment: To assess the amount of collaboration, we sent a baseline survey to all teaching faculty in the College of Medicine. The survey asked participants whether they are basic science or clinical faculty and how often they collaborate across basic/clinical science lines. After the first MS1 curriculum planning period, we sent a survey to all MS1 unit co-directors asking how often they collaborated prior to and during the planning process. At the end of the MS1 year, we will send a follow-up survey. We are also measuring the number of integrated test question on unit exams.

RESULTS: In the baseline survey, 76.8% of clinical faculty and 46.2% of basic science faculty indicated that they never or rarely collaborate with basic science faculty on curriculum content. In the post-planning survey, 67% of MS1 unit co-directors indicated that their collaboration across basic/clinical science lines increased, 22% of faculty indicated that their collaboration remained the same.

CONCLUSION: The use of clinician/basic science teams as co-directors has provided opportunities for both presenting and assessing basic science content in a clinical context. We hope this improves student satisfaction with our new MS1 curriculum and aids in the long-term retention of important basic science concepts.

228 – An unlikely pair: A model for delivering high quality Step 1 programming through non-profit/for-profit partnerships
Mark Grichanik, Christopher Carrubba, and Michael Coords
Rush Medical College, Med School Tutors

PURPOSE: Discuss the successes and challenges of an innovative and successful three-year partnership between a non-profit medical school and a for-profit USMLE-preparation vendor.

METHOD: Incorporating the ever-changing biomedical content into curricula, suggesting current resources, and teaching effective test preparation, test taking, and wellness approaches required for Step 1 can overwhelm a school’s faculty and administrative resources. However, efforts to outsource portions of skill- and knowledge-building to commercial interests are often met with resistance from faculty, students, and administrators. Rush Medical College and Med School Tutors have developed a popular program that brings educational value for students and refined a relationship that satisfies stakeholders in both organizations.

RESULTS: The school perspective describes potential benefits of working with a commercial partner including increased accountability, subjection to market forces, providing educational value to students beyond the curriculum, and strategic consulting. It also highlights challenges such as managing transparency, gaining buy-in from internal stakeholders, utilizing program evaluation data in collaboration with a vendor, and ensuring that both organizations are a good fit.

Although the typical business model for test-preparation vendors is to put on loss-leader programming (e.g., lunch-and-learns) to entice students to purchase a product or service, the perspective presented here introduces a unique, honest test-prep business strategy, that develops programming that provides educational value, per se. This includes challenges such as minimizing conflicts-of-interest, presenting unbiased, well-informed opinions about products, services, and preparation strategies, understanding individual schools’ curricula in depth, and abstaining from promoting other products or services the vendor may offer. This perspective also includes overcoming challenges such as cost, external biases against vendors, building lasting relationships with faculty and administrators, and strategies for being considerate of medical school budgets.

CONCLUSION: There are generalizable best practices around making non-profit/for-profit USMLE collaborations work that can be used effectively by other schools and vendors.

229 – CREATING AND IMPLEMENTING A MODULAR, FLEXIBLE, AND CUSTOMIZABLE MEDICAL SCHOOL CURRICULUM
YunXiang Chu, Kristine Krafts, Catherine Johnson, and Tao Le
Harvard Medical School, University of Minnesota, ScholarRx, and University of Louisville School of Medicine

PURPOSE: Curriculum planning for medical educators is often a challenge due to limited resources, time constraints, and the fact that no standardized medical education curricula exist in the United States or internationally. This abstract describes a proposed Curriculum Project that will be a comprehensive repository of curriculum materials and support tools for faculty, designed to be used directly or customizable for curriculum needs at any medical institution. Such a solution is needed to address widespread medical education issues, including the need to fill curriculum gaps, to update existing curricula, to add active-learning sessions to coursework, to convert lectures into flipped-classroom, and to help create new lectures de-novo.

METHODS: We began by creating a Hematology Pilot, a single-system module that will showcase features of our Curriculum Project. This pilot project includes 40 authors and 4 editors who are medical students. Each author wrote two to four 800-1200 word “bricks” (course text) with learning objectives, active-learning questions, assessment questions, and corresponding instructional slides. Student editors were trained to edit and provide feedback on bricks, which were faculty and peer reviewed, and edited and finalized by developmental editors.

RESULTS: By autumn 2017, the Hematology Pilot will be tested at five United States institutions. Medical student satisfaction with content, accessibility, and digital utilization of “bricks” will be assessed as an end-of-course survey. Educational outcomes will be assessed through multiple-choice questions at the course end. Faculty reactions to use of curriculum content in preparing and giving lectures will be collected through surveys and informal feedback. The results of the Hematology Pilot will inform quality improvement for further development and scaling of the project.

CONCLUSION: If effective, the Curriculum Project could be used in medical schools internationally as an academic resource for customizable and digitally-accessible curriculum materials.

230 – Phantom Phest: A Halloween-Themed, Extracurricular, Team-Based Ultrasound Focused Educational Activity
Kevin D. Phelan, Gregory R. Snead, and Alisa Kanfi
Division of Clinical Anatomy, University of Arkansas for Medical Sciences, Department of Emergency Medicine, University of Arkansas for Medical Sciences, and Department of Radiology

PURPOSE: Medical school is a stressful environment that can adversely affect the mental health of students. Extracurricular activities allow students time to relax and get a “break” from their demanding studies. However, students may feel hesitant to allot time to activities unrelated to their education. As one strategy to provide students an outlet for relaxation, we developed a Halloween theme-based ultrasound (US) focused extracurricular activity as an extension of our new US curriculum.

METHODS: The two-hour event was designed to provide a balance between a focused learning experience and inclusion of team based fun activities in a relaxed atmosphere. Teams consisted of four randomly selected students (3 M1’s and 1 M2) at the registration desk. The 14-station event included the use of phantom simulators for learning US guided needle placement skills, scanning of standardized patients, US demonstrations, and US related puzzles and identification stations. An anonymous 12-question survey (8 LIKERT, 2 yes/no with comments, and listing of most/least enjoyed stations) was required to be included in a raffle.

