Medical Students' Perception of Telesimulation Training: A Qualitative Analysis

OBJECTIVES

Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced. The project aims to explore students' perspectives on simulated teleconsultation training compared to simulated clinics in person.

METHODS

Ten pre-clerkship students in the Faculty of Medicine at the University of Ottawa participated in interviews following in-person and teleconsultation simulated clinic sessions. The interview guide was developed based on previous work. The questions asked concerned experience with teleconsultation, interaction with the tutor and patient, practical or logistical obstacles, educational value and feasibility. The authors evaluated the results using a thematic analysis.

RESULTS

The interview analysis showed that the tutor feedback received during the simulated teleconsultation was comparable to that received after the in-person simulated clinic. Although most of the students enjoy teleconsultation, they raised the challenge of carrying out physical examinations and creating a personal connection with the tutor/patient.

CONCLUSION

Given the circumstances of the pandemic and students' comfort with technology, the new generation of medical students seems prepared to embrace teleconsultation. The themes identified in the analysis will enable the necessary adjustments to be made in order to optimize their teleconsultation training, an inextricable step in promoting the active offer of healthcare services.

Development of an undergraduate certificate in clinical and translational science: improving competence of the clinical research workforce

Introduction: Academic research centers often struggle to recruit and retain a well-trained and diverse clinical and translational science (CTS) workforce. In particular, the clinical research professional (CRP) career pathway is not well known to undergraduate students and other individuals outside of academic medicine despite being a potential career route. To address these workforce challenges, the CRP Task Force at the University of Cincinnati (UC) aims to train a competent and diverse CRP workforce through targeted educational programming in the UC undergraduate population. Methods: Using a six-step curriculum development process that included: 1) performing a needs assessment, 2) determining content, 3) writing goals and objectives, 4) selecting the educational strategies, 5) implementing the curriculum, and 6) evaluating the curriculum, we designed an undergraduate certificate program in CTS. Results: The needs assessment included both internal and external data gathering to inform curriculum development and program decisions. Content was determined using the Core Competency Framework for the Clinical Research Professional Version 3.1., and program learning outcomes were written with both the competency framework and local workforce needs in mind. Educational strategies were selected based on optimization of available resources and local expertise with an emphasis on interactive didactics complemented by experiential learning. Implementation is underway and evaluation will follow once students begin enrolling. Discussion: By educating an undergraduate student population about CTS methods and career opportunities, we anticipate increased numbers of well-qualified, diverse applicants who pursue CRP careers locally and regionally.

Making allyship visible: evaluation of a faculty development DEI curriculum

Undergraduate medical learners from historically marginalized groups face significant barriers, which was made concrete at our institution when a student presented her research indicating that Black students felt unsure about which faculty members to approach. To better support our students, we used Kern's model for curriculum development and a critical pedagogy approach to create a Faculty Allyship Curriculum (FAC). A total of 790 individuals attended 90 workshops across 16 months and 20 individuals have completed the FAC. A majority of participants reported they felt at least moderately confident in their ability to teach learners who are underrepresented in medicine, mentor learners who are different than they are, and teach allyship topics. An informal content analysis of open-ended responses indicated changes in awareness, attitude, insight, and use of language and being more likely to display advocacy. For others considering creating a similar program, partnering with an existing program allows for rapid implementation and reach to a wide audience. We also recommend: beginning with a coalition of willing learners to quickly build community and culture change; ensuring that the curriculum supports ongoing personal commitment and change for the learners; and supporting facilitators in modeling imperfection and upstanding, 'calling in' rather than 'calling out' learners.

The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism

INTRODUCTION

Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine.

METHOD

A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis.

RESULTS

Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education.

CONCLUSION

This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.

The Impact of Asking Medical Students What They Want to Learn on Student Participation in Lectures

BACKGROUND

The General Internal Medicine Acting Internship (GIM AI) at our school is a compulsory, one-month-long experience. Morning report-style case-based discussions were conducted on a weekly basis as part of the acting internship and were poorly attended. We sought to redesign our academic half day didactic curriculum and increase voluntary student attendance by allowing students to actively participate in determining the content of the acting internship academic half day.

