United States

Background: Mass casualty incident (MCI) training effectively increases trainees&#39; knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM (Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms.

Methods: Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of &lt;0.01 significant to correct for multiplicity using the Bonferroni method.

Results: Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, and understanding of emergency medical service training/transportation, as well as increased confidence in participating in an MCI (all p &lt; 0.001).

Conclusions: Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models&#39; ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

AMA Research Challenge 2024 

Triage for Dummies: A Low-Tech Mass Casualty Incident Training for Medical Students

Background: Mass casualty incident (MCI) training effectively increases trainees' knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM (Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms.

Methods: Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of <0.01 significant to correct for multiplicity using the Bonferroni method.

Results: Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, and understanding of emergency medical service training/transportation, as well as increased confidence in participating in an MCI (all p < 0.001).

Conclusions: Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models' ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

poster

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Background: Traditional didactic learning methods often fail to engage students actively, potentially limiting the retention of complex medical knowledge. This study introduces 'Adrenal Disorders Bingo', a game-based learning approach aimed at enhancing the understanding and recall of adrenal disorders among medical students.
Methods: This pilot study used a pre- and post-intervention survey with Likert-scale (1-5) responses to measure changes in students' knowledge, engagement, and application abilities regarding adrenal disorders. The game involved nearly 100 clues related to about 20 adrenal conditions. Students identified and matched these clues with their correct diagnoses on a bingo card. Whenever students achieved five matches in a row, they called "bingo." The game was supplemented by a comprehensive quiz and discussion session, promoting second and third-order thinking.
Results: The results showed significant improvement in students' confidence and ability to describe symptoms, differentiate between adrenal disorders based on clinical presentations and laboratory findings, and apply their knowledge in clinical scenarios. There was also a notable increase in student engagement and positive feedback on the learning experience.
Conclusion: 'Adrenal Disorders Bingo' offers a promising alternative to traditional learning methods, demonstrating potential for improved knowledge retention and engagement among medical students studying adrenal disorders. The interactive nature of the game, which incorporates nearly 100 clues about 20 adrenal conditions, fosters a more engaging and dynamic learning environment. This contrasts with the passive experience of traditional didactic lectures. By incorporating more interactive games into medical education, educators can enhance critical thinking, facilitate deeper understanding, and improve long-term retention of complex medical concepts. This approach not only makes learning more enjoyable but also prepares students to apply their knowledge more effectively in clinical settings. Future curricula should consider integrating similar game-based learning strategies to complement traditional methods, thereby providing a more effective and engaging educational experience.

Evaluating the Educational Impact of Game-Based Learning on Adrenal Disorders Among Medical Students

Background
Rhomboid strain, an increasingly common injury due to chronic digital display use, often goes underdiagnosed or mismanaged in adolescent patients. Enhancing physician knowledge and confidence in diagnosing and treating rhomboid strain can improve patient quality of life. This study aims to measure the impact of an educational lecture on physicians' understanding and confidence in managing rhomboid strain in an adolescent health setting.

Methods
A cohort of 11 physicians at a student health clinic on a college campus was surveyed before and after attending a targeted educational lecture on rhomboid strain. This was accompanied by the addition of a patient educational handout in the electronic medical record. The lecture covered the etiology, diagnosis, treatment options, and natural history of rhomboid strain. The pre-lecture survey assessed baseline knowledge and confidence levels, while the post-lecture survey evaluated changes in these levels. Both surveys utilized a 5-item Likert scale. For statistical analysis, scores of 4 and 5 were assigned a value of 1, while scores less than 4 were assigned a value of 0. Fisher’s Exact Test was performed in R Studio (C) Version 2024.04.1.

Results
Preliminary results indicated that baseline knowledge about rhomboid strain was variable, with a significant proportion of physicians reporting low confidence in their ability to provide patients information and teach home exercises for therapeutic benefit. Following the educational lecture, there was a marked improvement in confidence scores for diagnosis (55% vs 100%, p = 0.04), accessing patient educational materials (36% vs 100%, p = 0.01), and teaching home exercises (45% vs 100%, p = 0.01).

Conclusion
This study shows the value of education in enhancing physicians' knowledge and confidence in diagnosing and managing rhomboid strain in adolescent patients. These findings suggest that targeted educational interventions can effectively address gaps in physician training and improve patient care outcomes for new and evolving chief complaints. Further research is warranted to assess the long-term impact of such educational programs on clinical practice and patient health.

