HPEC Poster Session 2024

Context:
Schwartz Rounds (SR) is a live forum for healthcare providers to participate in honest and vulnerable discussions about their experiences providing patient care. Each SR session is focused on a central theme and involves one or more panelists sharing personal experiences, followed by a facilitated group discussion in which attendees are encouraged, but not required, to reflect on what was said and share their own experiences.
A comprehensive review of SR found that SR significantly improved the psychological wellbeing of healthcare workers. While SR for medical students is a relatively new concept, several pilot studies have shown positive feedback from students when comparing SR to traditional methods of reflection. Additionally, implementing SR for medical students may help to increase empathy and compassion for colleagues and patients.

Objectives:
Our objective is to implement a Schwartz Rounds curriculum planned and facilitated by trained medical students with mentorship from experienced members of a Schwartz Center affiliate site. We intend to provide students with an opportunity for productive self-reflection during their transition from preclinical years to clerkships that is targeted to their specific needs.

Description of Innovation:
Three SR sessions were conducted at JABSOM. The planning committee for these sessions consisted of 5 medical students and 3 SR faculty from the Queen’s Medical Center. Each session was facilitated by 2 students from the planning committee, and 2 other students were invited prior to the sessions to share experiences. All 3 sessions were conducted within the same medical school class, in the transition from 2nd into the 3rd year. Feedback was obtained via an adaptation of an evaluation form from the Point of Care Foundation. Attendance and completion of the feedback form were voluntary. The feedback form was anonymous.

Evaluation of Innovation:
The 3 sessions had 12, 13 and 22 attendees respectively, with 13 feedback responses. Overall, sessions received 6 ratings of “Exceptional,” 6 “Excellent” and 1 “Good.” Twelve of 13 respondents completely agreed with 4 statements: “The group discussion was well facilitated,” “This discussion helped with my personal insight and self-reflection,” “I would attend Schwartz Rounds again,” and “I would recommend Schwartz Rounds to classmates.” One “neither agreed nor disagreed” to all 4 statements. For two prospective outlook statements: “I have new insights into the perspectives and experiences of my classmates'' and “I have gained insight that will help me to take care of patients,” 11 of 13 completely agreed; 1 neither agreed nor disagreed and 1 agreed somewhat with each statement. Responses to “I feel more open to expressing thoughts, questions and feelings with my classmates'' were mixed, with 9 of 13 completely agreeing, 2 agreeing somewhat and 3 neither agreeing nor disagreeing.

Discussion/Key Message:
To our knowledge, our pilot study is the first to implement SR in a “by medical students, for medical students” format, whereby trained medical students developed the SR content with faculty mentorship and independently led the SR sessions. One of the key aspects of SR is that it provides a space where individuals can be emotionally vulnerable, and we believe that removing the hierarchical distinction between facilitators and participants helps to achieve the desired environment.

Target Audience:
All medical students in preclinical or clinical years.

Three key words/phrases (not part of character count):
Wellness, compassion, student-run

Introduction: ʻImi Hoʻōla (IH) is a 12-month post-baccalaureate program at the John A. Burns School of Medicine that provides educational opportunities to disadvantaged premedical students with ties to Hawaiʻi and the U.S. Affiliated Pacific Islands. Its mission is to increase the number of physicians who demonstrate a strong commitment to practice in underserved communities and primary care. Since its establishment in 1973, 306 participants have completed IH.

Objectives: To commemorate IH’s 50th anniversary, this study aimed to determine whether IH has worked towards its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by collecting feedback from alumni regarding the program’s impact on their careers.

Methods: An electronic survey was sent to 263 IH alumni by email from April 2023 to August 2023. The survey collected data on alumni demographics, current working status including specialty, location of practice, populations served, and their perceptions of working in underserved areas before and after completing IH based on a Likert scale. The data was summarized by descriptive statistics.

Results: The survey received responses from 100 IH alumni. The majority of IH alumni are practicing or training in primary care specialties such as internal medicine, family medicine, and pediatrics. For IH alumni who are current medical students, the most interested specialty is internal medicine. Before enrolling, a large number of alumni expressed a strong desire to practice in underserved communities in Hawaiʻi and the Pacific Basin. After completing IH, an even greater percentage expressed their dedication, with over 75% of practicing alumni serving in these areas of need. Furthermore, a majority of residents and medical students expressed a strong desire to practice in Hawaiʻi and the Pacific Basin. The top ethnic populations that practicing and retired IH alumni serve are Native Hawaiians and Pacific Islanders, Asians, and Whites.

Discussion: IH alumni’s choice of specialty shows that IH generates physicians who are willing to fill the primary care gap in Hawaiʻi and the Pacific Basin [1]. The alignment between IH alumni’s origins and choice of practice locations reflects the program's success in retaining current and future healthcare professionals in areas with underserved populations. Although IH is not ethnicity based, many participants come from ethnic minority groups, populations, and communities that are medically underserved. Physicians who come from underserved and minority communities are more likely to provide care to underserved populations [2]. The populations served by IH alumni support that IH is creating alumni who are providing greater access to healthcare in historically underserved populations.
This research is limited by a small sample size due to outdated contact information of alumni and collection of data through electronic surveys. The absence of investigation into other predictive factors on IH alumni’s specialty and location of practice limits the scope of the study. It can be concluded though, that IH has contributed to its goal of improving healthcare equity in Hawaiʻi and the Pacific Basin by increasing primary care physicians and healthcare access to underserved communities. The IH program’s infrastructure works in providing disadvantaged students an opportunity to attend medical school, and it can serve as a template for other medical schools interested in providing alternative pathways for disadvantaged students.

Target Audience: Medical Educators, University Administrators, Diversity Officers

Background: Nearly 1 in 3 diabetic patients have chronic kidney disease (CKD). However, many of these patients are asymptomatic and undiagnosed until advanced stages of disease. Thus, routine screening, early detection, and treatment are crucial for reducing the morbidity and mortality of CKD. Kidney health evaluation fulfillment is defined as having both estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) testing done within the measurement year. Currently, the national CKD screening rate is approximately 40% and even lower for marginalized groups. Similarly, we found the screening rate in the diabetic population at a primary care practice in West Oahu, which serves a large percentage of Native Hawaiians and Pacific Islanders, to be relatively low. The goal of this quality improvement (QI) project was to identify reasons for care gaps and implement patient outreach interventions to improve the screening rate in this population.

Methods: Chart review of the electronic medical records of 315 diabetic patients at this primary care office was conducted. Dates and results of the most recent eGFR and uACR lab tests were recorded. Patients were then determined to be screened or unscreened. According to screening criteria, patients older than 75, receiving hospice/palliative care, or diagnosed with end-stage renal disease (ESRD) or stage 5 CKD were excluded. Based on the most common reasons for care gaps, three patient-centered outreach interventions were implemented over 6 months. Two text message reminders about overdue lab tests were sent to unscreened patients, followed by two phone call reminders, and finally, two text message reminders to alternative phone numbers, if available. Chart reviews were conducted between each intervention to identify newly-screened patients.

Results: The baseline screening rate was found to be 52.4%. However, 57 patients did not meet inclusion criteria. Of the remaining patients, 58.1% fulfilled the criteria for CKD screening. The most common reason for care gaps among unscreened patients was due to incompleted uACR testing within the last 12 months (79.8%). Incomplete eGFR was the second most common (49%). Text message reminders, phone call reminders, and texts to alternative numbers increased screening rates by 10.8%, 5.5%, and 2.3%, respectively. At the end of 6 months, the screening rate increased by 29.4%, totaling 81.8% of patients screened for CKD.