INTERVENTION

Prior to the beginning of the acting internship, students were sent an email survey listing seven inpatient topics to rank on a scale of 1-5 (1=not at all interested, 5=very interested). Based on student feedback, one additional topic was added: antibiotic use for common inpatient diagnoses. Topics that received the highest score were selected for topic-based sessions. A total of 32 teaching sessions were conducted over eight months. Twenty-four of these sessions were topic-based and the remainder were case-based. Student attendance at these sessions was voluntary.

KEY RESULTS

Case-based discussions had the lowest preference ranking (n=94, mean=2.9), while cross-cover-based discussions (n=94, mean=4.3, p=0.001) and antibiotic use (n=52, mean=4.3, p=0.001) received the highest scores. Thirty-four percent (41/120) of possible learners attended case-based discussions, while 78% (281/360) of possible learners attended topic-based sessions (p<0.001). Learners reported a statistically significant improvement in comfort level in recognizing and managing 73% of sub-topics (29 out of 41) covered in topic-based sessions.

CONCLUSIONS

A learner-centered approach to curriculum design led to robust student engagement in our acting internship academic half day. Fourth-year students prefer specific topic-based teaching sessions over case-based, morning report-style sessions.

The Climate Wise slides: An evaluation of planetary health lecture slides for medical education

EDUCATIONAL CHALLENGE

There is an urgent need for innovations in planetary health medical education. Physicians must be prepared to provide high-value, low-carbon healthcare for patients increasingly impacted by the health consequences of climate change.

PROPOSED SOLUTION

The Climate Wise slides, an evidence-based, open-access pedagogical tool that provides didactic planetary health medical education organized by medical subspecialty, was developed and evaluated by a virtual lecture session that presented a subset of the slides to N = 75 Canadian medical students. Each participant completed a questionnaire before and after the Climate Wise virtual lecture that included multiple choice questions to assess their planetary health knowledge and a rating of their interest in including the Climate Wise slides in medical curricula.

LESSONS LEARNED

Participants showed significantly improved planetary health knowledge scores (p < 0.0001) and increased interest in including the Climate Wise slides in medical curricula (p < 0.001) after the virtual Climate Wise lecture session. This study demonstrates that the Climate Wise slides are a valuable pedagogical tool to advance planetary health medical education.

NEXT STEPS

Future directions include evaluating faculty perspectives on the Climate Wise slides, learning outcomes of the slides implemented longitudinally in medical curricula, and developing higher-order problem-based and simulation-based planetary health medical education resources. Given the urgent need for planetary health medical education, we recommend the global sharing of teaching resources to facilitate the rapid upscaling of validated pedagogical tools internationally.

Medical improvisation-based motivational interviewing for internal medicine residents: Mixed-methods evaluation of a novel course

PURPOSE

Develop and assess a novel medical improvisation-based motivational interviewing (MI) curriculum for residents.

MATERIALS AND METHODS

A 6-h medical improv-based MI curriculum occurred in 2022 for internal medicine residents. A mixed-methods evaluation included: pre- and post-role plays using the Motivational Interviewing Treatment Integrity Score (MITI) to assess MI competency, a post-course survey assessing confidence, and focus groups to understand learning through improvisation.

RESULTS

Participants increased their confidence in applying MI skills after the curriculum in responding to a patient's argument against change (29% pre vs. 72% post, p < 0.001), eliciting change talk (21% vs. 86%, p < 0.001), and providing information in an MI-centric way (39% vs. 86%, p < 0.001). All role-play participants achieved at least beginning proficiency on MITI technical and relational global summary scores post-course. MI-adherent behaviors increased, and MI-non-adherent behaviors decreased in post-course role plays. Themes on learning through improvisation included: (1) improvisation can enhance the learning of MI skills, (2) using non-medical scenarios in improvisation exercises has benefits, and (3) trying improvisation had positive effects on the learning environment.

