United States

Introduction: Needs assessment approaches are evolving to operationalize diversity, equity, and inclusion (DEI) climate and gaps in academic medicine. While efforts to address gaps exist at the level of residency training, validated institutional tools to identify areas for improvement may not capture the unique nature of individual clinical learning environments. Our goal was to create a targeted survey using eight DEI constructs outlined by the Association of American Medical Colleges.

Methods: We developed under IRB exemption a survey containing 25 questions scored on a 7-point Likert scale (7=strongly agree to 1=strongly disagree) and two free text response questions. Respondents could indicate inability to evaluate an item (4=neither agree nor disagree). After a DEI principles lecture, residents were invited to voluntarily complete an anonymous survey which only requested training level and gender preference. Survey was disseminated online using Survey Monkey. Item response across PGY status and gender preference was assessed using Chi Square with 2-sided p-value Bonferroni corrected respectively at .017 and .05. Association of item responses within each construct (internal validity) was assessed using Cronbach alpha. Variance in construct explained by item response (construct validity) was quantified as R2 (fractional proportion) computed using confirmatory factor analysis. Positive sentiment was quantified (%) using aggregated “strongly agree,” “agree,” or “somewhat agree” responses. Free text responses underwent parsing and filtering. Statistical analyses were performed using JMP Pro 16.2 (SAS, Cary, NC).

Results: Among 38 resident physicians, 32 (84%) completed the survey distributed across PGY-1 (6 females, 7 males), PGY-2 (4 females, 5 males) and PGY-3 (3 females, 6 males). One resident didn’t indicate PGY status or gender preference. Item response analyses revealed positive sentiment, internal validity and average construct validity respectively within DEI constructs “common purpose” (94%, 0.89, 0.95); “Access to opportunities (90%, 0.63, 0.80); “cultural competence” (85%, 0.43, 0.76); “trust” (87%, 0.59, 0.89); “state of belonging” (89%, 0.73, 0.84); “appreciation of individual attributes” (93%, 0.28, 0.74); and “respect” (93%, 0.56, 0.76). “Equitable rewards and recognition” construct included a single question with favorable sentiment of 78%. Overall positive sentiment was 89% with Cronbach alpha and R2 respectfully ranging from 0.74 to 0.95 and R2 0.13 to 0.96. Text mentions corroborated item responses regarding favorable diversity with some gaps in equity and inclusion. 

Conclusion: Approaches to improve DEI within residency training should be tailored to characterize context specific sentiment that operationalizes needs to be improved.

AMA Research Challenge 2022

Development and Design of an Assessment Tool to Improve Diversity, Equity and Inclusion in Graduate Medical Education

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poster

Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
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Ricardo Correa, MD, EdD
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Stuart M. Greenstein, MD
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Stephanie Strohbeen, MD
 
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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

### Sponsor
AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on Dec. 7 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


Background: Finances, time, transportation, connections, and confidence are just a few of the barriers to becoming a doctor. PhysioCamp is a nonprofit that aims to address these barriers and provide resources to foster future healthcare workers within three groups: K-12; undergraduate; and graduate students. 

Methods: PhysioCamp has held hundreds of hours of K-12 sessions, including virtual discussions on healthcare topics and in-person hands-on activities with anatomic models, preserved donor organs, and simulation equipment. Pre-health undergraduates took on volunteer roles or additional responsibilities as year round virtual interns. The role of graduate students included leadership of the sessions and oversight of volunteers and interns. For the past five years, medical students have worked with PhysioCamp to ensure continuity of leadership and partnership within the local Greenville, NC community. First and second year medical students lead in-person sessions, and transition to virtual leadership in third and fourth years of schooling.

Results: Periodic assessments of K-12 students, parents, and volunteers are performed to audit the impact of sessions. Results from K-12 student and parent surveys showed increased interests in the healthcare field, exposure to unfamiliar healthcare topics, and knowledge of making healthy foods and exercise choices. Survey results from undergraduate and graduate volunteers highlighted the importance of small group learning and hands-on activities to the success of the sessions.
The internship program was added in 2019 to aid in long term retention and mentoring of pre-health students. Since the start of the program, 99 interns have been onboarded, 67 of whom are still active within PhysioCamp. Interns reported they valued mentoring, advising and unique interactions with medical students. Many interns have now entered graduate school in healthcare fields, such as physician assistant and medical school.