Conclusion: Increased screening allows for earlier detection and treatment of CKD, thereby reducing its mortality and morbidity. Our findings suggest that suboptimal baseline CKD screening rates for diabetic patients can be increased through patient-centered interventions, with text messages being the most effective and efficient. Secondary analyses may be conducted to determine long-term outcomes, or if screening status is associated with other care measures or features of this population. While these initial results and interventions are limited to this setting, the results can be applied to other areas of primary care and expanded to include a wider scope of patients. Provider-centered interventions, either alone or in combination with patient-centered approaches, may also be a potential area of future research in increasing CKD screening rates.

Target Audience: Physicians, Residents, Medical Students

References:
Ferrè S, Storfer-Isser A, Kinderknecht K, Montgomery E, Godwin M, Andrews A, Dunning S, Barton M, Roman D, Cuddeback J, Stempniewicz N, Chu CD, Tuot DS, Vassalotti JA. Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes. Mayo Clin Proc Innov Qual Outcomes. 2023 Aug 29;7(5):382-391. doi: 10.1016/j.mayocpiqo.2023.07.002. PMID: 37680649; PMCID: PMC10480072. https://www.mcpiqojournal.org/article/S2542-4548(23)00041-3/fulltext
United States Renal Data System. 2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services; 2022. Accessed September 1, 2023. https://usrds-adr.niddk.nih.gov/2022
Chu CD, Xia F, Du Y, et al. Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease. JAMA Netw Open. 2023;6(7):e2326230. doi:10.1001/jamanetworkopen.2023.26230 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807656

Introduction
A post-code moment of silence is a designated set of time (a few seconds to a minute) of silence at the end of a code-event when a patient dies to reflect. It is a mindful moment of silence, without action or medicine, to honor a life that has just ended; and time to reflect on the gravity of the role that health care providers play in caring for patients and their families. It may also provide a way to build capacity and resiliency in one of the most difficult clinical situations.

Objectives
To increase the frequency in which this moment of silence occurs at Kapi’olani Medical Center for Women and Children (KMCWC).
To understand attitudes and barriers to having this moment of silence.
To identify and implement ways to lower the barriers for staff to be able to process and move forward after difficult outcomes.

Methods
Data was collected using a pre-implementation survey, followed by educational sessions for the emergency department (ED) and pediatric intensive care unit (PICU) staff at KMCWC. Surveys contained directed questions on previous participation in such events, assessed willingness to participate/lead; as well as open ended questions on overall attitudes and thoughts on participation. Surveys had voluntary participation, using a QR code link on flyers posted in each unit and in staff emails. Educational sessions consisted of reviewing the potential benefits for a moment of silence with ED and PICU physicians, and reviewing sample scripts for initiating. Similar sessions occurred at daily nursing huddles. Development of a script on code-carts in on-going, and a post-implementation survey tool will be distributed in early 2024 to better assess frequency and reassess staff viewpoints of such events.

Results
Of 63 completed surveys, 23% participated in a moment of silence at KMCWC, 31% indicating prior participation in their careers. The majority of respondents, 57.2% indicated feeling comfortable to very comfortable participating in a moment of silence with 9.6% indicating feeling uncomfortable. 21% of those surveyed were comfortable with initiating a post-code moment of silence. Qualitative data collected indicates that healthcare workers are open to moments of silence and find it beneficial. Responses included: “helps to check in with yourself and also take a moment before returning to ‘usual’ duties’” and “extremely beneficial to recognize the patient as a person and human aspect of what we are doing.” Barriers identified were time for a moment of silence, “can be tough depending on what else is going on in the unit” and leadership of the moment; “involvement of the code leader is crucial.” KMCWC is exploring moments of silence into a system-wide effort for improving debriefing.

Discussion
Implementing and educating staff about post-code moment of silence is possible. Staff responses are overall positive. Champions are a must for implementation, guidelines, and pediatric specific scripts would likely aid in occurrence and frequency. Further exploration of utility and benefit is on-going.

Introduction: Learning gross anatomy is an integral part of medical education, and having a solid foundation of anatomical knowledge is essential for clinical practice. However, anatomy continues to be a source of stress for many medical students, especially first years (MS1s). An initial survey was sent out to an MS1 class to gather interest for peer-led anatomy review sessions, and the results showed sizeable interest. Peer teaching was chosen because it benefits both the learner and the student tutors. It has been shown to create a safe and comfortable environment for students to learn and discuss, and also improves knowledge retention, leadership, and confidence in student tutors.1,2,3 This project explores how peer teaching can be utilized in the anatomy curriculum.

Objectives:
The main objectives of this project were as follows:
1) Analyze the effectiveness of peer-led anatomy review sessions in reducing stress levels in students.
2) Assess the effectiveness of peer-led anatomy review sessions in helping to better prepare students for their anatomy exams.
3) Determine the need for peer-led anatomy review sessions.
4) Evaluate the effectiveness of teaching anatomy in helping to better prepare students for USMLE Step 1 or USMLE Step 2 exams.
5) Estimate stress level of student tutors when preparing for review sessions.

Innovation: Peer-led review sessions were held on a weekly basis in the gross anatomy lab. Each session was led by either a second, third or fourth year medical student. Group sizes were kept small to facilitate better learning, and approximately 8-10 MS1s attended each session. Tutors were provided relevant lecture material and a list of structures to cover (“fair game topics list”) prior to their sessions. The format of the sessions varied and ranged from a guided review to a question-and-answer format. An online sign up sheet was sent out to the MS1 class weekly, and spots were filled on a first-come first-serve basis. At the end of each unit, a survey was sent out to the entire MS1 class to evaluate the effects of the anatomy review sessions in reducing stress levels and helping to prepare for exams. A survey was also sent out to 18 student tutors to evaluate how teaching review sessions affected them.

Evaluation of Innovation: A total of 66 responses were collected among the students who attended an anatomy review session over three different units. Of these responses, 92% (n=61) agreed they felt stressed at the beginning of each unit, 89% (n=59) agreed they felt less stressed after attending a review session, and 94% (n=62) agreed they felt the review session helped better prepare them for the final practical exam. All responders (n=66) agreed that the peer-led review sessions are valuable and should be continued. A total of 13 responses were collected from the student tutors. Of these responses, 11 students believed that teaching helped better prepare them for the USMLE 1/USMLE 2 exam, and 2 students felt stressed while preparing for the review session. All student tutors agreed they would be an anatomy tutor again.

Discussion: Overall, the peer-led anatomy review sessions were met with favorable feedback. The sessions effectively reduced the students’ stress levels about anatomy, and helped them better prepare for their final practical exam. Student tutors also benefited from these sessions, and many agreed it helped better prepare them for their respective licensing exams. All students who attended a review session agreed that peer-led anatomy review sessions should be continued, which highlights a potential opportunity within the medical education curriculum.

