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Introduction: The concept of medical student coachability, adapted from athletics and business management, offers a framework for characterizing students' roles as clinical learners. We defined coachability as effectively seeking, receiving, and using feedback-even negative feedback-to change behavior and reach learning goals. To facilitate success in our clinical clerkships, we sought to empower preclerkship students' capacity to be coached., Methods: Our curriculum comprised two large-group presentations and three small-group seminars totaling approximately 5 hours, distributed over 2 years: a year 1 orientation, a year 2 refresher, and a longitudinal year 2 seminar series. Medical students designed and first implemented the curriculum under faculty supervision in academic year (AY) 2015-2016 and have continuously managed and run it since. The AY 2022-2023 curriculum management team evaluated the curriculum cross-sectionally via student survey and focus groups., Results: Approximately 575 students have completed the curriculum since 2015. Immediately following curriculum delivery, AY 2022-2023 year 2 students (response rate: 70%-97%) rated it a valuable educational experience and described plans to implement the lessons learned in their clerkship. Focus group participants (eight clerkship students who participated in the coachability curriculum in AY 2021-2022) reported using coachability strategies to positive effect for their clinical learning and well-being., Discussion: Our curriculum's flexible, modular format facilitates adoption by others. Future development could expand coachability offerings across the continuum of medical school. However, the curriculum should remain led by students passionate about medical education and willing to try new things to continuously adapt content and instructional strategies., (© 2024 Tison-Brandon et al.)

Introduction: In busy clinical settings, there is limited time to teach physical examination (PE) and procedural skills, particularly when the traditional head-to-toe PE approach is time-consuming. Near-peer teaching of a more efficient approach, the hypothesis-driven PE (HDPE), increases students' learning opportunities. We developed a near-peer HDPE module to improve medical student confidence, knowledge, and skills for diagnosing and managing streptococcal pharyngitis., Methods: During this 1-hour module, residents taught the diagnostic approach for a patient with sore throat and facilitated small groups for practicing PE and throat swab skills. We assessed students using pre- and postmodule surveys including Likert-scale confidence scores (1 = not at all confident , 5= extremely confident ), multiple-choice knowledge questions, and a skills rubric. A control group was surveyed at clerkship conclusion., Results: Of the 71 pediatric clerkship students who participated, 69 (97%) completed premodule surveys and 65 (91%) completed skills assessments. Twenty-eight (39%) completed postmodule surveys and skill assessments. After participation, students' survey responses and rubrics indicated significant increase in confidence ( Mdn pre = 2 [IQR = 1,2], Mdn post = 4 [IQR = 4,5]; p < .001), knowledge ( M pre = 40%, M post = 77%; p < .001), and skills ( M pre = 5.3, M post = 7.5; p < .01). Participating students also had significantly higher confidence ( p < .005) and knowledge ( p < 0.01) compared to the control group., Discussion: This near-peer HDPE module improved students' knowledge, confidence, and skills related to streptococcal pharyngitis diagnosis and management and achieved compliance for a required clerkship skill., (© 2024 Podraza et al.)

Introduction: Near-peer instruction has grown in popularity in medical education; however, limited data exist to support its effectiveness. This study investigates the perceptions of near-peer style instruction in third-y medical students undergoing a surgical clinical clerkship. We hypothesized that near-peer instruction would provide a beneficial educational experience to third-y medical students during their surgical clinical clerkship., Methods: The authors anonymously surveyed third-y medical students undergoing their clinical clerkship in surgery on their perception of the near-peer instruction and mentorship they received from fourth-y medical students at the beginning of the clerkship. Near-peer instruction included teaching suturing techniques, surgical procedures and anatomy, operating room literacy, and sharing anecdotal experiences. Surveys were distributed 24 h after receiving the formal instruction., Results: A total of 85 students completed the survey (78% response rate). Students reported a similar or increase in value of learning from near-peer mentors compared to attending physicians (less valuable: 1.2%; just as valuable: 52.9%; more valuable: 45.9%). The majority of students indicated they would like to experience more near-peer style instruction in medical school as demonstrated in surgical clerkship training (absolutely no: 0%; probably not: 0%; on the fence: 4.7%; probably yes: 25.9%; absolutely yes: 69.4%). After experiencing near-peer instruction and mentoring, students were more interested in becoming near-peer mentors (less interested: 1.2%; just as interested: 29.4%; more interested: 69.4%)., Conclusions: Students appreciate and desire near-peer instruction, seeing it as an effective learning method. Mentees undergoing near-peer style instruction have an increased interest in becoming near-peer mentors., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The use of digital online teaching media in improving the surgical skills of medical students is indispensable, yet it is still not widely explored objectively. The first-person-view online teaching method may be more effective as it provides more realism to surgical clerkship students in achieving basic surgical skills., Objective: This study aims to objectively assess the effectiveness of the first-person-view live streaming (LS) method using a GoPro camera compared to the standard face-to-face (FTF) teaching method in improving simple wound suturing skills in surgical clerkship students., Methods: A prospective, parallel, nonblinded, single-center, randomized controlled trial was performed. Between January and April 2023, clerkship students of the Department of Surgery, Pelita Harapan University, were randomly selected and recruited into either the LS or FTF teaching method for simple interrupted suturing skills. All the participants were assessed objectively before and 1 week after training, using the direct observational procedural skills (DOPS) method. DOPS results and poststudy questionnaires were analyzed., Results: A total of 74 students were included in this study, with 37 (50%) participants in each group. Paired analysis of each participant's pre-experiment and postexperiment DOPS scores revealed that the LS method's outcome is comparable to the FTF method's outcome (LS: mean 27.5, SD 20.6 vs FTF: mean 24.4, SD 16.7; P=.48) in improving the students' surgical skills., Conclusions: First-person-view LS training sessions could enhance students' ability to master simple procedural skills such as simple wound suturing and has comparable results to the current FTF teaching method. Teaching a practical skill using the LS method also gives more confidence for the participants to perform the procedure independently. Other advantages of the LS method, such as the ability to study from outside the sterile environment, are also promising. We recommend improvements in the audiovisual quality of the camera and a stable internet connection before performing the LS teaching method., (© Freda Halim, Allen Widysanto, Petra Octavian Perdana Wahjoepramono, Valeska Siulinda Candrawinata, Andi Setiawan Budihardja, Andry Irawan, Taufik Sudirman, Natalia Christina, Heru Sutanto Koerniawan, Jephtah Furano Lumban Tobing, Veli Sungono, Mona Marlina, Eka Julianta Wahjoepramono. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Abstract: Students with physical disabilities are underrepresented in medicine, driven in part by ableist beliefs about the ability of individuals with disabilities to complete procedure-based or surgically oriented clerkships, including obstetrics and gynecology (Ob/Gyn). There is a growing commitment to disability inclusion by medical and specialty training associations. Yet published case studies and accommodation protocols for medical student wheelchair users navigating an Ob/Gyn clerkship are absent in the literature. This article describes successful disability inclusion for an Ob/Gyn clerkship, including accommodations for medical student wheelchair users. The authors share mechanisms to address and combat ableist assumptions and facilitate access for future medical students by working collaboratively with student and key stakeholders to develop an inclusive and accessible training experience.These recommendations are shared through the story of a third-year medical student who rotated through the longitudinal clerkships at the Cleveland Clinic Lerner College of Medicine. The student, an individual with osteogenesis imperfecta who uses a power wheelchair with a seat elevator, completed third-year rotations and thrived in her clinical experiences. The authors describe her journey through a robust 4-week Ob/Gyn clerkship, in which she fulfilled the required clinical core conditions and observation skills with reasonable accommodation. Given the high acuity, surgery, and outpatient demands in Ob/Gyn-and the transferrable skills to other clerkships-the student's experience is an excellent exemplar for demonstrating disability inclusion and reasonable accommodation.Ob/Gyn clerkship directors and clinical faculty can broadly use the recommended timelines and communication protocols to create accessible training environments. With student input, minor scheduling adjustments, ongoing communication, reasonable accommodations, and an open mind, medical students on the clinical wards who are wheelchair users can successfully navigate the required expectations of medical training., (Copyright © 2024 the Association of American Medical Colleges.)

