United States

Background
Physical examination (PE) is an essential component of high-quality medical care that can aid in diagnosis, guide workup, and impact management decisions. Incomplete or deficient PE is a common source of diagnostic error and contributes to adverse patient outcomes. PE is one of many skills that should be developed and cultivated during medical training, but direct observation of, and feedback regarding, PE is limited. The coronavirus disease 2019 (COVID-19) pandemic led to a marked increase in telemedicine visits and a decline in in-person appointments, posing new challenges to performing the PE. Furthermore, while PE skills are associated with competency in other clinical domains during in-person encounters, little is known about PE skills during telemedicine encounters.

Methods
Forty-five internal medicine interns (24 females and 21 males) from two academic health centers participated in a clinical skills assessment via an online platform where they were evaluated by volunteer patients and faculty preceptors. Preceptors rated resident performance in seven domains: 1) physical examination technique; 2) identification of physical signs; 3) clinical communication; 4) differential diagnosis; 5) clinical judgment; 6) management of patient concerns; and 7) maintenance of patient welfare. The Spearman correlation coefficient was used to evaluate relationships between performance in these domains. Resident self-ratings for each domain were also obtained and compared to preceptor scores.

Results
PE technique was significantly correlated with accurate identification of physical signs (r = 0.42, P = 0.004), clinical communication (r = 0.31, P = 0.036), clinical judgment (r = 0. 60, P &lt; 0.0001), and managing patient concerns (r = 0.41, P = 0.005). Residents rated their performance more highly than did preceptors on the domains of clinical communication, clinical judgment, and managing patient concerns. Residents highly rated the feedback they received during the experience.

Conclusion
While the telemedicine PE differs from the in-person PE, our findings highlight that it remains an essential clinical skill that is associated with performance in multiple other clinical domains. Given the rise in telehealth visits during the COVID-19 pandemic and resident overestimation of their skills, there is an increased need for dedicated telemedicine PE teaching.

AMA Research Challenge 2022

Assessment of graduate medical trainee clinical skills during telemedicine encounters

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The purpose of the AAAI conference series is to promote research in Artificial Intelligence (AI) and foster scientific exchange between researchers, practitioners, scientists, students, and engineers across the entirety of AI and its affiliated disciplines. AAAI-25 will feature technical paper presentations, special tracks, invited speakers, workshops, tutorials, poster sessions, senior member presentations, competitions, and exhibit programs, and a range of other activities to be announced.



Background
Physical examination (PE) is an essential component of high-quality medical care that can aid in diagnosis, guide workup, and impact management decisions. Incomplete or deficient PE is a common source of diagnostic error and contributes to adverse patient outcomes. PE is one of many skills that should be developed and cultivated during medical training, but direct observation of, and feedback regarding, PE is limited. The coronavirus disease 2019 (COVID-19) pandemic led to a marked increase in telemedicine visits and a decline in in-person appointments, posing new challenges to performing the PE. Furthermore, while PE skills are associated with competency in other clinical domains during in-person encounters, little is known about PE skills during telemedicine encounters.

Methods
Forty-five internal medicine interns (24 females and 21 males) from two academic health centers participated in a clinical skills assessment via an online platform where they were evaluated by volunteer patients and faculty preceptors. Preceptors rated resident performance in seven domains: 1) physical examination technique; 2) identification of physical signs; 3) clinical communication; 4) differential diagnosis; 5) clinical judgment; 6) management of patient concerns; and 7) maintenance of patient welfare. The Spearman correlation coefficient was used to evaluate relationships between performance in these domains. Resident self-ratings for each domain were also obtained and compared to preceptor scores.

Results
PE technique was significantly correlated with accurate identification of physical signs (r = 0.42, P = 0.004), clinical communication (r = 0.31, P = 0.036), clinical judgment (r = 0. 60, P < 0.0001), and managing patient concerns (r = 0.41, P = 0.005). Residents rated their performance more highly than did preceptors on the domains of clinical communication, clinical judgment, and managing patient concerns. Residents highly rated the feedback they received during the experience.

Conclusion
While the telemedicine PE differs from the in-person PE, our findings highlight that it remains an essential clinical skill that is associated with performance in multiple other clinical domains. Given the rise in telehealth visits during the COVID-19 pandemic and resident overestimation of their skills, there is an increased need for dedicated telemedicine PE teaching.