Measuring Physician Confidence Before and After a Lecture on Rhomboid Strain in Adolescent Health

Purpose: This study investigates the feasibility, effectiveness, and patient response to using Mixed Reality (MR) technology, specifically the HoloLens, for preoperative education in patients requiring pancreatoduodenectomy. It aims to determine if MR improves patient understanding, comfort, and comprehension during informed consent compared to traditional methods.

Methods: A single center randomized controlled pilot study was conducted with patients recommended for pancreatoduodenectomy due to pancreatic mass between February and May 2023. Exclusion criteria included age under 18, lack of English fluency, or severe visual/hearing impairments. Participants completed pre- and post-intervention surveys assessing their understanding of their condition and care. The control group received standard education, while the intervention group used the HoloLens.

Results: Nineteen patients participated, with eight in the HoloLens group. Both groups showed improved understanding post-intervention, but only the HoloLens group had a statistically significant increase in overall comprehension (Z= -2.524, p= 0.012). The HoloLens group also had a significant improvement in understanding surgical steps and other aspects compared to controls. High comfort levels with the planned surgery were reported by 75% of participants in both groups.

Conclusions: MR technology, such as the HoloLens, can significantly enhance patient understanding and comfort in preoperative education for complex surgeries. Its integration into clinical practice was feasible and non-disruptive, suggesting broader applicability. The small sample size and single-center design limit generalizability, necessitating larger studies to confirm these findings and assess the full impact of MR on patient surgical education.

Enhanced Preoperative Pancreatoduodenectomy Patient Education Using Mixed Reality Technology: A Randomized Controlled Trial

Background: Meditation and breathing practices have been recognized to have a positive impact on stress reduction and well-being for various healthcare professionals, including physicians. The purpose of this pilot study was to examine the acceptability, feasibility and impact of a brief breathing and meditation workshop on surgeons and surgical residents.   

Methods: Surgeons and surgical residents participated in a meditation and breathwork workshop. Two techniques were taught, Isha Kriya meditation and Nadi Shuddi breathing, over two one-hour sessions. The participants were surveyed for perceived stress and wellbeing before and after the workshop. Participants also engaged in a focus group to examine impact, feasibility and acceptability. 

Results: All participants practiced Nadi Shuddi and Isha Kria 4x/week. Surgical Residents had a slightly higher initial median (IQR) perceived stress scores that Attending Surgeons 17.73 (14.0, 18.75) to 20.82 (17.8, 23.3) (p=0.06). Surgical Residents saw a 30% decrease in perceived stress score 20.82 to 14.0 (p<0.01). Warwick-Edinburgh Mental Well-being scale demonstrated increased wellbeing through the intervention. The cohort demonstranted being 70% more relaxed (1.7 to 2.9; p=.0003) and better able to deal with problemsdeal with problems (2.2 to 2.7; p=.02).   Participants expressed the following benefits: more focus, less irritability, more patience, and more acceptance of difficult issues. Participants offered constructive feedback to help guide adjustments in terms of format and delivery of workshop offering. 

Conclusion: This study shows that both surgical residents and attending physicians can improve perceived stress and wellbeing through mediation and breathwork practices. Leadership should consider offering structured meditation and breathwork opportunities through organizational support to practice enhancing surgical residents and attending physicians' wellness.

Enhancing Wellbeing of General Surgery Residents and Attending Physicians through Nadi Shuddi Breathing and Isha Kriya Meditation   

Background
Type 2 diabetes mellitus (T2DM) affects 11.6% of the US population and presents a significant global health challenge. Managing T2DM is expensive, costing Medicare 5000 dollars per person- year.
Having a reliable information source that the general population can easily access can significantly improve overall health literacy. With approximately 5% of all internet searches related to healthcare, generative artificial intelligence (GeAI) tools including OpeniAI’s Chat Generative Pre-trained Transformer (ChatGPT) have gained popularity among patients seeking medical advice.
This study aims to evaluate the accuracy of the responses generated by ChatGPT to common questions related to the prevention, diagnosis, and management of T2DM and to assess responses relative to those provided by first-year Internal Medicine residents enrolled in an ACGME-accredited program.