RESULTS: A total of 80 students voluntarily participated in the event with 58 completed surveys (72% response rate). Students enjoyed working as a team (4.78/5.00) and rated Phantom Phest as both a great educational opportunity (4.84) and a fun event (4.84). They uniformly appreciated the opportunity to learn US guided needle placement and thought it should be in the curriculum (4.64). Two stations focused on ultrasound artifacts and students reported a better understanding of US artifacts from this experience (4.20) though one of the artifact stations was most often rated as their least favorite.

CONCLUSIONS: Educationally focused team-based fun extracurricular events can be designed to provide students with a break from their studies. Our experience indicates that offering a balanced mixture of educational and varied types of fun activities is important to appeal to as many students as possible.

231 – TRAINING MEDICAL STUDENTS IN CLINICAL OBSERVATION: MEASURING THE EFFECTS OF A MULTI-DISCIPLINARY TRAINING PROGRAM
Briette Karanfilian and Norma Saks
Rutgers- Robert Wood Johnson Medical School

PURPOSE: Observation is a critical component of clinical diagnosis, but often medical schools do not explicitly teach this skill. This project was aimed to develop and evaluate the impact of a multidisciplinary training program on the ability of medical students to observe and describe clinical images.

METHODS: First year medical students participated in this study during the 2015-16 academic year. Forty-four students were included in the training, which consisted of three 1-hour observation sessions in an art museum directed by an art educator, three 1-hour live lectures by a physician who described images on slides, and two 30-minute recorded podcasts–one by a dermatologist focusing on dermatology images, and one by a radiologist with radiologic images. Descriptive vocabulary lists were provided in sessions to enhance communication. Thirty-three students comprised the Control Group and they participated only in the pre- and post-assessments. For the pre and post-assessments, students wrote descriptions of clinical images. These were scored holistically using an author-modified previously used scoring rubric.

Individual pre-test scores and post-test scores were directly compared to determine degree of improvement. A demographic survey and program evaluation were developed and distributed.

RESULTS: Preliminary results indicate that the design of this multi-faceted multi-disciplinary visual observation training program lead to an overall increase in the richness of student descriptions of images. Student evaluation comments conveyed that the objectives of the program had been met and that students enjoyed their participation. More specific data will be available for presentation at the IAMSE meeting.

CONCLUSION: Several studies have found that training programs specifically geared to enhancing visual observation skills can be useful; a multi-faceted training program for teaching visual diagnosis skills may be most effective. The continued testing and modification of a scoring rubric will be useful to identify the effectiveness of various programs to train clinical observation.

232 – Teaching Health Safety and Quality in Medical Education: High Value Education for High Value Care
Nicholas Kman, Iahn Gonsenhauser, Allison Heacock, Kimberly Tartaglia, Doug Danforth, and John Davis
The Ohio State University College of Medicine

PURPOSE: The Health Systems, Informatics, and Quality Project (HSIQ) is a longitudinal experience designed to create competency in the delivery of safe, timely, effective, efficient, equitable and patient-centered care as defined by the Institute of Medicine. HSIQ specifically develops competency in the application of DMAIC (Define, Measure, Analyze, Implement and Control) process improvement methodology to create meaningful healthcare improvement.

Methods: Our health safety and quality curriculum is continuous throughout all 4 years. In the first 2 years, students complete required IHI Modules. HSIQ in the Med 3 year consists of a combination of classroom didactics, individual assignments and group work to deliver a working knowledge of basic patient-safety, value-creation and process improvement methodology. The students work toward completing 2 projects in Med 4.

Med 4 Project Themes are:

• Cost-conscious Care/High-Value Care
• Improving the Patient Experience/Patient Satisfaction

Students are grouped based on their specialty of choice and identify system failures leading to decreased value in care delivery. The specific skills required to demonstrate mastery are: generation of problem statements, creating viable plans for data collection, selecting applicable QI methods, creating viable interventions and identifying potential failures of the proposed intervention.

RESULTS:Quality Improvement; High Value Care and Patient Safety are still regarded as ‘extracurricular’ by many current medical students. Engaged students are remarkably insightful in identification of systems-level problems within the health-systems that they experience. Assessing true competence in identifying systems issues is fairly straightforward; however, assessing competence in ‘contributing to a culture of safety’ is very challenging. Finally, finding and supporting faculty preceptors with an interest and time to teach has been a challenge.

CONCLUSIONS: Teaching health safety and quality is important to the development of future physicians. Longitudinal teaching in a project format is both practical and feasible.

233 – INCORPORATION OF STANDARDIZED PATIENT-BASED ACTIVE LEARNING IN AN INTEGRATED PRECLINICAL CURRICULUM
Steven Kubalak, Paul McDermott, David Bernanke, Corey Mjaatvedt, Yi-Te Hsu, Jerome Ondo, Ed Soltis, Henry Martin, Heather Boger, Donna Kern, and Debra Hazen-Martin
Medical University of South Carolina

PURPOSE: We sought to develop a capstone experience occurring at the end of the first-year preclinical curriculum that employs an active learning strategy combined with a standardized patient encounter to allow for students to actively engage their knowledge obtained in the first year.

METHODS: Our capstone experience, called Synthesis, begins with small student group (3 per group) encounters with standardized patients (SPs) portraying 1 of 3 different clinical symptoms that strategically reflect the basic medical knowledge content of the first-year curriculum. Clinical preceptors use a standard metric to assess the SP-student encounters. Students then assemble into study groups to create learning objectives in each of four defined curricular themes focusing on the basic knowledge needed to understand the patients’ symptoms. Students then meet to reach a consensus on a standard list of theme-based learning objectives for each of the 3 patients. Each student then presents basic knowledge content focused on one objective that is evaluated by preclinical faculty and student peers. A MCQ examination is then constructed with all questions mapping to the student-generated learning objectives.

RESULTS: Synthesis provided an engaging, effective learning experience with well-trained SPs. More sophisticated student-generated objectives followed multiple opportunities for students to develop objective writing skills throughout the academic year. Students drew on the variety of knowledge and clinical skills gained in the four curricular themes to analyze the patient’s clinical problems and to construct their presentations, which served as an effective student-centered review of the yearlong curriculum. The year-end examination and the patient encounter provided additional effective means for confirming to the students the effectiveness of their learning in their first year.

