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

Background: The transition to clinical clerkships brings many new experiences, which can incite feelings of unease in third year medical students (MS3s). During the pediatric inpatient rotation, MS3s describe challenges surrounding family centered rounds (FCR) and oral presentations, leading to feelings of self-doubt, unpreparedness, and anxiety.

Objective: Through a quality improvement process, resources were developed and disseminated in multiple phases, with the primary aim of reducing self-reported anxiety scores and increasing preparedness for FCR. The secondary aim was to involve faculty and residents in improving the pediatric clerkship experience and incentivizing their participation with maintenance of certification (MOC) part 4 points.

Methods: We developed and measured the efficacy of preparatory resources (such as electronic medical record informational videos and presentation templates) for all MS3s to use on the pediatric rotation in 3 phases, with each new phase commencing with the new academic year. Anxiety and preparedness were assessed with Likert scales graded 1-5, via surveys that were administered during the clerkship orientation, and at conclusion of the 4-week rotation. For phase 3, we created worksheets to introduce the development of assessments and organization for FCR oral presentations, and improved access to supplemental videos and resources from phases 1 and 2. Regular meetings with faculty and residents were used to disseminate information about the resources, students’ comments, and to solicit feedback. Surveys were also given to residents and attending physicians to assess efficiency of MS3s during the rotation.

Results: During the ongoing phase 3, perceived preparedness for the rotation increased from 2.3 pre-rotation to 4.0 at the end of the rotation (p-value = 0.0000027). FCR preparedness increased from 2.4 to 4.4 (p-value = 0.00000000014), as compared to the increase from 2.6 to 3.6 (p-value = 0.0000078) in phase 2. FCR anxiety decreased from 3.5 to 2.5 (p-value 0.002), compared to the lack of change in FCR anxiety in phases 1 and 2. Sixty-seven percent of the hospitalist faculty participated, particularly with feedback. Residents reported spending an average of 30-40 minutes in phase 1, and 10-20 minutes in phases 2 and 3 to orient the MS3s.

Discussion: By providing worksheets and showing our supplemental videos in phase 3, we demonstrated improvement in MS3s’ perception of preparedness for both FCR and the rotation as well as a decrease in anxiety for FCR compared to our previous phases. Anxiety is a personal and subjective measure, which may account for the variability in responses, thus student testimonials are included in the surveys. This quality improvement initiative not only benefits students and physicians, but also facilitates a concise and informative FCR to enhance patient care and could be adapted for other MS3 clerkships. Phase 3 will conclude in May 2022.

Description of Innovation
Anki is a free flashcard program that can be downloaded from the internet onto electronic devices. Unlike other flashcard programs, it uses a learning technique called “spaced repetition” whereby Anki uses an algorithm to automatically test students with newer and more difficult flashcards more frequently than older and less difficult ones. To use Anki to study for exams, students may make their own flashcards in the form of “decks” (sets of flashcards divided by subject) and/or download “decks” from the internet made by peers from other medical schools.

Evaluation of Innovation
In the past several years, Anki gained popularity among medical students from both allopathic and osteopathic schools (Rana et al., 2020) after it was shown that students who used Anki performed better on the USMLE Step 1 than students who did not use Anki (Deng et al., 2016).
Anki was introduced to JABSOM students when JABSOM’s ℅ 2023 made Anki decks which covered material on JABSOM’s MD2 (Cardiology and Pulmonology) unit. These decks were then shared with students from the ℅ 2024, the majority of whom reported success with using Anki to study for MD2 exams (Koshi et al., 2021).

Context
During the start of medical school, most first year students (MS1s) have difficulty identifying study habits that best suit their individual learning styles. This project introduced Anki to MS1s during JABSOM’s MD1 (Health and Illness) unit in hopes of easing the ℅ 2025’s transition to medical school and expanding upon the findings of Koshi et al., which were limited to JABSOM’s MD2 unit.
The distributed Anki decks came with certain limitations. First, they only covered material related to MD1 PBL cases. Second, they were released one at a time after students finished their corresponding PBL cases so as to not interfere with the PBL process. Lastly, decks from PBL cases 5 and 7 were omitted to encourage students to practice making their own flashcards.
This project also consisted of online workshops that taught students how to use Anki and “AnKing,” the most commonly used premade Anki deck for the USMLE Step 1 and 2. Students’ comfort with and utilization of Anki were monitored throughout the unit via weekly surveys.