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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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

### Sponsor
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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
The authors identified gaps in the Indiana University School of Medicine (IUSM) reproductive curriculum and surveyed students for interest. Respondents expressed interest in comprehensive pregnancy options counseling, which was not previously included. Using evidence-based recommendations, the authors collaborated with faculty to develop an educational session about medical shared decision-making related to pregnancy. As a result, a pregnancy options counseling panel was added to the preclinical Endocrine, Reproductive, Musculoskeletal, and Dermatology (ERMD) course.

Methods
The authors and reproductive course management team developed an optional, live 90-minute physician panel held via Zoom videoconferencing software and disseminated to students at all nine regional campuses. Three recorded lectures, fifteen minutes each, were produced by experts about abortion, adoption, and continuing pregnancy to provide background information. The panel included providers with diverse practices and opinions about abortion and reproductive healthcare. After the panel, a 19-item survey was distributed including questions asking students to rate abortion, adoption, and pregnancy continuation counseling preparedness before and after the panel on a scale of 1-5. Paired t-tests were performed to determine whether preparedness significantly improved. The study was reviewed as an exempt project by the IUSM Institutional Review Board (protocol #13987).

Results
Out 353 students second year students, 207 (57%) attended the panel. Fifty-three attendees (26%) responded to the survey; 39 (73%) identified as female, 12 (23%) as male, and 2 (3%) as nonbinary. 41 (77%) respondents were White, 6 (11%) Asian, 4 (8%) Black or African American, and 2 (4%) identified as other. The mean improvement for abortion counseling preparedness was 1.33 (p<0.001, 95% CI [1.12,1.53]). For adoption counseling the mean improvement was 0.75 with (p<0.001, 95% CI [0.52,0.98]). Finally for pregnancy continuation mean improvement was 0.87 with (p<0.001, 95% CI[0.64,1.09]).

Conclusion
Overall students rated their preparedness significantly higher after attending the panel for comprehensive pregnancy options counseling. Using a statewide physician videoconference panel modality can help provide students across a multi-campus medical school access to physician expertise and unified content. Having access to the experts from other regional campuses is a powerful resource for bridging gaps in pregnancy counseling and creating much needed standardized curriculum.

Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education

Background
A minimally-invasive approach is the standard for most benign pelvic surgeries, which now are increasingly performed with robotic assistance. Currently, there is no standardized curriculum for robotic training among Ob-Gyn residents and no method of quantitative assessment of robot confidence at Creighton. 

Methods
PGY1-PGY3s completed a pre-survey to establish baseline comfort with robotic surgery. A Likert scale (1 - very unsatisfied or not at all confident, 5 - very satisfied or extremely confident) was used to determine self-assessed comfort with robotic components: port and instrument placement, docking, bipolar and monopolar instrumentation, camera, switching instruments, suturing, and overall comfort with surgery. Residents completed an Intuitive training module for the da Vinci Xi P8 robot. An in-person training was led by a representative and attending where residents were taught basics of robotic surgery and how to access the simulation trainer and complete modules independently. PGY1-PGY3s completed a post-survey to evaluate changes in competence and confidence in robotic training.

Results
Paired T-tests were performed using pre and post-responses. There was a significant increase in overall satisfaction of gynecologic training opportunities among all residents (p < 0.001). The average satisfaction before intervention increased from 2.58 to 4.36. PGY1s had improved confidence with basic components of robotic surgery, from 1 to 2.66 (p = 0.03). There was no difference in confidence regarding suturing and performing an entire DaVinci surgery. PGY2s had improved confidence with port placement of instruments and docking the camera & instruments at the bedside (both p = 0.01). Average confidence of port placement and docking improved from 2.5 to 4.5. There were no significant increases in PGY3s’ confidence among measured components. Among all residents, confidence increased in components of robotic surgery except for suturing and performing an entire surgery (p < 0.05).

Conclusion
Residents indicated improved satisfaction with the robot curriculum. They demonstrated improved confidence in several robot surgery components, aside from overall confidence in completing a robotic surgery. In future iterations, residents will have online and in-person training during intern orientation, simulator sessions during didactics, and simulator modules correlated to each year.

