HPEC Poster Session 2025

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Impact of UV-Aging Software on Sun-Protective Attitudes of Outdoor Pickleball Players in Hawai'i
(2025) Danko, Ana; Zimmerman, Heather; Ho, Taylor; Tokunaga, Darcy S.; Nierva, Amadeo; Elpern, David; Horio, David
Introduction: Pickleball is a popular sport in Hawai'i, with many outdoor courts exposing players to UV radiation. Given Hawai'i’s high UV index, sun protection is crucial, as outdoor activities like pickleball increase the risk of skin cancer, including melanoma.1 Although health-based sun-safety interventions have improved knowledge about skin cancer, they may not be the most effective at encouraging sun-protective behaviors.2 Research suggests that appearance-based sun-safety education, highlighting the effects of UV exposure on premature aging, may be more effective in promoting sun-protective actions.2,3 Objective: This study investigates whether the inclusion of UV-aged images improves sun-protective behaviors among Hawai'i pickleball players more than a sun-safety video alone. Methods: Pickleball players were selected due to the abundance of outdoor courts throughout parks in Hawai’i. Participants were randomly approached while playing pickleball outdoors an offered inclusion in the study. Exclusion criteria included those less than 18 years of age, playing pickleball less than once a week outdoors, and not agreeable to a follow-up survey. After enrollment, a baseline survey was administered, assessing demographics, sun-safety attitudes, and behaviors. Subjects were then randomly divided into two groups: Group A received only an educational sun-safety video, while Group B received the same educational video along with viewing of UV-aged images of themselves using the previously validated Sunface app. These images demonstrated how their face may appear in 15 years without the use of sun protection, and a comparison was provided demonstrating how it may appear if sun protection was used. Identical follow-up surveys were administered to both groups immediately post-intervention and again at a 1-month interval to assess changes in attitudes and behaviors. Responses were recorded on a Likert scale, converted to numerical scores, and analyzed to compare pre and post-intervention changes between Groups A and B. Results: Both groups showed improvement in planned future behavior while group B showed higher levels of improvement and additional improvement in sun-safety attitudes. In response to the statement “In the future, I plan to use sunscreen on all exposed areas of my body daily” pre and post intervention, group A’s average Likert score increased by 0.24 while group B’s score increased by 0.54. In response to the statement “I believe that sun and UV light damage cause wrinkles” group A’s average Likert score increased by 0.05 while group B’s score increased by 0.25. High baseline scores in both groups suggested that participants had substantial knowledge about sun safety before the intervention, limiting the overall impact on knowledge and behavior improvement. To more closely examine the impact on participants with lower baseline knowledge, an additional analysis was performed excluding participants who marked ""Strongly Agree"" on the pre-survey. This refined analysis showed a more pronounced change in Likert scale scores post intervention. In response to the statement “In the future, I plan to use sunscreen on all exposed areas of my body daily” pre and post intervention, group A’s average Likert score increased by 0.44 while group B’s score increased by 0.77. In response to the statement “I believe that sun and UV light damage cause wrinkles” group A’s average Likert score increased by 0.27 while group B’s score increased by 0.64. Discussion: Preliminary findings suggest that including UV-aged images of participants may improve the effectiveness of an educational sun-safety video in enhancing sun-safety attitudes and planned behavior among Hawai'i pickleball players. The inclusion of UV-aged images appears to better influence UV risk perception and the intention to adopt protective behaviors. Additional data collection and the inclusion of 1-month follow-up data will help further assess the long-term impact of this intervention on attitudes and behaviors. A limitation of this study is the reliance on self-reported behaviors and experiences. Future studies may consider recording objective data, as self-reported data may vary.
Night-float In The OB/GYN Clerkship: As The Sun Sets, A Resilient Resident Rises
(2025) Beaman, Amanda Y.; Kameoka, Alyssa M.; Malley, Alyssa; Hiraoka, Mark K.; Saito-Tom, Lynne Y.
Introduction While virtually all residency programs require some form of night call, a minority of medical students have overnight experiences. At the John A. Burns School of Medicine, although many clerkships have “late-call” experiences, OB/GYN is the only rotation with an overnight component in the form of night float. Previous studies have described students’ night float experiences in clerkships other than OB/GYN. Some studies have found more opportunities for admission history and physicals during the nighttime with varied impacts on the quality of teaching overnight, and most studies demonstrated either better performance or no impact on NBME scores (1,2,3). Few studies have surveyed students directly, and no studies have been conducted on this topic in the OB/GYN clerkship. Objectives The purpose of this study was to characterize third-year medical students’ perceptions and experiences during a four-consecutive night float shift on Labor and Delivery. Methods Medical students who completed the OB/GYN clerkship during the 2023-2024 academic year answered unlinked, pre- and post-clerkship surveys. Students responded to statements of their experiences using a 5-point Likert scale and reported the number of patient interviews and deliveries they participated in. Statistical significance was tested with Chi-square. Results Among 75 students, there was an increase in the percentage of students (pre-8% vs. post-31%) who “strongly disagreed” / “disagreed” that students should experience a night float rotation during medical school (p<0.001). Students reported more patient interviews (4 or more) during the day (59%) versus night shift (36%; p<0.001), but the same number of deliveries (7 or more) (day-55% vs. night-63%; p>0.05). The majority of students agreed/strongly agreed that night float allowed them to experience a resident schedule (73%) and taught them how to function when tired (57%). Discussion Overall, medical students seemed to have a negative perception of night float with similar numbers of patient care experiences as the day shift. However, night float provided students with a taste of a residency schedule and taught them resilience. Having exposure to their first night shift during medical school may provide comfort to incoming residents as they are bombarded with new challenges and experiences to overcome during their intern year. References 1. Talib N, Toy S, Moore K, Quaintance J, Knapp J, Sharma V. Can incorporating inpatient overnight work hours into a pediatric clerkship improve the clerkship experience for students? Acad Med. 2013 Mar;88(3):376-81. doi: 10.1097/ACM.0b013e318280d271. PMID: 23348086. 2. Tran JH, Fine ME, Holzer H. Student and Educator Perceptions of Night Float in the Internal Medicine Inpatient Clerkship. J Gen Intern Med. 2023 Apr;38(5):1319-1321. doi: 10.1007/s11606-022-07956-w. Epub 2022 Dec 1. PMID: 36456845; PMCID: PMC10110800. 3. Connelly CR, Kemp Bohan PM, Cook MR, Moren AM, Schreiber MA, Kiraly LN. A night float week in a surgical clerkship improves student team cohesion. Am J Surg. 2016 May;211(5):913-8. doi:10.1016/j.amjsurg.2016.01.011. Epub 2016 Feb 23. PMID: 26988619.
