Poster Day 2021: Abstracts: Medical Education

Adam Thomas, OMS-III; Tiffany Rey, OMS-IV; Rheketah Berwick, OMS-IV; J. Gage Sanders, OMS-III; Paige Darrow, OMS-III; Kate Cedoz, OMS-III; and James Nolin, FNP    

Previous studies have investigated the palpatory skills of medical students in a transverse plane using a static lumbar spine model. The integration of 3D printed models is especially useful in allowing students to learn and practice palpatory skills (Han et al., 2020). The end goal of this project was to create a more accurate lumbar spine model that could be validated and incorporated into existing osteopathic medical education.

First-, second-, and third-year medical students were instructed to determine the orientation of the lumbar segments based on rotation and filled out a survey to calculate results. 

GraphPad Prism version 9.1 was used for statistical analysis.  The ratio of correct to incorrect identification of rotation at 0 mm, 2 mm, 4 mm, 6 mm, and 8 mm were 0.51 +/- 0.046, 0.27 +/- 0.042, 0.25 +/- 0.040, 0.34 +/- 0.045, and 0.46 +/- 0.047, respectively. A One-way AVOVA with a Dunnett post-hoc test was used to compare statistical difference from the 0 mm control revealing 2 mm (p=0.0008), 4 mm (p=0.0001), and 6 mm ( p=0.0298) were statistically significant. The 8 mm segment was not statistically significant (p=0.82) compared to the control. 

When compared to the control, students were just as likely to determine rotation of a spinal segment at 8 mm of rotation. Students did not perform as well when segments were rotated at 2 mm, 4mm and 6 mm as determined by a one-way ANOVA. This suggests that 8mm is the rotation to set the model to future studies.

Sameeksha Malhotra, BA; Gustavo R. Sarria, MD; Ramsey Timmerman, BS; Michael Hermansen, PhD; Betty Chang, BA; Raymond Carter, BS; David A. Martinez, MD; Gustavo J. Sarria, MD; Frank A. Giordano, MD; Indrin J. Chetty, PhD; Dante Roa, PhD; and Benjamin Li, MD, MBA

Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America.

Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included one month of weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed.

One hundred and seventy-five radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p<0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p<0.001).

Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries.

Parth Desai, Dr. Mark Hernandez, Dr. Joseph Baker, Dr. John T. Giannini, Ms. Dianne Walker, and Mr. Jim Nolin

Interprofessional Education (IPE) has become increasingly emphasized as an important aspect of medical education. The premise of IPE involves students of different healthcare professions working together in collaborative sessions. The hope among medical educators is that students of various disciplines can better work together to treat future patients. This study aims to investigate trends in both satisfaction and participation in IPE among graduating osteopathic medical school seniors.

The annual national data of graduating seniors published by the AACOM was analyzed for response trends to selected survey questions regarding IPE. The three main areas of focus included participation in IPE, setting/type of IPE events students participated in, and overall satisfaction in IPE events.

Analysis of the data for the past decade (2012-2020) indicated that students are participating in more IPE events; however, student perception of benefit from these events has decreased. Furthermore, among the events that were implemented, it was seen that events classified as ‘Active Engagement with Patients’ saw a steady decline mirroring the same years that student benefit was declining. From these trends, a correlation study was run between Active Patient Engagement IPE events and Student Perception of IPE yielding a 0.99 correlation constant value.

These data show that reduction in Active Patient Engagement events and reduction in perceived student benefit may be correlated. Further investigation will be necessary on the impact of reduction of ‘Active Patient Engagement’ events and their impact on student benefit from IPE events.

Dayeon Kang, Fred L. Helms EdD, Joseph Baker, II, DO, and Mark Hernandez PhD

The United States is facing a physician shortage in underserved areas. Although many interventions (financial incentives, increased rural training, etc.) have been created, there has been a limited effect on this shortage. Numerous studies demonstrate that physicians are more likely to work in the areas where they train. Analyzing how medical students’ interest in practicing in underserved areas change with the progress of medical school can help explain how to best address the physician shortage.

In this study, allopathic and osteopathic medical students’ interest in rural/underserved area practice during enrollment and graduation was investigated using the annual data summary reports published from the AAMC and AACOM satisfaction instruments respectively.

The data showed that during the past decade entering osteopathic medical students have demonstrated decreased interest in practicing in underserved areas. However, the percentage of osteopathic medical graduates who wanted to serve in underserved areas increased. Additionally, more entering allopathic medical students wanted to serve in underserved areas but less allopathic medical graduates wanted to serve in underserved areas.

It has been reported pre-clinical curriculum does not significantly affect students’ attitudes towards practicing in underserved areas.  Changes in students’ intention to practice in rural/underserved regions may be explained by other factors (empathy level, personal satisfaction, economic forces, power of suggestion, etc.). Further research into students’ satisfaction with their clerkship education and clinical experience in underserved areas during medical school can be helpful in identifying how clinical curriculums impact students’ interest in serving the underserved.