Improving Ob/Gyn Resident Confidence and Competence in Robotic-Assisted Surgery through Establishing a Robot Curriculum

As part of their holistic care of women, family physicians must provide comprehensive reproductive health services, including education about and provision of contraception. Studies have also shown that contraceptive knowledge base is inconsistent within primary care specialities. While lessons about contraception may be covered in the preclinical years, students often don’t have the chance to integrate and apply such knowledge prior to encountering patients. Studies have shown that interactive approaches and team based learning result in higher satisfaction and equivalent knowledge gain compared to standard lecture styles. Therefore, primary care clinical curriculum should contain engaging content about contraception to solidify students’ knowledge and ensure that they are comfortable discussing options with patients in the future. The aim of this poster is to share an interactive approach to integrating contraception into the clinical curriculum via a jeopardy style session during the clerkship year. 


Utilizing An Interactive Jeopardy Format to Teach About Contraception in the Family Medicine Clerkship

Purpose
Supervision must be documented for every patient encounter during residency training. This is especially indicated when a bill is submitted to a payor for services performed with the involvement of a resident. The teaching physician must include an attestation documenting the level of resident involvement in the patient encounter. When submitted to CMS the GC modifier is also utilized to indicate that a resident, under the direction of a teaching physician, is involved in a patient encounter. We retrospectively reviewed our documentation of the teaching physician in a resident ophthalmology clinic. 

Methods
All patient encounters performed by ophthalmology residents over a 5-month period (January through May 2021) were retrospectively reviewed for appropriate documentation of the teaching physician. All patient encounters were supervised by teaching physicians in an outpatient ambulatory ophthalmology clinic at the Texas Diabetic Institute, San Antonio, TX. Each electronic medical record (EMR) was reviewed for appropriate documentation of the teaching attestation and GC modifier. The data was analyzed using R software. 

Results 
A total of 1,500 patient encounters were reviewed. All records (100%) documented the teaching attestation. The GC modifier was utilized in 1,388 of patient encounters (92.5%). January (95%) and May (88%) showed the highest and lowest compliance, respectively. The GC modifier was not documented in 7.5% of patient encounters.

Conclusion
All patient encounters included appropriate documentation of the teaching attestation. Residents in clinic have direct supervision by the teaching physician and the EMR sends all notes to teaching physicians to be signed and attested. In addition, all notes are reviewed internally for compliance and are amended if not documented appropriately. Compliance with the GC modifier was significantly lower. This is attributed to inadequate understanding of proper usage and that it may not be required by all payors. With recent increase emphasis on the attestation for all notes, providers are less enthusiastic to also ensure documentation of the GC modifier due to this redundancy. Good practices aim for 100% compliance in documentation. Both teaching and resident physicians should be educated on appropriate supervision and how it should be best documented in the medical record.

Compliance with Documenting the Presence of a Teaching Physician in a Resident Ophthalmology Clinic

Detection and Diagnosis of Retinoblastoma: Can Mobile Devices be the Next Step Toward Early Intervention?

Abstract Title: DoubleVision Ophthalmoscope: A novel teaching fundoscope for medical student learners and beyond
Background: Learning to operate a standard fundoscope is an unintuitive process and recognizing retinal pathologies can be a subjective struggle requiring guesswork. While technologies exist to facilitate learning via screen projection from various ophthalmoscopes, a modality for the standard fundoscope, most utilized in medical student training, has not been well established. Our innovation aims to facilitate clearer instruction by physician preceptors while simultaneously lowering the barrier to entry for competent fundoscopy exams. Competent performance of a fundoscopic examination is a required skill per the American Council of Graduate Medical Education and is mandated in moderate and high-level neurologic workups per private and federal insurance agencies. 
Methods
The initial design includes a unique fundoscope based on similar mechanics of standard fundoscopes with a mini camera attachment and connection to monitor screen. The monitor screen will allow for improved visualization for the learner, image saving, and real-time annotation capabilities. 
Results
Through this innovative design we compare the current unintuitive status of fundoscopy training to a novel approach in training. We utilize various criteria in evaluating effectiveness including student/physician interviews and comparisons to other devices in the literature alongside biomedical design processes. We discuss in detail the product value proposition, market feasibility, ethical considerations, and global impact, as these concepts in relation to such device are scarce in the literature.
Conclusion
Clinical studies have emphasized the difficulty in the objectivity of the fundoscopic procedure. Simulations and training models lack fidelity due to high degree of variance between patients, as well as variance between patients and simulations. Residency and intern training of this technique have been difficult, but increased time with hands-on instructor led workshops have reduced this difficulty. There is a need for standardized training protocols across multiple centers, although some clinics may not have access to high end mentorship due to geographic constraints. The remote capabilities of our device would allow education to be performed globally. Prototypes of teaching ophthalmoscopes have been associated with improved confidence and more accuracy in objective measures of pathology identification. 