Background: Medical students in the U.S. must demonstrate urgent and emergent care competence before graduation. Urgent and emergent care competence involves recognizing, evaluating and initiating management of an unstable patient. High-fidelity (HF) simulation can improve urgent and emergent care skills, but because it is resource intense, alternative methods are needed., Study Objective: Our primary purpose was to use program evaluations to compare medical student experiences with HF and virtual reality (VR) simulations as assessment platforms for urgent and emergent care skills., Methods: During their emergency medicine clerkship, students at The Ohio State University College of Medicine must demonstrate on HF manikins, competence in recognizing and initiating care of a patient requiring urgent or emergent care. Students evaluated these simulations on a five-point quality scale and answered open-ended questions about simulation strengths and weaknesses. Faculty provided feedback on student competence in delivering urgent or emergent care. In 2022, we introduced VR as an alternative assessment platform. We used Wilcoxon Signed Ranks and Boxplots to compare ratings of HF to VR and McNemar Test to compare competence ratings. Comments were analyzed with summative content analysis or thematic coding., Results: We received at least one evaluation survey from 160 of 216 (74.1%) emergency medicine clerkship students. We were able to match 125 of 216 (57.9%) evaluation surveys for students who completed both. Average ratings of HF simulations were 4.6 of 5, while ratings of VR simulations were slightly lower at 4.4. Comments suggested that feedback from both simulation platforms was valued. Students described VR as novel, immersive, and good preparation for clinical practice. Constructive criticism identified the need for additional practice in the VR environment. Student performance between platforms was significantly different with 91.7% of students achieving competence in HF, but only 65.5% in VR ( p ≤.001, odds-ratio = 5.75)., Conclusion: VR simulation functions similarly to HF for formative assessment of urgent and emergent care competence. However, using VR simulation for summative assessment of urgent and emergent care competence must be considered with caution because students require considerable practice and acclimation to the virtual environment.

Introduction: Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation., Method: We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance., Results: A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter., Discussion: This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills., (© 2024 Shenai et al.)

Introduction: Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors., Methods: We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group)., Results: Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts ( p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience ( p < .05)., Discussion: Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy., (© 2024 Neeley et al.)

Introduction: This module teaches core knowledge and skills for undergraduate medical education in reproductive health, providing instruction in the management of normal and abnormal pregnancy and labor utilizing interactive small-group flipped classroom methods and case-based instruction., Methods: Advance preparation materials were provided before the education session. The 2-hour session was facilitated by clinical educators using a faculty guide. Using voluntary surveys, we collected data to measure satisfaction among obstetrics and gynecology clerkship students and facilitators following each education session., Results: Capturing six clerkships spanning 9 months, 116 students participated, and 64 students completed the satisfaction survey, with 97% agreeing that the session was helpful in applying knowledge and principles to common clinical scenarios. Most students (96%) self-reported that they achieved the session's learning objectives utilizing prework and interactive small-group teaching. Nine clinical instructors completed the survey; all agreed the provided materials allowed them to facilitate active learning, and the majority (89%) agreed they spent less time preparing to teach this curriculum compared to traditional didactics., Discussion: This interactive flipped classroom session meets clerkship learning objectives related to the management of pregnancy and labor using standardized materials. The curriculum reduced preparation time for clinical educators as well., (© 2024 Wagoner et al.)