CONCLUSIONS: A novel strategy has been developed to incorporate active learning into an integrated, non problem-based curriculum, which serves to reinforce clinically relevant basic science with patient-focused application. Importantly, students also develop skills for life-long learning.

234 – Comprehensive approach of Medical Spanish curriculum in medical education in USA
Alberto E. Musto and Richard M. Conran
Eastern Virginia Medical School

PURPOSE: 55 million of persons in USA are identified as Hispanic. The most common cause of death among Hispanic population are: cancer, heart disorders and accidents. One of the approaches to reduce mortality and to improve quality of life in Hispanic population is to provide effective medical interventions focused in early diagnosis and prevention. Proper communication between health care professionals and Hispanic patients is critical. Medical students will play a critical role in the future health care of the Hispanic population. In order to improve the medical-patient relationship, understanding, cooperation and improve empathy among the Hispanic population a comprehensive approach to teach Medical Spanish is proposed.

METHODS: A pilot of series of small group sessions of Medical Spanish were designed during the fourth year of medical school. The sessions, speaking in Spanish, were delivery by Hispanic instructors based on medical cases related with the most prevalent disorders of the Hispanic population. The learning goals were: to understand the medical-Hispanic patient relationship, to identify different way of communications, to recognize the cultural anthropological perspective for each medical disorder, to provide effective communication for diagnosis and adherence for therapies. The small group interacted with standardized Hispanic patients. Medical anthropology, socio-economics, vocabulary and reflection of the health care for Hispanic population was discussed. Assessment of the session was focused on the facilitator, proper delivery of the information and usefulness of the session for student’s future residency programs.

RESULTS: A preliminary assessment of these sessions, indicated that instructor and all aspect of Hispanic culture, including social-economic and anthropological aspect of the Hispanic population was strongly accepted by medical students as a key component for their future career.

CONCLUSION: A longitudinal program which incorporate a comprehensive approach of Medical Spanish should be applied in the new curricula program in the Medical Schools in the USA.

235 – An Evidence-Based Approach to Course Revision
Eileen CichoskiKelly, Charlotte Reback, and Aaron Hurwitz
UVM LCOM

PURPOSE: Considerable effort and resource is often employed to develop medical curricula, but the process for revising them can be less rigorous. The purpose of this is project is to detail the process used to apply an evidence-based approach to revising a UME course, which can be replicated by other medical curricula.

METHODS: Content was clustered into themes reflecting overall course goals, then a medical librarian was consulted to conduct literature searches on the clusters and determine what students need to know about each. Professional and educational medical societies were also researched for guidance on curricula and competencies. Institutional level curriculum was cross-checked to explore content redundancies for current and newly identified areas. Content experts were consulted to identify omissions and give advice on aligning course material with expectations for other levels of the curriculum. Instructional resources were consulted regarding appropriate modalities and best teaching practices. Lastly, the NBME comprehensive basic science exam and introduction to clinical diagnosis were reviewed to ascertain what Step One is testing for in each of theme clusters.

RESULTS: As a result of the course revision process, some new content areas were added, while others were eliminated or moved to other level courses. Faculty continuity was increased by creating larger blocks of related content taught by fewer core faculty. Student evaluations showed improvement in student satisfaction with the course and with their learning.

CONCLUSIONS: An evidence-based process can be successfully applied to curricular revision. Course directors should consider partnering with librarians and other institutional curricular supports to facilitate the work of aligning goals and content with methods for delivery and working with faculty to understand objectives with a focus on what students should be able to know and do.

Poster Award Nominee
236 – Self-reported confidence in anatomical knowledge and dissection skills among medical students after secondary dissection experience
Anastasia Turenkov, Evan DaBreo, Craig W. Goodmurphy, and Carrie A. Elzie
Eastern Virginia Medical School

PURPOSE: Our objective was to determine medical students’ confidence in anatomical knowledge and dissection ability upon completion of the 1st year curriculum, and after further study through intensive hands-on dissection time.

METHODS: After a semester-long anatomy course with full-body dissection, students participated in a 5-week anatomy dissection elective with more-focused dissections. Participants were asked to fill out surveys before and after each dissection during the elective. Students were asked to rank their level of confidence in several aspects of anatomical knowledge and dissection, as well as perceived level of anxiety in completing the task sufficiently. Student’s confidence was then categorized as “Not Confident”, “Neutral” or “Confident” in each of the corresponding metrics.

RESULTS: Seventy-eight percent (N=14) of students participating completed the pre- and post-dissection surveys, reporting on 23 individual dissection experiences. A higher rate of students reporting as “Confident” was seen in post-dissection surveys as compared to pre-dissection. Increased rates of confidence were observed in anatomical knowledge (87% vs 12%, respectively; P <0.001), dissection ability (79% vs 12%, P <0.001), ability to accurately present a case to a peer (83% vs 4%, P <0.001), instruct a colleague through the dissection (79% vs 8%, P <0.001), consider relevant physiology (66% vs 25%, P <0.05) and possess a sufficient level of knowledge for the year’s upcoming courses (70% vs 8%, P <0.001). Students also reported reduced levels of anxiety about their ability to perform a given dissection now or in the future (83% vs 37%, P <0.01). Also noted in this study were aspects of the experience that contributed most to learning, with 74% reporting hands-on dissection time and 57% reporting Text or Atlas studying helping most.

CONCLUSIONS: Given the importance of anatomy in medical education, involvement in continued dissection experience has shown beneficial in improving students’ confidence in their anatomical knowledge.

237 – IMPLEMENTATION OF CONTEMPORARY PATIENT-CENTERED HEALTH CARE INTO THE UNDERGRADUATE MEDICAL EDUCATION (UME) CURRICULUM.
Marta Ambrozewicz, Rajasekaran Koteeswaran, Senthil Rajasekaran, and Lauren Mazzurco
Eastern Virginia Medical School

PURPOSE: The traditional medical education in the United States has not prioritized health system sciences (e.g. social determinants of health, caring for the elderly and patients with multiple chronic conditions, cost conscious/high value care, and nutrition) in their UME curricula. We embedded these threads using clinical cases with virtual families in our new integrated curriculum.

