HPEC Poster Session 2022

Introduction: Medical students participate in away rotations to gain experience, learn about a program, and increase the likelihood they will match at a particular residency program. Transportation and housing costs for an in-person away rotation can be barriers for many medical students seeking to match to competitive residency programs or specialties. These barriers disproportionately affect medical trainees from marginalized backgrounds. With the COVID-19 pandemic, in-person away rotations were momentarily discontinued and partially replaced by virtual away rotations, eliminating the financial cost and creating more opportunities for inclusion of medical students with less financial resources. With these potential benefits, we aimed to analyze the breadth of specialties offered virtually.
Telehealth is well integrated into the field of obstetrics and gynecology. Virtual visits are utilized for prenatal care, gynecology surgical consultation, post-op follow up, contraceptive counseling, and abortion care. Based on this, we hypothesized that obstetrics and gynecology programs would be early adopters of virtual away rotations.

Objectives: To identify the number and types of virtual away rotations offered to medical students in the 2021 academic year, with a focus on obstetrics and gynecology rotations.

Methods: The University of Hawaii Institutional Review Board classified this study as not human subject research. Using the Association of American Medical Colleges’ Visiting Student Application Service, we searched a database of medical student away rotations for available virtual away rotations. For each available virtual rotation, we extracted data concerning rotation type, topic, and geographic location. We used descriptive statistics to analyze the results.

Results: We identified 99 exclusively virtual away rotations offered to US medical students in 2021. The majority of these rotations were classified as clinical rotations (79%). 52% of the virtual rotations focused on medical specialties and 21% focused on surgical specialties. Other specialties offering virtual away rotations included dermatology, emergency medicine, ophthalmology, and pathology. No virtual away rotations were offered by a department of obstetrics and gynecology. Only two family medicine departments offered virtual away rotations focused on women’s health topics including lactation and family planning.

Discussion: The limited opportunities for medical students to participate in virtual obstetrics and gynecology rotations is a missed opportunity to connect with residency programs, especially students who may be from marginalized groups. Geographically distant programs, such as Hawaii-based programs, may also benefit from including students who would otherwise not be able to afford an in-person away rotation.

Conclusion: There are limited opportunities for virtual away rotations focused on women’s health, obstetrics, or gynecology. This gap represents an opportunity for obstetrics and gynecology residency programs to develop virtual rotations focused on women’s health to help recruit from a wider population of medical students.

Introduction: During the COVID-19 pandemic, much healthcare education has been transitioned to remote platforms rather than in-person. However, remote facilitation is still considered a specific strategy applied in particular situations. The interaction between learners and instructors is essential to achieve effective healthcare simulation, but it is unclear whether this interaction can be performed adequately during remote facilitation. The purpose of this scoping review was to investigate the types of remote facilitation described in previous studies, their influence on learner outcome, and related factors.

Methods: The protocol followed the PRISMA-ScR and the framework by JBI. Inclusion criteria were: synchronous remote facilitation, health care personnel and related students, and educational simulation measured any learning outcome in the publication under a peer-reviewed journal before Apr 2021, written in English. We searched PubMed, Embase, CINAHL, Web of Science, and ERIC from Apr 19 to May 13, 2021. We conducted a pilot test with 50 randomly selected abstracts to assess their eligibility based on the inclusion criteria. Five reviewers worked as two teams, and in each team, two reviewers reviewed all abstracts and full-text independently for inclusion. A third reviewer reviewed where there was a conflict. We resolved disagreement by consensus of all reviewers. A data-charting form was developed and is updated in an iterative process. For critical appraisal, JBI critical appraisal tool was applied. The extracted data were synthesized, summarized, and reported in a descriptive format. We summarized the characteristics of simulation and facilitation initially. Then, we synthesized the essential qualitative data through discussions based on the research question and theme related to the learners’ outcome.

