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.

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