Target Audience: Medical educators, medical schools, medical students

References:
Tanveer MA, Mildestvedt T, Skjærseth IG, et al. Peer Teaching in Undergraduate Medical Education: What are the Learning Outputs for the Student-Teachers? A Systematic Review. Adv Med Educ Pract. 2023;14:723-739. Published 2023 Jul 11. doi:10.2147/AMEP.S401766
Ten Cate O, Durning S. Peer teaching in medical education: Twelve reasons to move from theory to practice. Medical Teacher. 2007;29(6):591-599. doi:10.1080/01421590701606799
Tullis JG, Goldstone RL. Why does peer instruction benefit student learning?. Cogn Res Princ Implic. 2020;5(1):15. Published 2020 Apr 9. doi:10.1186/s41235-020-00218-5

Title:
"Assessing Interest and Awareness Among Japanese Medical Students in International Standardized Testing: The Introduction of the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) in Japan"

Authors and Affiliations:
Emi Saegusa-Beecroft, M.D., Ph.D.1,2,4
Kentaroh Takagaki, M.D., Ph.D., B.Agr.3
Junji B. Machi, M.D., Ph.D., FACS1,2,4

1. Office of Global Health and International Medicine, John A, Burns School of Medicine, University of Hawai`i at Manoa
2. Department of Surgery, John A, Burns School of Medicine, University of Hawai`i at Manoa
3. Department of Anatomy and Systems Biology, Faculty of Medicine, University of Yamanashi, Japan
4. JrSr Corporation, Japan (A Non-profit Educational Organization)

Introduction:
Since 2016, the University of Hawaii John A. Burns School of Medicine, in partnership with the JrSr Corporation and 14 out of 82 medical schools in Japan, has been offering the Hawaii Medical Education Program (HMEP). This program offers clinical clerkships, workshops, on-demand course materials, and live online classes, all focused on global health and international medical standards. This study's primary goal was to examine the feasibility of rolling out the National Board of Medical Examiners (NBME) Comprehensive Basic Science (CBSE) and Clinical Science Examinations (CCSE) in Tokyo, potentially impacting the U.S. healthcare workforce, highlighted by Non-U.S. International Medical Graduates comprising 27.2 percent of all primary care positions in the 2023 U.S. match [1], with a particular focus on Hawai'i due to its significant Japanese heritage community (16.5%) [2].

Objectives:
1. To assess the level of interest among Japanese medical students in internationally standardized medical testing, specifically the USMLE Step 1 and NBME shelf examinations.
2. To present the implementation of the NBME CBSE and CCSE in Japan, affirming our HMEP program's direct role in this educational advancement.

Methods:
Using Google Forms, an online anonymous survey was conducted across 14 medical schools, with 1900 students on the HMEP mailing list (20% of medical students). Of those, 279 students (15%) were active participants, defined by direct participation in any of the HMEP curriculum. Participation was voluntary, and data were collected and analyzed by two independent researchers.

Results:
Out of 115 survey responses, 101 responses from medical students were retained (36% of active students), and the other responses from residents and faculty were excluded. Among the valid responses (n=99; 79 pre-clinical and 22 clerkship students), 98% expressed interest in participating in a testing-center-based NBME CBSE (n=97), with 23% strongly determined to take the exam (n=23). Only 1 student was not interested in the USMLE Step 1. While 55% (n=54) planned to take the Step 1 exam during medical school, 8% (n=8) intended to do so during post-graduate residency, and one third remained undecided (35%, n=35). Respondents cited various reasons for pursuing clinical training in the U.S., including experiencing advanced medical practice (64%, n=63), a desire to live in the U.S. (35%, n=35), perceived higher physician compensation (26%, n=26), a desire to see the world (83%, n=82), a passion for global healthcare and international medicine (60%, n=59), and the belief in potential career advantages within Japan (22%, n=22). Regarding the USMLE Step 1, 47.5% (n=47) faced challenges in balancing exam preparation with extracurricular activities and their busy Japanese medical curriculum, while 62% (n=61) found gathering information for effective preparation challenging.

Discussion:
Survey results show strong interest for the NBME CBSE and CCSE at testing centers among Japan's medical students. A majority wish to train in the U.S., aiming for the USMLE. Although this study was limited by its voluntary nature, the survey offers insights into the ambitions and barriers of the responders who are highly-motivated students pursuing international medical careers, who may stand to benefit from new center-based exams, particularly for U.S. residencies.

Conclusion:
The introduction of NBME Shelf Examinations in Japan by the HMEP marks a significant milestone in aligning Japanese medical education with international standards. This initiative is a substantial contribution to the modernization of medical education in Japan. It addresses the strong demand from students aiming for international medical careers and enhances proficiency in professional English communication. The successful implementation of these examinations is anticipated to profoundly impact the global healthcare workforce, including in the U.S., by producing a generation of medical professionals equipped with global competencies and perspectives.

Target Audience:
International Medical Students, Medical School Faculty, Medical School Administrators, Medical Education Researchers.

References:
[1]https://www.nrmp.org/wp-content/uploads/2023/05/2023-Main-Match-Results-and-Data-Book-FINAL.pdf
[2] 2020 Unites States Census

Faculty Development: JABSOM Partnering with HPMG Clinical Sites

Dee-Ann Carpenter, MD, JABSOM Department of Native Hawaiian Health and Office of Medical Education;
Martina Kamaka, MD, FAAFP, JABSOM Department of Native Hawaiian Health;
Bradley Chun, MD, HPMG Medical Director of Undergraduate Medical Education, JABSOM Department of Medicine;
Maile Tauali‘i, PhD, MPH, Collaborative Investigator;
Marcus Iwane, MD, Chief, Kaiser Permanente West Oahu Medical Office, JABSOM Department of Medicine;
Jeani Jow, PharmD, Director, Medical Education and Primary Care Operations, HPMG

Context:
Faculty Development for clinical faculty is needed whenever medical school curricular changes are made that impact clinical faculty. The John A. Burns School of Medicine (JABSOM) recently initiated a Longitudinal Clinical Preceptor (LCP) program for first and second year medical students, to supplement JABSOM’s core Problem-Based Learning (PBL) curriculum. Students meet with their LCP monthly. This curricular change requires more LCPs, who may need a basic understanding of medical school curricula, i.e. education and exposure students have had and what gaps may still exist in their education and training.
HPMG (Hawai‘i Permanente Medical Group) is composed of physicians at Kaiser Permanente, some of whom have become LCPs. Recently, HPMG Undergraduate Medical Education leadership reached out to JABSOM faculty about designing a half day faculty workshop to address some gaps in LCP knowledge about JABSOM’s medical student curriculum, anticipating that this workshop would be able to provide basic information so that the LCP could work more effectively with their medical student learner. JABSOM faculty were asked to partner in the planning for this faculty development and subsequent discussions have solidified an agenda.

Objectives:
Discuss an innovative collaborative faculty development workshop designed by JABSOM medical educators and HPMG to address knowledge and skills gaps for longitudinal clinical preceptors.
Describe how knowledge and skills gaps around understanding PBL, addressing feedback, and incorporating indigenous health were addressed in the faculty development workshop.

Description of Innovation:
Faculty workshop agenda addressed certain gaps identified by HPMG in discussions with their longitudinal clinical preceptors. The workshop will take place on Nov. 11, 2023 with an anticipated fifteen clinicians. Many clinicians will be longitudinal clinical preceptors in the inpatient or outpatient setting. In addition, team leads (in charge of HPMG physicians who work clinically with students), and physicians who teach third year medical students during longitudinal integrated clerkships will be in attendance. The agenda begins with cultural grounding in Native Hawaiian health, as it is incorporated into the JABSOM curriculum as well as with HPMG physicians. The rest of the agenda covers topics including: “tips for understanding todayʻs student learners,” giving feedback (including tools and resources for working with the “difficult” student), familiarization with the basics of Problem Based Learning, overview of clinical skills teaching, and finally, advice and perspectives from PBL tutors and Longitudinal Clinical Preceptors. These are all lecture style presentations, using case scenarios to involve audience participation.

