United States

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 &amp; 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

2022 AMA Research Challenge

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

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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.


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

poster

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. 


Analysis of Student Outcomes from an Interprofessional Education Transitions of Care Simulation

Background
Cerebral palsy is the most common motor disability in childhood. This condition can be found in up to 1 in 345 live births and is comprised of a plethora of symptoms—including spastic, dyskinetic, and ataxic. While this condition is extremely prevalent and is cared for by a myriad of medical professionals, we hypothesized that there is a lack of emphasis on cerebral palsy in board review materials. In this study, we explored cerebral palsy content in common board study resources.

Methods
Multiple platforms of preparatory materials for medical school licensing exams, including First Aid, Pathoma, Boards and Beyond, and other commonly utilized resources, were assessed for number of mentions of cerebral palsy. Focus was placed on USMLE Step 1 and Step 2 and COMLEX Level 1 and Level 2 due to the universality of these exams.

Results
Within board exam prep material, we found that the First Aid for USMLE Step 1: 2021 edition only mentioned cerebral palsy one time. Similarly, cerebral palsy was only directly covered in two questions within the entirety of the UWorld Step 1 question bank, updated in 2022. Other materials analyzed had zero mentions of cerebral palsy in any capacity within their scope.

Conclusion
In conclusion, there is a severe lack of coverage of cerebral palsy within the medical school board preparation materials. Given cerebral palsy is the most common childhood motor disability and requires a multitude of medical specialties to properly manage these patients, it must be increased within the curriculum and within board exam relevance. Board review content guides the studying of most medical students throughout their time in medical school, therefore, an increase in cerebral palsy education within board preparatory material would innately increase the emphasis on cerebral palsy education within medical school curricula across the country. According to a study published in 2005, an increase in curriculum may also result in a promotion of positive attitudes towards people with cerebral palsy and other disabilities. The medical student curricula should increase its overall coverage of cerebral palsy to promote the knowledge, understanding, and lessen the stigma within the medical community.

Low Prevalence of Cerebral Palsy Coverage Within Medical School Board Preparation Materials: Implications for Education and Attitudes

Background: Approximately 750,000 adolescents and young adults (AYA’s) with chronic conditions require transition from the pediatric model of care to adult care annually. The lack of a planned process known as healthcare transition (HCT) is associated with increased hospitalizations, care discontinuity, and increased morbidity. Multiple studies have reported the lack of HCT training and competency in graduate medical education (GME) trainees. However, little is known about the factors contributing to the development of HCT knowledge and practice. The present study employs a multi-center cross-sectional survey to better understand differences in HCT knowledge as well as barriers to providing HCT care and acquiring HCT training among medical trainees.

Methods: In March-June of 2022, participating residency and fellowship programs from 11 institutions were surveyed using a 74-item questionnaire. Differences in HCT knowledge and barriers to HCT care and education were analyzed between trainee type, presence or absence of Medicine-Pediatrics program or HCT champion (defined as any faculty or staff who is a mentor or leader in HCT) at residency or fellowship, and specialty type.

Results: Out of the 1,346 trainees receiving survey invitations, 154 responded (response rate: 11.4%). Mean HCT knowledge scores were higher in trainees who had a prominent HCT figure at their institution (p<0.005), attended at least one HCT lecture (p<0.001), and performed at least one transition care readiness assessment (p<0.005) or transition care consult for patient or caregiver (p<0.05). Trainees from institutions without a prominent HCT figure were more likely to cite “lack of transition coordinator” as a barrier to providing HCT care (OR 2.76; p<0.05). Residents, compared to fellows, more frequently cited “lack of skills to convey concept” as a barrier to HCT education (OR 3.52; p <0.05).

Conclusions: Results from this study highlight the importance of skills-based practice and an institutional prominent HCT figure in increasing HCT proficiency and the ability to provide HCT care. GME programs and accreditation bodies should consider these factors when developing curricula to provide effective HCT for transitioning AYA.

The Impact of Institutional HCT Champions and Med-Peds Programs on HCT Knowledge, Practices, and Attitudes: A Multicenter US Survey Study

An Altmetric Analysis of Medical School Research by Plastic Surgery Residents

Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). 

Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. 

Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. 

Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.

Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder

Objective: The impact of social media (SoMe) has been magnified in the COVID-19 era with virtual interviews becoming the new normal. Residency programs that effectively utilize SoMe have the potential to distinguish themselves and improve their resident recruitment. The platforms also give programs an opportunity to connect with applicants they otherwise might have limited ability to reach prior to the interview season. We sought to evaluate the presence of SoMe across diagnostic radiology residency programs and determine how they effectively leveraged these platforms in resident recruitment. 