Conclusion: Promoting early interest and mentorship contribute to a student’s academic success and career path. PhysioCamp provides longitudinal exposure to health science education from kindergarten to graduate school. Interns and graduate students also gain experience in leadership and mentorship. Sessions are a beneficial resource to the community and act as a place for K-12 students and undergraduate interns to cultivate their academic interests with mentors in the field.

Development and Institution of PhysioCamp: Providing a Community Resource

Abstract Title: 
Disability Connect: A Unique, Peer-to-Peer Mentorship Program at the University of Michigan Medical School (UMMS)

Background: 
Mentorship programs supporting underrepresented racial/ethnic minority students at the University of Michigan exist and improve representation in academic medicine. No program or literature currently exists for near-peer, medical student-only mentorship programs for those who identify as having a disability, at UMMS or nationally. There is a need for such mentorship, given the rise in disability disclosure occurring throughout medical schools nationally. Disability Connect aimed to fill this void.

Methods: 
Disability Connect is a voluntary, near-peer mentoring program, started in Fall 2021 at UMMS, that pairs medical students with disabilities and chronic illnesses with student mentors that share similar life experiences and can help them navigate their medical school experience. The program is student-run and intentionally separate from the university given researched obstacles/conflicts with disability disclosure. Students interested in the program were subsequently contacted and asked to categorize how they would identify their disability from a list of options which included: neurocognitive/neuropsychological, chronic illness, auditory, learning, and mobility/physical; If students felt willing to share, free text was available for students to describe their disability to aid in the pairing of mentor/mentees relationships. 

Results: 
In our pilot launch, a school-wide email was sent, and we received a total of 17 responses in October of 2021. With a student body of 684 students, this equates to 2.48% compared to the most recently calculated national average of 4.58% of medical students who disclose a disability. Of the 17 responses, every category listed in our methodology was represented by at least 1 program participant. 1 student unenrolled in the program. Of the final 16 students, 10 pairings were made. Students were told to expect a 6-month follow-up survey.

Conclusion: 
Data surrounding the importance of mentorship programs is clear, especially among students who have historically been excluded from pursuing higher education. At the 6-month interval, we will assess program effectiveness via validated mentorship evaluation tools with all program participants; Future direction of this program will be tailored based on feedback and student needs however with an increase in students from UMMS requesting accommodations rising from 0.7% to 13.6% since 2017, our programming has drastic implications for the culture of our healthcare system.


Disability Connect: A Unique, Near-Peer Mentorship Program

Background
Disparities in the diagnosis of skin conditions in the United States have long disadvantaged people of color. Addressing healthcare inequities through education is vital to improving quality of care. Pre-clinical medical curriculum introduces students to skin disorders through lectures. Classic clinical presentations are described using key phrases or “buzzwords” in vignettes; however clinical image exposure introduces the visual diagnostic and pattern recognition skills used in real healthcare settings. Past studies have shown that medical graduates do not feel adequately prepared in dermatology overall and struggle to recognize lesions equally in darker skin. Most skin lesions initially present to primary care physicians, emphasizing the need for improved training for non-dermatologic specialties beginning with undergraduate medical education. 

Methods
Participants were recruited from students at the end of pre-clinical skin curriculum. They completed a needs assessment showing eleven different skin disorders that included two clinical images each, one in darker skin and one in lighter (Fitzpatrick IV-VI vs. I-III), with no vignettes. The disorders were chosen based on the American Academy of Dermatology’s recommended medical student curriculum, USMLE Step 1, and prevalence according to a previous study assessing most common skin disorders in African American, Asian or Pacific Islander, Caucasian, and Hispanics of any race. Participants were asked to identify the images from a list of possible answers. The study assessed if students were able to visually recognize skin disorders and if any disparities exist concerning skin of color.