DISCUSSION

A medical improvisation-based course is a promising, engaging way to teach residents MI skills and can improve competence and confidence with MI.

Assessing the Impact of a Hospice and Palliative Medicine Mentored Clinical Shadowing Experience for First-Year Medical and Dental Students: A Pilot Study

Background: All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives: To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design: Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements: The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results: 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions: Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care.

Skills, Not Just Knowledge: Infectious Diseases Fellows' Recommendations Regarding Antimicrobial Stewardship Training

BACKGROUND

Antimicrobial stewardship (AS) is an important topic in infectious diseases (ID) training, yet many ID fellowships lack formal training, and little is known about fellows' learning preferences.

METHODS

We conducted 24 in-depth interviews with ID fellows across the United States during 2018 and 2019 to explore their experiences with and preferences for AS education during fellowship. Interviews were transcribed, deidentified, and analyzed to identify themes.

RESULTS

Fellows had variable exposure to AS before and during fellowship, which impacted their knowledge about and attitude toward stewardship as a career; however, all fellows expressed the importance of learning general stewardship principles during fellowship. Some fellows' training included mandatory stewardship lectures and/or rotations, but most fellows felt their primary stewardship learning occurred through informal experiences in the clinical setting, such as holding the antimicrobial approval pager. Fellows expressed a preference for a standardized, structured curriculum that included in-person practical, interactive discussions with multidisciplinary faculty along with the opportunity to practice and apply their skills; however, they emphasized that time needed to be set aside for those educational activities. Although they wanted to learn the evidence and rationale for stewardship recommendations, they especially wanted training in and feedback on how to communicate stewardship recommendations to other health professionals, particularly in the setting of conflict.

CONCLUSIONS

ID fellows believe that standardized AS curricula should be included in their fellowship training, and they prefer structured, practical, and interactive learning experiences.

A novel internal training program using Kern's 6-step approach to curriculum development for medical laboratory scientists training to be international quality assurance/quality control coordinators

OBJECTIVE

Patient Safety Monitoring in International Laboratories (pSMILE) is a resource ensuring quality testing in clinical laboratories performing National Institutes of Health-funded HIV research requiring specific staff training. We demonstrate the development of an online asynchronous training model using Kern's 6-step approach to support pSMILE functions.

METHODS

An existing curriculum was revamped to incorporate Kern's approach. Metrics for success were described in rubrics with feedback guiding improvements and updates.

RESULTS

Curriculum updates took more than a year. Direct observations of skills informed curriculum changes. Module self-evaluations were reviewed to assess performance and the overall curriculum. The content, curriculum, and training documentation were deemed compliant with International Organization for Standardization (ISO) 9001:2015.

CONCLUSION

Asynchronous training for highly skilled and self-directed staff is a novel way to deploy training while maintaining productivity of existing staff. Feedback and evaluation allowed for curriculum updates including previously underdeveloped topics. Kern's approach ensured that the needs of the sponsor, management, laboratories, and learners were met.

Applying the Prism Model to design arts and humanities medical curricula

The arts and humanities (A&H) play a fundamental role in medical education by supporting medical learners' development of core competencies. Like all medical curricula, those integrating the A&H are more likely to achieve the desired outcomes when the learning domains, goals, objectives, activities, and evaluation strategies are well-aligned. Few faculty development programs focus on helping medical educators design A&H curricula in a scholarly manner. The Prism Model, an evidence-based tool, supports educators developing A&H medical curricula in a rigorous way for maximum impact. The model posits that the A&H can serve four pedagogical functions for medical learners: 1) skill mastery, 2) perspective taking, 3) personal insight, and 4) social advocacy. Although this model has been described in the literature, no practical guidance exists for medical educators seeking to apply it to the development of a specific curriculum. This paper provides a step-by-step demonstration of how to use the Prism Model to design an A&H curriculum. Beginning with the first step of selecting a learning domain through the final step of curriculum evaluation, this paper helps medical educators apply the Prism Model to develop A&H curricula with intentionality and rigour to achieve the desired learning outcomes.