DoubleVision Ophthalmoscope: A novel teaching fundoscope for medical student learners and beyond

Purpose: To validate the clinical utility of Vision.app in measuring best corrected visual acuity (BCVA) in a pediatric cohort. 
Methods: OD/OS BCVA of pediatric patients was obtained by a) Landolt ring (VAApp) and b) Snellen chart (VAClinic). VAApp was measured by the phone application, Vision.app, from smartphones which used a 4-force choice procedure with a dark blue Landolt C optotype on a black background displayed at 100cm. VAClinic was the smallest line where optotypes were correctly identified with patient sitting 20 ft from an illuminated screen. The two methods were compared using Pearson correlation coefficient and Cronbach α. Vision.app sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to detect significant VA changes (≥0.3) logMAR from in-clinic baseline. A Bland-Altman plot was constructed to visualize the difference between the two methods. 
Results: A total of 49 participants completed the study with data on 98 eyes collected. Mean (SD) age of 10.22 ± 3.28 years with a 26:23 male:female ratio. Mean VA difference was -0.14 (95% CI, -0.193 to -0.087) logMAR or <1 line of difference with upper and lower limits of 0.23 and -0.51 logMAR. The Pearson correlation coefficient was 0.54 [p < 0.001, (95% CI: 0.38, 0.66)]and Cronbach α is 0.68 [p < 0.001, (95% CI: 0.52, 0.78)]. Vision.app had an 80% sensitivity, 73.5% specificity, 35.3% PPV, 95.3% NPV. 
Conclusion: In our study, Vision.app is a valid method of measuring visual acuity in children.

Smartphone app visual acuity screening in a pediatric population

Background
Orthopaedic surgery has been an increasingly popular field for medical students. Many schools offer elective time to explore areas of interest through clinical rotations and research; however, most are reserved for senior medical students. The purpose of this study was to evaluate the impact of a dedicated orthopaedic surgery symposium to increase awareness about the field, and to assess students’ interest and knowledge of orthopaedic surgery before and after the symposium.
Methods
A one-day free, virtual medical student orthopaedic surgery symposium was organized. Abstracts were reviewed and selected from nine different orthopaedic subspecialty categories. Survey assessments were sent to medical students to complete before and after the symposium. The survey included questions related to participant demographics, as well as interest and knowledge about the field of orthopaedic surgery. Statistical analyses were completed to compare the participants’ responses before and after the symposium.
Results
In total, 962 medical students registered for the four-hour symposium. Of these, 58.5% completed the pre-symposium survey, and 48.0% completed the post-symposium survey. 13.3% of the respondents reported being “very knowledgeable” about the various orthopaedic surgery subspecialties before the symposium, which increased to 18.4% after the symposium (p=0.137). 46.9% of the participants stated that they were “knowledgeable” about the daily life of an orthopaedic surgery resident before the symposium, which increased to 67.3%, post-symposium (p<0.001). Similarly, the percentage of respondents who reported that they were “very knowledgeable” about the residency match process increased from 12.2% pre-symposium to 22.4% post-symposium (p<0.001). 61.7% and 80.5% of participants reported being “very satisfied” with the breakout room sessions and the educational panels respectively, with 84% of participants reporting they would recommend the symposium to others.
Conclusions 
As the interest in a career in orthopaedic surgery increases, medical students desire access to information, mentorship, and opportunities to present their research in preparation for residency applications. Our study demonstrated that a large-scale national orthopaedic surgery symposium provided a platform to augment medical students’ knowledge of the field, present their research, and interact with faculty members.

The Impact of a Virtual Orthopedic Surgery Symposium on MedicalStudents: Increasing Interest and Knowledge of the Field

Abstract Title: An Evaluation of United States Undergraduate Medical Education in Otolaryngology

Background
With an expanding knowledge base, medical schools struggle to incorporate surgical subspecialty education, such as otolaryngology (OTO), into undergraduate medical curricula. OTO complaints comprise 25% of primary care visits, yet graduating physicians report being inadequately prepared to work-up common OTO disorders. Additionally, school factors, such as OTO student resources and an OTO residency program, can impact the competitiveness of student residency applications. Therefore, this study aimed to evaluate the extent of OTO curricula and resources at U.S. medical schools.