Results
Students demonstrated overall proficiency in visual diagnosis; however, students did not reliably recognize squamous cell carcinoma, eczema, and Stevens-Johnson Syndrome in darker skin. Conversely, they were less able to recognize basal cell carcinoma and tinea versicolor in lighter skin. Overall, students demonstrated lower scores for recognition of nine of the assessed disorders in darker skin.

Conclusion
The current pre-clerkship curriculum does not adequately prepare medical students to recognize skin disorders in darker skin. We believe that curriculum change should include more diverse visual representations and specific instruction concerning how the appearances of these disorders may vary depending on skin color, to better prepare medical students to care for the entire patient population.

Disparities in Visual Diagnosis in Diverse Skin Following Pre-Clerkship Medical Curriculum

Diversity and Inclusion Content Presented on US Primary Care Residency Program Websites

Background
Recent CDC data indicates that opioids account for nearly 71% of all drug overdose deaths. The COVID-19 pandemic has exacerbated recent efforts to curtail opioid overdoses. To prepare future clinicians to recognize and treat opioid overdose victims, it is imperative to provide hands-on training and equip medical students with naloxone in our communities. Secondarily, near-peer teaching in medical education consistently shows benefits to learner and instructor yet is underutilized due to logistical challenges. 
Methods
Pre-clerkship students participated in a 1-hour workshop that consisted of an inpatient simulated opioid overdose using high-fidelity mannequins followed by hands-on naloxone training with demos. Students received a two pack of Narcan nasal spray to keep with them following the workshop for emergencies. Pre- and post-tests/surveys were administered including the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS). Descriptive statistics and paired t-tests assessed for significant differences. Qualitative analysis incorporated Glaser's constant comparative method to identify themes.
Results
In total, 193 medical students participated in the workshop and 70 students completed the pre/post surveys. Results from the OOKS survey demonstrated significant gains in knowledge (percent correct, 76% versus 82%, p<0.05) and significant improvement in overall attitudes (OOAS) towards opioid overdoses [3.5 versus 4.2, p<0.001, (1=completely disagree, 5= completely agree)]. Themes from open-ended questions included how the hands-on instructions made students feel comfortable with using naloxone in real-life situations and the effectiveness of the training by a peer medical student with previous EMS training.
Conclusion
Our results demonstrate that a hands-on workshop focused on opioid overdose recognition and management significantly improved students’ knowledge of and attitudes towards opioid overdoses. This 1-hour workshop can be implemented by other programs to help combat the current opioid epidemic by increasing the number of healthcare trainees and clinicians trained in opioid overdose management. Additionally, based on the positive response regarding learning from an experienced peer, continued efforts to implement near-peer teaching within the medical school curriculum can be fruitful for knowledge acquisition and interprofessional collaboration, particularly by capitalizing on the unique backgrounds of students.

Effectiveness of a Naloxone Training Workshop and Opioid Overdose Simulation with Near-Peer Teaching

Background
One of the strategies to deal with the COVID-19 pandemic was Continuing Medical Education (CME) Online Courses with CME accreditation offered by various renowned universities and platforms for mass awareness and prevention regarding COVID-19 among healthcare professionals. This study was aimed to evaluate the practical significance of these courses in clinical practice and the effectiveness of these courses in revolutionizing and improving COVID-19 case diagnosis and management

Methods 
The multi-centric, cross-sectional study was conducted at various hospitals of Pakistan using a validated questionnaire that was filled by doctors and paramedics from 15th April 2021 to 20th May 2021. Snowball sampling was carried out by sending the questionnaire through social media platforms. We also reached out to the American Society of Microbiology to share the questionnaire with the doctors and paramedics who participated in their Online COVID course held in collaboration with NIH (National Institute of Health), Pakistan. The sample size was 225 and the data was assessed by IBM-SPSS version 26 where Chi-square test was applied to find out statistical significance.