METHODS: Last academic year, a team of both basic and clinical science faculty began developing a variety of clinical cases illustrating not only a health problem(s) but also incorporating a social and familial situation of the virtual patient. These cases were introduced to the first year medical students on a weekly basis to demonstrate basic science concepts and incorporate various financial, educational, resource- and zip-code-related issues and family dynamics that often facilitate or pose barriers to patient care. Each case was presented to students on Monday together with a “To do” list that required them to reflect/look for answers on a variety of topics regarding health system sciences. Finally, on Friday a short facilitated discussion of these topics was done by invited experts.

RESULTS: 150 medical students as well as 70 medical master students have completed three modules with 11 virtual patient cases. Based on their weekly feedback and modules evaluations these sessions received the highest rating as students strongly appreciated discussions which taught them to understand how socio-economic factors may shape their patient care management, deliver better quality health care, and advocate for their patients. At the same time they achieved excellent scores on NBME examinations that tested their basic science knowledge.

CONCLUSIONS: Introduction of non-traditional threads into the medical education program was appreciated by our students as it prepares them for the health care delivery models of the future.

238 – LAUNCH RAMP: AN EXPANDED PRE-MATRICULATION COURSE TO INTRODUCE COMPETENCY BASED MEDICAL EDUCATION
Judith Aronson, Michael Ainsworth, Oma Morey, Norma Perez, Jose Barral, and Anne Rudnicki
University of Texas Medical Branch (UTMB)

PURPOSE: Pre-matriculation courses historically help incoming students adjust academically and socially to medical school. We describe an expanded pre-matriculation course which interweaves key foundational science concept consolidation with clinical skills development in a competency-based environment.

METHODS: As the initial medical school experience in a competency-based curriculum pilot within the UT System Transformation in Medical Education (TIME) initiative, Launch Ramp was designed to provide balanced and integrated, learner-centered instruction focusing on medical knowledge, patient care, communication, and professionalism competency domains. An elaborated PBL case was used as a scaffold to explore key concepts in foundational science with the goal of developing students’ abilities to apply and integrate knowledge in clinical contexts. Building upon a clinical skills curriculum delivered to students during their undergraduate years, students completed an additional 28 hours of instruction, expert demonstration and standardized patient-based practice on the approach to evaluating the undifferentiated patient with a common medical complaint. Additional active learning sessions promoted effective use of reliable online and library resources, reflective writing, and digital storytelling. Medical improvisation techniques trained students in verbal and non-verbal communication, empathic response, listening skills, and self-care.

RESULTS: Student acceptance of active and self-directed learning was high; over 80% of students responded that pedagogical methods challenged them to integrate information and think critically like a physician. At the end of course OSCE, students performed basic clinical skills at a level similar to end-of-year 1 medical students. Students described appreciation for the utility of medical improvisation to their training as doctors. Students demonstrated empathy, reflection, communication and media literacy through sharing of personal digital stories.

CONCLUSION: We report anecdotal success in student perceptions of this pre-matriculation type course in which application of foundational science concepts was intimately intertwined with clinical skills training.

239 – Using basic research papers to facilitate curriculum integration
Louis Toth
Boston University School of Medicine

PURPOSE: A major challenge in developing an integrated medical curriculum is having both students and faculty appreciate linkages across traditional course boundaries. We wished to facilitate faculty and student interest and cross-disciplinary understanding through the inclusion of current basic science research papers.

METHODS: We introduced research paper discussions into a graduate medical course that integrates disciplines of cell biology, histology, embryology, anatomy, immunology and endocrinology into a tissue and organ centered approach. Each 1 hour lecture was followed by a 10-15 minute discussion of a current basic research paper. No notes were provided outside the discussion. When possible, a non-lecturing course faculty was chosen to lead the paper discussion. Material from the paper discussions was included on weekly quizzes.

RESULTS: Faculty chose 24 papers from journals with a median impact factor of 6.0. Major successes included opportunities to review previous topics, preview upcoming topics, and cover peripheral topics that served to further illustrate lecture points (such as pericytes in a circulatory system lecture). A detailed list of topics and integrated cross-topics that were covered will be presented. Quiz questions based on paper discussion encouraged lecture attendance. Students performed equally on paper vs. lecture based questions, which comprised 9.2% & 40.4% respectively of their course grade. For 14/24 topics, a faculty other than the primary lecturer was present to lead discussion of the paper. Faculty were overwhelmingly positive about the experience. Students achieved an enhanced appreciation for the relevancy of the lecture material, and for learning required vocabulary. Narrative student feedback is currently being collected.

CONCLUSIONS: Discussion of current basic research is an excellent way to facilitate integration of disciplines in a curriculum. Students appreciated the relatively low stress inclusion of current, basic research papers to facilitate their organizing of course material, absent traditional course structures.

240 – EXAMINATION OF THE RELATIONSHIP BETWEEN THE NEW MCAT SCORES AND THE STUDENTS’ PERFORMANCE DURING THEIR PRECLINICAL TRAINING IN MEDICAL SCHOOL.
Rebecca Rowe, Ling Cao, and Amy Davidoff
University of New England

PURPOSE: In 2015, the Association of American Medical Colleges released the new version of the Medical College Admission Test (MCAT). The purpose of this study is to determine if the new MCAT scores can be used as a predictor of student’s performance in the preclinical training period.

METHODS: Medical Students in the Class of 2020 at the University of New England College of Osteopathic Medicine (UNE COM) were used in this study. For each matriculated student, the MCAT scores, pre-admission GPAs and the assessment scores during their first semester of medical school were analyzed. The respective correlation between the old and new versions of the MCAT and student performance were evaluated.