Results: We identified 2,809 articles published in multiple databases or registers. After full-text screening and final assessment, 31 articles were included in the scoping review. Of them, 13 articles have been published since 2020. In eight studies, education was conducted in multiple geographic regions. The form of the simulation was VR and screen-based simulation (n=9), simulated human patient/guardians/coworkers(n=9), task trainer(n=8), and mannequin(n=6). The videoconference(n=26) was mainly used. In 14 studies, the student and the facilitator performed remote demonstrations simultaneously. Most facilitators were either previously trained or experts. There were 8 cases of facilitation during the simulation, 9 cases of facilitation after simulation, and 14 cases of both. There were still very few RCTs comparing the effect of local and remote facilitation, so the effects could not be quantitatively compared. Before 2018, some studies reported that bad connections and technical issues were a barrier to communication. Most authors said more efficient in cost, time, and human resources management than in-person facilitation. When the learners could see a facilitator’s facial expression and were asked or explored, they felt the presence of a facilitator more.

Conclusion: We expect a better understanding of the advantages and disadvantages of remote facilitation technologies. In future simulation-based healthcare education, remote facilitation will increase. The remote facilitation factors that affect learner outcomes will lead to improvement during the healthcare education instructional design process.

Online courses on platforms have created increased familiarity with instructional video-based learning. FunSim-J Online (FSJO; Fundamental Simulation Instructional Methods in Japanese Online) is an international faculty development course hosted by SimTiki Simulation Center, participants view recorded asynchronous lectures, and practice facilitation and debriefing synchronously via Zoom. Course feedback suggested a demonstration model debriefing; however, no sufficient internet examples were available and limited course time was available for synchronous demonstration during, therefore we created an instructional video. Debriefing is the most important part of simulation education, which is an activity to encourage participants’ reflective thinking and provide feedback about their performance in simulation. To create an effective instructional video, we followed several principles, such as the subtitle principle1. Separate videos of the scenario and of the debriefing were produced.

In a stepwise process, we aimed to create an instructional video for demonstration of a model structured debriefing of a simple scenario using the GAS (Gather-Analyze-Summarize) debriefing framework. GAS is used for ACLS which is the global standard resuscitation simulation course, and is the fundamental framework well known in the world. In the first step we established target learners as novice simulation educators enrolled in FSJO. In the second step we created a storyboard allocating two minutes for a demonstration scenario with actors, followed by 11 minutes of a demonstration debriefing. In the third step two expert simulation educators wrote scripts to highlight key elements of each GAS phase. In the fourth step of filming an expert simulation educator played the debriefer, and SimTiki staff played 3 standardized learners; all are native English speakers. The scenario was filmed with a ceiling camera, and debriefing was filmed with 2 tripod-mounted cameras to simultaneously capture both debriefer and students, respectively. Cue cards were used to support smooth dialogue. In the fifth step the English language video was edited with Adobe Premiere Pro to create 2 videos with Japanese subtitles.

Reduction of cognitive load is an important consideration in creation of an instructional video2 . A recent review recommends subtitles in the viewer native language when creating a video with English narration for a non-native English speaker, with slower than normal/natural speed of the English narration1. Actors in our video spoke scripted words in a cadence much slower than natural speech. Subtitles were color-coded for each speaker allowing viewers to easily identify the speaker, a challenge for non-native language viewers further complicated by the use of COVID masks by all actors. Subtitle colors were selected from the Color Universal Design palette, adapted for color blindness.

A production process strength is that the script was written by experienced simulation educators, resulting in a highly realistic representation. Finally, the Japanese Simulation Fellow translator has an expert working knowledge of the GAS framework which supports the creation of a culturally aligned natural language translation rather than a direct word-for-word translation, while maintaining key concepts of debriefing. This FSJO educational video was tested in November 2021 and will be made available to about 60 past participants. We will conduct a survey regarding learner impressions and understanding of the video.

1. Mayer RE, Fiorella L, Stull A. Five ways to increase the effectiveness of instructional video. Educ Technology Res Dev. 2020;68(3):837–852.
2. Castro-Alonso JC, Koning BB de, Fiorella L, Paas F. Five Strategies for Optimizing Instructional Materials: Instructor- and Learner-Managed Cognitive Load. Educ Psychol Rev. 2021;1–29. PMID: 33716467

Introduction: The State of Hawai‘i has an estimated 29% physician shortage.1 This deficit is particularly glaring in Hawai‘i’s rural communities which have shortages of 33-53%.1 Multiple studies have validated that health care providers from rural areas are more likely to practice in rural communities.2 3 Literature also suggests that rural medical training programs may improve physician recruitment. John A Burns School of Medicine (JABSOM) students can gain exposure in rural health care via the Hawaiʻi Rural Health Program (HRHP) which has been providing first-year medical students with opportunities to experience medical practice in rural Hawaiʻi communities since 2011. The main goal of the program is to encourage students to return to these rural communities in the future as practicing physicians.