Results
A total of 244 responses were collected from doctors and paramedics from different hospitals in Pakistan. The majority of participants attended the COVID awareness course by WHO, a COVID course by Harvard, and UHS Pakistan. 64.8% reported that the course was relevant to their current scope of practice and the information presented in the CME activity was balanced and free from commercial bias. We found that the courses contributed to the professional growth of the participants and also met their learning objectives. (Pearson’s Chi-Square, P-value <0.05) More than half of the participants reported that they’ll implement the knowledge gained from the courses in patient care. The rest of the participants required additional information and found a lack of PPE and COVID-19 diagnostic kits as perceived barriers in the implementation of acquired skills in practice. A significant number of participants reported that there is a need for new protocols, a more flexible system and New Online programs and Awareness campaigns regarding CME activity.

Conclusion
The online COVID courses proved to be effective in the prevention and awareness of the COVID-19 pandemic among doctors and paramedics.

Effectiveness of Online Covid Courses in Prevention and Awareness of Covid-19 Pandemic Among Doctors and Paramedics.

Background: 
Increasing application numbers constrain residency programs from conducting a holistic review of applicants. Pilot programs to improve holistic review are underway aimed at appraising applicants rapidly. Despite this, assessing narrative components of residency applications remains a bottleneck during applicant review, with many programs resorting to filters based on academic metrics and attributes to invite applicants that are known to have racial, gender, and other inequities. To address this gap and automate the process, the authors used natural language processing (NLP) to predict an interview invite based solely on their narrative experiences.

Methods: 
Narrative experience entries were extracted from 6500 residency applications across three application cycles (2017-2019) at one academic internal medicine program and paired with the interview invitation decision made by program directors. NLP was used to process the experiences’ entries; the importance of each word or phrase (called “tokens”) was calculated using the term frequency-inverse document frequency (TF-IDF). A logistic regression model was developed to determine words or phrases that predicted an interview invitation. Models were also built using structured application data such as USMLE scores and graduation year – either alone or combined with the NLP analysis. Model performance was evaluated on never-before-seen data using the area under the receiver operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The most influential words or phrases impacting interview invitation were examined.

Results: 
The NLP-only model had an AUROC of 0.79 and AUPRC of 0.48; phrases such as “student-run”, “pre-clinical clerkships”, “analyze data”, and “social determinants of health” increased the probability of receiving an interview invitation. Adding structured data significantly improved prediction, with an AUROC of 0.93 and AUPRC of 0.74. The variable representing the predicted probability based on NLP of the narrative experiences had the highest coefficient magnitude in this combined model. This emphasized the importance of experiences during the resident selection process.

Conclusion: 
To our knowledge, this is the first report on applying NLP to residency application materials to predict an interview invitation. NLP may provide a promising approach for a rapid holistic review and could advance the aims of equity and diversity in selection by expanding currently used metrics.


Enhancing Holistic Review During Residency Selection: Using Natural Language Processing of Applicants’ Experiences to Predict an Interview Invitation

Background: Throughout the COVID-19 pandemic, countless research publications were released regarding SARS-CoV-2 and its variants, suggested treatments, and vaccine safety and efficacy. Daily publication of new research became overwhelming for health professionals and the public to stay informed. In recent years, there has been increasing interest in the use of social media for dissemination of veritable information in academic medicine. A group of 70 students across the four colleges at Rush University created the “Rush University COVID-19 Journal Club.” Following expansion of the journal club to social media, audience opinion and engagement was surveyed. 
Methods: Easily accessible and understandable summaries of the newest research were written by students and sent to faculty sponsors for feedback. Following revision, summaries were published weekly on the Rush University COVID-19 Journal Club website for clinicians and students to use for reference. An Instagram page was then created and information was further condensed into succinct posts to address COVID-19 “FAQs.” Next, a survey was distributed to followers of the Instagram page with questions meant to assess the effectiveness of the platform and gain feedback. A 5 point Likert scale was used as the primary question format. 
Results: The Instagram page accrued 749 followers and posted 52 unique posts over a 2 year period. Preliminary results from the surveys demonstrate that over 80% of respondents strongly agree that the Instagram posts 1) are an effective platform for the public presentation of factual COVID-19-related information; 2) provide relevant and valuable information; 3) provide information that is clear, concise, and can be easily understood. 
Conclusion: These results suggest that the Rush COVID-19 Journal Club was able to successfully create a social media presence and convey information without sacrificing scholarly integrity. Other academic institutions may benefit from the application of this model to help students and clinicians with the interpretation and evaluation of research topics with large bodies of evidence.