The COVID-19 pandemic has had many effects on medical student education, ranging from safety measures limiting patient exposure to changes in patient diagnoses encountered by medical students in their clerkship experience. This study aimed to identify the impact of the pandemic on the inpatient experiences of third- and fourth-year medical students by assessing patient volumes and diagnoses seen by students. Frequency and types of notes written by medical students on hospital-based pediatric rotations at Kapi'olani Medical Center for Women and Children as well as patient diagnoses and ages were compared between 2 time periods: pre-pandemic (July 2018-February 2020) and pandemic (May 2020-September 2021). On average, the number of patients seen by medical students was significantly reduced in the pandemic period from 112 patients/month to 88 patients/month ( P =.041). The proportion of patients with bronchiolitis or pneumonia were also significantly reduced in the pandemic period ( P <.001). Bronchiolitis was diagnosed in 1.3% of patients seen by medical students during the pandemic period, compared with 5.9% of patients pre-pandemic. Pneumonia was diagnosed in 1.0% of patients seen by medical students in the pandemic period compared with 4.6% pre-pandemic. There was no significant difference in patient age between the 2 groups ( P =.092). During the first 18 months of the COVID-19 pandemic, medical students in this institution had a remarkably different inpatient experience from that of their predecessors. They saw fewer patients, and those patients had fewer common pediatric respiratory diseases. These decreases suggest these students may require supplemental education to compensate for these gaps in direct pediatric clinical experience., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2024 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Introduction: Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team., Methods: Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes., Results: Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model., Discussion: This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting., (© 2023 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Introduction: The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning., Methods: We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles., Results: Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students' professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about 'Positive Health'. We constructed four design principles, including: to question and discuss students' professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment., Discussion: Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Problem & Background: Medical education has acknowledged the impact of structural societal factors on health, prompting the need for curricula seeking to eliminate health inequities upstream while simultaneously caring for downstream effects of existing inequities. The Keck School of Medicine of USC (KSOM) implemented one such comprehensive curriculum, Health Justice and Systems of Care (HJSC), integrating health systems science, structural competency, and service-learning in a required course spanning the pre-clerkship and clerkship phases with an optional post clerkship elective., Approach: The HJSC course addresses topics including racism in medicine, health inequities, and health systems science. Using transformative learning theory, it fosters critical consciousness and structural competency. Assessments include case analyses, reflections, team-based learning sessions, and group projects related to social justice in healthcare. The program aims to instill cultural humility and practical application, fostering a holistic approach to medical education that implores physicians to become advocates for health justice., Outcomes of the Innovation: Feedback from students indicated generally positive perceptions of the curriculum. Students provided overall positive comments about discussions with guest speakers. However, students expressed a desire for more concrete examples of how health inequities can be remedied. Some found small-group activities less engaging. Other challenges included providing students of different readiness levels with tailored experiences and seamlessly integrating HJSC content within basic and clinical sciences courses., Critical Reflection: Next steps include continuing to integrate content into the science curriculum and clerkships, improving opportunities for meaningful student interactions, and enhancing faculty development to address health justice concerns in clinical settings., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: Pelvic fistulas affect a significant number of patients globally, with a relatively low prevalence in the United States. Virtual education offers an effective, scalable solution to bridge this educational gap and lead to a deeper understanding of more common conditions, such as urinary and fecal incontinence., Methods: We developed two virtual cases on rectovaginal and vesicovaginal/ureterovaginal fistulas to enhance medical students' exposure, knowledge, and confidence regarding assessment of pelvic fistulas. The cases could be completed in approximately 30 minutes, asynchronously, and at students' own pace. The cases were integrated into an OB/GYN clerkship. We conducted a survey among students receiving the cases to gather feedback on usability, acceptability, and educational value, which guided subsequent improvements., Results: Forty medical students, ranging from first to third year, participated in the urogynecology elective; 21 (53%) completed the survey. Ninety-one percent agreed or strongly agreed they were satisfied with the cases. All respondents found the format easy to use and appropriate for their level of learning. Most reported the cases improved their confidence in nonsurgical and surgical management options for pelvic fistulas., Discussion: Offering virtual and interactive patient cases on e-learning platforms represents an innovative approach to increasing clinical exposure to urogynecologic disorders. By providing medical students with the opportunity to interact with pelvic fistulas virtually, these cases can help bridge a gap in clinical education. Future exploration is valuable for examining knowledge deficiencies and developing cost-effective, self-paced, easily accessible educational resources to advance medical training and optimize patient care., (© 2024 Le Neveu et al.)

Objective: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets., Methods: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical., Results: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d ) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05., Conclusions: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship., Material and Methods: The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated., Results: Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction., Conclusions: We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes., (© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Despite its high potential, patient feedback does not always result in learning. For feedback to be effective students must engage with it, which partly depends on their perceptions of feedback. To better understand student engagement with patient feedback in a clinical context, this study explored the following research questions: 1) What are medical students' general beliefs about patient feedback and what are their specific perceptions of feedback messages? 2) What is the difference between these general beliefs and feedback message perceptions before and after patient feedback training?, Methods: The study context was a 12-week clerkship combining Pediatrics and Gynecology, which included feedback training for students and asking for patient feedback. Ninety 4 th -year medical students completed pre- and post-clerkship questionnaires. The questionnaires (Beliefs about Patient Feedback Questionnaire, Feedback Perception Questionnaire) were adapted from validated peer-feedback questionnaires. Questionnaires were quantitatively analyzed., Results: Both pre- and post-clerkship, students had positive general beliefs about patient feedback and positive perceptions of the feedback messages they received. However, paired t-tests showed that students' general beliefs and feedback message perceptions became less positive after feedback training and experience., Discussion: Patient feedback is not an easy means to learn and students do not become feedback literate in terms of patient feedback overnight. We suggest that future researchers further explore reasons for the decline in positive perceptions of patient feedback. We suggest implementing longitudinal feedback training in medical curricula, where students are guided and supported in the complex task of learning from patients through feedback., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

The transition between pre-clerkship and clerkship can be difficult for medical students. Near-peer teaching may fill knowledge gaps within curricular clerkship orientation, leveraging recent, relatable, and up-to-date experiences from near-peers. These benefits have not been formally evaluated in the context of a clerkship orientation. We therefore created the Clerkship Primer, a near-peer teaching initiative that aimed to introduce incoming clerks to clerkship through a curricular session facilitated exclusively by senior clerkship students. Sessions had high satisfaction among students. This pilot project suggests that curricular near-peer teaching is a valuable component of clerkship orientation., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 Zhao, Shirazi, Trinder, Hominuke, Ruddy, Malin, McKague; licensee Synergies Partners.)

Objectives: This study aimed to investigate and compare the clinical knowledge implications of the integrated management of childhood illness (IMCI) preservice education between pre-clerkship and junior clerkship medical students., Methods: This observational comparative cross-sectional study was conducted between June and August 2022 at Sultan Qaboos University, Muscat, Oman. A self-administered questionnaire was utilised and included questions on sociodemographic data, duration of IMCI preservice training, knowledge of the participants concerning the IMCI objectives and information on a range of childhood conditions., Results: A total of 97 medical students were included in the study. The majority of students (42.3%) had received 2 lectures in IMCI preservice training. The role of the IMCI approach in reducing childhood morbidity and mortality was advocated by the majority of students (80.8% in the junior-clerkship [JCR] group and 73.3% in the pre-clerkship group). The awareness of the IMCI component of improving the health system was higher in JCR compared to pre-clerkship participants ( P = 0.044). When compared to pre-clerkship students, the JCR participants demonstrated a slightly higher awareness of skin pinch ( P = 0.038), chest indrawing ( P = 0.008), anaemia assessment based on nail bed examination ( P = 0.002), diagnostic assessment of malnutrition based on palm examination ( P = 0.018), sucking capacity in breastfeeding ( P = 0.025), and vaccines such as those for tuberculosis ( P = 0.001), pneumococcal ( P = 0.018) and rotavirus ( P = 0.007)., Conclusion: The majority of students displayed good IMCI knowledge and JCR students showed better knowledge compared to pre-clerkship candidates., Competing Interests: CONFLICTS OF INTEREST: The authors declare no conflict of interest., (© Copyright 2024, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Stellenbosch University embarked on a renewal of its MBChB programme guided by an updated set of core values developed by the multidisciplinary curriculum task team. These values acknowledged the important role of (among others) context and generalism in the development of our graduates as doctors of the future for South Africa. This report describes the overall direction of the renewed curriculum focusing on two of the innovative educational methods for Family Medicine and Primary Health Care training that enabled us to respond to these considerations. These innovations provide students with both early longitudinal clinical experience (now approximately 72 h per year for each of the first 3 years) and a final longitudinal capstone experience (36 weeks) outside the central tertiary teaching hospital. While the final year experience will run for the first time in 2027 (the first year launched in 2022), the initial experience has got off to a good start with students expressing the value that it brings to their integrated, holistic learning and their identity formation aligned with the mission statement of this renewed curriculum. These two curricular innovations were designed on sound educational principles, utilising contextually appropriate research and by aligning with the goals of the healthcare system in which our students would be trained. The first has created opportunities for students to develop a professional identity that is informed by a substantial and longitudinal primary healthcare experience.Contribution: The intention is to consolidate this in their final district-based experience under the supervision of specialist family physicians and generalist doctors.