Foundational aspects of Learning Communities at JABSOM: Insights from the 2024 graduating class
(2025) Ushijima, Maya
Background: The John A. Burns School of Medicine (JABSOM), University of Hawaiʻi at Mānoa, launched our Learning Communities (LC) program in July 2020 in the midst of the COVID-19 Pandemic. With Hawaii’s increasing physician shortage and higher demands on health care providers, burnout and withdrawal are becoming increasingly prevalent. While many medical schools across the country have already implemented some form of a learning community, JABSOM’s program demonstrates a strong commitment to our diverse communities while enhancing the training of the physicians who will be caring for these communities. By promoting a safe and supportive environment focused on collaboration and wellness, the program aims to enhance students’ medical school experience, increase resiliency, decrease burnout, and better equip students for the future of medical practice in Hawaiʻi. Learning within these small longitudinal groups allows students to build meaningful relationships and to improve wellness, teach empathy, and develop their professional identity. Methods: The 2024 graduating class was the first class to participate in the Learning Community program throughout their entire time at JABSOM. The aim of this study was to evaluate the impact of the LC program in this class with a focus on wellness, empathy, and professional identity formation. The methods of this study involved the distribution of an anonymous survey to medical students following the completion of the 2023-2024 year. The survey consisted of 5 point likert scale questions to measure the perceived impact of the LC program and faculty mentors on student well-being, understanding of empathy, and development of professional and clinical skills as a physician. Additionally the students were asked to provide qualitative comments on the impact of the program on wellness and empathy and their top highlights. The qualitative data collected from these responses were analyzed to extract themes. Results: For the 2023-2024 year, 62 of 77 (80%) students completed the survey. Ninety-four (94%) agree (strongly agree or agree on the 5-point likert scale) LCs positively impacted their wellbeing and 99% agree it helped them realize the importance of wellness and its impact on their personal and professional life. Students said LCs ""were absolutely fundamental to (their) wellbeing” and “provided a smaller group to grow with throughout (their) four years.” Ninety-five (95%) agree LCs helped them demonstrate and understand empathy with their patients. Comments indicated a positive impact: “Throughout medical school these sessions on soft skills are the only times I have had faculty discuss with us the importance of empathy and how to navigate difficult situations with patients.” Ninety-seven (97%) agree LCs helped them understand the professional responsibilities of physicians. Ninety-nine (99%) agree the LC mentors strengthened their professional identity formation. Discussion: The findings of this study suggest that the LC program overall has had a significant impact on student wellbeing, empathy, and professional identity formation. Select comments expressed mixed reviews regarding the impact of specific activities on student wellbeing, with most concerns regarding the length of the scheduled activities. While most of the class agreed with statements that LCs helped them foster empathy with their patients, about 10% of the qualitative comments described little to no change in empathy from the program. One limitation is that this study did not include a comparison group of students who were not a part of a learning community. With the 2024 graduating class entering medical school at the start of the COVID-19 pandemic, JABSOM’s LC program played an integral role in their transition to medical school. For many students, their learning community was their entire social and academic group during their first year. The program creates a crucial connection between students and their peers and faculty, as well as the community that they intend to practice in. “(LCs) enabled me to see that my own perceived weaknesses and worries are often shared by my peers. It made me feel I'm not alone and enabled me to appreciate the fears, joys, and vulnerabilities that tie us all together.” Conclusion: This survey provided a cumulative look at JABSOM’s Learning Community program from the first graduating class to participate in the program for all four years of medical school. Overall, students in this class overwhelmingly agreed that the LC program had a positive impact on their wellbeing in medical school, their understanding of empathy, and the development of their professional identity as physicians. The longitudinal relationships and deeper sense of community fostered by JABSOM’s LC program allow students to build deeper physician-patient and physician-community connections that are crucial to increasing physician satisfaction and reducing burnout in the long run. Ultimately, the Learning Communities program at JABSOM will continue to provide an important element of human connectivity to medicine in Hawaii.
Virtual Reality Simulation Training for Surgical Procedures and Back Table Set Up for Nursing and Scrub Technician Students: Innovations in Education
(2025) Nakamura, Ryan; Wright, D-Dré; Fujimoto, Brent; Durocher, Joseph; Rovinsky, David
Context Current scrub technician/nurse training for specific procedures typically involves observing a senior scrub tech or nurse in the operating room (OR), followed by supervised practice until they are proficient enough to work independently; thus constituting a lack of consensus, standardized training regimens for specific surgical procedures. Virtual reality (VR), specifically the “Osso VR” software, offers a promising solution by allowing scrub techs and nurses to practice in a realistic, low-stress environment that mimics actual operations. It can potentially serve as a quick refresher before surgery or as a standardized method for teaching scrub techs/nurses a new procedure for the first time. Objectives This research aims to provide comprehensive insights into the effectiveness of VR in enhancing the training outcomes of OR scrub techs/nurses for back table setup procedures compared to traditional training methods. Description of Innovation VR offers a dynamic and interactive learning environment that can replicate the OR setting and provide repetitive practice without the risks to patients. The benefits of VR in surgical training have been reported across various specialties, both for medical residents and nurses, indicating its potential as an educational tool to enhance skill acquisition and reduce error rates. However, there is extremely limited research into the efficacy of educational training for surgical scrub techs/nurses. Evaluation of Innovation A randomized, controlled, single-blinded study comparing the use of VR training versus traditional training methods will be carried out to assess proficiency, efficiency, and accuracy of back table set up procedures for a total knee arthroplasty. Groups will be randomly assigned to a “VR group” and “traditional learning group” to train students on this procedure. The VR intervention will be carried out through the OSSO VR software, compatible with an Oculus VR headset while the traditional learning group will be provided a standard lecture-based educational session. They will then be asked to perform a back table set up, which will be graded by blinded attending surgeon using procedure-specific checklists and 5-point global assessment scale. Trainees will then be surveyed about their attitudes and experience with the VR training process. Discussion/Key Message By demonstrating the potential benefits of VR training, we hope to encourage its broader adoption in surgical education. Enhancing the training efficacy for scrub techs and nurses not only improves their preparedness and confidence but also contributes to overall patient safety, surgical efficiency, and surgical outcomes. Additionally, scrub techs and nurses may also undergo VR training of the actual surgical procedure, something that they would be unable to do in reality. The combination of this virtual surgical experience and the practice of VR back table set up will give the entire surgical team valuable insights into the procedure itself and foster a cohesive and collaborative working environment, all while being done in a way that is simple, enjoyable, and low-pressure. The findings from this study could pave the way for implementation of advanced technology and standardization of training for OR personnel - a large step forward from the “see one, do one, and teach one” approach that is currently in practice. Target Audience This pilot study will be tailored towards scrub tech and nursing students with the hopes of garnering this approach’s acceptance to every member of a surgical team. We envision the use of VR OR training for medical students, surgical residents, and even attending surgeons as a means to train and create fully competent and confident members of the surgical team.
Examining a Successful Match Year: A Bright Spot Amid National Pediatric Decline
(2025) Wong Ramsey, Kara; Mizuo, Barry; Len, Kyra
Context: The 2024 Residency Match year was marked by an unprecedented decline in the number of students matching into Pediatrics. This trend has raised concerns about maintaining an adequate pediatric workforce. In contrast, the University of Hawai`i’s (UH) 2024 graduating class achieved an unprecedented 20% match rate into pediatrics, demonstrating a notable contrast to the national trend. Understanding underlying factors in these students’ decision to pursue pediatrics may offer insights to reverse the national decline. Objectives: This study aimed to explore the key factors that motivated University of Hawaii students to pursue pediatrics, focusing on when and how their interest was sparked and solidified during their medical school training. Methods: An anonymous multiple choice survey (with the option to add in free text short answers to explain answer choices) was sent to all 16 graduating students from the University of Hawaii’s 2024 class who matched into pediatrics. Students completed the survey on a voluntary basis. The survey asked when their interest in pediatrics started and what specific experiences and factors influenced their decision to pursue pediatrics. Data was analyzed to identify recurring themes amongst our graduates. Results: 13 out of 16 graduates completed the survey. The majority (9 respondents, 69%) solidified their interest in a pediatrics career during their third-year inpatient pediatrics rotation. In particular, family-centered rounds and a supportive clinical environment played a critical role in fostering their interest. The Sub-Internship (Sub-I) experience was a decisive factor in confirming their specialty choice for 4 students. 3 students cited pre-clinical shadowing electives as the reason they first considered pediatrics, as these electives provided valuable one-on-one time with attendings without the pressure of evaluations weighing on the student’s ability to explore the specialty freely. 2 students identified impactful clinical experiences, such as discharging a patient from the Pediatric Intensive Care Unit (PICU), as the key moment that persuaded them to pursue pediatrics. Overall, students felt that faculty and residents during their clinical rotations played the most important role in their career decision. Feeling supported during pediatric rotations was a recurrent theme amongst comments from survey participants. Many students expressed that the collaborative and cordial nature of pediatrics made it stand out from other specialties. Areas for improvement included increasing the pre-clerkship pediatric experiences and organizing community events focused on child health. Discussion: Survey responses from UH’s highest proportion of students matching into pediatrics in a time where match rates fell across most of the nation underscores the value of early and meaningful exposure to the specialty. In addition, survey responses highlight the importance of having positive role models among faculty and residents interacting with students. Institutions seeking to increase their pediatric match rates may also benefit from prioritizing quality clinical exposure and developing learning environments that welcome students to the field.