RESULTS: Preliminary data showed a loose association between the MCAT scores and students’ assessment scores without a difference between versions of the MCAT. Further, we did not observe any correlation between the students’ performance in medical school and their pre-admission GPAs or their MCAT scores of the individual sections (both old and new versions). Once the semester ends, the remaining assessments will be included in the analysis. Additionally, the interactive contribution between pre-admission GPAs and MCAT scores to the students’ performance will be analyzed.

CONCLUSIONS: Based on the preliminary data, the new version of the MCAT did not show an advantage in predicting the students’ performance in the preclinical training. Further analysis needs to be done taking into account the different types of medical school curricula and students’ prior educational experience.

241 – UTILIZING CASE NARRATIVES FROM AN INTERDISCIPLANRY CASE CONFERENCE TO EXAMINE THE RELATIONSHIP OF SHARED DECISION MAKING AND EVIDENCE BASED PRACTICE
Elizabeth Painter, Mamta Singh, and Michelle Davidson
Louis Stokes VA Medical Center, Case Western Reserve University School of Medicine

PURPOSE: Seven Centers of Excellence in Primary Care Education (CoEPCE), established by the Veterans Affairs’ Office of Academic Affiliations, are implementing and testing innovative approaches for interdisciplinary, collaborative, patient-centered practices that provide coordinated longitudinal care. As part of this initiative, the Transforming Outpatient Care (TOPC) curriculum at the Cleveland VA has trialed many curricular innovations, including an interdisciplinary case conference, Aligning Care Options (ACO). It is recognized that in delivering evidence-based medicine (EBM), one must think of patient preferences, and at times shared decision making (SDM) can be a perceived threat to evidence-based practice. Our Aligning Care Options conference (ACO) allows for this explicit discussion in a patient case context, where SDM is a key objective.

METHODS: Prior to ACO, a designated learner identifies a complex patient from their continuity panel and meets with facilitators for presentation mentoring. They then lead a fifty-minute conference underscoring the complexity of the patient. Learners and consultants from various professions participate in discussion to develop a concrete action plan for next-steps for the patient with their context in mind. After the plan is enacted, progress is reported at the following session. These action plans and patient outcomes are then reviewed, where many SDM themes emerge.

RESULTS: ACO has received positive feedback from both learners and facilitators. Case narratives will be utilized to demonstrate the efficacy of teaching SDM and EBM through patient outcomes.

CONCLUSION: ACO was developed as an educational venue to engage teams and manage patients using an interdisciplinary approach. It is a sustainable forum which provides an opportunity surrounding patient-centered care in EBM as well as the evaluation of clinical outcomes. It not only has been well-received, it appears to have a positive impact on veterans with complex chronic conditions, thus demonstrating how collaborative practice can work in a resident-run continuity clinic.

242 – FIRST DO NO HARM: COGNITIVE INTEGRATION OF BASIC SCIENCE IN CLINICAL DECISION MAKING TO REDUCE MEDICAL ERROR AND PREVENT HARM
Ann Poznanski, Michael Dell, Leslie Fall, James Nixon, Tracy Fulton, and Amy Wilson-Delfosse
Elson S. Floyd College of Medicine Washington State University Spokane, Case Western Reserve University School of Medicine, MedU and Geisel School of Medicine at Dartmouth, and University of Minnesota School of Medicine

PURPOSE: We predict that the routine and deliberate practice of reviewing the basic science concepts underlying clinical decisions will reduce medical error and prevent harm. It has been estimated that deaths due to medical errors may be as high as 98,000 per year. Integration of basic and clinical sciences may help to prevent the subset of errors that related to clinical decision making or diagnostic error. In an environment of algorithmic medicine, we need to cultivate an awareness of when and how to slow down and cognitively engage basic science in clinical decision-making.

METHODS: A curriculum of clinical vignettes designed to deliberately integrate and reinforce core basic science concepts was developed in a collaborative project between MedU and IAMSE. Teams of basic scientists and clinicians developed a template for creating integrated learning objectives. A critical element in the template is the “clinical harm statement,” a mechanism for elaboration of the harm that might come to a patient should the learner not effectively understand and apply the basic science that underlies their clinical decisions. “Clinical decisions” included decisions around 1) diagnosis, 2) workup, 3) treatment, 4) course of illness and 5) prevention.

RESULTS: The “harm statement” has become a rallying point in this curriculum for basic scientists and clinicians. It provides a litmus test for each basic science concept developed and now serves as a “check” that indicates agreement by all parties that the basic concept is critical to clinical decisions.

CONCLUSION: By providing a curriculum that focuses on avoiding clinical harm and promoting the deliberate practice of cognitive integration, we aim to promote the appropriate shifts from type 1 to type 2 reasoning, reduce medical error and live up to our maxim: “first do no harm”.

243 – Development of a Model for the Integration of Basic Sciences into a Competency-Based Undergraduate Medical Education Curriculum
Madeleine E. Norris, Marjorie I. Johsnon, Kem A. Rogers, and Charys M. Martin
Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, The University of Western Ontario

PURPOSE: Competency-based medical education (CBME) assesses performance based on students’ abilities to apply knowledge and perform skills. The Schulich School of Medicine and Dentistry is undergoing a curriculum renewal to implement a CBME model. Consequently, the integration of basic sciences into the undergraduate medical education (UME) curriculum needs to be modified. Thus, the specific aims of this project are to develop a feedback model to inform curricular design of the high-yield basic science concepts using evidence-based data.

METHODS: Question sets will be developed and used as interview questionnaires with all six clerkship directors. Information gathered from the questionnaires will be utilized to create basic science assessments that address retention and application of basic science content necessary for clerkship. These assessments will determine if students are currently prepared for clerkship within the existing UME curriculum and to annually monitor basic science retention with curricular changes.

RESULTS: Information gathered from the interview questionnaire will provide insights into what basic science knowledge medical students should be able to apply to clinical scenarios prior to clerkship. Data collected from the basic science assessments will be used to critically evaluate the delivery and timing of basic science content in the existing UME curriculum, which will ultimately drive the curricular reform and influence the integration of basic sciences in the new CBME curriculum.