Time is Short: Tools to Integrate Palliative Care and Communication Skills Education into Your Surgical Residency

The need to integrate palliative care (PC) training into surgical education has been increasingly recognized. Our aim is to describe a set of PC educational strategies, with a range of requisite resources, time, and prior expertise, to provide options that surgical educators can tailor for different programs. Each of these strategies has been successfully employed individually or in some combination at our institutions, and components can be generalized to other training programs. Asynchronous and individually paced PC training can be provided using existing resources published by the American College of Surgeons and upcoming SCORE curriculum modules. A multiyear PC curriculum, with didactic components of increasing complexity for more advanced residents, can be applied based on available time in the didactic schedule and local expertise. Simulation-based training in PC skills can be developed to provide objective competency-based training. Finally, a dedicated rotation on a surgical palliative care service can provide the most immersive experience with steps toward clinical entrustment of PC skills for trainees.

Online Otolaryngology: A Comprehensive Model for Medical Student Engagement in the Virtual Era and Beyond

When in-person experiences were taken away from medical students and residency applicants during the COVID-19 pandemic, institutions had to pivot to virtual experiences. We present here a comprehensive overview of virtual engagement for medical students. As we increasingly embrace virtual opportunities, it may be possible to continue utilizing these programs for many years to come.

A pilot study on the use of a novel digital real-time evaluation system in undergraduate preclinical training of tooth preparation in fixed prosthodontics

INTRODUCTION

In the light of the digital teaching, it is necessary that the effectiveness of a new digital real-time evaluation system in the preclinical training of tooth preparation be evaluated.

MATERIALS AND METHODS

Forty undergraduate dental students of the fourth year were randomly divided into the control group and the experimental group to complete the training task of tooth preparation for porcelain fused to metal (PFM) crown restoring the upper right central incisor. The control students received conventional training with instructor's guidance. The experimental students received training with the digital system without instructor's guidance. Every student exercised preparation in two resin incisors in 3 h training by respective training methods. A third incisor was prepared on a dental model in the simulated head phantom by each student as the test on the next day. All students' tooth preparations were scored by the same two experienced experts. The experimental students were asked to answer a questionnaire regarding their attitudes and opinions on the digital evaluation system in preclinical training.

RESULTS

There was no significant difference between the scores of the experimental group and the control group (p > .05). The students of two groups obtained the similar scores in the test (p > .05). Most of the students were supportive of the application of digital training system in the preclinical tooth preparation training course.

CONCLUSIONS

The digital real-time evaluation system could provide effective training effects for the dental undergraduate students in the preclinical training of tooth preparation in fixed prosthodontics.

Common Components of General Surgery Robotic Educational Programs

OBJECTIVE

Robotically assisted surgery has become more common in general surgery, but there is limited guidance from the Accreditation Council for Graduate Medical Education (ACGME) regarding this type of training. We sought to determine common elements and differences in the robotic educational curricula developed by general surgery residency programs.

DESIGN

Robotic educational curricula were obtained from the 7 individuals who presented at the workshop, "Robotic Education in General Surgery" at the 2023 Association of Program Directors in Surgery annual meeting.

RESULTS

All 7 general surgery programs had training beginning intern year, required online robotic modules, had at least 1 dedicated simulation training console not used for clinical purposes, and ran dry and wet (tissue) robotic labs at least annually. All programs had bedside and console surgeon case minimums and had administrative support to run the educational programs. Differences existed regarding how training intern year was executed, the simulations required, clinical practice minimum requirements, how progress was monitored over time, and how case numbers were tracked. Some programs had salary support for a director of robotic education.

