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The learning environment is shaped by both formal and hidden curricula. Faculty play a critical role in the learning environment but may not be prepared to address the hidden curriculum. This workshop teaches faculty how to manage the hidden curriculum's challenges.Medical students' end-of-clerkship evaluations revealed low ratings in the domains of feedback, respectful interactions, professional language use, and empathy. We created a virtual 60-minute case-based faculty development workshop to highlight the role of faculty in improving the learning environment. A preworkshop survey was emailed to participants. At the workshop, following a brief introduction, participants were divided into groups to discuss the cases and develop strategies to improve the learning environment. A postworkshop survey was used to assess the workshop.Sixty faculty members attended the seminar. Fifty-seven percent completed a preworkshop survey, and 33% completed the postworkshop survey. After the workshop, more faculty felt well prepared to engage students and residents. The majority of participants (85%) reported being more aware of issues around the learning environment. Most (85%) felt that their interactions with medical students would change in a positive way after the workshop. Ninety percent agreed the workshop was relevant to their needs, 70% agreed they learned a new skill in the workshop, and 80% committed to creating an inclusive learning environment after the workshop.This workshop was well received by participants and was associated with an improvement in learning environment ratings. Faculty development seminars are an efficient tool to improve the learning environment.

Objectives To determine if faculty perceive standardized oral examinations to be more objective and useful than the non-standardized format in assessing third-year medical students’ learning on the obstetrics and gynecology rotation. Methods Obstetrics and gynecology faculty at three teaching hospitals were sampled to complete a survey retrospectively comparing the standardized oral examination (SOE) and non-standardized or traditional oral examinations (TOE). A Likert scale (0-5) was used to assess satisfaction, objectivity, and usefulness of SOE and TOE. Wilcoxon signed rank test was performed to compare median Likert scale scores for each survey item. A Spearman’s correlation coefficient was used to investigate the relationship between the perceived level of objectivity and SOE characteristics. For qualitative measures, content analysis was applied. Results Sixty-six percent (n=25) of eligible faculty completed the survey. Faculty perceived the standardized oral examination as significantly more objective compared with the non-standardized (z=-3.15, p=0.002). Faculty also found SOE to be more useful in assessing overall clerkship performance (z=-2.0, p

Background Mistreatment has potential downstream effects on students. General surgery rotations tend to have a higher incidence of mistreatment reports. This study was undertaken to identify dominant themes contributing to a negative learning environment. Methods A qualitative study was performed using Delphi consensus technique to develop a discussion guide. Four focus groups were performed (n = 30 participants) with medical students, residents, nurses, and attending surgeons. Participants were selected using purposive-stratified criterion-based sampling. Results Multiple themes emerged: 1) unclear expectations for medical students; 2) passive mistreatment (neglect); 3) failure to integrate students into surgical team; 4) witnessed or experienced active mistreatment, 5) negative attitude of residents towards medical students' lack of knowledge. Conclusions Medical student mistreatment persists and is a threat to the learning environment and individual learning process. Passive mistreatment (neglect) represents the most distressing component of mistreatment. These findings suggest a need for education aimed at surgical residents and others in the learning environment.

Background: “Student-as-Teacher” (SaT) programs have been growing in number to prepare medical students for their teaching roles in residency and beyond, but it remains unknown what content areas should be covered in SaT curricula. Aim: To determine five to ten “essential” content areas for inclusion in SaT curricula using expert opinion. Methods: Using a three-round Delphi process, moderators iteratively surveyed a panel of 28 medical educators (25 academy directors and three individuals identified as having expertise in undergraduate medical education) representing 25 medical schools in the United States. This “SaT Delphi Working Group” was tasked with rating topics for inclusion in SaT curricula on a 3-point scale (i.e. 1. “essential,” 2. “important, but not essential” 3. “not important”). Topics achieving ≥70% consensus as “essential,” “important” or “not important” were accepted by the moderators and removed from subsequent rounds. Results: Hundred per cent response rate (n = 28) was achieved for all survey rounds. Five content areas reached consensus as “essential” for inclusion in a SaT curriculum: feedback, bedside teaching and clinical precepting, small-group teaching, case-based teaching and professionalism as a medical educator. Conclusion: This consensus from a group of leaders in medical education is a first step toward the implementation of more developmentally-appropriate SaT competencies.

Introduction Patient handoffs, the communications required for the safe transfer of patient care, are known to be a common source of medical errors. Simulation exercises are effective techniques for teaching the procedures and patient interaction skills involved in a handoff. We developed a teaching tool that allows students to individually interact with a simulated patient, develop a treatment plan, and practice a handoff to another provider. Methods The curriculum is a flexible instructional tool to teach patient handoffs in the context of a simulated obstetric emergency for learners at the clerkship through first-year obstetrics and gynecology resident levels. The curriculum secondarily teaches management of first-trimester bleeding with acute blood loss and can be adapted to allow advanced learners to practice obtaining informed consent. To evaluate this simulation for educational effectiveness, we developed a faculty observation assessment tool. Results The simulation assessments for history taking, fund of knowledge, and interpersonal skills were predictive of subsequent clerkship clinical grades. Eighty percent of students agreed the exercise was realistic, 95% agreed it was relevant to the clinical curriculum, 90% agreed the simulation taught handoff skills, and 73% agreed the simulation increased confidence in handoff skills. Students uniformly found the curriculum to be relevant, realistic, and effective at teaching handoff skills. Discussion Use of this curriculum has the potential to improve students’ communication skills, handoff performance, and confidence during an obstetrics and gynecology clerkship. The assessment tool may allow early identification of students in need of improvement in communication skills.