CONCLUSIONS: The primary goal of CBME is to graduate physicians with the knowledge, skills, and attitudes necessary to successfully practice medicine. Information collected from this project will provide evidence to inform the design and delivery of basic sciences within the reformed curriculum, thus, this content will be linked to outlined abilities and milestones students must achieve. Annual evaluation of student preparedness prior to clerkship will provide evidence about basic science content retention and enable us to analyze the effectiveness of the CBME curriculum.

245 – The Utility of Cadaver “Patient Hand-offs” in Anatomy Lab
Carrie A. Elzie, Katie Van Winkle, Anthony P. Trace, and Craig Goodmurphy
Eastern Virginia Medical School

PURPOSE: A patient handoff is a critical part of medical care and safety in which information is accurately transmitted from one provider to another. Due to the importance of this skill, we generated a similar experience in the anatomy lab in which a “cadaver handoff” occurred between alternating dissection groups. Presenting students were graded and given verbal and written feedback.

METHODS: First year medical students were assigned every other anatomy dissection. Two students from teams of four were expected to “handoff” their dissection to the alternating group and were graded randomly twice during the course. This handoff was limited to seven minutes. Students were given feedback on dissection completeness, organization and accuracy of presentation, what went well and suggestions for future presentations. Grades were then correlated to questions on the lab practical that directly pertained to their presentations and to overall performance on exams. These grades will also be correlated to the overall course grades upon completion. Comparisons between dissectors and non-dissectors were also correlated. Qualitative feedback on this activity was also collected in focus groups.

RESULTS: Students performing dissections typically performed better on related questions than non-dissectors. In general, presenters performed better on relevant practical questions than non-presenters. This was especially true for the more difficult dissections such as the brachial plexus (7% difference). The average grade on the handoff was a 95% (range of 78-100%). 92% of students were consistent or improved with their second presentation. Overall students felt that the handoffs were a highlight of the course and very beneficial to their learning.

CONCLUSIONS: Cadavers can serve as an early and effective model of the clinical patient handoff. Simulated handoffs in the anatomy lab had positive effects on exam performance and provide a good environment to expose students to written and oral feedback from peers and faculty.

246 – Collaborative Development of Illness Scripts to Improve Intentional Integration of Basic Sciences into Clinical Learning and Patient Care
Leslie Fall, Michael Dell, Tracy Fulton, James Nixon, Ann Poznanski, and Amy Wilson-Delfosse
MedU and Geisel School of Medicine at Dartmouth, Case Western Reserve University, University of California at San Francisco, University of Minnesota, and Floyd College of Medicine at Washington State University

PURPOSE: Medical schools continue to struggle to meaningfully integrate basic science core concepts and teaching into the clinical curriculum, particularly in a manner that supports clinical reasoning and understanding common clinical conditions. Furthermore, cognitive research demonstrates that expert scientists and clinicians have difficulty deconstructing their knowledge and making it available to teach novice learners. Illness scripts have been shown to be an effective method by which novices learn clinical reasoning skills. We describe collaborative development of illness scripts by basic scientists and clinicians as a means for schematic integration of basic science concepts into these cognitive representations of core clinical conditions.

METHODS: Collaborative faculty development retreats were held at three medical schools in AY 2015 – 2016. Required common clinical conditions were selected from the relevant core clerkships. Using a traditional illness script structure, clinicians listed the key epidemiologic factors and diagnostic clinical findings for each condition. For each finding the relevant basic science faculty provided a causal mechanism, drawing from foundational basic science concepts. Basic science and clinical faculty were asked to collaborate to provide a simple picture or figure to aid memory recall. Care must be taken to ensure that consistent explanations are provided across illness scripts, where relevant.

RESULTS: All faculty found the exercise engaging and facilitated effective collaborative discussions. Clinical faculty felt the scripts were an effective method for structured integration of basic science concepts into clinical learning and patient care. Basic science faculty found their structured participation advanced their understanding of the clinical relevance of basic science core content. Groups that did not have strong basic science faculty representation to facilitate script development struggled to ‘unpack’ their understanding.

CONCLUSIONS: Collaborative development of integrated illness scripts is an effective method for integration of relevant basic science concepts into the core clerkships, and provides a tool to facilitate clinical and basic science faculty conversations and deconstruction of their relative expertise. Integrated illness script development may also serve as a self-directed learning tool for medical students.

247 – Training Future Anatomy Educators in an Ever-Changing Medical Curriculum
Valerie Dean O’Loughlin, Polly Husmann, and James Brokaw
Indiana University School of Medicine

PURPOSE: Indiana University School of Medicine (IUSM) first implemented its education track in Anatomy PhD program in 2008. Until recently, our program required students to enroll in (and later teach in) our separate gross anatomy, histology, and neuroanatomy courses. When IUSM began implementation of an integrated medical curriculum in Fall 2016(that would disband the separate anatomy courses previously required for our PhD students), faculty were required to rethink the training and course requirements for the PhD students. This presentation describes our revisions to the anatomy educator PhD curriculum and the short term outcomes.

METHODS: The authors (members and chair of the PhD admission committee) determined which new medical courses would serve as adequate replacements in the PhD curriculum. These new required courses include:

• Human Structure – gross anatomy, histology, and organ systems histology
• Molecules to Cells to Tissues – subcellular and tissue histology, genetics, cell biology, and biochemistry.
• Fundamentals of Health and Disease – physiology, pathology and pharmacology principles.
• Neuroscience and Behavior – neuroanatomy, neurophysiology and psychiatry.

RESULTS: Three (3) new anatomy PhD students currently are students in the new medical curriculum. Two (2) PhD students served as teaching assistants in the new curriculum. New students are customizing the timing of taking these courses, so as to balance medical courses, teaching responsibilities, and degree progression.

CONCLUSION: Training future anatomy educators is challenging, but not impossible, when the medical curriculum undergoes substantial revision. Anatomy PhD students trained in revised medical curricula will have unique experience (as both students and teachers) that they will bring with them to their future faculty positions.