Rationale and Objectives: Radiology remains underrepresented in U.S. medical school clinical curricula, and preconceived opinions about the field may impact whether students pursue elective exposure. A core radiology clerkship at one academic institution presents an opportunity to evaluate students' early preferences for different radiology subspecialties, thus informing curricular design and inspiring student recruitment., Materials and Methods: At a single allopathic medical school, a required, four-week, clinical-year radiology clerkship that occurs in the second year includes immersive one-week experiences in two subspecialties. Prior to their clerkship, students rank their immersion preferences by distributing 100 points across eight fields, the values of which were analyzed as a proxy for interest. A secondary survey was distributed to active first- and second-year medical students to further investigate the factors drawing them to radiology., Results: Immersive experiences in musculoskeletal, body, and breast imaging were most preferred, earning ≥20 points from 41.6 %, 34.3 %, and 31.9 % of students, respectively. Women were significantly more likely than men to express interest in breast imaging (35.8 % vs. 24.8 %, p = 0.037) and pediatric radiology (28.8 % vs. 12.8 %, p = 0.001). Men were significantly more likely than women to prefer body imaging (41.9 % vs. 30.2 %, p = 0.034), neuroradiology (29.1 % vs. 19.5 %, p = 0.048), and nuclear medicine (11.1 % vs. 5.1 %, p = 0.044)., Conclusion: Early in their clinical education, medical students prefer certain subspecialties, especially musculoskeletal, body, and breast imaging. Women expressed significantly stronger interest in breast imaging and pediatric radiology, while men indicated significantly stronger interest in body imaging, neuroradiology, and nuclear medicine., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students' clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan., Methods: In April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students., Results: The LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents., Conclusions: The LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students., Trial Registration: Ethical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2-106-05-018)., (© 2024. The Author(s).)

Introduction: The surgical clerkship is a formative experience in the medical school curriculum and can leave a lasting impression on students' perception of surgery. Given the historical negative stereotypes of surgeons, the clerkship represents an opportunity to impact students in a meaningful way., Methods: Our institution developed a program in which research residents can serve as junior clerkship coordinators and educators; working closely with medical students on their surgery clerkship. At the end of their clerkship, students were administered a survey with Likert-scale and free text responses regarding satisfaction with the rotation, lectures, feedback, and value of the clerkship. Student survey results were compared before (2015-2016) and after (2017-2019) the implementation of the scholar program with nonparametric statistical analysis and qualitative text analysis., Results: A total of 413 students responded to the survey with no significant difference in response rate by term (P = 0.88). We found no statistical difference with respect to overall course perception (92.3% versus 91.2%, P = 0.84), but a statistically significant difference was noted for the clarity of the provided written clerkship materials (80.3% versus 91.3%, P = 0.02) and usefulness of the feedback (57.5% versus 78.7%, P = 0.01). Qualitative analysis demonstrated an overall positive shift in perception of the clerkship, improvement in the course materials, and organization., Conclusions: The scholar program was overall well received by the students with improvements in certain aspects of the clerkship: organization, feedback, and course materials. This program represents a potential strategy to improve certain portions of the medical school clerkship experience., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment., Method: In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership., Results: Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 1-4; range, 0-50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were "always" aware of the outcome of bias reports., Conclusions: Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting., (Copyright © 2023 the Association of American Medical Colleges.)

Introduction: Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC., Methods: The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed 'Secrets to success'. The session was recorded with the participants' consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified., Results: Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed., Discussion: This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC., (© 2023. The Author(s).)

Background: While educators observe gaps in clerkship students' clinical reasoning (CR) skills, students report few opportunities to develop them. This study aims at exploring how students who used self-explanation (SE) and structured reflection (SR) for CR learning during preclinical training, applied these learning strategies during clerkship., Methods: We conducted an explanatory sequential mixed-methods study involving medical students. With a questionnaire, we asked students how frequently they adopted behaviours related to SE and SR during clerkship. Next, we conducted a focus group with students to explore why they adopted these behaviours., Results: Fifty-two of 198 students answered the questionnaire and five participated in a focus group. Specific behaviours adopted varied from 50% to 98%. We identified three themes about why students used these strategies: as "just in time" learning strategies; to deepen their understanding and identify gaps in knowledge; to develop a practical approach to diagnosis. A fourth theme related to the balance between learning and assessment and its consequence on adopting SE behaviours., Conclusions: Students having experienced SE and SR regularly in preclinical training tend to transpose these strategies into the clerkship providing them with a practical way to reflect deliberately and capture learning opportunities of the unpredictable clinical context., Competing Interests: The authors report there are no competing interests to declare., (© 2023 Chamberland, Beaudoin, Boulais, Bergeron, St-Onge, Dubé; licensee Synergies Partners.)