Methods: A list of diagnostic radiology residency programs within the United States was obtained from the American Medical Association (AMA) FREIDA Residency Database. A subsequent search for the presence of Twitter, Facebook and Instagram was performed for each of these programs. For programs that did not have a dedicated residency SoMe account, the department account was used in lieu if the authors appreciated residency-related content being commonly shared. The authors then tabulated the presence of each radiology residency program on the aforementioned SoMe platforms. Further analysis was then done to determine the year of creation of the account (if available on the platform), the total number of Twitter followers, the total number of Instagram followers, and the total number of Instagram posts. Descriptive statistics with Microsoft Excel was performed to analyze the data.

Results: Based on the analysis, the most utilized SoMe platform by radiology residency programs was Twitter (61.73%), followed by Instagram (47.45%), and then Facebook (37.76%). Given that Twitter was the most utilized, further analysis was done to evaluate the total number of followers and the year of account creation. The results showed that the average program had 1081 ± 1438 followers and the mean year of creation was the year 2017 ± 2.6.

Conclusion: Social media is an effective tool to disseminate information efficiently and effectively to prospective residency candidates. It is important that those involved in graduate medical education stay up to date with current and future trends in social media while simultaneously maintaining an active professional presence on these platforms.

“From Rads to Riches” – How Radiology Effectively Utilizes Social Media in Residency Recruitment

Background: Virtual anatomy modules are convenient for students to complete, but their utility compared to traditional in-person anatomy didactics is unclear. Additionally, the recent demand for remote-learning materials has provided an advantageous opportunity for our institution to develop and assess the efficacy of online modules to teach pre-clerkship anatomy. Our aim was to develop, deploy, and evaluate the utility of Online Radiographic and Cadaveric Anatomy (ORCA) modules for teaching anatomy.

Methods: We created online renal, pulmonary, and cardiovascular anatomy modules that incorporated pictures of cadaveric prosections, 2D models, and radiographic images to teach principles of anatomy for first-year medical students (MS1) at Paul L. Foster School of Medicine. Efficacy of our online modules was assessed through pre- and post-module tests. Additionally, voluntary surveys were administered to students to assess their opinions on this type of learning experience.

Results: Out of 116 students in the MS1 class, 77 completed the renal module, 85 completed the pulmonology module, and 47 completed the cardiovascular module. Pre- and post-module assessments showed that of the 77 MS1s who completed the renal module, 53% scored an 80% or higher on the post-module quiz, and 14% scored a 20% or lower. Additionally, of the 85 students that completed the pulmonary module, the percentage of students who scored 80% or above on the pre- and post-test were 25% and 47%, respectively. Post-unit surveys indicated that 70.2% of MS1s found the modules useful for teaching principles of anatomy, 54.1% feel confident applying their knowledge of anatomy to answer clinical vignettes, and 70.6% wanted similar modules in the future.

Conclusion: The results of this study suggest that ORCA modules may be helpful in teaching anatomy; however, additional studies are needed to assess whether they significantly improve test performance. Furthermore, a majority of MS1s found the modules to be useful for learning principles of anatomy, feel confident applying their knowledge to vignettes, and want similar modules for future anatomy units.

Learning Anatomy Using Online Radiographic and Cadaveric Anatomy (ORCA) Modules

Background
Live interactive patient cases have shown to be a valuable resource in medical education. Previous studies have shown that using patients as teachers helps students develop clinical reasoning, motivates students to learn, and has important educational benefits; however, there is limited research on medical student feedback for these patient cases. Therefore, the objective of this study is to evaluate second year medical students’ (MS2) perceptions on interactive patient encounters during the teaching of the skin and rheumatology course (BMS6635).

Methods
Following the completion of the BMS6635 course, MS2s completed a survey on their experience from four to five interactive patient cases at University of Central Florida College of Medicine from 2016-2022. The interactive cases involved patients with diagnoses of systemic lupus erythematosus, psoriatic arthritis, dermatomyositis, scleroderma, and pyoderma gangrenosum. All MS2s enrolled in BMS 6635 were included. Statistical analysis was performed on survey responses. 

Results
700 surveys were completed following the interactive patient encounters. 90% of participants answered that they enjoyed the interactive patient cases. 92% of students agreed that the patient cases were an appropriate learning experience for their education. 76% of students agreed that the patient encounters helped them retain knowledge of the diseases. However, only 36% agreed that the number of patients in the patient cases should be increased. From 2016 to 2022 there has been a slight decrease in enjoyment in the interactive patient cases over time (97%, 88%, 93%, 94%, 86%, 81%, p<.001, respectively per year). From 2016 to 2022, there was a slight decrease in students agreeing that the patient cases were an appropriate learning experience in their education (98%, 92%, 94%, 95%, 93%, 84%, p=.001, respectively per year).