Poster Award Nominee
248 – INTER-PROFESSIONAL TEAMS START EARLY: DEVELOPING STUDENTS’ TEAM SKILLS ACROSS A HEALTH SCIENCE INSTITUTION
Nana Coleman, Alana Newell, Christopher Burnett, Susan Marriott, and Nancy Moreno
Baylor College of Medicine

PURPOSE: There is a need for today’s health professionals and scientists to solve complex problems collaboratively, so it is essential that they function as effective members of high-performing teams. To address this need, Baylor developed Launch Pad – an innovative, interprofessional course designed to develop students’ teamwork skills. This abstract describes the course pilot and its outcomes.

METHODS: Launch Pad was developed during summer 2016 by an interprofessional group of faculty members, representing each of the four schools within our health sciences university. Curriculum development was a collective, creative intellectual process, characterized by shared functional ownership of curricular materials and content, and collaborative facilitation of the course. The course was piloted as four three-hour-long modules consisting of active learning experiences, student reflective exercises, and didactic instruction on team skills: 1) Foundations of Teamwork, 2) Building High-performing Teams, 3) Optimizing Team Performance: Communication, Team Cognition and Cooperation, and 4) Optimizing Team Performance: Conflict Management, Negotiation and Tools for Building High-Reliability Teams.

RESULTS: Twenty-two students from nine programs in the medical, graduate and allied health sciences schools participated in the pilot. Effectiveness was gauged through student content pre- and posttests, ratings of perceived pre- and post-module outcomes, and course ratings. Students had statistically significant mean gains on the content tests and all retrospective self-ratings of module learning outcomes, and rated the course quality highly on all indicators.

CONCLUSION: Launch Pad enhanced students’ team skills, and received positive student feedback, suggesting that it could serve as a model for interprofessional teamwork training in education. Subsequent iterations of the course will strive to incorporate a greater depth of team skills knowledge, as well as an enhanced focus on active learning.

249 – Teaching Medical Students About Human Trafficking Through the Use of Standardized Patients
Michelle J Mertz, Mariah McNamara, and Cate Nicholas
University of Vermont College of Medicine

PURPOSE: Human trafficking is one of the top three fastest growing and most profitable illegal worldwide businesses. There are more people living in slavery today than in any other point in history. Victims are all around us, in the restaurant business, hospitality, construction, farming, landscaping, domestic services, etc. Less visible but as prevalent are those that serve as slaves in the illicit drug industry and sex trade. Complicated socioeconomic, cultural, and safety factors, among others, prevent victims from leaving their offenders. For complex reasons, these individuals don’t visit doctors to readily discloses their struggles. Unless providers have high suspicion through prior training to recognize victims, and utilize a human rights-based approach to helping victims, they will be ineffective or potentially compromise patient safety. University of Vermont College of Medicine is committed to teaching about human trafficking so every student will be made aware of the enormity of the problem globally, and acquire basic skills toward helping patients affected by trafficking.

METHODS:Students received a thorough presentation on human trafficking. A discussion followed regarding how to approach suspected victims without infringing on privacy and human rights. Next, students watched as faculty demonstrated a patient/provider encounter, using a standardized patient role-playing the victim. Next, multiple standardized patients of various demographic backgrounds participated in a role-playing exercise with medical students as students practiced taking sensitive and thorough histories.

RESULTS: The session concluded with students and standardized patients having thoughtful discussion regarding the experience. Students completed pretests and posttests regarding their understanding of human trafficking, and provided critical qualitative feedback to instructors.

CONCLUSION: This was some students’ first exposure to the topic of human trafficking and many didn’t realize how ubiquitous this problem is, even in Vermont. Students benefited from role-playing with skilled standardized patients and learned crucial communication tools and community resources.

250 – IMPLEMENTATION OF AN INTERPROFESSIONAL COURSE DESIGNED TO PROVIDE HEALTH PROFESSIONS STUDENTS AN EXPERIENCE THAT BRIDGES BENCH TO BEDSIDE AND BACK
Steven Kubalak
Medical University of South Carolina

PURPOSE: There is an ever-growing need to develop curricular components that provide earlier opportunities for students to augment their training with structured clinical and basic science experiences relevant to their academic goals. This abstract describes the development, implementation, and student feedback on a novel interprofessional course, called Integrated Interprofessional Studies. The course is designed to expose students to clinical and basic science professionals to achieve a more comprehensive translational training experience.

METHODS: Basic science-focused students are matched with the clinical department relevant to their dissertation work and attend weekly clinical case conferences and grand rounds. Clinically oriented health professions students are matched with a basic science lab that complements their professional interest and attend weekly lab meetings and participate in laboratory experiments. Students reconvene weekly for an in-depth discussion regarding connections between the basic science underpinnings and the clinical symptoms (bench-to-bedside). They prepare case reports containing defined elements, including the patient history, signs and symptoms, diagnosis, basic science, treatment, health/healthcare disparities, healthcare team, future directions, and relevance to their dissertation or professional goals.

RESULTS: Case reports have been impressive. Over the course of any given semester, each student’s vocabulary across each of the aforementioned elements expanded considerably. Students enjoyed discussing patient scenarios in a bench-to-bedside format particularly as they began to understand better the full spectrum of basic science to patient symptoms. End of semester course evaluations consistently scored between 4 and 5 (on a scale of 1-5; 5 being best) on a range of questions. In some cases, students maintained open lines of communication for future collaborations.

CONCLUSIONS: Even though the class is in its infancy (six classes thus far), there has been an overwhelmingly positive response from students and clinicians that have participated in the class. Additionally, end of semester student evaluations provided very helpful tips that have guided subsequent course offerings.

251 – Integrating Pediatrics and Basic Science: A Childhood Module
Judith L. Rowen, Marie Dawlett, Virginia Niebuhr, Victor Reyes, and Judith Aronson
University of Texas Medical Branch

PURPOSE: As part of an initiative for streamlining medical education, we created a pilot competency-based curricular track (SEA CHange =Student-centered Education for Achieving Competencies in Healthcare), which abolishes the traditional separation of pre-clinical and clinical phases. The curriculum is presented in modules corresponding to phases of the life cycle. The Childhood module provided a unique opportunity to integrate Pediatrics and foundational science.