Evaluation of Innovation:
A post-curricular assessment will be given to all attendees immediately following and a few months after the workshop. The workshop is taking place after the submission date for the abstract. Therefore, results will be available and shared at the time of the HPEC conference. We hope to see a change in behavior of the preceptors so that the students are able to see a difference in their teaching, more efficient, effective teaching encounters with cultural grounding, as well as more personalized student feedback.

Discussion/Key Messages:
The following are the key messages from the workshop:
Cultural grounding is important for not only medical learners but also teachers. In an Indigenous space, that includes knowing the basics about Indigenous health statistics, history, values and cultural strengths.
Clinical teachers of medical students (those teaching “at the bedside” or in clinical settings) need to have a basic understanding of medical student educational curricula and content in order to prepare for effective teaching encounters.
Teachers or preceptors should have an idea of the content that medical students should already have mastered as well as an understanding of where gaps may exist.
Giving effective feedback is an important skill for clinical instructors and medical schools should ensure that faculty are trained in this teaching responsibility.
It is our hope that this type of workshop can be easily incorporated into the clinical teaching setting.

Target Audience: medical educators

Education context: Since it was first introduced in medical education literature in the late 1990s, Narrative Medicine (NM) has become increasingly researched as a form of pedagogy for medical learners of all levels. NM is an approach that employs the skills needed to recognize, absorb, interpret, and be moved by stories of illness (Charon 2007). It is concerned with making meaning of the experiential knowledge within patients stories and integrating this with medico-pathological knowledge and modern, data driven medical narratives. A wide variety of NM-related pedagogic interventions have been described in the literature. A common goal among these is proficiency in clinic-based patient-centered interviewing in order to create a rich patient narrative. Opportunities to practice mental schemas like FIFE (Feelings, Ideas, Function and Expectations) can be especially helpful for new learners (Weston et al.1989).

Objective: Participation provides an opportunity to hone skills relating to NM, such as active listening, self-reflection, the process of empathy building, comfort with synthesizing a patient-centered interview and narrative writing.

Description of Innovation: Our innovation is an Instagram account (@somebodystories) that documents the lived experiences of someone with a chronic illness, covering diseases of various organ systems. Each illness covered includes three posts of background information to help users better contextualize the interview and six posts of interview-based summaries. The participant conducts a semi-structured interview with a volunteer who has that given illness. Participants are involved in 1) Identifying a patient, 2) Interviewing, 3) Gathering background information, 4) Summarizing background information and interview content into posts using layman’s terms. To maintain consistency, we utilize the same background research template and interview guide. Volunteers are informed verbally and through writing that any identifying information is omitted from the posts and that interview-based content is posted only after their approval.

Evaluation of Innovation: We will utilize a pre and post survey. Both include components of the Kirkpatrick model, which is widely used to evaluate the utility of an educational intervention. All participants complete a pre survey. Participants who lead at least one interview or help to craft a narrative from the raw interview are given a post survey, to be completed within 1 week of their work. The volunteer interviewees are also sent an optional feedback form.

Discussion/Key Message This innovation is a novel approach to Narrative Medicine that utilizes patient-centered interviewing and social media. It also aims to amplify local stories from Hawai’i.

Target Audience The participant who is involved in creating an interview-based Instagram post.

Title: Innovation in Patient Safety Education for Learning Communities

Authors: Eyrica S. Sumida B.S, Melanie H. Teruya B.A, Vanessa S. Wong M.D, Kyra A. Len M.D, Travis S. Hong M.D

Context:
In Fall 2020, the John A. Burns School of Medicine implemented a Learning Community (LC) program to enhance the existing curriculum. One of the primary objectives of LC is to help learners understand health systems science, with a focus on identifying barriers to high-quality care and patient safety.

Objectives:
The primary objective of this scavenger hunt is to increase students’ confidence in identifying patient safety hazards in a hospital setting through a small group activity and discussion. A secondary objective is to determine the efficacy of this type of simulated learning environment for fourth year medical students.

Description of Innovation:
In 2022 and 2023, fourth year medical students participated in a patient safety scavenger hunt with their LC groups. Students were tasked with identifying as many patient safety hazards as possible in both an adult and pediatric hospital room setting, within a set time interval. Led by their faculty mentor, students debriefed and, using a QR code, accessed brief teaching points that further described specific safety hazards. At the completion of the activity, students completed a post-survey.

Evaluation of Innovation:
A post-program survey determined that 93.8% of 65 students in the 2022 cohort and 87.5% of 40 students in the 2023 cohort agreed that the program helped them identify patient safety errors in a hospital setting. Students also showed statistically significant increases in confidence in their abilities to identify various patient safety hazards, strategies to improve patient safety, and indications for infection precautions, as well as to recognize risk factors for catheter-associated urinary tract infections (CAUTI), falls, restraints, decubitus ulcers, medication errors, skin breakdown, and errors during a code.

Discussion/Key Message:
The patient safety scavenger hunt successfully helped 4th year students increase their confidence in identifying patient safety hazards as well as strategies to improve patient safety. Utilizing a simulation activity with faculty-led discussion allowed them to share ideas and discuss how to improve the performance of our healthcare system at a larger level. An early emphasis on recognizing these hazards promotes student awareness before entering residency. For future sessions, we recommend extended discussions on necessary steps after recognition of these safety hazards while placing increased emphasis on how interdisciplinary teams can approach patient safety.

Target Audience:
Target audience includes medical students who are in the clinical phase of their education and other learning community mentors. Developing confidence in identifying, discussing, and even remediating patient safety hazards is important for students about to enter residency programs where they will be expected to manage patient care and safety. Learning community mentors at JABSOM and other institutions can also use an activity like this to incorporate patient safety into their curriculum as well.

Introduction:
Adverse Childhood Exposures (ACEs) were first identified by Felitti et al. through surveys sent to 9,508 respondents. More than half of the respondents had exposure to at least one ACE. Furthermore, there was a graded relationship between the number of ACEs experienced and the odds ratio for experiencing adverse health outcomes such as severe obesity, ischemic heart disease, any cancer, stroke, etc.

Objectives:
Increase community awareness about the significance of ACEs
Increase provider engagement in administering ACE screening questionnaires and providing appropriate interventions
Increase patient engagement in completing ACE screening questionnaires

Methods:
When Kaiser Permanente West Oahu Medical Office at Kapolei began screening for ACEs, all the screening questionnaires were completely negative. The Pediatric ACEs and Related Life Events Screener (PEARLS) questionnaires were being given at the front desk attached to the routine one year questionnaire without any explanation or cover letter. We hypothesized that the inclusion of a cover letter and re-ordering the items on the PEARLS would improve patient engagement and comfort with responding.

Results:
De-identified responses to ACEs screening questionnaires were recorded from the beginning of administration throughout the implementation of both the cover sheet and the re-orderd PEARLS. The average total scores for the original PEARLS, cover sheet with the original PEARLS, and cover sheet with revised PEARLS was recorded. The re-ordered PEARLS given with a cover sheet had the highest average total score, followed by PEARLs given with a cover sheet, then PEARLS given without a cover sheet.