Hands-On Learning: Teaching Neonatal Circumcision with an Affordable Simulation Model
(2025) Wong Ramsey, Kara; Mizuo, Barry; Len, Kyra
Context: Neonatal circumcision, the most commonly performed neonatal procedure, is primarily performed by pediatricians or obstetricians. Given differences in parental desires for this elective neonatal procedure across different populations (as high as 89% in Hawaii), opportunities for medical students to gain experience in circumcisions prior to residency are variable. Simulation models for circumcision obtained commercially or those requiring specialized equipment such as 3-D printers can be cost prohibitive for medical training programs. While several models have been studied among pediatric or obstetrical gynecology residents, limited data is available on the effectiveness of circumcision simulation models on medical student learning. Objectives: The purpose of this innovation was to develop and evaluate the impact of a low cost, portable, newborn circumcision simulation model that can be quickly assembled with over-the-counter and non-perishable items on medical student circumcision related medical knowledge and self-reported improvement in confidence performing the procedure. Description of Innovation: Between 2022 to 2024, 26 fourth year medical students matching into pediatrics participated in a circumcision workshop. Students were given a short didactic going over medical contraindications, benefits, and risks involved with circumcision. A newborn circumcision model was built using a Boon™ bottle drying rack, Similac™ disposable slow flow nipple, Playtex™ tampon plastic applicator, and glove finger tips cut from a Biogel™ size 6 sterile glove. The model was developed and pilot tested by a neonatologist skilled in circumcisions. Faculty demonstrated circumcision using a Gomco clamp on the model and then provided one-on-one guidance as each student demonstrated circumcision skills on the model. The guided practice allowed students to refine their technical skills and build confidence in performing the procedure. Students took a pre-test and post-test to measure improvement in medical knowledge (related to benefits, risks, and key procedural steps of circumcision), and self-rated confidence in their procedural skills using (1= not very comfortable, 5=very comfortable). Results were analyzed using paired student T-test. Evaluation of Innovation: Medical students demonstrated improvement in mean ratings of self-reported confidence in explaining the risks (1.96->4.07), steps of the procedure (1.65->4.27), and performing the procedure independently (1.58->4.23), p<0.01 for all questions. Student performance on a multiple choice quiz testing pertinent medical knowledge also improved (mean percentage correct 83->93%, p<0.01). Students found the model realistic (mean score 4.11 out of 5.0) and helpful in learning the procedure (mean score 4.81 out of 5). Discussion/Key Message: A portable, easily assembled, and low-cost model of neonatal circumcision was effective in improving medical knowledge and self-reported confidence in procedural skills among inexperienced fourth year medical students, a demographic not previously assessed in the literature. This model has the potential for widespread adoption across other health professions or specialities that may also benefit from circumcision training education. Limitations include lack of anthropomorphic features which detracted from the realism of the model and difficulty in using the scalpel to cut through the glove tip. Future directions will assess the impact of this simulation training model on subsequent procedural performance during the pediatric intern year and retention of skills in senior year to further validate the model's effectiveness and its contribution to clinical practice readiness.
Illuminating the Pediatric Clerkship: Visual Art Reflections from Medical Students
(2025) Wong Ramsey, Kara; Mizuo, Barry; Len, Kyra
Reflection exercises via group discussion or written essays are gaining in popularity in medical student education to facilitate development of professionalism, humanism, emotional intelligence, and empathy. However, implementation is limited by clerkship time constraints. Little is known about the impact of non-verbal reflections on trainee experiences. Identifying “bright spots”, or areas of success, is a solution-focused method of approaching challenges that is a useful strategy to address complex problems requiring behavioral, social and technical changes. Objectives: Evaluate the impact of a visual art based reflection exercise and group sharing on third year medical students’ self reported feelings of: 1) Connection with their peers and patients; 2) Satisfaction with their overall third year clerkship experience. Description of Innovation: 22 third year medical students participated in a 30 min reflection exercise in-person facilitated by faculty between August to October 2024. Midway through their 4-week long pediatric inpatient rotation, each group of 6 to 8 students were instructed to spend 10 minutes drawing a picture of a personally joyful memory from their pediatric clerkship. The students next took turns sharing their drawing with the group, explaining why this moment was joyful, and what actions they might undertake to experience similar feelings in the future. At the end of their 4-week rotation, students completed a survey rating their feelings of connection with their peers and patients as well as their change in overall perception of their third year experience before and after the exercise using a Likert scale 1->4 (1= very negatively, 4=very positively). Results analyzed with paired T-test. Evaluation of Innovation: Students’ mean score of their overall perception of their third year medical student experience after the reflection activity increased (mean 3.22->3.39, p=0.04). The activity made students feel more engaged and connected with both their classmates and their patients (mean score 3.17 and 3.09 respectively). Students rated agreement with the statement “The activity enabled me to identify new specific behaviors, strategies, perspectives or attitudes that I will incorporate in the future as a medical student or future physician” with a mean score of 3.22. When comparing the practice of reflection through drawing versus written essays, 21 of 22 students stated a preference for drawing. Reasons cited included ease of expression, increased sense of engagement, and increased enjoyment. Discussion/Key Message: A reflection activity using visual art as a medium of expression to identify bright spots was effective in improving the perception of the clerkship experience, increasing students’ feelings of engagement/connectedness with their peers and patients, and enabling students to identify professional behaviors that yield a sense of personal fulfillment in the clinical area. Thematic analysis of student drawings and bright spots identified is ongoing.
Evaluating Musculoskeletal Anatomy Knowledge Among First-Year Medical Students: A Longitudinal Analysis
(2025) Snyder, Eli; Sonnleitner, Mikayla; Johnson, Franchesca; Lee, Ho Hyun; Lew, William; Shimoda, Brent; Aytac, Gunes; Stickley, Christopher; Oshiro, Elliott; Nishimura, Stephanie; Lew, Henry
Introduction: Several studies have highlighted insufficient musculoskeletal (MSK) anatomy knowledge among medical students and residents. The current study evaluated MSK anatomy examination scores between successive cohorts of first-year medical students to compare three interventions: (A) a teaching-assistant-led pre-examination review session; (B) a clinical skills teaching session of the knee and shoulder joints, which was reinforced during anatomy dissection sessions, and (C) a combination of interventions (A) and (B). Methods: Intervention A was administered to cohort A (Class of 2025) during their first year of medical school. Intervention B was administered to cohort B (Class of 2026) during their first year of medical school. Intervention C was provided to cohort C (Class of 2027) during their first year of medical school. Outcome measures included (1) scores from a 30-question multiple-choice anatomy final examination, and (2) scores from 10 of the 30 questions that were related to the clinical skills teaching session. Results: Data from all members of each class of 77 students were captured (n = 231) and outliers (data points outside 1.5 times the IQR from the lower and upper quartiles) from each class were removed for analyses. Results showed (1) cohort C scored 3.3% higher than cohort B (p < 0.05) on all 30 questions and (2) cohort C scored 5.1% better than cohort B (p < 0.05) and 5.0% higher than the cohort A (p < 0.05) on the 10 questions related to the clinical skills teaching session. No other comparisons yielded significant results. Discussion: The significantly higher MSK anatomy examination scores in cohort C suggested that a combination of pre-exam review sessions with clinical skills teaching sessions (intervention C) enhanced students' knowledge of MSK anatomy more effectively than intervention A or intervention B alone. Longitudinal assessments and similar research at other institutions may further elucidate the differential effects of clinical skills teaching and pre-examination review sessions on medical students’ MSK anatomy knowledge.