Objectives: The goal of this abstract is to describe JABSOM’s HRHP and share the insights from students who completed the program.

Methods: HRHP sends two groups of six students to rural towns on Hawaiʻi Island for a 12-week block during their first year of medical school. The program covers the costs of living and transportation. Students participate in the same educational activities as their counterparts on Oʻahu, including problem-based learning (PBL), clinical shadowing, and community engagement, all in a unique rural setting. Each group on Hawaiʻi Island is paired with a local physician to serve as a tutor during their bi-weekly PBL sessions. Students also shadow local physicians and engage with the community by participating in local health events, mentoring elementary and high school students, and exploring the natural beauty of the island. Final exam grades from 2015 to 2019 were compared between HRHP and non-HRHP JABSOM students to ensure that the new model did not affect their academic performance. In 2019, surveys were sent to the 12 students once they completed their time on Hawaiʻi Island.

Results: To date 97 students have participated in HRHP, 29 of whom have completed residency training. Six of the 29 (21%) are working in rural communities. Five of the six are working Hawaiʻi and one is working in rural California. From 2015 to 2019, there were no statistical differences between the end-course exam scores for HRHP students vs. non-HRHP students, showing it does not compromise their academic education. Reflections were collected from 10 students of the 2019 cohort, all highlighting themes of community involvement, mentorship, empathy, and advocacy.

Discussion: Programs like HRHP are vital to educating physicians who will practice in rural communities. It is promising that 21% of former HRHP students currently practice in rural communities. The literature shows that 11% of JABSOM graduates3 and 11% of the medical students nationally1 go on to practice in rural communities. Our data also supports that HRHP students performed as well as non-HRHP students on medical school examinations. The addition of student reflections helped to illustrate the value this program offers beyond the promising d

As a multi-disciplinary team, funded by Clinical Scholars, a national leadership program of the Robert Wood Johnson Foundation (RWJF), we brought together our areas of expertise to work to empower emerging health professionals (EHP’s). On our team we have two medical doctors, an endocrinologist and an Internal Medicine physician, a pharmacist, a psychologist, and a social worker. Our multidisciplinary team brought together our students to empower their abilities in several areas, including resilience, through training, mentoring, and modeling through a partnership with the Hawaii Homeless Outreach and Medical Education (H.O.M.E.) project. Due to COVID-19 the H.O.M.E. project was unable to work with patients in person for a period of time. We realized that this, combined with the stress the EHP’s were experiencing, was an opportunity to help empower our students through resiliency education. Thus the focus of this project is on empowering our EHP’s to build both resilience in themselves and in the houseless population they work with.

Houselessness is a major health problem in Hawai‘i. In 2019, according to the Point-in-Time count, 48 out of every 10,000 individuals were experiencing homelessness in the state, one of the highest rates in the nation (Henry, et. al. 2019). Previous studies show homeless individuals have many other concerns compared to the majority of the population besides not having a home. Due to their difficult living situation, it is common for these individuals to lose their sense of self-efficacy as well as their identity (Buckner, Bassuk, & Zima, 1993). It is very common for homeless individuals to struggle to take care of their health on a daily basis.

Healthcare professionals work in high stress environments which is naturally demanding both physically and emotionally. Professions involving human contact and quick decisions with weighty impacts are usually the most stressful (Koinis et al., 2015). The high level of stress healthcare professionals encounter can lead to burnout, staff turnover and absenteeism (Morse et al., 2012), as well as causing detrimental effects to patient care (Salyers et al., 2015). Resilience can increase motivation, help one persist when they are tired, and reduces the number of choices to make on a daily basis, which can prevent one from considering to resign from a taxing profession. Resilient people are able to cope and adapt to difficult situations which in turn result in maintaining a higher quality of life (Leppin et al., 2014). A resilient mindset allows one to have self-efficacy, a belief that they can change what is changeable and makes one persist in trying again after each failure. Healthcare professionals who are resilient not only have self-efficacy, but they are able to transmit that belief to their patients as well, which results in better patient outcomes.