Conclusion:
The implementation of a cover sheet and re-ordering the items on the PEARLS seemed to improve patient engagement with the questionnaires, suggesting that these alterations may increase patient comfort in disclosing ACEs. For patients who responded to the questionnaires, appropriate referrals and resources were provided.

Desired impact:
This project was created to encourage health professionals to consider the relationship between ACEs and pediatric patient health and how questionnaires addressing sensitive topics may be administered for optimal patient engagement.

Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, Volume 14, Issue 4, 1998, Pages 245-258, ISSN 0749-3797, https://doi.org/10.1016/S0749-3797(98)00017-8.
Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse Negl. 2019;97:104127. doi:10.1016/j.chiabu.2019.104127
Zhang X, Monnat SM. Racial/ethnic differences in clusters of adverse childhood experiences and associations with adolescent mental health. SSM - population health. 2022;17:100997-100997. doi:10.1016/j.ssmph.2021.100997

Introduction: Musculoskeletal (MSK) complaints are among the most common reasons patients seek medical care in the US. Appropriate management of MSK problems requires foundational knowledge of MSK anatomy. However, several studies in the US and Canada have highlighted insufficient anatomy knowledge among medical students and residents.

Objective: This study evaluated MSK anatomy final examination scores between two successive cohorts of first-year medical students to compare two interventions: (1) a teaching-assistant-led pre-examination review session in the first cohort; (2) a clinical skills teaching session of the knee and shoulder joints, which was reinforced during anatomy dissection sessions within the same semester of the second cohort.

Methods: The Class of 2025 received traditional anatomy education during their first year of medical school, as well as a pre-examination review session led by teaching assistants. The Class of 2026 received the traditional anatomy curriculum without the benefits of a pre-examination review session led by teaching assistants. Instead, the Class of 2026 received a newly added clinical skills teaching involving the knee and shoulder joints. We analyzed scores from a 30-question multiple-choice anatomy final examination completed during March of each class’s first year of medical school. Of these 30 questions, six were directly related to the muscles, ligaments, and bones of the knee and shoulder. Unpaired two-tailed t-tests were used to determine statistical significance of both comparisons.

Results: Scores from all 77 students in each class were analyzed. For the entire test of 30 questions, the Class of 2025 (who received the pre-examination review session) did not perform significantly better than the Class of 2026 (average scores 84.7% versus 82.3%, p=0.142). For the 6 knee/shoulder-specific questions, the Class of 2026 (who received focused clinical skills teaching of the knee and shoulder joints) also did not perform significantly better than the Class of 2025 (average scores 92.0% versus 91.6 %, p=0.845). Interestingly, within the same cohort, students in the Class of 2026 scored 12.1% higher on the 6 knee and shoulder questions than on the remaining 24 questions. On the other hand, students in the Class of 2025 scored only 8.6% higher on those 6 questions than on the remaining 24 questions. The difference (12.1% versus 8.6%) approached significance (p=0.06) but did not achieve statistical significance at p<0.05.

Discussion: Despite not having a pre-exam review session, the Class of 2026 did not score significantly worse than the Class of 2025 on either the 30 general MSK questions or the 6 knee/shoulder-specific questions. It is interesting that the difference between the 6-question and 24-question averages among the two classes approached significance (p=0.06) but did not achieve statistical significance at p<0.05. Longitudinal assessments may further elucidate the differential effects of pre-examination review sessions and clinical skills teaching on medical students’ anatomy knowledge of the musculoskeletal system.

Target Audience: US and Canada medical school education directors; preclinical medical students.

Introduction: Generative artificial intelligence (gen AI) is rapidly advancing and holds promise for transforming nursing care and education. With the increasing prevalence of gen AI use in the classroom and healthcare systems, it is important to develop strategies to guide nursing students on how to use gen AI tools responsibly and prepare them for future gen AI-enhanced workplaces. While research efforts to examine gen AI in education are occurring on a global scale, little is known about nursing students’ current perceptions and practices regarding gen AI tools.

Objectives: This presentation will share findings from a study that examines nursing student use and perceptions of gen AI. The findings will guide administrators in making informed decisions on how gen AI is integrated into department policies and provide insight into how faculty can incorporate gen AI into their courses.

Methods: An anonymous online survey was administered to UH Mānoa undergraduate and graduate nursing students in October 2023. The 43-question survey instrument was informed by the Theory of Planned Behavior and reviewed by faculty stakeholders. The survey measured students’ perceptions, attitudes towards, and likeliness of using gen AI tools for learning activities. The survey also queried concerns students have about gen AI in nursing education. Planned data analysis includes descriptive analysis of Likert-type items and thematic analysis of open-ended responses.

Results: Data analysis is ongoing. Full findings will be reported at the time of the presentation. Of the 58 students that participated, 41 students completed the survey. Among those who completed the survey (N=41), most (n=30, 73%) were graduate students, 10 (24%) were undergraduate students. Preliminary findings indicate previously unreported attitudes regarding AI and its use in nursing education learning activities. Over half of participants agreed or strongly agreed that gen AI is a valuable tool to assist with coursework (n=22, 54%), nearly half (n=19, 46%) responded “neutral” when asked to consider whether gen AI is acceptable to use to assist with coursework. Attitudes regarding how gen AI tools should be used also varied. For example, when prompted to consider which learning activities students would complete with gen AI assistance, nearly half of the participants responded they were either likely or very likely to use gen AI for idea generation (n=20, 49%) and as a tutor to explain challenging course concepts (n=19, 46%). Most participants responded they were unlikely or very unlikely to use gen AI for generating a first draft of an essay (n=29, 71%), creating a first draft of a multimodal project (n=28, 68%), revising a final draft of an essay (n=26, 63%), and revising a final draft of a multimodal project (n=26, 63%).

Discussion: Preliminary findings reflect broad attitudes and behaviors regarding how gen AI should be used for learning in nursing school. While most students view gen AI as a valuable tool to assist with coursework, many are still undecided whether using gen AI to assist with coursework is acceptable. These preliminary findings suggest that students may benefit from clearer guidance from faculty on how to use gen AI responsibly in their coursework. Insights gained from this study may be helpful to identify concerns students have about the role of gen AI in their nursing education, and inform proactive efforts faculty may take to shape student attitudes and behaviors regarding the use of gen AI tools, including responsible use of AI tools, as well as building skills to apply gen AI tools in nursing education.

Conclusions: NAWSON is utilizing findings from the survey to inform practices and policies on the responsible use of gen AI in coursework. Actions currently being undertaken include developing a school-wide generalized syllabus statement and guidance document for nursing faculty/students. Faculty training on how to integrate gen AI into coursework is also planned, which will prioritize specific activities identified by students in this study. Gen AI brings many opportunities but also challenges for nursing education. Nurse educators have an important role to carefully guide students to use gen AI tools in ways that best prepare them for professional nursing roles.

Target Audience: The target audience includes nursing/health professions educators, administrators, and students. The findings are relevant for developing nursing/health professions program policies on AI and teaching responsible use of AI tools.