Improving Colorectal Cancer Screening in the West Oahu Community of Hawaii
(2025) Yamasaki, Aaron; Santiano, Agnes Catherine; Cazin, Marguerite; Kamada, Natalie; Liu, Tyler
Introduction: Colorectal cancer (CRC) is the third most common cause of cancer-related mortality in Hawaii (1). Only 65% of Hawaii’s population between ages 45 and 75 has been screened for CRC (2), which is below the American Cancer Society National Colorectal Cancer Roundtable goal of 80% (3). Similarly, we found the screening rate in the population attributed to a large primary care practice in West Oahu to be low at 45%. Objective: Identify root causes for low CRC screening rates and test possible interventions to improve screening rates in this population. Method: First, we interviewed and observed the primary care team to understand their current workflows for both patient in-reach and outreach. Second, chart reviews of the electronic medical records (EMR) of 388 patients covered by Hawaii Medical Service Association (HMSA) insurance at this primary care office were conducted to include patients who were deemed at “average risk” for CRC. Patients were excluded from the root cause analysis if they were at “high-risk” for CRC (e.g., family history of CRC, past medical history of CRC, history of inflammatory bowel disease, familial adenomatous polyposis, Lynch syndrome, past colectomy, or past radiation to pelvis), since these high-risk patients required a different workflow and made up a very small percentage of the population. Third, Plan-Do-Study-Act (PDSA) cycles were then conducted over two months with the intent of targeting the most common root causes. The first cycle standardized electronic orders for the Fecal Immunochemical Test (FIT). The second cycle utilized a HIPAA-compliant text-messaging outreach tool to notify patients who were due for CRC screening. The third cycle focused on calling patients who could not be reached via text. Chart reviews were conducted throughout all PDSA cycles to measure changes in screening rates. Results: Baseline screening rate was 45% (314 adherent patients out of 702 eligible HMSA patients). After chart review, 74 additional patients were found to be adherent and 14 high-risk patients were excluded, increasing the screening rate to 57%. The most common reason for this 12% increase was a discrepancy between insurance claims data and EMR data. For the remaining unscreened patients, the most common reason for care gaps was a lack of standardized workflows for addressing CRC screening gaps during in-office visits. Discussion: Close collaboration with the office staff was crucial for implementing and facilitating PDSA cycles. Focusing on patient outreach uncovered social determinants of health affecting the clinic’s population, such as transportation and financial difficulties. Future incorporation of these projects into the JABSOM curriculum can provide an opportunity for students to apply populational health concepts in a clinical setting.
Localized Student DASH to improve rating of faculty debriefing after simulation
(2025) Shimoda, Brent; Ho, Taylor
Introduction Debriefing is a crucial component of simulation-based education; the Debriefing Assessment for Simulation in Healthcare (DASH) is a behaviorally-anchored rating scale that evaluates debriefing quality within 6 elements. DASH was validated with trained raters evaluating simulation debriefings; the student version (DASH-SV) has not been validated. Reported DASH-SV scores cluster on the high end of the 7-point rating scale and may not accurately reflect debriefing quality. Objective We modified the DASH-SV with localized instructions to improve student understanding and rating accuracy (e.g. DASH-SV: “I felt that the instructor respected participants” vs. localized DASH-SV: “I felt that the instructor respected participants - Rate 4 or higher only if the instructor’s intention is to teach, instructor is respectful and curious about learner perspective, and asks open-ended questions”). We hypothesize that the localized version will lower score inflation, yielding more accurate scores and useful feedback for simulation faculty development. Methods Between June and September 2024, medical students at the University of Hawaii were sorted into two balanced groups based on their last name initial (Group A: A-K and Group B: L-Z). After participating in various routine faculty-facilitated simulation scenarios/debriefings, Group A completed the original DASH-SV and Group B completed the localized DASH-SV. These anonymous evaluations were completed via an online survey embedded in the standard post-course feedback form. Surveys included an attention-check question: “Please select 2 in the drop-down menu to show you are paying attention”. Data was analyzed using Fisher’s exact test for categorical variables, Wilcoxon rank sum test for continuous variables and for cases with more than 2 groups of comparison (such as when comparing students from three different medical years), and Kruskal-Wallis rank sum test for continuous variables. We report an interim analysis of this ongoing study. Results Group B (n = 63) rated debriefers lower than Group A (n = 66) across DASH behaviors 2a, 2c, 2d, 2e, 3b, 3c, 4a, 4b, 4c, 4e, 6b, and 6c (p<0.05). These behaviors comprise DASH debriefing elements of maintaining an engaging learning context, organizing the debriefing, promoting reflective discussion, and helping student performance. Group B answered the attention check question correctly at a higher rate (92%) compared to Group A (73%) (p<0.005). There was a significant difference across medical student years for correctly answering the attention check question - 94% of 1st year, 88% of 2nd year, and 48% of 4th year students answered correctly (p < 0.001). Fourth year medical students assigned a maximum score of 7 more often than 1st year medical students (p<0.05). Discussion Our localized DASH-SV resulted in lower scores compared to the original for select debriefing behaviors, suggesting reduced score inflation. Students who used the localized DASH-SV exhibited greater attentiveness. Upperclassmen were more likely to give maximum scores and fail the attention check, compared to 1st year students, suggesting less critical evaluation and engagement. The localized DASH-SV may be a more accurate tool for student assessment of debriefing quality and support meaningful faculty feedback to improve debriefing skill. Future direction will include methods to improve and validate rating accuracy and attentiveness, especially when surveying more senior medical students after simulation. Target Audience The findings of this study are particularly relevant to medical educators and faculty who oversee simulation-based education, simulation facilitators, medical education researchers, and medical students.