Methods
In this single-blinded observational study, a set of frequently asked questions on T2DM were compiled by physicians experienced in type 2 diabetes and were used to assess the accuracy of GeAI responses relative to those by resident physicians.
The latest version of ChatGPT (GPT-4) served as the preferred GeAI tool for the study. Each question was presented three times to ChatGPT, and two researchers independently summarized the majority response.
The same set of questions was presented to 11 first-year Internal Medicine residents, and the responses were summarized by two members of the research team. Three board-certified internal medicine physicians blinded to the source of each response then reviewed and scored responses as either appropriate (aligning with the standard of care) or inappropriate (inconsistent with the standard of care).

Results
Of the responses generated by ChatGPT, 92% (23/25) were found to be appropriate vs 84% (21/25) by residents, and 8% (2/25) were found to be inappropriate, vs 16% (4/25) by residents.

Conclusion
ChatGPT exhibited high consistency in providing appropriate responses with 92% of the responses scored as appropriate. This suggests that the responses offered by ChatGPT were compatible with the standard of care, and even slightly superior to the responses provided by resident physicians.
While promising, the focus of this study is on response appropriateness without assessing the understanding of patients of the responses provided. Furthermore, this study did not evaluate the impact of human factors such as sympathy in delivering health-related information, which are essential in delivering compassionate care; Continued research is essential to fully realize AI’s benefits in healthcare while ensuring ethical implementation.

Evaluating AI in Type 2 Diabetes Care: ChatGPT vs Internal Medicine Residents.

Background
The Revised IDEA (R-IDEA) assessment tool, a validated instrument iterating on the IDEA tool developed by Baker et al., allows for residency programs to provide dependable feedback on clinical reasoning skills. It evaluates clinical documentation on admission notes utilizing four categories: interpretive summary, differential diagnosis, explanation of reasoning for lead, and alternative diagnoses. The R-IDEA tool provides more detailed anchors in each domain than the original, and a composite score of 6 or more (out of 10) signifies high-quality clinical reasoning. This study evaluates the pre- and post-intervention degrees of satisfaction, self-confidence, and ease of use of the R-IDEA tool among residents and interns during inpatient clinical rotations. Additionally, it assesses the degree of improvement in interns' clinical reasoning scores. By measuring these factors, the study aims to determine the tool’s effectiveness in enhancing clinical reasoning skills and the feedback process within an academic medical setting.
Methods
A single-blinded prospective cohort study with simple randomization was conducted at the ProMedica Toledo Hospital across five inpatient services (four general medicine and one ICU) over three months. The admission notes of 20 interns were evaluated by trained senior residents using the R-IDEA tool at the onset of the month-long rotation, followed by standardized feedback to the interns within the first week. A second evaluation using the R- IDEA tool at the end of the month gauged the interns' clinical reasoning improvement. A blinded faculty member reviewed residents' scoring for consistency. Satisfaction and confidence levels in delivering feedback with the R-IDEA tool were measured through pre- and post-intervention surveys of 17 senior residents and 16 interns.
Results
Using regression models for ordinal data, the R-IDEA scoring of 40 intern admission notes showed a significant increase (p<0.001) in the composite score from an average of 5 to 9, suggesting an improvement in the quality of clinical reasoning.
Using a Likert scale, results from the intern pre- and post-R-IDEA tool survey showed significant improvement (p<0.001) in median scores for confidence and knowledge in writing interpretive summaries and creating differential diagnoses. Results from the resident surveys showed significant improvement (p<0.001) in median scores for confidence in the assessment, evaluation, and feedback process.
Conclusion
These findings underscore the significant enhancement in intern clinical reasoning with the R- IDEA tool. Moreover, it bolsters residents' confidence in their feedback methods. This tool can be integrated into Internal Medicine residency programs as a structured tool to augment interns' clinical reasoning effectively.