Methods
A 48-question survey evaluated the extent of OTO teaching and resources at U.S. medical schools. The survey was distributed by email to all 155 LCME accredited U.S. allopathic medical schools in 2020 and 2021.

Results
68 unique responses were received, representing 43.9% of U.S. medical schools. Evaluation of OTO teaching practices found 36.8% (n=25) of schools reported having formal expectations of OTO knowledge in their curricula. Only 1 school (1.5%) reported having a required OTO rotation. Evaluation of OTO resources found 89.6% (n=60) of schools reported having an OIG and 91% (n=61) provide opportunities for research with OTO faculty. Schools with residency programs were more likely to have otolaryngologists teach basic science lectures and the Head & Neck exam (OR = 13.7, 95% CI [1.86, 153.9] and OR = +infinity, 95% CI [3.35, +infinity], respectively), have formal expectations of rotating students (OR = 5.67, 95% CI [1.15, 27.71]), provide students with opportunities for OTO research (OR = +infinity, 95% CI [17.06, +infinity]), offer an optional third year rotation (OR = 4.27, 95% CI [1.07, 16.99]), have an OIG (OR = 27.5, 95% CI [3.66, 148.9]), and were more likely to have an OMSED (OR = 43.56, 95% CI [6.16, 488.9]) compared to schools without residency programs. 

Conclusion
This study found U.S. medical schools associated with residency programs, larger class sizes, and who employ their faculty through an OTO or surgery department have more robust OTO curricula and resources. Despite the ubiquity of OTO presentations, incorporation of OTO knowledge and resources into U.S. undergraduate medical curricula remains variable, and at times limited.



Abbreviations: 
OTO = otolaryngology
OMSED = Otolaryngology Medical Student Education Director 
OIG = Otolaryngology Interest Group

A Cross-Sectional Survey Study Evaluating Otolaryngology Education at United States Medical Schools

Authors & Affiliations: Erik Feldtmann, BSN1, Valerie Nemov, BS1, Presley G. Busch, BS2, Vinita Kiluk, MD3, Andrew Galligan, MD, MS3, Amy Weiss, MD, MPH3, Scott Coon, PharmD, BCACP2, Aimon C. Miranda, PharmD, BCPS2, Dawn Schocken, MPH4, Erini S. Serag-Bolos, PharmD2

1USF Health Morsani College of Medicine, Tampa, FL. 2USF Taneja College of Pharmacy, Tampa, FL. 3Department of Pediatrics, USF Health, Tampa, FL.4Department of Medical Education, USF Health, Tampa, FL.

Abstract Title: Analysis of Student Outcomes from an Interprofessional Education Transitions of Care Simulation

Background: Interprofessional education (IPE) improves students’ understanding of other professions, promotes communication skills, and facilitates a high functioning healthcare team. The primary objective of this study was to evaluate changes in students’ behavior and knowledge as they worked through virtual transitions of care simulations with their interprofessional teams. The secondary objective was to evaluate whether student knowledge of pediatric asthma exacerbation treatment improved through an interprofessional simulation. 

Methods: Third year medical (n= 164) and pharmacy (n= 139) students at the University of South Florida participated in an IPE simulation via Microsoft Teams in 2021 and 2022. Students were presented with a pediatric (age 12) asthma exacerbation patient and progressed through four, 15-minute stations. Each station required clinical management in the following scenarios: emergency department, pediatric critical care, pediatric floor, and discharge planning. Pre- and post-simulation surveys included nine identical questions and were analyzed using the Wilcoxon signed-rank test, Wilcoxon-Mann-Whitney test, and the MEANS Procedure.

Results: Students showed statistically significant improvement in each domain, including understanding their roles and abilities to work in an interdisciplinary environment and clinical knowledge. There was no significant difference found between cohorts, indicating that students from each year benefited from participation similarly. When analyzing differences based on professional program, it was found that interdisciplinary and clinical knowledge improved for both medical and pharmacy students, although they did not always benefit equally. 

Conclusion: This simulation improved both medical and pharmacy students’ perceptions of interdisciplinary healthcare teams and their ability to manage a pediatric asthma exacerbation patient. 


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Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education

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