CONCLUSIONS

There are several common elements to robotic educational curricula in general surgery, however significant variation does exist between programs. Given the frequency of robotic use in general surgery and current lack of standardization, formal guidance from the ACGME specifically regarding robotic education in general surgery residency is warranted.

Training future clinicians in telehealth competencies: outcomes of a telehealth curriculum and teleOSCEs at an academic medical center

Background

This study describes the program and learning outcomes of a telehealth skills curriculum based on the Association of American Medical Colleges (AAMC) telehealth competencies for clerkship-level medical students.

Methods

A total of 133 third- and fourth-year medical students in a required family medicine clerkship at Stanford University School of Medicine participated in a telehealth curriculum, including a telehealth workshop, site-specific telehealth clinical encounters, and telemedicine objective structured clinical examinations (teleOSCEs) between July 2020 and August 2021. Their workshop communication and physical examination competencies were assessed in two teleOSCEs utilizing a novel telehealth assessment tool. Students' attitudes, skills, and self-efficacy were assessed through voluntary pre-clerkship, post-workshop, and post-OSCE surveys.

Discussion

Most learners reported low confidence in their telehealth physical examinations [n = 79, mean = 1.6 (scale 0-5, 5 = very confident, SD = 1.0)], which improved post-workshop [n = 69, 3.3 (0.9), p < 0.001]; almost all (97%, 70/72) felt the workshop prepared them to see patients in the clinic. In formative OSCEs, learners demonstrated appropriate "webside manner" (communication scores 94-99%, four items) but did not confirm confidentiality (21%) or review limitations of the visit (35%). In a low back pain OSCE, most learners assessed pain location (90%) and range of motion (87%); nearly half (48%) omitted strength testing.

Conclusion

Our telehealth curriculum demonstrated that telehealth competencies can be taught and assessed in medical student education. Improvement in self-efficacy scores suggests that an 80-min workshop can prepare students to see patients in the clinical setting. Assessment of OSCE data informs opportunities for growth for further development in the curriculum, including addressing visit limitations and confidentiality in telehealth visits.

A Community-engaged Curriculum at Alpert Medical School: Centering Patient Communities in Medical Education

BACKGROUND

Incorporating opportunities for community engagement into undergraduate medical education (UME) can help learners to identify and address social determinants of health (SDoH). Multiple challenges exist in operationalizing these experiences.

METHODS

Using the Assessing Community Engagement (ACE) model, course directors at the Warren Alpert Medical School of Brown University (AMS) mapped community engagement initiatives to the four-year curriculum.

FINDINGS

Service-learning, community engagement projects, and clinical rotations at health centers and free clinics aim to equip learners at AMS with the necessary skills to address SDoH. Careful consideration should be given to the time and resources required to facilitate relationships with community-based agencies, learner reflection, program evaluation, and community-level outcomes.

CONCLUSIONS

Community engagement activities should be aligned with learning objectives during the pre-clerkship and clerkship stages of the existing UME curricula. Embarking on a curriculum redesign can create opportunities to expand partnerships with local agencies and deepen student engagement.

A Systematic Approach to the Design and Implementation of Clinical Informatics Fellowship Programs

Clinical Informatics (CI), a medical subspecialty since 2011, has grown from the initial four fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) in 2014 to more than 50 and counting in the present day. In parallel, the literature guiding Clinical Informatics Fellowship training and the curriculum evolved from the original core content published in 2009 to the more recent CI Subspecialty Delineation of Practice and the updated ACGME Milestones 2.0 for CI. In this paper, we outline this evolution and its impact on CIF Curricula. We then propose a framework, specific processes, and tools to standardize the design and optimize the implementation of CIF programs.

Early Engagement in HIV Research: Evaluation of the Penn CFAR Scholars Program Aimed at Increasing Diversity of the HIV/AIDS Workforce

BACKGROUND

Demographic diversity is not represented in the HIV/AIDS workforce. Engagement of underrepresented trainees as early as high school may address this disparity.