Impact of R-IDEA Tool on Interns' Clinical Reasoning and Satisfaction During Medicine Rotation

Background
Peutz-Jeghers syndrome (PJS), is an uncommon autosomal dominant disorder caused by a mutation at 19p13.3 that manifests as mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal system. We report a case of a 19-year-old young girl presented with intermittent episodes of abdominal pain and few occasions of fresh per rectal bleeding as well as features of anemia.
Case Presentation
A 19-year-old female patient with a urinary tract infection was brought into our internal medicine department. It was discovered that she had mucocutaneous pigmentation and iron deficiency anemia. She also reported having vague stomach ache and a couple instances of hematochezia since she was fifteen. Colonic polyps, colon cancer, or any other gastrointestinal condition were not present in the family history. Physical examination revealed no abnormalities, except for the presence of dark-brown pigmented maculae around the oral mucosa, lower lip and pulp of fingers. Numerous pedunculated polyps were seen dispersed throughout the colon during a colonoscopy. There were a lot of giant polyps. Polyps were seen in the large as well as small bowels during MR enterography.
Background
Peutz-Jeghers syndrome (PJS), is an uncommon autosomal dominant disorder caused by a mutation at 19p13.3 that manifests as mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal system. We report a case of a 19-year-old young girl presented with intermittent episodes of abdominal pain and few occasions of fresh per rectal bleeding as well as features of anemia.
Case Presentation
A 19-year-old female patient with a urinary tract infection was brought into our internal medicine department. It was discovered that she had mucocutaneous pigmentation and iron deficiency anemia. She also reported having vague stomach ache and a couple instances of hematochezia since she was fifteen. Colonic polyps, colon cancer, or any other gastrointestinal condition were not present in the family history. Physical examination revealed no abnormalities, except for the presence of dark-brown pigmented maculae around the oral mucosa, lower lip and pulp of fingers. Numerous pedunculated polyps were seen dispersed throughout the colon during a colonoscopy. There were a lot of giant polyps. Polyps were seen in the large as well as small bowels during MR enterography.
© 2018 American Medical Association. All rights reserved.
Discussion: PJS syndrome is incredibly rare; babies with an estimated incidence of 1:8,500 to 1:200,000 are affected. The young lady in our presentation met the inclusion criteria for the syndrome since she had mucocutaneous pigments on her hands and lips in addition to many Peutz-Jeghers polyps in the small the small and large intestine. Approximately 95% of PJS patients have mucocutaneous pigmentations, which may be the initial clinical clue prior to the onset of gastrointestinal symptoms. When a kid has iron deficiency anemia, which is common in youngsters, it is crucial to perform a complete physical examination and look into the family history. This enables the early detection of uncommon illnesses like Peutz-Jeghers syndrome. PJS patients have a cancer incidence that is almost fifteen times greater than the normal population. This case emphasizes the value of routine surveillance, patient education, and tertiary prevention strategies in preventing complications in individuals with post-diagnosed Puetz-Jeghers syndrome.

Iron Deficiency Anemia and Mucocutaneous Pigmentation: Diagnostic Clues for Peutz-Jeghers Syndrome

Background
Medical school training must prepare future clinicians to care for our aging population by providing them with skills and knowledge about older adults, including tools for avoiding the negative health impacts of ageism. Mentoring programs with older adults have been previously shown to improve medical students’ attitudes toward aging patients but have been difficult to sustain. A more reliable approach is needed. 
Methods
The authors performed a scoping review to describe the landscape and impact of programs using older adults as mentors for medical students, and then designed an innovative pilot curriculum involving older medical school alumni as the mentors for learning about aging. In December 2023, scoping review authors searched OVID Medline, Embase, Web of Science, and PsycInfo for relevant articles. The pilot curriculum on aging included an introduction session and four topic-focused calls between students and alumni: the evolution of medicine; perceptions of aging; life stages; and ageism, ableism, diversity/ equity/ inclusion. The spring 2024 pilot program involved seven student-alumni mentoring pairs, curriculum implementation, a debrief session, and analysis of feedback surveys.
Results
The scoping review included 26 studies in the final analysis. In all programs, the senior mentors were drawn from patient panels or the general community and both students and mentors reported a positive experience. None of the programs utilized medical school alumni as mentors and public data indicated that just 47.4% (n = 9) of the programs are still ongoing. For the pilot program, anonymous student and mentor surveys revealed that 100% students and mentors rated their experience as effective and the connection with their mentor or student as positive. Students commented that they enjoyed connecting with an individual from a different generation, and mentors commented that they felt value from the opportunity to share their stories. 
Conclusion
This scoping review reveals that prior older adult mentorship programs are positively received by students but may be difficult to sustain. Our pilot program took a different, potentially more sustainable approach, using older medical school alumni as mentors and locating ageism in intersectionality with a larger health equity context. This pilot program, highly rated by both students and mentors, proved to be a positive experience for both mentors and students, provided a balance of career advising and insight into the aging experience, and offered a potentially powerful model for combating ageism and preparing students to care for older adults with empathy and excellence.