Frame-of-reference (FOR) training has been used successfully to teach faculty how to produce accurate and reliable workplace-based ratings when assessing a performance. We engaged 21 Harvard Medical School faculty members in our pilot and implementation studies to determine the effectiveness of using FOR training to assess health professionals' teaching performances.All faculty were novices at rating their peers' teaching effectiveness. Before FOR training, we asked participants to evaluate a recorded lecture using a criterion-based peer assessment of medical lecturing instrument. At the start of training, we discussed the instrument and emphasized its precise behavioral standards. During training, participants practiced rating lectures and received immediate feedback on how well they categorized and scored performances as compared with expert-derived scores of the same lectures. At the conclusion of the training, we asked participants to rate a post-training recorded lecture to determine agreement with the experts' scores.Participants and experts had greater rating agreement for the post-training lecture compared with the pretraining lecture. Through this investigation, we determined that FOR training is a feasible method to teach faculty how to accurately and reliably assess medical lectures.Medical school instructors and continuing education presenters should have the opportunity to be observed and receive feedback from trained peer observers. Our results show that it is possible to use FOR rater training to teach peer observers how to accurately rate medical lectures. The process is time efficient and offers the prospect for assessment and feedback beyond traditional learner evaluation of instruction.

Introduction This training program was developed to help educators train obstetrics and gynecology (OB-GYN) faculty in becoming oral examiners and to implement a consistent process for oral examination in order to assess medical student knowledge and clinical reasoning skills at the end of their core OB-GYN clerkship. Methods The slide presentation is utilized to introduce faculty to the clerkship so they understand how the oral examination fits into the overall assessment of student performance. Videos are then used to familiarize faculty with the performance of students at different levels and how to use the evaluation form. The oral examination sample questions and answers further familiarize faculty with how to ask students standardized questions based upon student case topic selections and how to differentiate students at different levels. Results From 2011–2014, 609 students took the oral examination. Two faculty members graded the students, and a composite of these two grades was used. This was done so that if the faculty differed in their ratings, both grades are accounted for in the final oral examination grade. Thirty-three percent of the learners received two Honors with Distinction grades, 32% received an Honors with Distinction and an Honors grade, and 23% received two Honors grades. Discussion The oral examination has been part of the Harvard Medical School Obstetrics and Gynecology Core Clerkship assessment for over a decade, and a common format for its use at all sites was developed. The implementation of this module has resulted in a standardized assessment across multiple sites.

Introduction The medical education literature shows that residents spend at least 25% of their time teaching, enjoy teaching, consider it important, and agree that teaching improves their clinical knowledge and clinical skills. However, in today's busy training environments, there is limited time to formally train residents as teachers. Methods We developed a multidisciplinary, resident-as-teacher curriculum that includes a DVD series and accompanying self-study and facilitator guides to help program directors, medical educators, and residents take the first step in implementing cross-departmental teacher training. The entire curriculum was presented to all Beth Israel Deaconess Medical Center (BIDMC) residency program directors and at the Harvard Medical School's Resident-as-Teacher Curriculum Showcase. To date, the departments of medicine, obstetrics and gynecology, surgery, emergency medicine, dermatology, anesthesiology, neurology, and radiology have used the facilitator's guide to lead small-group resident-as-teacher sessions or have engaged their residents in self-study using the guide and videos. The DVD series may be used as part of a resident self-study program, as the basis of a facilitator-led teaching series for house staff, or as preparatory material for “flipped” classroom-type sessions. Results Eleven senior residents, from across departments, and three junior faculty members piloted and assessed the quality of the series. All found the series to be “Quite” or “Extremely Useful” in terms of introducing the skills of clinical teaching and all found the overall quality of the series to be “Excellent.” We also conducted an assessment of the effectiveness of presenting the series in AY2014 and 2015 as part of a “Fourth-Year Boot Camp” to senior Harvard Medical students (n = 22) who were about to start surgical or obstetrics and gynecology residencies. Pre− and post-evaluation of the large-group sessions using the DVD modules, PowerPoint, pocket guide, and facilitator's guide showed that the students perceived significant improvements in several areas in terms of their teaching comfort and confidence. Discussion We are currently conducting a multidisciplinary, clinical teaching observation study to determine the extent to which the series and accompanying guide have an impact on the residents' clinical teaching skills, regardless of department. Preliminary data from this study indicate that during the post-intervention observation, residents are more likely to ask students about their learning goals, encourage more student questions, inquire about the student's perspective on a case, encourage self-directed learning, and provide specific learner feedback.

Traditionally, medical school committees have been charged with curricular improvement and modification, while medical students have had little or no involvement in reform efforts. However, medical students can sometimes be ahead of faculty in recognizing new topics that need to be covered, and their energy, commitment, and vision can be a very important impetus for curricular change. In 1995-96, as part of a general curricular restructuring effort, faculty at Dartmouth Medical School began to design and offer new electives in innovative topics, with the idea that electives might become part of the required curriculum if the material presented in them were deemed to be "core." Students were invited to organize their own electives if a topic in which they were interested was not being covered. The authors (two were second-year medical students and the third was their faculty sponsor) developed an elective in women's health. This paper describes the development and implementation of this elective, and the process by which the course was later made part of the required curriculum at Dartmouth. The success of the authors' efforts highlights the crucial role students can play in reforming medical curricula.