This study consisted of first, measuring EHP’s levels of resilience using the Connor-Davidson (CD) Resilience Scale, and second, measuring the efficacy of a resiliency training. This presentation will report on the findings from this study as well as a provide a description of the training module. In evaluating the training, we found that participants reported increased scores from pre-test to post-test in each domain measured. In examining the CD scale, we found a generally high level of resilience in our EHP’s, averaging 4.02 on a 5-point agreement scale. Our presentation will provide a descriptive breakdown of these data.

The University of Hawaii (UH) Health Sciences Library (HSL) provides a variety of resources critical for science and medical education at the UH, John A. Burns School of Medicine (JABSOM). These resources are accessible by all of the UH students and faculty, including affiliated sites. To provide tailored services for medical students, their educational needs must be identified. Currently, there is no standardized system that evaluates this. The usage data of HSL resources is collected through the number of log-in’s through the UH library system by all of UH Manoa users. As such, it does not distinguish between medical students and other UH users. We propose that resource utilization by medical students differs from those utilized by other UH users.

The objectives of the survey were three-fold: 1) To identify utilization of HSL resources by medical students; 2) Compare the pattern of utilization of the HSL resources by medical students with UH Manoa users by comparing our survey results to 2021 HSL usage data; and 3) To identify utilization of resources not available through HSL system.

An online survey was emailed to all current JABSOM medical students. The six item survey included two likert scale questions regarding utilization of library resources available and not available through the JABSOM library. Items were assigned a numerical value; Never =1, Rarely=2, Sometimes=3, Very Often=4, and Always=5 and an average value was calculated for each resource. The remaining four items were open-ended.

Sixty-six total responses were obtained with 21% first years, 35% second years, 18% third years, and 26% fourth years. The most utilized HSL resources were Access Medicine, PubMed, Textbooks, and Clinical Keys. The least used library resources were Health and Psychology instruments, Natural Medicine database, JoVE, and Psych Articles. For both medical students and UH Manoa users, Access Medicine and Clinical Key were among the most used, whereas Health and Psych instruments, JoVE, and Natural Medicine database were among the least used. On the other hand, Cochrane was ranked higher and Psych Articles was ranked lower in overall relative usage among medical students compared to the relative ranking among UH Manoa users. The most utilized non-HSL resources among medical students were Boards and Beyond, Sketchy, Pathoma, and AMBOSS, respectively.

In conclusion, our study assessed medical student resource utilization of library and non-library resources at the JABSOM library. The rank order of the utilized resources were similar between medical students and UH Manoa users, with some exceptions. The results identified the utility of non-HSL resources, suggesting they are key supplemental tools in medical education. Further studies should investigate why some resources are used more or less to guide efforts in improving availability of these services.

Context:
The John A. Burns School of Medicine’s (JABSOM) Learning Community Program aims to address different social determinants of health, including unequal access to healthcare and the resulting health inequities, within the context of Oahu’s six moku, or land divisions. Access to healthcare is limited by the size of the physician workforce and the availability of healthcare resources, especially in rural areas. Physicians should be aware of the underlying factors contributing to these shortages and the resources available to address these issues. Currently, there are few opportunities for students to engage with community physicians and discuss these issues in the pre-clerkship portion of undergraduate medical education.

Objectives:
Understand the physician shortage in Hawaii
Discuss barriers and facilitators to healthcare access
Identify the healthcare resources within each moku on Oahu

Description of Innovation:
The project began with a survey of the distribution of specific healthcare resources throughout Oahu, which was then organized according to their respective moku. In September 2021, a lecture was given to first and second year medical students describing the physician shortage in Hawaii and healthcare accessibility. The students then divided into their respective moku and discussed three hypothetical patient scenarios that helped them identify specific resources available within their moku. The resource list was also provided to students to demonstrate the disparity in resource availability. Community healthcare providers then offered their perspectives, especially in light of the COVID-19 pandemic, through a panel discussion and pre-recorded interviews. Students shared their findings and reflections using a shared Google Slides presentation.