Going Viral: Expanding a Student-Run COVID-19 Journal Club to Social Media

Background
Across the nation, racism has been declared a public health crisis. To provide high value healthcare, providers and medical student must define and recognize manifestations of stress related to racism and discrimination. By student request, we aimed to provide knowledge of the physiological effects of stress from perceived discrimination, screening tools, and dialogue frameworks for clinical discussions. 

Methods
Second year medical students and neurobiology faculty developed an hour-long teaching session addressing the stress response. To prepare for the session, learners were assigned readings, a video lecture, and tasked to create an HPI on a prompted scenario. The session acknowledged current systems of oppression in society and established ground rules for psychological safety. Students traded self-created cases between groups and discussed each clinical scenario identifying stress-related responses in different patient populations. After the session, a debriefing period was offered to address lasting concerns. 

Results
Students identified the impact of acute and chronic stress on various body systems through an understanding of physiological mediators of the stress response. They discussed the various health related consequences of racism and other forms of discrimination concerning social identity and intersectionality. Groups demonstrated structural competency in the clinical impact of the stress response through the creation of clinical case-based scenarios, group discussion and a debrief including the importance of trauma-informed language for both provider and patient.

Strengths included a peer-created, peer-delivered course curriculum where second year medical students provided didactic instruction, facilitated small group discussion, and led a debrief session for first-year students. Ideally, a topic of this sensitivity would include additional instruction from an expert in the field of healthcare advocacy or discrimination.

Conclusion
Our medical education innovation highlights the importance of using student feedback in the curriculum to address the biochemical response to social determinants of health. Peer course delivery and interactive clinical case creation facilitated reflective conversations amongst students and faculty. Nationally, healthcare becomes more equitable when providers are able to recognize and respond appropriately to the stress response resulting from racism and discrimination. 


Implementation of a Peer-Led and Peer-Facilitated Interactive Course on Racism-Related Stress and Culturally-Responsive Interactions with Patients in Clinical Settings

Abstract Title: 
Medical student reported patterns, attitudes, and challenges of interpreter use throughout core clinical clerkships

Background 
In the United States, around 30 million people report speaking English less than “very well.” This Limited English Proficiency (LEP) impacts all aspects of daily life, including medical care. LEP is associated with reduced access to care, higher rates of preventable errors, and impaired understanding of health overall. Despite the impact that LEP status has on health access and outcomes, medical students, who will become the next generation of doctors, continue to feel unprepared to care for the growing LEP patient population. This study sought to understand the practices, patterns, and attitudes of interpreter use encountered by medical students at the University of Pittsburgh on their core clinical rotations, with the goal of pinpointing challenges in accessing language services to be addressed in future additions to the pre-clinical curriculum. 

Methods
We developed a 17-item, novel survey instrument that assessed patterns of interpreter use in clinical settings, team attitudes towards interpreter use, and student-reported confidence and success in accessing interpreter services. The survey was developed using input from content experts and literature review and underwent pre-distribution testing and revision. It was administered electronically to 150 medical students after their first year of clinical rotations. Results were analyzed using descriptive statistics. 

Results
Of the 37 respondents, 97% of students reported encountering obstacles to accessing and providing interpretation services, citing reasons such as interpreter availability and interface unfamiliarity. 30% of students cited the supervising physician’s resistance to using an interpreter as a barrier that prevented access. Additionally, 65% of students reported that they felt the pre-clinical curriculum did not adequately prepare them to work with patients with LEP, and 35% of students stated that they did not feel as comfortable caring for patients with LEP as English-speaking patients.

Conclusion
Our findings suggest clear obstacles to interpreter use in the clinical setting, as well as a lack of confidence in implementing the skills needed to provide language-concordant care. At the same time, students recognized this deficiency and expressed desire to better learn these skills. These results will be used to shape a pre-clinical curriculum directed at teaching tangible skills to address these gaps prior to clinical training.


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