Student-Run Free Clinic Integration into Medical School Curriculum: Impact on Medical Students’ Attitudes Towards the Houseless Before and After Participating in Direct Patient Care
(2025) Kimura, Michelle; Choi, Sean; Lee, Brennan; Schiff-Elfalan, Teresa; Omori, Jill
Introduction: The O‘ahu Point in Time Count is an annual street and shelter count which measures the number of people experiencing houselessness[1] on a single night in January. In 2024, 4,494 individuals were identified as houseless across O‘ahu; 51% identified Native Hawaiian/Pacific Islander (NHPI) as either their only race or part of a multiracial identity. Houselessness continues to be a prominent social issue in Hawai‘i, especially for NHPI populations, and remains an important factor of consideration in working to improve health equity for the local community. In response to this long-standing, continually growing gap in health equity, the Hawai‘i Houseless Outreach and Medical Education (H.O.M.E.) Project serves to improve quality access to healthcare for individuals experiencing houselessness while increasing student and physician exposure and understanding of the houseless population and their healthcare needs. H.O.M.E. Project provides free medical services to houseless individuals through multiple weekly student-run free clinics at various sites across O‘ahu. Since 2021, H.O.M.E. Project has been formally integrated into both the pre-clerkship and clerkship curriculum for all medical students at the John A. Burns School of Medicine (JABSOM) with the intent of providing all students with more opportunities to understand, advocate for, and apply the impact of social determinants of health to patient cases and outcomes. The goal is with repeated opportunities for hands-on learning, students gain experience and confidence in their ability to empathize with and deliver equitable care to diverse and vulnerable patient populations. Objectives: The objective of this study is to evaluate the efficacy of curriculum integration of H.O.M.E. clinic on students’ knowledge, skills, comfortability, and efficacy when working with the houseless community. Methods: 77 medical students at JABSOM who experienced first-year clinical experiences with H.O.M.E clinic were asked to complete pre-surveys at the start of the school year and post-surveys immediately after completion of first year. Surveys assessed students’ pre and post knowledge and attitudes towards houselessness as a result of participation in H.O.M.E. clinic. To compare differences in pre- and post-survey responses, paired t-test was used. Statistical analyses were performed using version 4.2.0 of R software. Results: Of 77 total medical students, 66 completed both pre- and post-surveys. 42% (n=28) held leadership roles during their H.O.M.E. Project experience. Results illustrated a significant increase in confidence among students’ knowledge of issues faced by the houseless community and availability of local aid resources (p<0.001). Data also showed significant increase in skills such as working with others, navigating difficult patient interactions, managing patient expectations, and interacting with patients using a trauma-informed lens (p<0.05). Discussion: Based on data thus far, H.O.M.E. Clinic integration into curriculum has a statistically significant impact on student’s knowledge, skills, comfortability, and efficacy when working with the houseless community. Further evaluation is needed to better understand the strengths, challenges, and limitations of the impact of curriculum integration. Future investigation includes expanding the survey to additional cohorts of students, and conducting similar studies with students of other backgrounds (social work, nursing, etc) to evaluate impact on their learning. Target Audience: Health professions educators interested in incorporating diversity, equity, inclusion, and social justice into curricula References: 1. 2024 Homeless Point in Time Counts – Hawai’i Health Data Warehouse. Hhdw.org. Published September 4, 2024. https://hhdw.org/na-2024-homeless-point-in-time-counts/ 2. Matters HH. Hawaii Health Matters :: Resource Library :: 2024 Point in Time Count. Hawaiihealthmatters.org. Published 2024. https://www.hawaiihealthmatters.org/resourcelibrary/index/view?id=33623032766485311
Wellness and Stress in First Year Medical Students, Impact of Exercise Patterns and Barriers to Exercise
(2025) Zimmerman, Heather M.; Danko, Ana; Matsunaga, MM; Kasuya, Richard
Wellness and Stress in First-year Medical Students, Impact of Exercise Patterns and Barriers to Exercise Heather Zimmerman BS,1 Ana Danko BS,1 Masako Matsunaga PhD,1 and Richard Kasuya MD1 1 University of Hawai’i John A. Burns School of Medicine Abstract Introduction: Exercise promotes both physical and mental health by reducing anxiety, stress, and depression while also boosting executive function.1,2 Recent studies indicate that medical students experience significant increases in stress and a noticeable decline in mental and emotional well-being throughout the first year.3 Given its benefits, regular physical activity may play a valuable role in managing these challenges. Objective: To examine wellness and stress levels among first-year medical students and identify modifiable behaviors that might contribute. Methods: A voluntary, 4-point Likert survey was newly constructed, which considered various aspects of student wellness and stress, with attention paid to the time of day to identify any relationships or patterns. Responses were categorized as follows: 1 = very poor to 4 = very well; 1 = very stressed to 4 = very relaxed. The survey was administered to two cohorts of first-year students in successive years at one medical school—additional close-ended questions centered on physical exercise habits and barriers to exercise, including categorical barriers. Responses were analyzed by determining the mean, standard deviation, frequency, and percentage. Students were then stratified based on categorical responses, which the study group conjectured may affect outcomes (Pre-class Exerciser vs. Non-Pre-Class Exerciser; Exerciser vs. Non-Exerciser; Barriers to Exercise vs. No barriers to Exercise; On-Campus Exerciser vs. Non-On-Campus Exerciser), and differences in wellness/stress responses between groups were analyzed using Welch’s two t-tests and Fisher’s exact tests. Results: The data included survey responses from 53 out of 154 eligible students (34% response rate). On average, students generally felt “well,” including in the moment of the survey (mean Likert 3.09, 3.06); however, on average, they reported feeling “poor” the prior day and upon awakening (mean Likert 2.83, 2.79). Regarding stress, on average, they felt “stressed” in all temporal scenarios presented (generally, in the moment, upon awakening, prior day). Sixty-six percent of respondents reported engaging in exercise, with 73% facing one or more barriers to exercise. Most reported not exercising before class (83%), and 70% had never attended on-campus exercise classes. Pre-class Exercisers reported feeling “very well” (67%) or “well” (11%) upon awakening, which was a higher response compared to Non Pre-class Exercisers (p=0.005). However, overall, differences in wellness and stress levels between the stratified groups were not observed. Discussion: First-year medical students were selected for this survey due to their temporal proximity to pre-medical training. Most students felt their wellness and stress levels were below the optimized level (defined by Likert scale response of 3 or above) regardless of their exercise habits or barriers to exercise. The exception is that pre-class exercisers had higher wellness upon awakening compared to non-pre-class exercisers. Interestingly, those who faced barriers to exercise reported feeling less stressed than non-barrier students the prior day, which may be explained by curricular structure differences, such as differences in coursework on the day of administration or the prior day. Importantly, most students were still able to exercise despite reporting barriers. Based on these results, further studies should explore ways for students to improve wellness and reduce stress, including strategies beyond increasing physical activity levels. Relationships between specific barriers, stress levels, and wellness could also be examined. A limitation of this study was that it did not use a pre-validated survey tool. Additionally, wellness and stress were not defined for the survey takers and, therefore, subjective. Future studies should attempt to remedy this and consider expanding the survey to other stages of medical training. Reported barriers should also be analyzed beyond frequencies, and solutions analyzed. Target Audience: Medical educators, organizational wellness directors Acknowledgments: The project described was supported by the JABSOM Office of the Dean. MM was partially supported by the U54MD007601 (Ola HAWAII) and U54GM138062 (PIKO) grant from the National Institute of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. References 1. Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas. 2017 Dec;106:48-56. doi: 10.1016/j.maturitas.2017.09.003. Epub 2017 Sep 7. PMID: 29150166. 2. Contreras-Osorio F, Ramirez-Campillo R, Cerda-Vega E, Campos-Jara R, Martínez-Salazar C, Reigal RE, Hernández-Mendo A, Carneiro L, Campos-Jara C. Effects of Physical Exercise on Executive Function in Adults with Depression: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(22):15270. https://doi.org/10.3390/ijerph192215270 3. McKerrow I, Carney PA, Caretta-Weyer H, Furnari M, Miller Juve A. Trends in medical students' stress, physical, and emotional health throughout training. Med Educ Online. 2020 Dec;25(1):1709278. doi: 10.1080/10872981.2019.1709278. PMID: 31902315; PMCID: PMC6968533.