Objectives
Made and shared Anki decks covering most MD1 PBL material with the ℅ 2025 to introduce and transition them to using Anki.
Hosted workshops to teach the ℅ 2025 how to use efficiently Anki and AnKing as well as how to make their own flashcards and decks.

Discussion
The JABSOM ℅ 2025 (n=77) were emailed 9 Anki decks out of a total possible 11 PBL cases. An average of 66.14 students (85.9% of the class) used the PBL decks. At the beginning of this project, 30.8% of respondents felt somewhat or very comfortable with creating new Anki cards. At the conclusion of this project, this percentage increased to 65.7%. The final survey showed that all 67 respondents would recommend Anki as a study resource to future students. All but one respondent planned to continue using Anki as a study resource.

Conclusion
Most students gave positive feedback about the Anki decks, reporting they were helpful study tools. Furthermore, most students reported that this project eased their transition into medical school and would continue to use Anki to supplement their studying in future units.

Target Audience
The intended audience of this presentation includes health professionals, and medical school faculty, educators, and students.

References
1. Deng F, Gluckstein JA, Larsen DP. Student-directed retrieval practice is a predictor of medical licensing examination performance [published correction appears in Perspect Med Educ. 2016 Nov 18;:]. Perspect Med Educ. 2015;4(6):308-313. doi:10.1007/s40037-015-0220-x
2. Koshi E, Nielsen T, Fujiuchi B, Walter M, Kuniyoshi C, Sakai D. Qualitative Assessment of Anki as a Tool for Medical Education. Health Professions Education Conference (HPEC). 2021. hdl.handle.net/10125/73407
3. Rana T, Laoteppitaks C, Zhang G, Troutman G, Chandra S. An Investigation of Anki Flashcards as a Study Tool Among First Year Medical Students Learning Anatomy. The FASEB journal. 2020;34(S1):1-1. doi:10.1096/fasebj.2020.34.s1.09736

Introduction:
The first year of the medical student curriculum at the John A. Burns School of Medicine consists of four blocks. The first block–MD1: Health and Illness–is a 9-week introduction to Problem-Based Learning (PBL) and foundational sciences. In response to the COVID-19 pandemic, MD1 introduced online modules (pre-recorded lectures assigned outside of scheduled lecture times) for fall 2020. While student ratings of MD1 were mostly favorable, students expressed specific concerns regarding online modules in MD1 mid-course evaluations. Comments included, “we feel overwhelmed by the length and content in addition to the scheduled lectures we already have” and “we were not huge fans of the online modules”. Additionally, “Q&A and review sessions” corresponding with each online module were scheduled in the second half of MD1 to provide dedicated time for students to meet with instructors. The formats of these sessions were left to the discretion of the instructor, resulting in high variability. Students were surveyed to elaborate their thoughts towards online modules and review sessions. Although this project was done in the context of MD1 online modules, we hope to extend the recommendations to all lectures in the pre-clerkship units.

Objectives:
The purpose of this study was to identify strengths, areas of improvement, and suggestions regarding online modules assigned in MD1.

Methods:
A quality improvement online survey was administered in October 2020 to 77 students in the JABSOM Class of 2024. Quantitative and qualitative questions were newly developed based on feedback from the MD1 mid-course evaluations and addressed areas including preferred presentation style, lecture reviews, effective characteristics, and overall sentiment of the online modules. Patterns among the qualitative responses were identified by the authors to recognize student preferences.

Results:
The survey was completed by 63 (81.8%) students. Of note, 100% of enrolled students earned passing scores on MD1 end-course exams. Students rated their overall feelings about the online modules 5.9±1.5 out of 10. The majority (55.6%) of students preferred practice questions provided and discussed in pre-recorded lectures. Student comments suggested the most effective review session formats were based on instructors’ practice questions or overviews of key lecture slides. Respondents also reported the most effective lectures had exam-like practice questions with explanations and direct connections to MD1 PBL cases. Additionally, respondents recommended scheduling in specific time blocks to watch pre-recorded lectures during school day hours, to more closely mimic live, in-person lectures.