Conclusion
While there may have been a slight decrease in positive feedback in interactive patient cases, patient cases are a valuable resource in medical education and should be integrated in medical curricula. Students enjoyed the patient cases, believed they were an appropriate learning addition to their education, and aided in retention of material.

Second Year Medical Student Feedback on Live Patient Cases in the Skin and Rheumatology Course

Background
The use of race as a biological construct without proper social, political, and historical context is dangerous and can lead to the perpetuation of racism and racial and ethnic health disparities.1–4 The goal of this project was to assess the ways in which race and ethnicity are presented in the Foundations of Medicine and Health pre-clerkship curriculum at Case Western Reserve University School of Medicine and appreciate ways in which the curriculum could improve to be more structurally competent.

Methods
This project began by creating ten learning objectives to guide instructors and students on the skills and knowledge necessary to promote race and ethnic diversity in medicine. We systematically reviewed 398 lectures with 20,630 slides across six basic science integrated blocks from 2020-2022 looking for the following terms: race, ethnicity, black, white, asian, hispanic, native American, racial, or photos of people of color. Each lecture PowerPoint was reviewed for the relevant terms and images; and the following information was recorded for each reference: faculty author, block, lecture title, number of slides in that lecture that mentioned key
terms, topic covered in the lecture that included race-ethnicity, application of the term (e.g risk, diagnostic), and areas for improvement.

Results
The results of this project were the creation of 10 learning objectives that are consistent withmCultural Competence Education for Medical Students guidelines AAMC standards. Curricular examination identified 245 slides across ninety lectures in the 2020-2022 preclinical curriculum that mention race, ethnicity, black, white, Asian, Hispanic, Native American, racial, or contain photos of racially and ethnically diverse people. Of the 245 slides reviewed, 220 slides (89%)
mentioned key terms as biological constructs without proper mention of structural factors.
Conclusion
The results of this project are in alignment with previous literature on the subject.17
Added context should be included throughout all the preclinical curriculum to ensure that students are prepared to effectively care for individuals from a variety of races and ethnic backgrounds. Moreover, medical education still lacks a concise and direct way to discuss race and ethnicity. The learning objectives created in this project offer a framework on how to make discussion on race and ethnicity in medicine relevant, accurate, and solution oriented.

An institutional evaluation of race and ethnic diversity in pre-clerkship lectures

Background: Physicians regardless of specialty will encounter patients who have experienced addiction, making addiction medicine training vital. Unfortunately, medical schools devote little time to addiction-related training, with many students graduating without adequate knowledge or skills to treat patients with substance use disorders (SUD).

Methods: Michigan State University (MSU) created a pilot 4-week addiction medicine elective for PGY-1 students with the goal of increasing student’s knowledge, awareness, and skills in assessing patients with SUD. The Addiction Medicine Student Interest Group (AMSIG) was created to implement additional foundational principles. The 4-week elective was developed and made available to students online, including asynchronous modules, small and large group meetings, clinical cases, and expert and patient interviews. Utilizing these methods allowed for a broader reach and appealed to multiple learning styles. AMSIG held several events beginning with a de-stigmatization campaign where people-first language was emphasized. Other events included a patient panel, and naloxone and buprenorphine educational sessions.

Results: 36 PGY-1 students at MSU-CHM (MSU College of Human Medicine) completed a baseline attitudes survey in May 2021. An overwhelming majority of students “agreed” or “strongly agreed” that physicians who diagnose SUD early improve the chance of treatment success (89%), family involvement is a very important part of SUD treatment (97%), SUD is treatable (92%), alcohol use disorder is treatable (97%). The majority “disagreed” or “strongly disagreed” that once a patient is abstinent and off all medication for their SUD, no further contact with a physician is necessary (100%), a patient with SUD who has relapsed several times probably cannot be treated (100%), a patient with a SUD cannot be helped until they hit “rock bottom” (94%). The de-stigmatization campaign had 21 participants, the patient panel had 30 attendees, the naloxone training was overwhelmingly popular with 66 participants, and the buprenorphine session had 26 participants.

Conclusion: Early supplementation of the medical school curriculum with addiction medicine training can boost students’ confidence in their ability to assess patients with SUD. Moving forward, the goal is to share what MSU-CHM has learned from the elective and AMSIG. Our hope is that other medical schools will incorporate these principles into their curriculums.

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