Introduction: Medical students historically receive little to no preclinical exposure to surgery and surgical subspecialties. As a result, by the time they reach their clinical clerkship time, students often have already found interest in other specialties. The goal of this study is to utilize the knowledge to action (KTA) implementation framework to design and refine a clinical immersion experience during the second year of medical school., Methods: A total of 94 second-year Harvard Medical School students underwent the surgical immersion experience between 2019 and 2022 (the program was postponed in 2020 due to COVID). The development and refinement of the curriculum were nicely modeled by the KTA implementation framework. We identified a gap in medical student preclinical education, adapted a curriculum for preclinical medical students at Massachusetts General Hospital , selected the curriculum components to provide a high-level overview of surgery, monitored the student experience, and evaluated outcomes using the student surveys. Based on the survey results, inductive thematic analysis was utilized to identify prominent positive and negative themes. The feedback was then used to tailor subsequent iterations of the immersion experience., Results: Eighty-eight medical students completed the survey (RR = 93.6%), and 85% rated the immersion experience as "excellent", 11% "very good", 4% "good", and 0% "fair" or "poor". There was no significant difference in ratings between sessions. Several key themes were identified, including changed perceptions, diversity of surgical fields, teamwork, surgery clerkship preparedness, and the need for more preclinical exposure., Conclusions: Preclinical medical students gave overwhelmingly positive reviews of the surgical immersion experience. A half-day intervention is sufficient to begin changing students' views toward surgery, disproving stereotypes, and even inspiring some to consider a surgical field themselves. In addition, the KTA implementation framework is a useful model for the development and refinement of medical education curricula., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background and Objectives: The COVID-19 pandemic necessitated rapid changes to medical education for student and patient protection. A dearth of published US studies examine resulting clinical education outcomes due to pandemic-induced curricula changes. We describe adaptations made to a family medicine clerkship to move it from traditional in-person delivery to virtual only, and then from virtual to hybrid; and compare educational outcomes of students across delivery types., Methods: We stratified 386 medical students in their third year completing their 8-week family medicine clerkship by type of content delivery, including in person, virtual only, and hybrid instruction. We examined the impact of these changes on three clerkship learning outcomes: the midblock assessment score, the National Board of Medical Examiners (NBME) exam score, and the final numeric score (FNS)., Results: In our sample, 164 (42.5%) received content in person, 36 (9.3%) received virtual only, and 186 (48.2%) received hybrid content. Students receiving virtual only (M=76.4, SD=9.1) had significantly higher midblock assessment scores (F=8.06, df=2, P=.0004) than students receiving hybrid (M=71.7, SD=8.8) and in-person training (M=74.5, SD=7.2). No significant differences existed in students' NBME exam scores or FNSs across delivery types., Conclusions: Students receiving virtual-only or hybrid content performed at least as well on three clerkship-related educational outcomes as their pre-COVID peers participating in person. Further research is needed to understand how changes to medical education affected student learning and skill development.

Evaluating medical students during surgical clerkships relies on multifactorial methods of evaluation. Clinical evaluations, combined with standardized multiple-choice exams, are often the foundation of evaluation highlighting the challenge of combining subjective and objective measurements. Oral board exams are standard amongst medical certification and employ an additional element to evaluate students more holistically. Course evaluations from years that incorporated an oral board exam were compared to a year that omitted the exam. We found course satisfaction was higher in the years that included the oral exam (3.25 /5) than years without the oral board exam (3/ 5). The oral exam adds a novel element to the evaluation of a medical student that allows for a comprehensive understanding of a student's fund of knowledge and helps prepare them for future board certifications. Because students have an opportunity to demonstrate knowledge in a standard, more comprehensive format, they have higher satisfaction with the course.

Objectives: It often is challenging to deliver clerkship didactic sessions in a time-effective and engaging manner for learners. The flipped classroom approach, which fosters independent learning before applying knowledge in group settings, is an evidence-based way to enhance engagement and learning. Electronic learning methodologies were used widely during the coronavirus disease 2019 pandemic to ensure student safety while continuing didactics remotely. Student teaching of didactics delivers key content in innovative ways while also providing students with the opportunity to teach their peers., Methods: During the Family Medicine clerkship at Florida International University Herbert Wertheim College of Medicine, students deliver an interactive, 15-minute presentation on a core Society of Teachers of Family Medicine National Clerkship Curriculum topic. During the first year of the pandemic (2020), this assignment was transitioned to be conducted remotely via Zoom. For the 2020-2021 academic year, students completed an anonymous, optional, computer-based, postactivity survey to assess their satisfaction with and perceptions of the assignment., Results: The majority (80%) of respondents reported that they enjoyed teaching in the online format. In addition, students reported that this assignment made them feel confident in their teaching abilities, that they learned from their peers, and that teaching helped clarify their understanding of the topic., Conclusions: Student-led teaching is beneficial to learners because it enhances engagement. It can be easily implemented and help reduce faculty burden for curricular development. In a distributed, community-based clinical model such as ours, electronic learning allows for coordinated teaching efforts across geographical boundaries.

Objective: Improvements to the medical student surgical learning environment are limited by lack of granular data and recall bias on end-of-clerkship evaluations. The purpose of this study was to identify specific areas for intervention using a novel real-time mobile application., Design: An application was designed to obtain real-time feedback from medical students regarding the learning environment on their surgical clerkship. Thematic analysis of student experiences was performed at the conclusion of 4 consecutive 12-week rotation blocks., Setting: Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts., Results: Fifty-four medical students at a single institution were asked to participate during their primary clerkship experience. Students submitted 365 responses over 48 weeks. Multiple themes emerged which were dichotomized into positive and negative emotions centered on specific student priorities. Approximately half of responses were associated with positive emotions (52.9%) and half with negative emotions (47.1%). Student priorities included the desire to feel included in the surgical team (resulting in feeling engaged/ignored), to have a positive relationship with members of the team (perceiving kind/rude interactions), to witness compassionate patient care (observing empathy/disrespect for patients), to have a well-planned surgical rotation (experiencing organization/disorganization within teams), and to feel that student well-being is prioritized (reporting opportunities/disregard for student wellness)., Conclusion: A novel, user-friendly mobile application identified several areas to improve the experience and engagement of students on their surgery clerkship. Allowing clerkship directors and other educational leaders to collect longitudinal data in real time may allow for more targeted, timely improvements to the medical student surgical learning environment., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Virtual patient cases (VPCs), a type of simulated, interactive electronic learning, are a potentially important tool for military health care providers in austere or pandemic settings to maintain skills but need more validation. Our military internal medicine clerkship is spread across military treatment facilities around the country and has 15 weekly live student lectures, but students randomly miss the first, second, or third 5 weeks due to their psychiatry clerkship. We hypothesized that VPCs would be an adequate replacement for lost lectures., Materials and Methods: We compared live lectures to a web-based VPC and analyzed the academic outcomes of 734 students from 2015 to 2022., Results: Using our end-of-clerkship Script Concordance Test (SCT) as the primary outcome, there was no significant difference in performance between the 2 learning methods (VPC, 63.9% correct; lectures 63.2%, P = .27). After controlling for gender, baseline knowledge, and the total number of VPCs completed, there was still not a statistically significant difference between teaching methods (F(1,728) = 0.52, P = .47). There was also no significant differences in all other clerkship outcomes including National Board of Medical Examiner and Objective Structured Clinical Examination scores., Conclusion: VPCs appear noninferior at teaching clinical reasoning as measured by SCT. VPCs might be substituted for traditional, live lectures in clerkships when time or other resources are limited, in austere environments such as military deployments, or during conditions limiting interpersonal contact such as pandemics but are not a complete substitution for in-person learning., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Accurate and efficient self-assessment is a critical skill for medical students to develop as part of their professional development. Along with clinical training reform at Fukushima Medical University, rubric-based student self-assessment and teacher assessment of students' performance using our proposed assessment tool, which includes several aspects of clinical skills and abilities, was initiated to improve the clinical clerkship process. To investigate how students identified their weaknesses and strengths, we analyzed the results of 119 fourth-year medical students' self-assessment and corresponding teacher assessment. Our study revealed substantial consistency between student self-assessment and teacher assessment, despite some overestimation and underestimation in student self-assessments. Students who incorrectly assess themselves require a variety of feedback to increase their self-efficacy and self-confidence, as well as to identify their weaknesses.