Discussion:
The prevalence of online learning in medical school curricula has increased, perhaps due to the COVID-19 pandemic. We surveyed the JABSOM Class of 2024 about their MD1 online learning experience and consolidated feedback to the following recommendations. (1) Regarding content, we recommend lecturers (a) relate the material to PBL cases and (b) discuss clinical examples. (2) Regarding practice questions, we recommend lecturers prepare and discuss practice questions during their lectures. (3) Regarding review sessions, we recommend lecturers prepare a summary of both (a) testable, key concepts and (b) additional practice questions. We propose these changes and practices can lead to improved learner satisfaction while maintaining the high standard of learner performance outcomes that faculty and students share.

Target Audience:
Students and educators, JABSOM Office of Medical Education

Patient safety is one of the most important health provider priorities. Medical Near-Miss/Adverse Event Information (MN-M/AEI) has been collected in Japan since 2004, from 1473 hospitals to prevent adverse medical events and promote patient safety. Many medical organizations promote patient safety in regular practice, yet providers find it difficult to apply patient safety concepts in practice. This study aimed to develop and evaluate an Online Patient Safety Simulation Training (OPSST) program based on reported MN-M/AEI data.

DESIGN STEPS
1. Create the interactive screen-based online interactive program in Adobe Captivate;
2. Convert to Sharable Content Object Reference Model (SCORM);
3. Upload and store in Moodle Learning Management System (LMS).

CONTENT: Incorporating Japanese MN-M/AEI data regarding a 9.1% complication rate rerated central venous catheters (CVC), the OPSST program focused on patient safety factors in the management of CVC. To simulate and assess a Medical Near-Miss/Adverse Event, the program engaged learners with a self-paced 5-challenges sequential interactive management challenge, designed in Adobe Captivate. The 5 challenges: I. Identify specific focus areas for patient safety; II. Write a brief description and drag and drop your response to each item in the challenge I; III. Embed the patient safety actions in a preformatted narrative to confirm understanding of the rationale and process of solving the patient safety problem; IV. Review real-life examples from MN-M/AEI data; and V. Repeat identification of specific patient safety focus areas from challenge 1to summarize learning and apply in patient safety practice.

RESULTS: One hundred and forty-one full-time working nurses aged 27-58 years completed the initial and 6-month repeat program. All participants joined a continuing education with 252h per year, including the OPSST program. OPSST program was included in the test so that we could assess knowledge retention. The questionnaire included a 5-point Likert scale and open-ended questions to collect feedback about visibility, usability, and satisfaction. Moodle LMS logs were analyzed to evaluate the appropriateness of the content as the time required.
By learning log, Eighty-eight of the participants used the program multiple times. And, the mean of learning time in the initial trial was 10 minutes, and the 6-month was 6 minutes. The correct response rate in the initial trial was 72.4%, increasing to 90.7% in the 6-months.
Mean 5-point Likert scale (1=Low / 5=High) ratings of visibility, usability, and satisfaction were 3.6, 3.3, 3.8 respectively. Open-ended question comments were included by several participants who had never performed CVC management who felt that they learn key points of patient safety (n = 14). Some comments indicated that the program content was difficult to use (n = 17).

Conclusion
This study indicated that specific patient safety knowledge outcomes were maintained for 6 months following the completion of an interactive on-demand online simulation-based patient safety module. Gagne argues (Gagne 1985) in the information processing model that it is important to rehearse or code information to establish long-term memory. This program repeated the structure including the process of problem-solving in 5-challenges. This process may have coded participant working memory accounting for the preserved memory and 6-month knowledge retest results. Our results suggest that nurses with and without experience in CVC management were able to envision and understand error situations and demonstrate correct responses in a cognitive simulation training exercise. Since the time engaged in the simulation was short, it can be inferred that the difficulty level and cognitive load were appropriate for the participants. In general, it is said that the appropriate length of e-learning content should be less than 10 minutes (Association for Talent Development Research 2017), so the program described in this study was appropriate. Regarding the usability of the program, it needs to be improved by adding explanations.

References
Association for Talent Development Research (2017) Microlearning: Delivering Bite-Sized Knowledge
Gagné, R. M. (1985). The conditions of learning and theory of instruction. Belmont CA, Wadsworth Pub Co.