HPEC 2024 Oral Abstract for Innovations in Education

Title: Building on Project ECHO® methods to develop capacity for hepatitis C elimination

Author: Daniel Saltman, MD FACP

Affiliations: Department of Medicine, John A. Burns School of Medicine, University of Hawai`i Project ECHO: Hawai`i Learning Groups

Context: Hawaii has one of the highest rates of liver cancer incidence and mortality in the US, primarily caused by viral hepatitis. Safe and effective treatments exist to cure hepatitis C infection (HCV). Hawaii has a statewide goal aligned with a national initiative to eliminate HCV by 2030. Hawaii’s island geography makes access to quality care difficult for isolated populations, including those in rural areas, incarcerated, or among people who use drugs.
Both local and national experience has identified treatment of hard to reach populations as a bottleneck in HCV elimination efforts. Hepatitis C is transmitted through blood-blood contact. Risk factors include injections overseas, blood transfusions prior to 1992, low hygiene tattoos, and injection drug use. Early screening efforts targeted those born between 1945 and 1965 as at risk with many unaware of their chronic infection. Current recommendations are for one- time screening everyone over age 18 and anyone with ongoing risk factors. New infections are increasing among young people who use injection drugs.
The ECHO model was identified as a best practice to develop a localized network of treating providers using case-based, inter-disciplinary, collaborative learning with hepatitis experts.
The ECHO model leverages video-conferencing to develop a sustainable hub-and-spoke program of mentorship and guided practice. The hub is composed of specialists and content experts, and the spokes are primary care providers and their teams.
We recently completed a third series centered on hepatitis evaluation and treatment. In 2021, we produced a 16-week series focused on HCV; in 2022, 16-weeks focused on hepatitis B (HBV) and in 2023, 12-weeks focused on HCV.

Objectives: Our goal is to build capacity for the evaluation and treatment of chronic HCV.

Description of Innovation: From January 2021 through October 2023, we produced 44 clinics. Forty-six de-identified patients were presented and discussed.
We emphasize the primacy of case-based learning by typically starting each session with the patient case. Recent sessions had 45 minutes for case presentation and discussion and 40 minutes for a didactic with Q&A. The program leads model inclusivity and a team-based approach to promote interdisciplinary learning.
A Case Presentation Form was designed to communicate clinical content and to focus discussions.
A facilitation method is used that separates the patient background, history and physical exam from the expert recommendations. This promotes participation, a patient-centered approach to care, and helps level disparate backgrounds of participants. All participants are invited to ask questions after the presentation to gain a deeper understanding of the patient’s case. A facilitator summarizes this background and confirms the accuracy with the presenter. The content experts and others are then invited to provide recommendations regarding further evaluation and treatments and the expert recommendations are summarized to the group. The expression “all teach, all learn” becomes manifest in these discussions.
We are accredited to offer continuing education awards to physicians, nurses, pharmacists and social workers. We collect evaluation surveys after each session using REDCap (Research Electronic Data Capture) and deliver a participant- and session- specific, printable CE certificate upon completion.
Presentation slides, references and resources are posted on the HLG webpages after each session to provide greater depth of learning for interested participants.
Through REDCap, we distributed pre- and post- series questionnaires. Twenty-six questions were grouped by Self-efficacy, Access, Clinical Benchmarks, Series Evaluation, and Comfort with practical practice goals like vaccination, screening, lab interpretation, and use of standing orders.

Evaluation of Innovation: We had 1455 hours of attendance by 197 individuals. Fifty-nine physicians, 30 pharmacists, and 56 nurses participated from zip codes across all the Hawaiian Islands.
Average attendance increased over the 3 years (45 to 95 to 115) to include providers from the Hawaii Dept of Public Safety prison system, Community Health Centers, pharmacies, drug treatment programs and insurance carriers.
For the years 2021, 2022, and 2023, respectively, of those non-faculty who completed the questionnaires:
8/11 (73%), 30/37 (81%), and 25/28 (89%) Agreed or Strongly Agreed their participation reduced the need for travel for their patients.
8/11 (73%), 24/37 (65%), and 14/28 (50%) Agreed or Strongly Agreed their prescribing practice will change as a result of what they learned.
7/11 (64%), 27/37 (73%), and 19/28 (68%) Agreed or Strongly Agreed their referral pattern will change as a result of what they learned.
After participating in the 2023 HCV ECHO series, 68% of respondents agreed or strongly agreed with the statement: “Compared to other providers, I can manage primary care liver problems very well” compared to 36% before participating in the training(s) – a 32% increase.

Discussion/ Key Message: This year, the Medicaid Quest plans eliminated prior authorization requirements for prescribing direct-acting antiviral treatments for HCV and explicitly recognized the value of this HCV ECHO program therein.
A program of mentorship and intentional education for primary care participants was shown to increase the capacity for the management and treatment of HCV. Ongoing efforts like these are essential to hepatitis C elimination plans in Hawai`i. Centering patients and provider experience by emphasizing case-sharing as the primary learning method has resulted in strong engagement. Participants reported changes in prescribing and referral practices, expressed improved confidence in managing liver conditions, and strong program satisfaction.
We hope for further recognition that evaluation and treatment of hepatitis C with a shared practical goal of elimination is an ideal model for how to leverage technology in the primary care setting to further broad public health goals. Hepatitis C is a teaching case for developing population-based care using screening protocols and standing orders, decision support and reporting standards.

Target Audience: Educators, primary care providers, pharmacists, health care systems, public health workforce

References:
National Elimination Plan: JAMA. 2023;329(15):1251-1252. doi:10.1001/jama.2023.3692 Hawai`i Elimination Plan: https://www.hepfreehawaii.org/hep-free-2030
HCV ECHO 2023 Resources: https://www.hawaiilearning.org/hcv-2023-resources/

INTRODUCTION: In 1978, ʻŌlelo Hawaiʻi (OH) became one of the official languages of the State of Hawaiʻi, the ancestral home of Native Hawaiians (NHs). Since 1986, Hawaiian language immersion and fluency have grown and OH is now frequently spoken among NHs and non-NHs throughout the State. With the growing demand for OH fluency, medical education and health care services are experiencing an expressed need for “language-concordant care”. Language-concordant care (LCC) occurs when patients and providers communicate in a shared language, and it has been shown to improve trust and health outcomes and reduce medical errors and adverse events. LCC studies investigating the incorporation of Spanish, Arabic, and te reo Māori into medical education have shown increased comfort and rapport with patients. They also demonstrate that physicians who have undergone LCC training are more likely to take care of a patient who prefers to speak that language in the future. This emphasizes the need to prioritize the integration of language into medical education rather than relying on interpretation services. These are among a limited number of studies evaluating the potential impact of teaching indigenous language fluency (i.e. OH) to medical students as a means to improve patient-provider relationships, health outcomes, behaviors, and/or health literacy. Yet, Indigenous peoples, such as NHs, are known to experience persistent health disparities that could be improved with stronger communication skills, patient-provider interactions, and the building of trust.

OBJECTIVE: To better understand the opportunities and challenges of teaching conversational ʻŌlelo Hawaiʻi (OH) in medical school curricula in Hawaiʻi.

METHODS: IRB approval was obtained. Participants (n=19) engaged in semi-structured focus groups (n=4) or a key informant interview (n=1). These included 11 medical students (median age=27 years), 3 OH language instructors (median age=51 years), and 6 medical education faculty (median age=60 years). Thirteen participants (68.4%) were women and 13 (68.4%) identified as Native Hawaiian. All 19 participants reported that their first language was English. The most selected language spoken at home was English (64.3%), followed by Hawaiian (17.9%), Pidgin (7.1%), French (3.6%), Tahitian (3.6%), and Japanese (3.6%). Two researchers employed thematic content analytic methods and used both inductive and deductive coding to independently code all 5 transcripts.