METHODS

We established the Penn Center for AIDS Research (CFAR) Scholars Program, a mentored research experience for underrepresented minority (URM) trainees spanning educational stages from high school to medical school. The program provides participants with tailored educational programming, professional skill building, and mentored research experiences. We conducted qualitative interviews with scholar, mentor, and leadership groups to evaluate the program's impact.

RESULTS

Eleven participants were selected to partake in 1 of 5 existing mentored research programs as CFAR scholars. Scholars attended an 8-week HIV Seminar Series that covered concepts in the basic, clinical, behavioral, and community-based HIV/AIDS research. Program evaluation revealed that scholars' knowledge of HIV pathophysiology and community impact increased because of these seminars. In addition, they developed tangible skills in literature review, bench techniques, qualitative assessment, data analysis, and professional network building. Scholars reported improved academic self-efficacy and achieved greater career goal clarity. Areas for improvement included clarification of mentor-mentee roles, expectations for longitudinal mentorship, and long-term engagement between scholars. Financial stressors, lack of social capital, and structural racism were identified as barriers to success for URM trainees.

CONCLUSION

The Penn CFAR Scholars Program is a novel mentored research program that successfully engaged URM trainees from early educational stages. Barriers and facilitators to sustained efforts of diversifying the HIV/AIDS workforce were identified and will inform future program planning.

The development and evaluation of a provider-focused educational intervention about alcohol use disorder in patients with cirrhosis

Background

Alcohol use disorder (AUD) is a leading cause of cirrhosis. Insufficient clinician knowledge and comfort managing AUD impacts access to treatment. Using Kern's Framework for Curriculum Development, we aimed to (i) develop and evaluate the effect of an "AUD in cirrhosis" educational intervention on clinicians' knowledge, attitudes, comfort, preparedness, and intention (practice habits) to integrate AUD management into their practice, and (ii) assess clinicians' motivation using Self Determination Theory.

Methods

Kern's approach was used for curriculum development. Pilot session feedback informed a three-part flipped-classroom series conducted by interdisciplinary clinicians in hepatology, psychiatry, primary care, and addiction psychology. Participants watched a video followed by a live session focused on (a) withdrawal, (b) screening and brief intervention, and (c) prescribing pharmacotherapy. Questionnaires assessing knowledge and practice habits were adapted from the literature. Attitudes were evaluated using the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Self Determination Theory informed motivation questions.

Results

Paired sample t-tests on pre-post questionnaires (n = 229 clinicians; 95 completed questionnaires) revealed significant improvements in preparedness and comfort screening, providing a brief intervention, prescribing pharmacotherapy, and SAAPPQ domains. No significant changes were observed in the intention to prescribe pharmacotherapy. Effect size analysis showed medium to large effects across most topic areas.

Conclusions

The developed sessions improved knowledge, attitudes, and practice habits of clinicians caring for this patient population. Given the rise in AUD and significant consequences in cirrhosis, this data offers promise that interactive education may improve practice habits of clinicians interfacing with this patient population.

Medical education in Latvia: an overview of current practices and systems

Located in northern Europe, Latvia is one of the three Baltic States with a population of 1.9 million. The country has a rich history of medical education spanning a century and is becoming an emerging global hub for medical education. Although the surge in international students has been beneficial for the development of educational and research infrastructure, increasing demands from local students, along with institutional capacity constraints, have overburdened the available resources. Substantial investments are being made to adapt to the rapidly changing geopolitical and techno-biomedical landscape. This perspective paper presents an overview of the country's medical education system, its challenges, and prospects from pre-university to doctoral level.

Essential anatomy for core clerkships: A clinical perspective

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.

Developing a European longitudinal and interprofessional curriculum for clinical reasoning

Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

Even one voice: Teaching legislative advocacy as a core competency in family medicine

Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health and as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME's recently revised statement on the training mission of family medicine residencies and with their most recent update of the Milestones which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular experiences in family medicine residency programs.