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Purpose: To compare the content covered by student-generated, case-based, learning objectives with United States Medical Licensing Exams (USMLE) core-content guidelines, both in terms of range of topics covered and time spent with different topics. Secondarily, to examine the impact of online learning during the COVID-19 pandemic on the content covered by student generated learning objectives (SGLOs). Methods: The data used in this study was drawn from university records of SGLOs over the course of five years, including approximately 1,600 individual SGLOs, organized by semester and year. SGLOs were coded to correspond to topics on the USMLE core content guidelines. Two lists of core content provided by the USMLE were used in this study. The first consisted of 18 broad topics and 222 nesting subtopics tested on STEP 1. The second consisted of 11 broad topics with a corresponding percent range of how many questions on STEP 1 address that topic. Findings: Percent Coverage: 50-60% of USMLE core content topics are covered within the first year. Multiple regression analysis showed this number remaining consistent between first year classes, between semesters, and during COVID. Topic Weight: 7 out of 11 broad topics fell within the same ranges of the USMLE, with Social Sciences being the greatest outlier (significantly more coverage). 2 out of 11 topics were addressed less by SGLOs than by the USMLE. Gaps: 53 individual USMLE core content sub-topics were not addressed by a UP first year class in any learning objective. Notable trends in the identified content gaps included topics relating to congenital disorders, embryonic development, male and female reproductive systems, endocrine disorders (other than thyroid disorders and diabetes), normal ageing and age-related changes, psychiatric disorders and behavioral health, and drug adverse effects. Conclusions: SGLOs covered consistent amounts of material from year to year, suggesting curricular stability over time. The same standard of SGLO creation was also maintained during online COVID 19 activities. The agreement in weighting of topics between our student-driven curriculum and the USMLE core content indicate that students prioritize topics effectively. Identified gaps in coverage represent areas for improvement. This study further supports successful collaborations between faculty and medical students in regards to curriculum development and execution. Conflicts of Interest: None. This study (Study ID: STUDY00015600) was deemed exempt by the Institutional Review Board (IRB) at the Penn State College of Medicine.

Regional medical campuses (RMCs) were initially established to address a projected physician shortage and have gained popularity throughout the country in also providing unique medical educational experiences. Despite the increasing prevalence of RMCs and progress toward meeting these needs, the overall perceptions of RMCs by faculty and students at the associated main campus have yet to be fully explored. In an attempt to address this gap, we administered a survey to both main campus and RMC students and faculty inquiring about perceptions of its associated RMC, including relative student competencies and opportunities for academic success at the RMC compared to their main campus counterpart. Furthermore, we paired these subjective perceptions with objective Match data, USMLE Step 1 and Step 2 CK results, and research output data in order to better substantiate or challenge these viewpoints. Not only did we find significant differences in a variety of perceptions surrounding the RMC and its associated students, but we also identified overall negative viewpoints of RMC-trained students by main campus students and faculty. Looking more deeply, RMC students surveyed were found to believe their RMC may be even more negatively perceived by main campus faculty than actual responses indicated. Contrary to the prevailing views by main campus students and faculty, Match data revealed no significant differences between successful acceptance into both primary care and surgical specialties across both campuses. Furthermore, there were no significant differences between USMLE Step 1 and Step 2 CK scores or research output across both campuses. This study identifies several unexpected perceptions of a successful RMC curriculum and its students held by main campus students and faculty responding to a survey. However, such viewpoints do not correlate with objective evidence, suggesting the presence of bias. Results suggest the need to further explore and define cross-campus perceptions between main campuses and their RMCs with objective metrics while also considering the potential unintended effects of crosscampus bias.

Abstract This standardized patient case and its accompanying sequence of activities are intended to build skill among first-year medical students in recognizing patient clues and eliciting contextual information. Additional activities include a large-group introduction prior to the standardized patient encounter, a stimulated review of the standardized patient encounter, and a small-group reflection and discussion. The standardized patient case embeds three contextual themes (beliefs about treatment, stressful environment, and fear of what symptoms mean) that are each assigned a specific behavioral cue or clue. Standardized patients are trained to drop these clues and then to give further information only if the student interviewer follows up on the clue. Each theme is constructed to yield potentially meaningful differences in physician decision-making if the clue is or is not followed up on. Students and standardized patients then review the video independently and mark moments in the video that they feel represented clues and whether or not the clue was followed up on. Once the moments have been marked, the students view the video a second time to compare their own markings with those of the standardized patient. Lastly, the students meet in small groups with a faculty facilitator to share one exemplar moment and discuss with the group. Students indicated that the stimulated recall video review of their standardized patient encounter was the most effective activity for triggering reflection, followed by the small-group discussion and the review of the merged standardized patient bookmarks. Students felt that the activities were effective overall in promoting reflection on the relevance of context in the medical encounter.

Abstract Introduction This exercise is a small-group discussion about bias for medical students who have had at least some clinical experience. It is designed to cultivate awareness that bias is inherent in all humans, including physicians, and can impact patient care. The aim is to foster self-reflection through an exercise that challenges assumptions about personal bias. Methods The Implicit Association Test (IAT) is used as a trigger, and a small-group discussion format is used to create reflection about personal biases and their effects on clinical decisions. Students discuss what it was like to take the IAT, how they felt when they got their results, if their results were expected, when bias can be helpful, clinical experiences with bias, and what they will do with their results. The content is presented as a set of guidelines and features materials for training facilitators and conducting the discussion. These materials comprise an outline of the exercise, advance preparation assignments, instructions for students, and a small-group facilitator guide. The materials also include evaluation tools consisting of pre- and postdiscussion student surveys and facilitator postdiscussion surveys. Results As evidence that the IAT does generate meaningful discussion in a facilitated small group, we report the analysis of our pilot data (n = 72). Our exercise resulted in an increase in the perception that personal bias could have an impact on patient relationships (p < .001) among students reporting a lower belief that bias can have impact (n = 6). Among students who rated themselves as having a lower self-awareness prior to the exercise (n = 14), there was an increase in self-awareness of personal bias after the exercise (p < .001). Finally, students reported significant increases (p < .01) in the perception that the IAT was an effective tool for generating small-group discussion about personal bias (p < .001) and that the reflection exercises and small-group discussions were effective tools for raising awareness about personal bias (p < .001) after attending the session. Discussion Our results suggest that the primary value of this exercise lies not simply in taking the IAT but rather in the cognitive processing of the IAT and other potential biases that takes place during the small-group session. The IAT in conjunction with the discussion appears to be what leads to increased self-awareness and self-reflection.