Stefany Panunzio; Starla Meighan, PhD

The COVID-19 pandemic has tested resilience nearly worldwide with the need to adapt to extremes of isolation, overwhelming stress on medical infrastructure, profound loss of life, interruptions in jobs and income, and the uncertainty of an endpoint to the pandemic. Amid this loss and uncertainty, students in professional curricula have been faced with changes to curriculum delivery that have created a learning environment unlike any they have experienced and learned to succeed in prior to the pandemic. Traditional didactic, in-person education transitioned to virtual learning overnight. With this transition, there has been a loss of in-person interaction with faculty and peers that could have an impact on morale, group study, skill-learning, problem-based learning, and forming personal and professional relationships, yet students have been tasked with performing as if normal. This likely presented a unique challenge for students in demanding healthcare curricula where pre-pandemic statistics already indicate high rates of stress-related depression and anxiety.

Participants (ACOM medical, Troy and Wallace nursing, and Auburn PharmD students) completed a 30-question survey on resilience and their ability to succeed in virtual curriculum delivery during the pandemic.

Although generally, participants indicated a high self-perception of resilience, in specific areas there were significant differences in perception between the students in different programs. These differences included the factors each student cohort indicated were most important to fostering their resilience in their program of study.

These data could be important in developing curriculum-tailored modules to foster student resilience in healthcare training programs.

Shivani Subhedar, MS; Mark J. Hernandez, PhD; Michael Ibiwoye, MD, MPH, PhD; Melinda Ledbetter, PA-C; Richard Thacker, DO; and Emmanuel Segui, MS

Medical students often pursue global health experiences abroad to acquire unique training to deliver healthcare to those who are socioeconomically disadvantaged in remote, resource-scarce regions. Identifying the factors that predict interest in global health can help us design better opportunities in our curriculum for those students.

We developed and implemented a survey for pre-clerkship and clerkship medical students at the Alabama College of Osteopathic Medicine to evaluate experience in global health and future interest in completing an international medicine elective clerkship.

There has been a decline in international volunteerism over the years 2012-2020 according to AAMC matriculating and graduating data on global health activities. In our institution, we found greater global health interest and involvement by first-year students and females of all years despite decreasing interest in participation from first year to later years. While females found aspects such as ability to provide care for patients of different ethnicities to be “Very Important”, males were drawn towards unanticipated risks and risk of injury associated with global health experiences.

This multi-year analysis of global health experience, interest, and gender differences shows a decline in global health participation prior to and during medical school, which may relate to inadequate financial incentive or training opportunities. The Covid-19 pandemic may have also caused a shift in interest, warranting further studies. The discrepancy in early female interest and later male participation calls attention to the need for global health training programs that support all students interested in pursuing international medicine.

Schmitz, Ariail, DO; D'Aguilar, Sasha-Kay, MD; Skandhan, Amith, MD; Gadgil, Meghana, MD; Heersink, Juanita, MD; and Seqera-Sanchez, Carlos, MD

Mentorship has long been an impactful process in the training of medical students and physicians. It is apparent that young professionals benefit from mentorship, but objective benefit and process improvement is difficult to quantify. We elected to approach the revitalization of our mentorship program through a 6-month human centered design (HCD) project to form a curriculum built by residents and medical students and supported by teaching faculty.

A diverse selection of faculty, residents, and medical students were appointed to champion this program. We collaborated with UCSF, “Better Lab”, to assist in the running a HCD program and received a $5,000 grant from the Society of Hospital Medicine. Three months were spent exclusively data gathering, utilizing surveys from the residents, medical students, and faculty. Additional data was gathered from 14 interviews with the local medical community and “Fire-side Chats” from 14 exemplary and nationally recognized physicians. This resulted in multiple meetings of reflection and consolidation of common themes. Prioritization matrices and collaborative virtual whiteboards were used to categorize, prioritize, and brainstorm ideas.

Curriculum consists of a low mentor to mentee ratio with pod assignment. Mentorship pods are targeted to encourage peer mentorship among residents and students. Scheduled monthly digital check-in and quarterly in-person meetings with goal-oriented checklists assure mentees are receiving  scholarly, professional, and emotional support.

This process forged a culture of mentorship and assembled a mentorship program targeted to our community. This allows us to continue to gather beneficial data on resident well-being and resiliency, scholarly activity, and professional development.

Jordan Palmer, OMS-II; Quoc Vinh Tran, DO; and Andrew Little, DO

Ultrasound is a tool that is becoming more widely utilized in clinical practice; however its use is limited by the operator’s skills. Phantoms and simulation models are attractive options for developing ultrasound skills as they allow inexperienced users to practice without the risk of endangering patients. The purpose of this study was to identify commercially available and homemade ultrasound models to describe them in terms of materials used, cost, and whether they are high or low fidelity for medical student education.

This was an investigational study on cost effective ultrasound training methods for medical students. Our study was done by conducting searches in Google and Pubmed for ultrasound compatible models for the following five modalities: foreign body identification, ultrasound-guided lumbar puncture, IV injection training, abdominal ultrasound, and ocular ultrasound.

Over the course of a month, the five modalities were investigated for the cheapest training models that are either available for purchase or can be made. IV injection training models were the cheapest commercially available models. Most homemade models for IV injection training, ocular ultrasound, and foreign body identification could be created for less than $20.

With the increase in the use of ultrasound in clinical practice comes the need for early exposure to ultrasound training for medical students. This study provides initial guidance and suggestions when it comes to ultrasound training models that are currently available. Ultrasound models that can be cheaply made or purchased increase accessibility for students to gain exposure cost-effectively and safely.