Examining Psychiatric Comorbidities and Demographic Links in Hawaii’s Pregnant Population
(2025) Mikami, Brandi; Xiong, Lucia Y.; Kronen, Cable; Natavio, Melissa; Tschann, Mary
Introduction: Psychiatric comorbidities are common in pregnancy, with as many as 1 in 5 women suffering from a mental health or substance use disorder during the perinatal period. These psychiatric comorbidities have the potential to negatively impact the health and care of both the mother and fetus. Given Hawaii’s distinct and diverse population composition, it is imperative that the demographics and psychiatric comorbidities of pregnant women in Hawaii are described. Identification of these factors may promote more inclusive and informed healthcare and educational practices. Objectives: This study aims to describe the demographic factors, including age, race/ethnicity, financial status, educational background, and obstetric history of pregnant patients with psychiatric comorbidities. Methods: We conducted a cross-sectional web-based survey of individuals who were female sex-assigned at birth, ages 18-45, Hawaii residents, with reproductive potential, and with self-reported mental health disorders. Recruitment relied on flyers in OBGYN, primary care provider, and psychiatry clinics and social media postings between September 2021 to September 2022. We compiled descriptive statistics using Microsoft Excel and SPSS 29.0. Results: We received 98 complete responses. Eighty (81.6%) respondents reported having a psychiatric disorder. Self-reported mental health diagnoses included 54 (68%) responses for anxiety, 18 (23%) for ADHD, 8 (10%) for bipolar disorder, 54 (68%) for depression, 6 (8%) for eating disorders, 7 (9%) for OCD, 20 (25%) for PTSD, 1 (1%) for schizophrenia/schizoaffective disorder, 8 (9%) for substance use disorder, 6 (6%) for other, 8 (10%) for none, and 46 (58%) for multiple. Race/ethnicity composition of those with a psychiatric disorder included 36 (45%) Native Hawaiian, 9 (11%) Pacific Islander, 34 (43%) Asian, 39 (48%) White, 4 (5%) Black, 2 (3%) Native American/Alaska Native, and 6 (8%) Latina. 37 (46%) respondents reported obtaining financial assistance. The vast majority of respondents (84%) had some college education or more, and the majority of respondents (54%) were 19-30 years old. Most respondents (73%) had been pregnant before. Respondents had varied pregnancy history, with 22 (28%) nulliparous, 58 (73%) parous, and 23 (29%) respondents who were currently pregnant. Discussion: It is not uncommon for pregnant patients to manage psychiatric comorbidities, and in our sample, these diagnoses spanned socioeconomic, racial, and educational backgrounds. Medical education should focus on normalizing and improving psychiatric screening in pregnancy and achieving competence with management of medications, psychological supports, and anticipatory guidance for patients navigating the transition to parenthood. Future research should focus on how equipped medical students and primary care providers feel to address the psychiatric needs of patients during pregnancy. Target audience: Healthcare providers, educators, and researchers involved with maternal and mental healthcare. References: American Psychiatric Association. Perinatal Mental Health and Substance Use Disorders: A White Paper on the Status of Care in the United States. American Psychiatric Association; 2023. Accessed November 2, 2024. https://www.psychiatry.org/getmedia/344c26e2-cdf5-47df-a5d7-a2d444fc1923/APA-CDC-Perinatal-Mental-and-Substance-Use-Disorders-Whitepaper.pdf
Innovation through the U.T.E.R.U.S: Utilization of a Three-D Model for Education and Research in Uterine Simulation
(2025) Mikami, Brandi; Thompson, Jesse; Lozanoff, Scott; Raidoo, Shandhini; Stowers, Paris
Context: Learners often struggle to build confidence with intrauterine procedures like IUD insertion/removal and uterine aspiration. Current simulation models for developing these skills vary from costly high-fidelity models, low-cost low-fidelity models, or one-time use fruit models which lack realistic simulation of instrumentation of the cervix and uterus. Effective training assets for instruction of these procedures remain scarce. With increasing restrictions on abortion training, intrauterine procedure simulation may be especially important for learners in areas with limited abortion training access. Objectives: This study aims to develop a low-cost, reusable, high-fidelity model using 3D printing technology for learners to practice intrauterine procedures. Description of Innovation: The workflow to create the uterine model consists of Model Creation, Review, and Production. For Creation, an anonymized cadaver was MRI scanned, allowing for uterus identification and segmentation (Slicer), providing a mesh model that was subjected to artistic edits (Maya software). In Review, the model was uploaded to Sketchfab and Z-Space for visualization and final alterations. The final Production step comprised 3D printing using a Bambu X1C printer and Bambu Studio for support and infill settings. The model dimensions are 87x177x32 mm using Polylactic Acid filament. 95A thermoplastic polyurethane (TPU) filament and colorFabb VarioShore TPU were attempted to produce more malleable models with variable shore hardness ratings. TPU reels are kept in a heated filament dryer for 12-24 hours before printing at a relative humanity (RH) of 15%, while ambient room RH is maintained at 50% RH. A 7% maze-like Hilbert curve infill was utilized for overhang support while reducing the rigidity of the printed model compared to the grid infill pattern. Volumetric print speed is also lowered, allowing better adhesion between layers. Additional design modifications may use multiple materials for different components. Evaluation of Innovation: Complex Family Planning experts have reviewed and tested the initial models for anatomical accuracy, functionality, and durability using uterine dilators and uterine sounds. Experts provided feedback regarding elasticity, dimensions, shape, and additional components such as handle implementation for improved portability of the model. Current enhancements focus on developing a more anatomically realistic model with a uterocervical angle and increased flexibility. The model continues to undergo improvements/revision through an iterative process. Upon development of a suitable model, learners and practicing clinicians will trial various iterations of procedural simulation, then complete a survey concerning ease of procedure, realism, and overall perception of the models. Survey responses will be analyzed using descriptive statistics. The resulting feedback will be used to revise and improve the model, and the cycle will repeat with multiple groups. Discussion/Key Message: The workflow facilitates production of a lightweight, low-cost, and ease-of-use model with an inexpensive and widely available 3D printer. Immediate next steps include revisions using TPU filament for printing allowing for more malleability. Future work focuses on assessing the instructional effectiveness of the 3D-printed uterus, with learners evaluating/comparing simulation fruit, high-fidelity, and 3D-printed uterine models. Target audience: Medical educators who teach intrauterine procedures and learners including medical students, residents, and fellows.
Connecting Rural and Public Health Across Hawai'i: A New Rotation for Family Medicine Residents
(2025) Quattlebaum, Thomas H.
Context: The COVID-19 pandemic demonstrated the importance of local public health working with local health care providers. Yet public health professionals and community clinicians frequently have limited practical understanding of each other’s roles and how to collaborate. In rural communities, this interdependence is arguably more pronounced, as these areas experience disproportionate health care workforce shortages and may be subject to worse health outcomes without a robust primary care and public health safety net. To increase the connection between public health and primary care as well as to incorporate rural health care in Graduate Medical Education training, the authors developed a Rural and Public Health Selective that combines experience working with the local health department and a Federally Qualified Health Center (FQHC). Objectives: Develop an educational experience that provides learning in rural and public health for resident physicians. Evaluate the impact of the experience on residents’ knowledge of the island’s community health landscape, understanding of health equity, and desire to practice in a rural setting after graduation. Description of Innovation: The authors along with community preceptors at local FQHCs collaborated over a period of six months to develop a four week Rural and Public Health Selective for third year Family Medicine Residents. This experience is the first official collaboration between a GME program and a district health office in Hawaii. Starting in Fall 2023, all residents must complete this rotation and have the option to choose between rotating on O‘ahu or Kaua‘i for their experience. Residents spend half of their time at an FQHC (Ho‘ola Lahui Hawai‘i on Kaua‘i or Waimanalo Health Center on Oahu) working under the supervision of primary care physicians to provide direct patient care. The other half of their time is spent at the local district health offices working alongside and learning from public health frontline staff. Learning experiences here include a combination of foundational public health readings, community health needs assessments, and field experiences with public health staff. Specific rotation objectives upon completion include for residents to: Identify a policy issue that may have unintended health consequences and describe at least one way advocacy could address those consequences Describe at least 3 ways in which primary care and public health intersect Participate in at least 3 public health field activities Residents spend time with the physician DHO, attending local, statewide, and national meetings and workgroups. Specific field activities are driven by program schedules tailored to resident interest and have included mosquito surveillance, leptospirosis testing and data review, Hansen’s Disease clinics, and many more. Evaluation of Innovation: The authors gathered evaluation data and feedback from the residents through a confidential online survey distributed upon completion of the rotation as well as informally through an exit interview. As of this submission, ten residents have completed the rotation with an even mix between those who rotated on Kauai vs Oahu. Seven residents have completed the evaluation survey thus far (70% response rate). Resident feedback has been generally positive, particularly for the Kauai experience, with comments reporting an improved understanding about DOH operations. 