United States

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.

AMA Research Challenge 2022

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

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Charles Lopresto, DO

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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.


poster

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.


Medical Student Reported Patterns, Attitudes, and Challenges of Interpreter Use throughout Core Clinical Clerkships

LGBTQ+ health concerns have become increasingly prevalent in medical education, however, intersex individuals and their respective healthcare needs are frequently lumped into this category and not appropriately represented as standalone content in standard curricula. Intersex education is typically taught in conjunction with disorders of sexual development – an outdated and stigmatized term. The authors, who represent medical student and faculty educator stakeholders, aimed to develop a discrete intersex educational pilot training session to better inform how conversations supporting intersex individuals can be facilitated in undergraduate medical education.

Medical Student Sensitivity Training on the Differences of Sex Development

Melanated Suture Pad Implementation into Medical Education for Culturally Competent Curriculum Reform

Following the murder of George Floyd in Minneapolis on 5/25/20, and in the absence of a University-issued response in the days that followed, five Minnesotan medical students designed a dense one-week block of medical DEI curriculum to replace the previously scheduled content. The curriculum was formally proposed, and conditionally approved, and a few supportive faculty joined with the students to build the curriculum into Canvas. Each student assumed responsibility for one topic to be delivered over the course of one day and agreed upon a set or parameters. Though rapid, this was a highly collaborative and iterative process. We assessed student satisfaction through a course evaluation and found exceptionally high satisfaction, engagement, and perceived relevance. Through careful documentation and focused review, we identify core elements necessary for the success of this curriculum and we present a template for use in broader settings.


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

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