Evaluation of Innovation:
Students completed a 17-item Google Form survey after the presentation to assess their change in understanding of the physician shortage in Hawaii, their confidence in identifying barriers to healthcare access, and their knowledge about resources compared to prior to the presentation. The project’s success and relevance to their future careers were also assessed after the presentation. Students rated all responses on a 5 point Likert scale.

Discussion/Key Message:
On average, students’ (n=138) self-rating of their knowledge of the physician shortage in Hawaii increased from 3.4 to 4.2 (p < 0.001). Furthermore, their ability to identify solutions to barriers to care in their respective moku increased from 3.3 to 4.1 (p < 0.001), while their understanding of differences of healthcare and access between moku increased from 3.1 to 4.0 (p < 0.001). Of the surveyed students, 78.3% of students agreed that the presentation was relevant to their future practice, and 85.5% agreed that the various activities helped them understand the importance of addressing their patients’ social determinants of health.
The presentations and activities gave JABSOM students the opportunity to further understand the patients’ perspective of how unevenly distributed resources affect their healthcare experience. This project also provided an opportunity to understand the importance of patience and compassion in providing holistic care. The project was well-received, and students particularly enjoyed the personal accounts from healthcare providers from different moku.
Based on these findings, future studies can compare and contrast healthcare resources or other healthcare topics between the six moku of Oahu and the neighbor islands.

Target audience:
Medical school educators, medical students, and health care professionals in Hawaii.

Introduction: The number of trained abortion providers in the U.S. has been steadily declining even though 1 in 4 pregnancy-capable people will have an abortion in their lifetime [1, 2]. Nationwide surveys on abortion education in medical schools reveal that only 32% of schools provide lectures on abortion and only 45% of Ob/Gyn clerkships provide clinical exposure to abortion care [3, 4]. During the COVID-19 pandemic, there has been an increase in patients seeking medication abortions via telemedicine and a decrease in direct patient care opportunities for medical students [5]. The Doula Project is a program that provides JABSOM students with the opportunity to remotely serve as telemedicine doulas (teledoulas) for patients undergoing medication abortions in Hawaii.

Objectives: The purpose of our study was to investigate medical students’ experiences volunteering as abortion teledoulas in providing emotional support, education, pain management, and self-advocacy via phone call and text messaging to patients throughout the medication abortion process.

Methods: We designed online pre- and post-training surveys for JABSOM medical students undergoing training as teledoulas to assess the following: (1) clinical knowledge and attitudes towards abortion, (2) acquisition of skills including communication and patient advocacy, and (3) impact on professional goals pursuing fields in reproductive healthcare. We invited a total of 28 medical student teledoula volunteers (22 preclinical and 6 clinical across two training cohorts) to participate in our study. The first cohort of 10 teledoulas completed the post-training survey only. The second cohort completed both pre- and post-training surveys. This study was determined to be exempt by the University of Hawaii IRB.

Results: Nine teledoulas (90.0%) from the first training cohort completed the post-training survey. Six of the 18 teledoulas (33.3%) from the second cohort completed both the pre- and post-training surveys. All self-identified as “pro-choice.” Prior to training, 93.3% had not had clinical exposure to abortion care. After training, most felt more capable of advocating for their patients (73.3%) and answering questions regarding the medication abortion procedure (86.7%), common complications (80.0%), and pain management options (93.3%) (Figure 1). Overall, most students reported a positive impact on their personal development (66.7%), emotional maturity (66.7%), and education (80.0%) (Figure 2). After participating in the program, 60% reported a greater inclination to pursue a career in women’s health or incorporate it into their career path and 80% reported that they intend to become abortion providers. When self-rating communication skills on a Likert scale, pre-training students reported a mean comfort level of 3.53/5 in discussing difficult topics with patients while post-training students reported a mean comfort level of 3.93/5 (p-value = 0.14; NS) (Figure 3).