Introduction: The COVID-19 pandemic presented unique challenges to medical student education. Medical student activities involving direct patient contact were limited, challenging anesthesiology programs to develop innovative means of presenting a clinical experience to trainees. In response, the Department of Anesthesiology at the University of Minnesota Medical School quickly transitioned its introductory anesthesiology clerkship to be entirely virtual. We designed the resulting curriculum to provide medical students with the most experiential learning experience possible., Methods: We created and conducted a virtual curriculum for medical students that incorporated video-recorded simulation-based scenarios to facilitate case-based learning discussions (CBLDs). At the end of their 2-week rotation, students completed a postclerkship survey with Likert-scale questions and an open-ended question intended to elicit feedback and evaluate the efficacy of the virtual curriculum., Results: Twenty-eight medical students finished the 2-week virtual anesthesiology clerkship over eight blocks, with all 28 students completing the postclerkship survey. Survey responses demonstrated that the virtual clerkship met or exceeded expectations in all areas. A majority of students (74%, 14 of the 19 who answered the associated question) felt that the faculty-led CBLD exercises were informative. All 28 students agreed or strongly agreed that the virtual assignments were valuable and facilitated learning., Discussion: We successfully implemented a virtual anesthesiology clerkship curriculum in response to constraints presented by the COVID-19 pandemic. The virtual format provides trainees with a simulated clinical experience that can be utilized not only during future pandemics but also in modern training curricula., (© 2023 Nguyen et al.)

Objective: The Uniformed Services University of the Health Sciences 5-week psychiatry clerkship educates about 180 students a year at sites around the USA. In 2017, weekly in-person experiential learning sessions were implemented for local students and resulted in improved performance in several end-of-clerkship Objective Structured Clinical Examination (OSCE) skills as compared to distant learners who did not receive these sessions. The difference in performance (~ 10%) highlighted a need to provide comparable training for distant learners. Providing in-person, repeated simulated experiential training at multiple distant sites was not practical, requiring development of a novel online approach., Methods: Students at all four distant sites over 2 years (n = 180) participated in five weekly synchronous online experiential learning sessions, while local students (n = 180) received five weekly in-person experiential learning sessions. Tele-simulation used the same curriculum, centralized faculty, and standardized patients as the in-person iterations. Overall end-of-clerkship OSCE performance was compared for learners receiving online versus in-person experiential learning for non-inferiority. Specific skills were compared to receiving no experiential learning., Results: Overall OSCE performance was non-inferior for students who received synchronous online as compared to in-person experiential learning. Performance on each skill other than communication improved significantly when comparing students who received online versus no experiential learning (p < 0.05)., Conclusions: The use of weekly online experiential learning to enhance clinical skills is comparable to in-person efforts. Virtual, simulated, synchronous experiential learning provides a feasible and scalable platform for training complex clinical skills to clerkship students, a critical capability given the impact the pandemic has had on clinical training., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: To assess the unmet needs associated with surgical education and skill development during the pre-clerkship years of medical school., Design: A mixed-methods design was employed that leveraged semi-structured interviews and quantitative surveys followed by qualitative analysis., Setting: A large midwestern academic medical center., Participants: Eighteen participants were enrolled representing second year medical students with an interest in surgery, surgical residents, and attending surgeons from a diverse array of surgical specialties., Results: Unanimous support for the creation of a pre-clerkship surgical skills course emerged due to 2 main themes: (1) gaps in current surgical education offerings and (2) the value of early exposure to surgery and surgical skills followed by longitudinal practice. The components that participants deemed essential to a well-designed course were also revealed. Each stakeholder group (medical students, residents, surgeons) would benefit across all factors uncovered., Conclusions: There is a significant unmet need across all stakeholder groups for the creation of a longitudinal surgical skills course for pre-clerkship medical students. Future studies should seek to design a curriculum based on these study results and assess a pilot version of the curriculum to understand its feasibility under application., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Due to the COVID-19 pandemic, numerous institutions converted medical education didactics to electronic formats including both live teleconference didactics and recorded faculty lectures. This study aims to compare the effect of recorded versus live teleconference didactic lectures on medical student examination scores during the surgery clerkship., Design: Medical students completing the Surgery Clerkship received a weekly series of didactic lectures taught by faculty via a teleconference (2020-2021 academic year) or recorded format (2021-2022 academic year). Performance outcomes included weekly quizzes, National Board of Medical Examiners (NBME) Surgery Shelf Exam, and clerkship Objective Structured Clinical Examination (OSCE) scores., Setting: University of Miami Miller School of Medicine., Participants: All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over two academic years (n = 312)., Results: Students who received live teleconference lectures (n = 156) demonstrated higher average scores on weekly quizzes (89%) and the NBME shelf exam (76%) compared to those receiving recorded lectures (n = 156; 71% quiz, 70% shelf exam), both p < 0.001. There was a significant association with performance in the highest quartile (Q1) of weekly quiz scores and receiving live lectures (40% vs. recorded lectures 1%, p < 0.001). Comparing only MS3 students, mean weekly quiz scores and Q1 achievement were significantly higher (both p < 0.001) in the teleconference cohort with no significant difference in NBME shelf exam performance (p = 0.971). No difference in OSCE performance was observed between groups., Conclusion: These results suggest that synchronous teleconferences may be more effective than recorded lectures for achieving institutional learning objectives on the surgery clerkship without any negative impact on NBME shelf exam or clinical evaluation parameters. This information should be used to inform future institutional clerkship design and educational initiatives., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