85% of respondents expressed they had improved knowledge about the community health landscape of the island where they worked and 85% also expressed increased or strongly increased understanding of health equity. 43% of respondents stated this experience increased their interest in practicing in a rural area after graduation. The remainder (57%) expressed no change in interest though comments suggested that many of them already had an interest in rural practice. 71% of respondents reported an increased interest in pursuing opportunities for advocacy at the local, state, or national level. Discussion: This collaborative initiative has enriched public health staff and Family Medicine resident training. Resident comments, written assignments, and final presentations indicate goals and objectives of the experience are well met. Residents strongly prefer experiential activities: “Let us join you while you do your work; don’t just tell us about it.” Regarding disease reporting, one resident commented, “I’ve been a bad doctor; I’ll do better from now on!” This work may be applicable for others working to enhance cooperation between public health and health care providers. Future directions include replicating aspects of this experience in other district health offices and including more structured experiences for advocacy or longitudinal projects. Limitations include the small sample size and reliance on self-report; future evaluations can measure graduates’ practice location and application of knowledge gained from this experience. Key Message: A first of its kind Rural and Public Health Selective in Hawaii has been a valuable experience for resident physicians with improvements in knowledge about the intersection of rural health and primary care. Target Audience: All health professions educators, trainees interested in rural and/or public health
PSQI@JABSOM: Evaluation of a Web-Based Patient Safety Curriculum Resource for First-Year Medical Students
(2025) Owen, Liana; Kasuya, Richard
Introduction: Patent safety and quality improvement (PSQI) has gained increasing attention in recent years among medical schools and residency programs. The USMLE began emphasizing PSQI concepts in 2015 (1). PSQI exposure in the first-year curriculum at JABSOM includes an AMA module and selected patient safety topics in problem-based learning (PBL) sessions. However, the AMA module has anecdotally failed to generate much enthusiasm about PSQI with little interactivity and content not yet relevant to medical students early in training. While PBL cases encourage active participation, they provide an incomplete and fragmented survey of foundational PSQI concepts. There remains a need for a comprehensive and engaging introduction to PSQI in the preclinical years. Objectives: The purpose of this study was to evaluate the effectiveness of an interactive, multimedia online module in increasing knowledge, interest, and belief in the importance of PSQI among first-year JABSOM students. Methods: After completing an online PSQI module, 77 first-year medical students were asked to participate in a survey assessing the following metrics before and after the intervention: perceived knowledge, interest, and belief in the importance of PSQI, likelihood of participating in future PSQI-related educational opportunities, and likelihood of reporting medical errors. The survey also included questions about students’ reactions to the module. The module, delivered as a website, included content about the origin of PSQI, the application of the Swiss Cheese Model of accident causation to medical errors, and strategies to reduce medical errors. Interactivity was emphasized through multiple choice questions, content revealed on click, a simulated shadowing experience, and a reflection question with prior responses made visible to other students. Results: 54 survey responses were received (70%). Students reported significantly increased knowledge about PSQI (p=0.001), interest in PSQI (p<0.0001), likelihood of participating in future PSQI-related educational opportunities (p<0.0001), and likelihood of reporting medical errors (p<0.0001). Belief in the importance of PSQI did not significantly change (p=0.566). However, 76% of participants already rated PSQI as “very important” before completing the module. Furthermore, “strongly agree” responses were obtained from 80% of participants that the module was enjoyable, 96% that it was relevant to them as medical students, and 83% that they would recommend the module to future JABSOM students. In their subjective responses, students most often cited interactivity and simplicity as the module’s strengths. Discussion: The survey results support the module’s effectiveness in evoking both attitude and behavioral changes regarding PSQI. The module increased students’ perceived knowledge and interest in PSQI, likelihood of participating in future PSQI-related educational opportunities, and likelihood of reporting medical errors. Belief in the importance of PSQI remained relatively unchanged as most students already recognized its importance. The module’s success may be attributed to an interactive yet simple design and content tailored to first-year medical students, which students found both enjoyable and relevant to their education. These results further highlight the power of students teaching students–a foundational concept of PBL. An intuitive understanding of peers’ educational needs and preferences may aid students in designing effective curriculum resources. Target Audience: Medical educators and medical students. References: Changes to USMLE® 2015 – 2016. United States Medical Licensing Examination. December 22, 2014. Accessed October 27, 2024. https://web.archive.org/web/20150122003200/http://www.usmle.org/pdfs/Changes_to_USMLE_handout.pdf
Students-4-Students: A Mutually Beneficial Near-Peer Teaching Program
(2025) Abe, Justin; Yasuda, Brooke; Mitchell, Jacey; Kasuya, Richard; Higa, Jason
Title: Students4Students—A mutually beneficial near-peer teaching program Presenters: Justin Abe (MS3), Jacey Mitchell (MS1), Brooke Yasuda (MS1) Faculty: Dr. Jason Higa PhD Affiliation: John A. Burns School of Medicine (JABSOM) Office of Medical Education Context: Whether it be upperclassmen medical students teaching underclassmen, residents teaching medical students, or upper residents teaching interns, near-peer teaching is a long-standing tradition within medical education. As near-peer teachers often have a similar knowledge base and a less significant power dynamic imbalance with their learners than formal professors, it allows for more effective learning and a more comfortable and supportive learning environment [1]. Although there is an overlap in content between undergraduate physiology classes and pre-clinical physiology content for medical students, there is no formal near-peer teaching opportunity to connect these two populations at the University of Hawaii. Objective: The purpose of this innovation was to provide near-peer teaching sessions to improve undergraduate students’ knowledge of anatomy and physiology as well as to give medical students an opportunity to review board-relevant content Description of Innovation: We recruited six medical student volunteers on a volunteer basis to be physiology teachers for our program “Students4Students” (S4S). These students held a forty-five-minute virtual teaching session that reviewed a physiological system before the undergraduate students took the corresponding exam. Through seven teaching sessions, S4S sessions reviewed the Cardiovascular, Pulmonary, Immunology, Digestive System & Metabolism, Urinary System & Fluid Balance, and Reproductive Systems, which were tested by Exam 2 and Exam 3 in a introductory physiology course. The medical student teachers also provided personal time to answer questions about the content or their professional journey at the end of each session. Evaluation of Innovation: Scores from students who attended S4S sessions were compared with other students who did not attend S4S. There was a total of 18 students in the group that attended S4S sessions and a total of 394 students in the group that did not attend S4S sessions. The students in the S4S group were recruited on a voluntary basis. For exam 2, the average score for S4S attendees was significantly higher (p=<0.01), with S4S attendees scoring a mean percentage of 84% and S4S non-attendees scoring a mean percentage of 72%. Similarly, for exam 3, the average score for S4S attendees was significantly higher (p=0.011), with S4S attendees scoring a mean percentage of 82% and S4S non-attendees scoring a mean percentage of 65%. Discussion/Key Message: The evaluation of our innovation suggests that Students4Students may be effective in improving undergraduate students’ knowledge of physiology. This is an example of how a student-driven, student-created project can benefit the learning experience of near peers. One limitation of this study is that there could have been other confounding factors that led to a significant difference in scores between the S4S-attendees and non-S4S attendees. For example, it is possible that students who voluntarily attended the sessions have a baseline higher level of intrinsic motivation and better studying habits than students who did not attend the sessions. Additionally, this study is limited by our relatively small sample size and increasing the sample size in future iterations could enhance the generalizability of your findings. Students4Students will continue to serve undergraduate students, and future studies can re-evaluate the effects of Students4Students with a greater sample size of students. Future efforts can also explore the effect of the Students4Students sessions on the medical student teachers’ knowledge base and explore how near-peer teaching between graduate and undergraduate students can be adapted for other educational contexts. Target Audience: Medical students, undergraduate students Citations Hall, S., Harrison, C. H., Stephens, J., Andrade, M. G., Seaby, E. G., Parton, W., McElligott, S., Myers, M. A., Elmansouri, A., Ahn, M., Parrott, R., Smith, C. F., & Border, S. (2018). The benefits of being a near-peer teacher. The clinical teacher, 15(5), 403–407. https://doi.org/10.1111/tct.12784
New Pharmacy Practice Electives to Improve Student Clinical Application and Professional Identity Formation
(2025) Fujimoto, Cierra; Prudencio, Jarred; Fukunaga, Bryce; Meguro, Aryn; Gomez, Lara; Tokumaru, Sheri