Older medical school alumni as mentors: A scoping review and pilot program for medical students

Objective: According to the CDC, HPV vaccination can prevent over 90% of HPV-related cancers, including cervical and oropharyngeal cancers. However, the rate of HPV vaccination in eligible adults remains low. We conducted two qualitative studies to gain a better understanding on what cervical and oropharyngeal cancer patients know about the HPV vaccine and how they have approached discussing the vaccine with others. Using data from the two studies, the objective of this analysis is to compare specific perceptions of the HPV vaccine within cervical cancer patients versus oropharyngeal cancer patients. 

Methods: Patients with a history of oropharyngeal or cervical cancer were identified through EMRs and invited to participate. In focus group discussions, patients were asked about their knowledge on HPV and its relation to their cancer, their discourses with others about HPV vaccination, and barriers preventing further conversation. After reviewing the interviews, common responses were coded. 

Results: The cervical cancer group consisted of 23 participants between August 2016 and March 2017, of which all who answered a demographics questionnaire were white females and had an average age of 49. The oropharyngeal cancer group consisted of 14 participants between April 2024 and June 2024, which consisted of 71% white males, 29% white or black females, and an average age of 60. Most patients in the cervical cancer group had some previous knowledge of HPV, whereas 78% patients in the oropharyngeal cancer group had never heard of HPV until their cancer diagnosis. By the time of interviews, only 42% of the oropharyngeal group knew that HPV could cause cancer. The largest barrier to HPV vaccination discussions was stigma in the cervical cancer group, versus the overwhelming lack of knowledge of HPV and the vaccine endorsed by 71% of the oropharyngeal cancer group. Both groups showed general uncertainty of vaccinations especially since COVID-19 pandemic, although most patients were willing to serve as healthcare educators if it could prevent others from developing cancer. 

Conclusion: For patients to become community advocators on the importance of HPV vaccination, barriers such as lack of knowledge and reducing stigma must be addressed, especially among oropharyngeal cancer patients.

Comparing Perception of HPV Vaccination in Cervical and Oropharyngeal Cancer Patients

Background: Although mandated by the ACGME, access to comprehensive abortion training is severely limited, and recent legislative restrictions have further decimated educational opportunities for learners. In states with limited to no abortion access, resident physicians must travel to external programs to gain this necessary training. Simulation-based training has been shown to increase clinical proficiency and improve patient care outcomes. There is a critical need for pre-clinical, comprehensive, simulation-based training to prepare resident physicians for abortion care clinical experiences. 

Methods: Using an iterative design process, we created an innovative, affordable, and modifiable pelvic training model with an associated clinical curriculum under the guidance of two board-certified obstetrics and gynecology (OB/GYN) physicians. The ReproSTART model and curriculum is designed to teach five key surgical techniques necessary for procedural abortion and is modifiable for various clinical situations. OB/GYN physicians and trainees tested each procedural station and component of the model to provide qualitative feedback. Thirty-one resident physicians representing all years of training completed three varying workshops and provided feedback via pre- and post-session evaluations. A website was created to disseminate the ReproSTART model and curriculum to other institutions (https://obgyn.mcw.edu/repro-start/ password:abortion). 

Results: Abortion care experts and resident trainees found the ReproSTART model and associated curriculum to be superior to currently available models and hands-on trainings for abortion procedural techniques. Learners across all levels of training found the simulation to be useful for developing familiarity with procedural techniques, and first-year resident physicians showed a significant improvement in reported confidence with the abortion-related procedural techniques after completing the training. Furthermore, Ob/Gyn Residency Programs have reported success in building the model and implementing the training using only the website as a guide. 



Conclusion: The novel ReproSTART model and curriculum is an innovative simulation-based training to familiarize resident physicians with abortion procedural techniques. The model provides a more accurate, dynamic, and comprehensive pelvic anatomy than previous models, and the simulation allows for increased familiarity with procedural techniques and improved confidence in early learners. The ReproSTART model, curriculum, and website allows for more equitable and accessible abortion procedural training. The simplicity and adaptability of the ReproSTART model provides potential additional wide-reaching benefits for simulation-based training in obstetrics and gynecology.

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