The Education-Centered Medical Home (ECMH) is a longitudinal clerkship where students provide care to patients at one clinic site for the entirety of medical school. Studies have demonstrated that ECMHs have higher completion rates of preventative measures than traditional student-run free clinics (SRFCs). However, data comparing ECMHs with licensed primary care provider clinics are limited. We performed a prospective chart review that examined vaccination and cancer screening rates of patients in an ECMH and those seen by primary care physicians (PCPs) at the same free clinic site. We then compared these groups with participants in the 2018 National Health Information Study (NHIS). A total of 62 ECMH patients, 3,515 PCP patients, and 25,045 NHIS participants were included in the study. Within the ECMH, 72.7% and 80.0% of patients were screened for breast and cervical cancer, respectively. These rates did not differ significantly from those of PCP patients or NHIS participants. While the percentage of ECMH patients screened for colon cancer was similar to that of PCP patients (78.9% vs. 65.8%, p = 0.09), it was proportionally greater than NHIS screening rates (78.9% vs. 63.3%, p = 0.043). In addition, the rate of influenza and pneumococcal pneumonia vaccination among ECMH patients (41.4% and 58.3%, respectively) did not differ significantly from the PCP and NHIS groups. Our study found that the ECMH model allows students to deliver preventative care comparable to licensed practitioners and national benchmarks. It reaffirms the ECMH as an effective method for students to provide high quality care to underserved patients.

Purpose: Racial/ethnic disparities exist in clinical clerkship grading, yet little is known about medical student and faculty perspectives on why these disparities occur. This study explored what happens during clerkships that might explain grading disparities., Method: Medical students and clerkship teachers at 3 U.S. medical schools completed a demographic survey and semistructured interview. The constant comparative method was used to analyze transcripts by inductively developing codes; grouping codes in categories; and refining codes, descriptions, and group assignments to identify themes. Interpretations of and relationships among themes were iteratively discussed to develop a grounded theory., Results: Fifty-nine participants (29 medical students, 30 teachers [28 clinical faculty, 2 residents]) were interviewed in 2020. The Social Milieu of Medical Education (relationships, fit, opportunities, and judgments in the clinical-learning setting) was the organizing theme, influenced by 5 additional themes: Societal Influence (experiences in society), Students' Characteristics and Background (personal characteristics and experiences outside medical school), Assessment Processes (collection of student performance data and how data inform grades), Learning Environment (resources available and messaging within the clinical setting), and Students' Interactions and Reactions (interactions with and reactions to peers and teachers). The grounded theory highlights complex, multilayered aspects of how the social milieu of medical education is shaped by and shapes students' experiences, relationships, and clerkship assessments and promotes clerkship-grading disparities., Conclusions: Mitigating clerkship-grading disparities will require intervening on interrelated, contextual factors to provide equitable opportunities for students from diverse backgrounds and with varying styles of engagement in clinical-learning settings, along with attending to modifying assessment processes., (Copyright © 2022 by the Association of American Medical Colleges.)

Objective: We describe a novel approach to promoting medical student learning and engagement during trauma resuscitation with implementation of a structured observation and debriefing tool., Design: In the context of a multifaceted quality improvement effort in our emergency room, we implemented a structured trauma observation tool (SOT) for medical students based on ATLS trauma guidelines. The SOT reflects the American College of Surgeons and Association for Surgical Education (ACS/ASE) trauma evaluation module for medical students. Two medical students from our quality improvement working group undertook a proof-of-concept study to determine whether the SOT facilitated accurate observations of trauma resuscitations and promoted educational debriefs with precepting providers. Results were encouraging, so the tool was implemented for elective use on surgical clerkships. Clerkship students who used the SOT were given the opportunity to share its impact on their experience. Institutional Review Board approval was obtained under Pro00109569., Setting: A large level 1 trauma center at an academic hospital in the southeastern United States., Participants: An interdisciplinary working group including surgeons, emergency medicine physicians, nurses, and students developed the observation tool. Two medical students from this team showed that the tool was effective at guiding observations and facilitating debriefs prior to its broader implementation on the general surgery clerkship., Results: A total of 630 resuscitation tasks were observed during 15 trauma activations prior to implementation on the surgery clerkship. There was over 97% agreement between students observations and evaluating physicians self-reporting on which tasks were completed. Tasks on which there was disagreement were discussed to aid student learning. The tool was implemented for elective use on the surgery clerkship where students reported positive experiences., Conclusions: Early data suggest that this structured observation tool facilitates accurate trauma assessment observations and provides an opportunity for high-yield debriefs with the evaluating physician. This promotes student comprehension of ATLS principles. The SOT is being implemented as a pedagogic tool for students on the surgery clerkship to guide their observations, improve comprehension of decisions made in a hyperacute setting, and offer real time feedback as part of their learning in the trauma bay. The tool appears to be a valuable supplement which supports the ACS/ASE curriculum., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Feedback during clinical rotations can be valuable in improving medical student education, but it is unclear what effect such feedback has on subsequent clinical performance and also which feedback topics are the most important in student growth and education. We compared medical student clinical performance before and after mid-clerkship feedback in a Neurology clerkship, with evaluators at the mid-clerkship and at the end blinded to the others' comments. We found that the most important areas holding back student clinical performance were communication, interpersonal interactions, and work ethic rather than textbook knowledge, or the ability to take a history, and do a physical and neurologic examination. Further, students who had concerning comments at the mid-clerkship feedback session usually continued to have the same problems after the feedback (in an admittedly short clerkship). The results suggest that more attention should be given to communication and other interpersonal skills and involvement in the clinical service during feedback sessions and that feedback continue over a much longer period than during a relatively brief Neurology clerkship alone., (Copyright ©2022, Yale Journal of Biology and Medicine.)

Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs. A mixed-methods survey concerning LIC prevalence, variety, and experiences of responses to Covid-19 was circulated to all 33 UK medical schools through academic networks. 25 survey responses were received, representing 20 institutions. 12 faculty completed follow up semi-structured interviews. 13 LICs were reported: 1 wasn't running during 2020, 5 were running unchanged, and 7 with alterations. 2 additional LICs were planned. Thematic analysis of free-text survey and interview responses revealed that relationships between faculty and institutions were central in facilitating recent adaptations to UK LICs. Given model flexibility, an increased drive to develop LICs was also evident. Barriers to adapting programmes included uncertainty regarding progression of Covid-19 restrictions and issues with secondary care access. Investing in faculty development and support networks could increase LIC sustainability. By highlighting the relative resilience of UK LIC placements during Covid-19, these findings offer important insight for the future delivery of sustainable LICs within, and beyond, the UK.