Context: The Daniel K. Inouye College of Pharmacy (DKICP) implemented a new contemporary curriculum in Fall 2023. This innovative curriculum introduces the threading of topics throughout students’ studies, allowing them to build on their knowledge and apply what they learn in clinical practice. In response to the evolving field of pharmacy practice, DKICP has transitioned from a legacy curriculum that required only four elective credits to a contemporary curriculum that now requires eight elective credits. Objectives: This innovative design allows students to explore new electives that align with the evolving healthcare landscape, providing a broader range of choices that are essential for their professional identity and development. By offering expanded options, it aims to increase satisfaction with elective offerings and foster a more personalized educational experience. Description of Innovation: The new curriculum introduces a range of electives that cater to various aspects of pharmacy practice and students’ personal and professional development. Students can select from clinically-focused courses, such as Infectious Disease Cases and Cardiology Cases, which reinforce important pharmacotherapy concepts and simulate real-world scenarios. Students can also explore non-pharmacological options through Lifestyle Changes for Chronic Diseases, focusing on dietary and physical activity modifications that pharmacists can recommend to patients managing chronic conditions. Additionally, electives such as Social Media for Pharmacists examine the role of digital communication in healthcare, while Story-Telling in Healing highlights narrative communication to understand the patient experience and the journey to becoming a healthcare provider through storytelling. Courses such as Prescription to Wellness and Resilience and Intro to Post-Graduate Residency Applications not only enhance student well-being, but also provide important preparation for future career opportunities. This diverse selection of electives highlights the wide range of opportunities DKICP has to offer. While a broad range of electives offers valuable opportunities, it may lead to low enrollment in some courses and decision fatigue for students. To address this, not all electives are offered every semester, which helps prevent low enrollment and reduces the overwhelming number of options for students. By selecting electives based on student interest and relevance, and offering course categories, such as clinical, digital communication, or wellness courses, it can help students navigate their choices and select courses that align with their personal interests. Evaluation of Innovation Each proposed elective is evaluated by the curriculum committee. After the course is completed, student evaluations are viewed closely and course coordinators respond to student feedback. We will be reviewing de-identified student evaluations that are completed at the end of each semester and provide examples of the comments reported about the newly added elective courses. This feedback will offer valuable insights into student experiences, satisfaction, and their relevance to the overall curriculum. By reviewing this feedback, course coordinators will be able to make feedback-driven decisions to improve the elective options and ensure they continue to meet students’ personal interests and professional development goals. Discussion/Key Message These curriculum changes significantly enhance the student learning experience by tailoring education to individual interests and reinforcing prior clinical knowledge through an integrated approach. Students are likely to experience greater satisfaction, improved performance outcomes, and ultimately, enhanced patient care. These changes reinforce clinical topics, enhancing students’ ability to provide patient-centered care and adapt to evolving pharmacy trends. By offering a more personalized curriculum, students are better prepared for clinical rotations and specialized roles, while also supporting their professional identities through electives that align with their personal interests.
Making Computer-Generated Animated Videos to Illustrate the Neurological Examination
(2025) Unebasami, Emily M.; Miles, Jeffrey D.
Context Digital tools have become more common in medical education, enhancing different fields due to their unique presentational benefits. The cornerstone of clinical neurology is the neurological examination, which can be used to determine the patient’s neurological function. While past 3D animation software (Poser) sufficiently exhibits the neurological examination, videos would need to be coded again when using a different character. Using Daz3D software, there was a possibility to transfer the movement data from one character to another more efficiently.
Objective The objective of this project is to create videos of the neurological examination using commercially available 3D animation tools. An innovative process was tried in order to facilitate changing aspects of the videos, allowing the user to adjust the appearance, age, or gender of the animated characters and streamline the animation process.
Description of Innovation Using Poser and purchased digital resources, the authors created multiple vignettes depicting different characters undergoing a neurological exam by a neurologist in a clinical room. Each character had a unique physical appearance and exam findings and were built separately. Using Daz3D software, the neurological exam was coded again to be performed on a female character. The movements and positions were then copied to a different figure with different physical characteristics (“morphs”).
Evaluation of Innovation The innovative copy of movements was successfully done with the movements copied and pasted onto a different character of different size and appearance. The copied movements were deemed visually appropriate for the new character by the project investigator and rendered.
Discussion/Key Message This project should streamline the process of creating animations of the neurological exam for various educational purposes. In the past we have used these stimulations in the setting of Problem-Based Learning (PBL) groups to show a neurological exam rather than describing the exam, enabling students to practice recognizing findings rather than conceptualize them. Portions of the exam can be independently changed and be used for a variety of characters and scenarios. The potential use of the videos are extensive. The list includes but is not limited to problem-based learning cases, clinical skills assessments, and lectures. For future projects, we plan to evaluate the utility and effectiveness of these animations in use of PBL cases and clinical skills examination through student feedback.
Target Audience Medical education instructors interested in physical exam simulations.
Aging with Grace: Intraprofessional Nursing Simulation to Improve Geriatrics Workforce Readiness
(2025) Nunokawa, Courtnee M.; Miranda, Bridget
In 2020, approximately 17% of the United States population was over the age of 65 years, projected to double by the year 2050. In Hawai‘i, the kūpuna (older adult) population percentage is higher than the national average, with 19% of the state’s population being 65 years or older. Additionally, life expectancy in Hawai‘i is the highest in the US, with an average lifespan of 81 years, compared to the national average of 77 years, and 71 years in the state with the lowest life expectancy. The rapidly growing proportion of the population over the age of 65 makes it vitally important that the US and Hawai‘i prepare a workforce of highly skilled, competent and confident health care professionals who can provide geriatric care.
The purpose of this poster is to describe an innovative, evidence-based geriatrics curriculum called “Aging With Grace.” The learning activity fostered intraprofessional collaboration, defined as a collaboration among individuals from varied backgrounds within the same discipline, including Nurse Practitioner and pre-licensure Registered Nurse (RN) students. This curriculum was designed to: 1) improve knowledge and competency in caring for kūpuna (older adults), 2) apply skills to a simulated scenario caring for a kūpuna with complex needs in a safe and positive environment, 3) build competency in intraprofessional collaboration and promote career ladder growth for RN students, and 4) develop competency in telehealth.
Miller’s Pyramid of Clinical Competence was utilized to scaffold learning activities. Students engaged in asynchronous preparatory work to build knowledge competence, and then progressed to a three-part intraprofessional simulation activity with Simulated Patient (SP) actors to demonstrate competencies. The scenario involved an older adult and unfolded over three distinct time periods, which followed the patient as they transitioned through different health care settings: 1) independence at home, 2) post-acute skilled nursing, and 3) long-term care. The scenarios engaged students to assess and manage common geriatric syndromes, utilize telehealth, and practice addressing patient care holistically, applying the 5Ms model for age-friendly care. Each part was followed with a faculty-led debrief to allow for self-reflection and growth.
Evaluation results demonstrated students quantitatively evaluated the simulation exercise process well, with good scores on the Student Survey of Simulation Standards for Continuous Improvement (S4CI). Students demonstrated improvement in pre-post confidence in telehealth with statistically significant improvements in all Confidence in Telehealth Domains scores after the simulation exercise (all p <0.0001). Students qualitatively evaluated the simulation well, reporting no major problems or recommendations for improvement. Problem areas identified were related to time management and technology challenges.
In conclusion, as the aging population in the United States and Hawai‘i continues to grow, the demand for a skilled geriatric health care workforce becomes increasingly urgent. The implementation of targeted educational interventions, such as this innovative simulation, offers a promising strategy to prepare future health care providers for the complexities of geriatric care. Continued efforts are needed to enhance student recruitment into geriatric specialties and to address systemic barriers that hinder their entry into the field. By fostering a supportive, intraprofessional, psychologically safe, and competency-focused learning environment, nursing schools can improve new graduate competencies and workforce readiness in geriatrics.

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