RESULTS: Five major themes emerged: (1) Language and the Native Hawaiian cultural context; (2) Use of ‘Ōlelo Hawaiʻi in the community; (3) Clinical benefits of speaking ‘Ōlelo Hawaiʻi; (4) Structure of integrating ‘Ōlelo Hawaiʻi - logistics, barriers, and opportunities; and (5) Medical education curricula enhanced by ‘Ōlelo Hawaiʻi - teachers, content, and design. Overall, themes 1-3 suggested that ʻŌlelo Hawaiʻi would provide NH cultural context, meet community support, and provide clinical benefits. Themes 4 and 5 addressed practical issues such as time constraints and development of curricula.

DISCUSSION: Initial perspectives from teachers (medical education and ʻŌlelo Hawaiʻi) and learners of medical education were overwhelmingly positive on incorporating ʻŌlelo Hawaiʻi into medical education and eventually into health care services. Future studies are needed to further refine the process of development and implementation and to investigate expected outcomes such as quality of care, trust, and reducing health inequities.

TARGET AUDIENCE: Medical students and medical education faculty.

Introduction: Interest in generative AI and its application to various disciplines, including medical education, has been exponentially growing. ChatGPT was released in 2022 and has garnered much attention due to its free public access. However, research exploring its use to design scenario-based simulations (SBSs) is limited. Rodgers’ Simulation in Healthcare article (2023) describes ChatGPT’s potential as a useful tool for simulationists to streamline instructional design. Yet, they underscore the crucial role of human intervention in addressing shortcomings related to errors, complexity, and formatting. A background in simulation educational design may be a prerequisite. Often when SBS design is undertaken by novice simulationists, the process can be overwhelming and the instructional design may be incomplete, especially without the guidance of experienced simulationists. The applicability of ChatGPT in aiding non-simulationists with SBS design in healthcare education has not been explored.

Objective: To describe the instructional design process and outcomes of SBS created by medical students using ChatGPT and compare them to SBS created by medical students with simulation-expert faculty guidance.

Methods: Five existing SBSs designed by medical student interest groups (SIG) with simulation faculty guidance were collected from simulation center archives, and scenario goals and patient synopsis were extracted. Medical students unfamiliar with the complete scenario details used the extracted goals and synopsis to create new scenarios using ChatGPT. A blank scenario design template outlining essential elements was used for reference. The ChatGPT conversation tool facilitated iterative refinement of missing elements, errors, or desired modifications. Five scenarios were produced in one session, with elapsed time recorded. The number of design elements and objectives were quantified and compared to the scenarios crafted by SIGs; analysis employed a two-tailed T-test.

Results: On average (n=5), the ChatGPT scenarios design time was 37±11.8 minutes and 5.8±1.3 prompts were needed to produce the final scenario. In contrast, SBSs designed by SIGs with faculty input were created over months, and required multiple faculty-student meetings. ChatGPT produced an average of 4.0±0.7 learning objectives, compared to 3.2±1.6 when developed with faculty. ChatGPT’s objectives were often repetitions of the initial input goals. ChatGPT fulfilled an average of 11.8±0.8 out of 18 template elements, compared to 12.8±3.8 in faculty-guided scenarios.

Discussion: The most notable difference between ChatGPT and faculty guided scenarios is substantial reduction in creation time. AI-assisted scenarios were created in mere minutes, while faculty guided scenarios took months to complete. Time efficiency could allow students to jumpstart the design process and time saved could support further simulation refinement under faculty guidance. There were no statistical differences between groups in the number of fulfilled elements (p=0.53) or objectives (p=0.35). However, the quality and accuracy of the ChatGPT scenarios have yet to be examined by simulation experts. Challenges experienced while using ChatGPT include the omission of requested scenario components, inadvertent removal of desired elements during the iterative process, and inconsistencies in formatting between scenarios.

Target Audience: Novice and expert simulationists, medical students, faculty

Introduction: Musculoskeletal (MSK) conditions are common in clinical settings, with approximately 20% of primary care and emergency department visits related to MSK issues. However, medical students in the United States and Canada often show a relative lack of confidence in conducting MSK examinations, especially when compared to their perceived examination skills of other organ systems.

Objective: This study surveyed medical students at a local institution regarding their confidence with MSK examination skills, MSK examination education experience, and collected their suggestions about improving the curriculum.

Methods: An anonymous, online survey was conducted among preclinical medical students at a state-funded allopathic medical school (John A Burns School of Medicine, University of Hawaii at Manoa). The survey, adapted from previous studies, included Likert scale and open-ended questions. Students reported their confidence in various physical exams, perceived preparedness for clerkships, usefulness of existing MSK clinical activities, and suggestions for improvement.

Results: 64 out of 77 students from the Class of 2025 completed the survey. When compared with their perceived examination skills of other organ systems, students expressed less confidence in their ability to perform the musculoskeletal physical exam. Existing MSK teaching activities (Orthopedics, Rheumatology, and Transition to Clerkship Training), were deemed valuable by over 90% of students. It should be noted that 98.4% of students agreed that adding clinical MSK skills to their MD3 anatomy unit would be beneficial. Students also provided constructive comments and suggestions on how to integrate MSK exam curriculum with relevant anatomy units and increase small-group learning sessions for MSK exam practice.

Discussion: The survey results indicated that third-year medical students lacked confidence in performing MSK examinations compared to other organ systems, aligning with findings in the existing literature. Traditionally, the Office of Medical Education (OME) incorporates MSK cases into pre-clerkship problem-based learning (PBL) sessions in the second year. The students expressed a desire for early exposure to MSK clinical skills. In response, the OME is implementing changes such as introducing MSK clinical exam skills in the first year with the collaboration of a physiatrist and the anatomy department. The same survey will be administered to future cohorts to assess the impact of these modifications, and objective outcomes such as anatomy examination results and standardized patient examination results will be collected. This initiative reflects a commitment to enhancing MSK education in medical school, with plans for further research and objective assessment.

Introduction: Medication errors and insecure practices harm healthcare systems worldwide. Each year, around 7,000 to 9,000 people in the United States die due to medication errors. (Tariq et al., 2023). There is no standardized method of educating healthcare providers on medication calculations.

Objectives: Identify evidence-based instruction strategies for drug calculation skills development and describe the strategies based on the research-based principles for smart teaching.

Methods: Through an evidence-based systematic review, we followed Whittemore and Knalf (2005) steps to assess the level and quality of evidence. The research process involved five steps: (1) defining the research question, (2) conducting a literature review, (3) gathering data from primary sources, (4) analyzing data, and (5) presenting findings. An electronic search of CINAHL, PubMed, and PsycINFO was conducted using the search terms “students,” “nursing,” “education,” “drug dosage calculations,” and “mathematics.” To qualify for inclusion in the review, the studies had to include nursing students or nurses, be written in English, and not restricted in regards of the country. Articles were not restricted to any one country because medication calculation errors related to patient safety remain a significant global issue. From 2014 to 2020, a total of 1793 articles were retrieved.

Results: For this review, we found 51 studies that met the eligibility criteria. Most of these studies reported results based on evidence levels III (23.5%) and V (41.2%). The majority of the information quality was from Level B (82.4%). Table 1 summarizes the level of evidence, quality of evidence, role of evidence in learning and teaching, and the research-based principles addressed in the studies reviewed. The major teaching strategies were early diagnostic assessments of students' knowledge, anxiety, and self-confidence; stimulate self-directed learning, and working on knowledge organization by scaffolding complex tasks, and being explicit about objectives and expectations. The use of e-learning has become increasingly popular since 2018.