METHODS: The module was organized around age groups, shown below. There are no lectures, active learning methods are used.

RESULTS: Students showed growth in their ability to apply basic science concepts to clinical cases in their essays. Performance on the CBSSA (national basic science exam) improved over the course of the module. Students performed at the level of traditional year 3 students on their clinical assignments. Student commented on the value of immediately seeing clinical relevance to the material studied in foundational science activities.

CONCLUSIONS: This module successfully integrated foundational science and clinical science, focused on a population less often considered in depth in the preclinical years.

252 – Preliminary Identification of Youth Suicide Prevention Competencies for Undergraduate Medical Education
Thomas Delaney and Alison Howe
University of Vermont Larner College of Medicine

PURPOSE: Primary Care Providers are well positioned to play a role in screening, assessment, safety planning and obtaining additional care for people at risk for suicide, many of whom receive medical care but are not receiving mental health services. To date, an educational competency approach for suicide prevention in children, youth and young adults at risk for harming themselves has not been described in the literature. The current study aims to identify a set of suicide prevention educational competencies for caring for young people, and which can be integrated in the undergraduate medical curriculum.

METHODS: Following a literature search of suicide-related educational competencies, we developed a semi-structured interview tool and refined it following initial interviews with two medical educators knowledgeable about educational competencies. The final version used 6 open-ended and 4 Likert-like scale rating questions, and was administered with a convenience sample (n=6) of psychiatric providers experienced with suicidality in children. Interviews involved detailed note taking but no recordings were made. A brief orientation on existing educational competencies related to mental health was provided at the beginning of each interview. Data are being analyzed using a thematic content analysis approach (Vaismoradi M, et al. (2013) Nursing and Health Sciences, 15, 398-405)

RESULTS: Preliminary results support that there are a set of discrete, observable behaviors essential to providing effective care for young people at risk for suicide. These include suicide screening, risk assessment, lethal means safety and linking to additional resources.

CONCLUSIONS: This study offers guidance for developing a set of medical education competencies related to effective suicide prevention care for young people. Following additional data collection and analysis, we expect the focus of the study to shift towards validating the competencies and testing different models for teaching them.

253 – INTEGRATING PROFESSIONAL AIR & GROUND MEDICAL TRANSORT TEAMS USING CLASSIC AND INNOVATIVE ENDOTRACHEAL INTUBATION TECHNOLOGY TRAINING 1ST YEAR MEDICAL STUDENTS WITH MULTIMODAL STIMULATION FROM CADAVERS AND MANNEQUINS
John Mang, Erin Asher, Jane Acebo, Tim Case, and Brion Benninnger
Western University of Health Sciences, COMP-Northwest, College of Dental Medicine, Departments of Orthopaedics and General Surgery

INTRODUCTION: The A in ABC not only stands for airway but also absolute because obtaining and maintaining advanced airway is ABSOLUTELY vital. Majority of medical schools provide a one-time airway management with endotracheal intubation(EI) training course, with no follow up or required EI successes. Achieving proper skills and confidence to perform EI, providers must receive multiple practical education sessions. Some health providers are required to perform predetermined successful intubations prior to their clinical education. The objective of this study was to create an airway management and practical skills session during millennial anatomy lab(MAL) course utilizing a combination of anatomical education and a clinical skills session from real world providers.

METHOD: Literature search was conducted regarding airway management and practical skills with first year medical students(MS1). Professional air and ground medical transport teams taught multiple tutorials in the MAL. MS(m=86)were divided into groups of 6-8 for multi-station sessions including: Sectra-3D, direct view EI laryngoscope, video-assisted EI portable C-MAC laryngoscope, video-assisted EI Glidescope and video-assisted EI Flexible Intubation Optics(FIO). Practical skills tutorials included manikin and cadavers. Airway anatomy and Likert-scale questionnaire was assessed.

RESULTS: Literature search revealed no known studies. All MS completed airway management theory and practical skills. MS passed practical airway anatomy questions. Likert-score revealed students found tutorials beneficial and obtained airway theory(4.2) and were confident if required to perform live(2.8). EI is the gold standard in airway management. Many health professionals who intubate regularly believe monthly exposure with increased repetition versus annual training is vital to development and execution. For MS to best succeed at lifesaving EI before clinical rotations, multiple opportunities to practice is paramount.

CONCLUSION: This study demonstrated professional air and ground medical transport teams successfully integrated classic and innovative EI technology training MS1’s suggesting a multimodal educational method to provide confidence and skills for live EI.

254 – INTERNSHIP TO HELP THE CAREER TRANSITION FROM RESEARCH PHD TO MEDICAL EDUCATOR
Isabel Dominguez and Ann C. Zumwalt
Department of Medicine, Boston University School of Medicine and Department of Anatomy & Neurobiology, Boston University School of Medicine

PURPOSE: Biomedical research Ph.D.s are highly specialized and their career transition to jobs outside research laboratories is not easy. In the past, little or no help was provided during their training to facilitate this transition. However, recently, an increased awareness of this problem has facilitated the launching of different initiatives to help with career transition.

METHODS: At BUSM we have launched a training program for Ph.D.s that would like to become medical educators. For this two faculty members, a medical educator and a basic scientist with career development background, have teamed up. We have designed an internship that includes medical educators interested in mentoring research PhDs. The internship was advertised through the BEST program at BU.
During this internship, trainees receive dual training in:

1) The trainees undergo clinical shadowing experiences to increase their exposure to the relevance and practical application of basic science content.

2) Their educator training initially focuses on best practices in teaching biomedical sciences and will culminate with the trainees developing educational materials for use in a clinical training setting.

In addition, the trainees benefit from the career advise of all the mentors.

RESULTS: This pilot program started in October 2016. We will present data on the buying-in from stakeholders, the number of faculty and trainees that participated in the program. We will describe the challenges and lessons learned in the development of the approach and curriculum of this training program in this pilot year. If time allow, we will present data on the impact that the internship had on the program directors, faculty mentors and trainees.

CONCLUSION: Our pilot program is designed to provide Ph.D. trainees with the skills to appreciate, develop, and ultimately teach integrated curricular content.