Objective This cross-sectional national study determined which educational approaches are associated with the effectiveness of online clerkship for medical students. Method A survey was conducted for medical students at 78 medical schools in Japan from May 29 to June 14, 2020. It comprised the following aspects: (a) participants' profiles, (b) number of opportunities to learn from each educational approach (lecture, medical quiz, assignment, oral presentation, observation of a physician's practice, clinical skill practice, participation in interprofessional meetings, and interactive discussions with physicians) in online clerkship, (c) frequency of technical problems, and (d) educational outcome measurement (satisfaction, motivation, knowledge acquisition, skill acquisition, change in self-study time, and understanding of the importance of medical care team). Results Of the 2,640 respondents, 2,594 (98.3%) agreed to cooperate. Ultimately, 1,711 matched our inclusion criteria. All educational approaches but assignments were positively associated with satisfaction and motivation. All educational approaches excluding assignment submission and interprofessional meeting were positively associated with knowledge acquisition. Observation, practice, and interprofessional meeting were positively associated with skill acquisition. Only assignment submission was positively associated with the change in self-study time. Educational approaches excluding medical quizzes were positively associated with understanding the importance of the medical care team. Technical problems were negatively associated with motivation, knowledge acquisition, and skill acquisition. Conclusions Educators should implement various educational approaches, especially observation and practice, even in online clinical clerkship. They also need to minimize the technical problems associated with the Internet, as they reduce the effectiveness of online clerkship.

Background: Although suturing is an essential competency for medical students, there has been limited research into the skills acquisition process over the course of medical school curriculum. This study aimed to determine whether suturing ability improved over the course of clerkship and whether an interest in a surgical discipline was associated with improved skill acquisition., Methods: The suturing ability of third-year medical students at a large Canadian medical school was assessed at the beginning of clerkship (August 2018) as well as before and after their surgery rotation by 2 expert reviewers using a validated, objective scoring system as well as a qualitative assessment, both in person and via blinded video recordings. Students were randomly allocated to 4 groups for their clerkship year by the medical school., Results: Of 133 eligible students, 115 (86.5%) completed the study. Median suturing assessment scores improved significantly after the surgery rotation (214.5 [interquartile range (IQR) 191.1-235.0] v. 238.0 [IQR 223.5-255.0], p = 0.001). Groups that had completed a procedural rotation (emergency medicine, obstetrics and gynecology) between clerkship and starting their surgery rotation had improved scores between these time points ( p < 0.05), whereas scores decreased for groups that did not have a procedural rotation between assessments. Regardless of previous rotations, suturing scores were similar between groups after the surgery rotation. The 21 students (18.3%) who were interested in a surgical discipline had higher suturing scores than students who were not interested in surgery at the beginning of clerkship (229.1 [IQR 220.2-253.0] v. 208.0 [IQR 185.0-228.0], p < 0.001) and after the surgery rotation (252.0 [IQR 227.0-268.0] v. 235.8 [IQR 220.5-251.2], p = 0.02)., Conclusion: Medical students' suturing ability improved during the surgery rotation but was also influenced by other procedural rotations and students' interest in procedure specialties. Skill acquisition by medical students is complex and requires additional investigation., Competing Interests: Competing interests: None declared., (© 2022 CMA Impact Inc. or its licensors.)

Background: Oral health is an important component of medical education given its connection to overall health and quality of life; however, oral health is infrequently incorporated into medical school curricula in the United States. The aim of this study was to pilot a novel oral health care clerkship for United States medical students that implemented the Smiles for Life (SFL) curriculum, in-person clinical activities, and pre and post curricula assessments to assess knowledge acquisition, attitude change, and clinical skill development., Methods: Third year medical students at Albert Einstein College of Medicine, Bronx, New York, volunteered (n = 37) for a clerkship in oral health. Students completed the Smiles For Life National Oral Health Curriculum and participated in three half-day clinical sessions in a hospital-based dental clinic. The participants were evaluated on knowledge acquisition, attitude change, and clinical skill development through a pre and post clerkship assessment in order to assess the efficacy of the intervention., Results: There was a 23.4% increase in oral health knowledge (p < 0.001) following participation in the online modules and clerkship. Additionally, attitudes in the following domains showed improved familiarity and proficiency: causes and prevention of dental caries (78.4%, p < 0.001) and periodontal disease (83.8%, p < 0.001), provision of oral health information to patients (67.6%, p < 0.001), and ability to conduct an oral examination (62.2%, p < 0.001)., Conclusions: Third year medical students who participated in a novel oral health clerkship demonstrated significant increases in basic oral health knowledge and reported increased comfort in providing oral examinations and anticipatory guidance to patients. The results support the feasibility of this approach to incorporating oral health education into a medical school curriculum in the United States., (© 2022. The Author(s).)

Background: Effective teaching positively impacts student experience during the surgical clerkship. We sought to better understand how medical students characterize excellent surgical educators and how these characteristics may differ between residents and attendings., Methods: 289 nominations by third-year medical students for a surgical resident and attending teaching award were examined for thematic content using conventional content analysis., Results: Six major themes emerged: inclusion of students, prioritizing student education, facilitating procedural involvement, utilizing effective educational methods, providing mentorship, and role modeling. Residents were more frequently commended for the first three themes, while residents and attendings were recognized equally for the latter three., Conclusions: In identifying excellent surgical educators, students emphasized the educators' roles in fostering a positive learning environment where student education is prioritized. Residents were recognized more often than attendings for a broader set of qualities valued by students. Residents as teachers training should be structured to develop these qualities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Dual-process theory characterizes clinical reasoning (CR) as Type 1 (intuitive) and Type 2 (analytical) thinking. This study examined CR on a summative clinical clerkship structured clinical oral examination (SCOE)., Methods and Subjects: 511 clinical clerks at the University of Toronto underwent SCOEs. Type 1, Type 2, and Global CR performance were compared to other internal medicine clerkship assessments using descriptive statistics and Spearman correlations., Results: Clinical clerks achieved mean marks >75% on the three clinical reasoning stations, on Type 1 and 2 CR tasks, and the overall SCOE. Performance on the SCOE CR stations correlated with each of the other clerkship assessments: written examination, inpatient, and ambulatory clinic assessments. The correlation of performance between Type 1 and Type 2 clinical reasoning tasks was statistically significant but weak ( r s = 0.28). This suggests that defined measures of Type 1 and Type 2 reasoning were indeed assessing distinct constructs., Conclusion: Clinical clerks used both Type 1 and Type 2 reasoning with success. This study's characterization of Type 1 and Type 2 CR as separate domains, distinct from existing measures on the SCOE as well as the other clerkship assessments, can suggest a further addition to multimodal clerkship assessment.

Background: Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures., Methods: A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis., Results: The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance., Conclusion: Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

Introduction: The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education., Project Description: A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system "ILIAS"., Results: A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen's d=1.28)., Conclusion: A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022 Lenouvel et al.)