Discussion: Utilizing technology can greatly benefit education by complementing in-class practice and providing students with opportunities for creative, autonomous, collaborative, and interactive learning. In recent years, there has been an increase in publications utilizing e-learning, smartphone apps, and web pages to improve drug calculation skills (for example: https://www.safemedicate.net/ and https://testandcalc.com/index.html). However, due to the low levels and quality of evidence, we recommend that future studies use research designs that produce higher levels of evidence. For instance, randomizing teaching methods per semester allows for a standardized approach to data gathering in nursing programs, which enhances consistency in monitoring student progress and evaluating teaching effectiveness. Implementing web-based software can also support effective research-based approaches. We recommend that teaching approaches address cognitive, motivational, and developmental goals to ensure student success. Future trends are adaptive web-based technology aiming at improving the learning of medication calculation skills (Ravik & Andresen, 2023).

Title: Physical Activity and Wellness Among Medical Students at the University of Hawaiʻi John A. Burns School of Medicine (JABSOM)

Authors: Johnathan Kim, Maya Ushijima, and Richard Kasuya MD

Affiliations: University of Hawaiʻi John A. Burns School of Medicine

Introduction: Previous studies indicate the benefits of physical activity on academic performance, cognitive function, and attention span. Regular exercise is also linked with fewer depressive and anxiety symptoms. Medical students have limited time to engage in regular physical activity, which may affect their ability to learn and wellness. There is limited research combining the effect of physical activity on both academic performance and wellness in medical students. We defined metrics of wellness as stress and anxiety levels, energy levels, and sleep quality.

Objectives: To obtain a better understanding of how physical activity impacts perception of academic performance and wellbeing of medical students at JABSOM.

Methods: All medical students enrolled at JABSOM during the 2023-2024 school year were considered for enrollment in this study. An electronic survey was administered to all participants.

Results: Approximately 70% of respondents agree that physical exercise is directly correlated with their academic performance and motivation to study. 80% found that exercise improved their ability to focus and concentrate while studying or in class. 90% of students believed exercise is directly correlated with sleep quality and energy levels at school. Over 80% agreed that exercising regularly lowers stress and anxiety levels.

Discussion: Previous studies demonstrated a direct correlation between physical activity and academic performance in both medical and non-medical students. Our data supports this correlation in medical students. Over 85% of participants engage in physical activity. The most common types of exercises reported were walking, weight lifting, and jogging. While the majority of students believed that physical activity is directly correlated with their academic performance, motivation to study, and ability to focus, one-third of students disagreed with these statements. Regular exercise has been proven to have beneficial effects on mental health. The data elucidates a direct correlation between physical activity and perceived quality of sleep, lower stress and anxiety levels, and concentration and energy levels in medical school. More students seemed to agree with the statements about wellness (90%) compared to the statements about academic performance (70%), suggesting that students may exercise for reasons related to their well-being rather than reasons related to their academic performance. The most common reason cited by students for not engaging in regular exercise was lack of time. Other common reasons included cost, lack of access, caregiving responsibilities, and lack of confidence or knowledge. Next steps include broader sampling of future years of medical students and other medical schools. There were some quantitative differences between classes, which can be analyzed in a future study. An area of interest would be a longitudinal study to see if levels of physical activity change throughout medical school, and if these changes are correlated with fluctuations in academic performance and wellness metrics. Data from this project can provide a framework to create novel programs in medical schools to encourage and support physical activity within the student body to engender positive outcomes in academic performance and wellness.

Target Audience: Educational professionals or students interested in curriculum development, including the promotion of emotional wellbeing and resilience.

Introduction: In Fall 2020, the John A. Burns School of Medicine (JABSOM) implemented Learning Communities (LC) for medical students. LC consists of small groups of faculty and students who work together throughout all 4 years of medical school. LC’s main aim is to foster a supportive learning environment and provide an opportunity for students to practice their clinical skills. During these hands-on practice sessions, students receive valuable feedback from their faculty mentors and collaborate with their peers to build their repertoire of clinical knowledge. Recognizing the importance of point-of-care ultrasound (POCUS) in clinical practice, JABSOM leveraged the potential of small group learning environments within the LC framework to introduce a comprehensive POCUS curriculum. Ultrasound in clinical application has expanded over the past decades1-3. Ultrasound is a critical skill that will be important for practicing physicians as it is listed as a training guideline in a number of residency specialties. POCUS training in medical school will allow JABSOM graduates to be prepared for many residency specialties.
The launch of the LC POCUS curriculum started with the fourth-year medical students in 2020 and gradually incorporated different components of the curriculum starting from the MS1 year. Currently, the POCUS curriculum includes organ-specific ultrasounds that correlate with its respective course (i.e. cardiac ultrasound during the student’s MD2 cardiac unit) and ultimately culminates in “Sono-Games” as a POCUS challenge. This challenge utilizes an interactive game-like framework, promoting a fun learning experience where students apply their POCUS skills they learned through both LC and their clerkship years.

Objectives: The objective study was to assess the usefulness and effectiveness of the LC POCUS curriculum, and further, whether it enhanced the students’ confidence in their understanding and usage of POCUS including organ specific and eFAST (Extended Focused Assessment with Sonography in Trauma) skills.

Methods: The methods of this study involved distribution of anonymous surveys to medical students following the completion of each preclinical unit. The surveys consisted of 5 point likert scale questions to measure the perceived impact of the organ specific, eFAST and sonogames workshops in helping them to understand POCUS.

Results: Data was analyzed from 2 academic years of 2021-2022 and 2022-2023. Notably 96.4% of students in MD1 felt that the LC session was a useful introduction to POCUS (n=112), 93.1% MD2 students felt the cardiac US session was useful (n=135), 90.4% MD3 students felt the renal US session was useful (n=115), 84.3% of MS3s felt the session improved their confidence in performing an eFAST exam (n=64) and 88.0% of MS4s reported Sono Games was useful to help them review POCUS (n=50).

Discussion: The implementation of a POCUS curriculum in JABSOM’s learning community small group framework has yielded positive outcomes for medical students. The results indicate overall positive response regarding LC POCUS sessions, with students finding them useful for learning organ-specific ultrasounds. Notably, 84.3% of MS3s reported increased confidence in performing an eFAST exam, showing the broader applicability of POCUS training.
Positive feedback from the MS4s on Sono Games highlight the continued impact of the LC POCUS curriculum, reinforcing POCUS skills through engaging game-based activities.
In the future, it would be interesting to expand this study and ask JABSOM graduates whether they found this new addition to the curriculum helpful while in residency, especially since they would have used POCUS more extensively in the real-world setting on patients. Increasing POCUS use throughout clinical rotations would also be another valuable addition to the current POCUS curriculum. For example, medical students could use POCUS to help triage patients as well as collect additional information on the patient’s they are seeing, particularly in their OBGYN and emergency medicine rotations where POCUS is used more heavily. In addition, incorporating POCUS assessments within each unit would be valuable in determining strengths and weaknesses of the curriculum. For instance, POCUS could be incorporated in standardized patient scenarios and end-of-unit clinical skills exams. These methods would allow us to evaluate the competency of the students’ POCUS skills and could further assess the efficacy of this new curriculum addition.
In conclusion, integrating the POCUS curriculum within Learning Communities at JABSOM has proven valuable for medical education, with consistent positive feedback across academic years supporting its success.