Discussion: Medical students volunteering as teledoulas report improvement in their clinical knowledge, patient advocacy, and communication skills. Clinical exposureto abortion care and patient support during medical school as teledoulas can impact medical students’ awareness of reproductive health, support them in their career goals, and improve their self-perceived ability to communicate with patients.

Target Audience: Medical curriculum coordinators

References:
1. Pace L, Sandahl Y, Backus L, Silveira M, Steinauer J. Medical Students for Choice’s Reproductive Health Externships: impact on medical students’ knowledge, attitudes and intention to provide abortions. Contraception. 2008;28(1):31-35. doi:10.1016/j.contraception.2008.02.008.
2. Jones RK and Jerman J, Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. American Journal of Public Health. 2017;107(12):1904-1909. doi:10.2105/AJPH.2017.304042.
3. Espey E, Ogburn T, Chavez A, Qualls C, Leyba M. Abortion education in medical schools: A national survey. Am J Obstet Gynecol. 2005;192(2):640-643. doi:10.1016/j.ajog.2004.09.013
4. Espey E, Ogburn T, Leeman L, Nguyen T, Gill G. Abortion education in the medical curriculum: a survey of student attitudes. Contraception. 2008;77(3):205-208. doi:10.1016/j.contraception.2007.11.011
5. Aiken ARA, Starling JE, Gomperts R, Tec M, Scott JG, Aiken CE. Demand for Self-Managed Online Telemedicine Abortion in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol. 2020;136(4):835-837. doi: 10;1097/AOG.0000000000004081.

Introduction: Orthopaedic surgery continues to be an increasingly competitive specialty for medical students to match into. Recent studies have identified the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 CK scores, Alpha Omega Alpha Medical Honor Society induction, and mean number of research products as independent factors contributing to a successful match into orthopaedic surgery. Of these metrics, orthopaedic research is the only one that can be continuously improved over the course of medical school. Orthopaedic-specific research demonstrates scholarly activity, as well as interest in and commitment to the specialty. Given the rising competitiveness of matching into orthopaedic surgery residency and emphasis placed on research, the purpose of this study was to analyze medical student publication trends in four major orthopaedic journals over a 10-year period.

Objectives: Identify the proportion of medical student publications in major orthopaedic journals and how these trends have changed over time.

Methods: Websites of four major orthopaedic journals (American Journal of Sports Medicine, Clinical Orthopaedics and Related Research, Journal of Arthroplasty, and Journal of Bone and Joint Surgery) were accessed to identify articles published between 2011 and 2020. Articles were reviewed for the year, number of authors, degree(s) of each author, sex of each author, country, and state (if USA). Non-clinical studies were defined as basic science, biomechanical, technique, and educational studies. Country and state were determined based on affiliation of the senior author. Medical students were defined as authors who held a bachelor’s only degree. Editorials and letters to the editor were not included.

Results: 15740 articles were included in this review (13510 clinical, 2230 non-clinical). The total number of authors was 82837. MDs constituted the majority of first authors in this study (64.5%). A total of 5242 medical students were listed as authors on 3769 publications (21.49% of overall publications). Out of the 3769 publications, 919 (24.38%) were first author publications. Linear regression demonstrated an increasing annual trend of first author (p=0.001) and any author (p<0.001) medical student publications over the study period, with increases of 291% and 206%, respectively, from 2011 to 2020. Linear regression demonstrated an increasing annual trend of female first author medical student publications (p=0.01), with an increase of 346% from 2011 to 2020. Overall number of publications did not significantly change over the study period. States with the most first author medical students were New York (111/919, 12.1%), Pennsylvania (96/919, 10.5%), and California (82/919, 8.9%). States with the most any author medical student studies were New York (514/3769, 13.6%), Pennsylvania (347/3769, 9.2%), and California (298/3769, 7.9%).

Discussion: First author and any author medical student publications increased over the last 10 years, despite a constant number in overall orthopaedic publications. Additionally, the growing female medical student involvement in the literature highlights the importance and efficacy of advocacy, mentorship, and opportunities in improving diversity in orthopaedics and medicine. Lastly, states with the most first-author and any author medical student publications contain institutions with ample research funding, providing access and opportunities for students at the institution and others within geographic range.

Target Audience: Medical students, orthopaedic chairs, and program directors