Context
First-year medical students at JABSOM are required to participate in a Community Health Program. One such program founded in 2018, Medical Students for Mental Health (MSMH), focuses on serving individuals with mental health illnesses and promoting community advocacy related to mental health. Students co-led groups and provided therapeutic socialization for patients at the Hawaii State Hospital (HSH). In March 2020, MSMH transitioned to a partnership with the United Self Help (USH), an organization which facilitates peer-led self-help groups for persons with mental illness. In May 2020, second-year medical students were invited to become leaders for MSMH to recruit, mentor and supervise first-year medical students. In 2021, MSMH created an additional partnership with McKinley High School to introduce high school students to mental health topics through a Problem-Based Learning case. Psychiatry residents have led training and didactics for medical students in MSMH.

Objectives
- Outline the MSMH curriculum and relevant changes
- Analyze whether MSMH provides a meaningful volunteer experience for medical students in serving vulnerable populations and increasing community awareness regarding mental health
- Evaluate how participation in MSMH affects medical student competencies including interpersonal communication, self-evaluation, cultural competence, and knowledge of medicine and human behavior
- Assess the impact of MSMH medical student interest in mental health and specialty choices
- Compare the experiences of students involved in MSMH in different academic years to evaluate the efficacy of didactics, training and supervision for students engaging in clinically-based service

Key Message
MSMH gathers feedback from medical students through monthly meetings with program leaders, surveys conducted by JABSOM, quarterly reflection essays and a 2021 survey offered to all current and past MSMH students. While at HSH, medical students initially reported concerns including lack of a clear service role and a mismatch between clinical severity and level of training. Since transitioning to USH, students have reported an improved service experience and self-evaluated competencies as above. MSMH training has transitioned from didactics focused on safety, de-escalation and other inpatient psychiatry topics to a psychotherapy-informed training. Second-year students, along with resident leaders, have led group supervision and training and managed elective logistics, experiences which reportedly positively impacted their leadership and teaching skills. COVID-19’s impact on the mental well-being of children and adolescents led second-year student leaders to expand the MSMH curriculum to a public school setting.

Conclusion
Changing service roles has generally improved student service experiences and self-assessed competencies while creating new training needs and challenges. While students reported an increased interest in mental health and felt well equipped to navigate conversations about mental health issues, early feedback is mixed regarding how MSMH has affected long-term career choices. A planned site expansion may expose students to a wider breadth of mental health topics and settings and facilitate the development of core competencies while continuing to provide a meaningful experience in serving individuals with mental illness and increasing awareness and education regarding mental health issues.

Target Audience
Any educational professional interested in current service-based activities for students in mental health.

Introduction: Cultural consideration in debriefing is required, yet there is a lack of consensus on how to incorporate cultural elements in a translation process. SimTiki researchers developed a Japanese version of the published PEARLS debriefing tool.

Objective: Linguistic, conceptual, and cultural considerations were incorporated in a process conducted by American and Japanese simulation-based education (SBE) Certified Healthcare Simulation Educator® (CHSE®) or Certified Healthcare Simulation Operations Specialist® (CHSOS®) experts. This report aims to describe the process to identify, reconcile and harmonize discrepancies that emerged during the translation.

Methods:
Step 1: The translation method aligned with PEARLS English language author suggestions and followed other translation guidelines including use of a team approach.
Step 2: Forward translations were created by two Japanese native-speaking simulation education fellows, synthesized by consensus, and reviewed and revised in a meeting with other team members.
Step 3: Two back-translations (BT) were completed; by a non- SBE expert bilingual physician, and by DeepL®, a neural machine translator. Two American SBE experts with CHSE assessed each BT phrase individually and discrepancies that emerged were reviewed and reconciled with forward translators.
Step 4: To ensure conceptual equivalency and cultural validation, three Japanese SBE experts with CHSE or CHSOS independently rated the reconciled translation and convened for a focus group.
Step 5: Team review, adjudication, and revision resulted in a final harmonized translation.

Results: A total of 59 translated phrases were assessed as acceptable or unacceptable and harmonized using the 5-step process. As an example of the process, an original PEARLS phrase, “How are you feeling?”, was translated into “感想を教えてもらえますか？” and was back-translated to “Tell me what you thought about it” by the physician and “Can you tell me what you think?” by DeepL. American experts assessed both BT’s as “unacceptable”. Discrepancies were discussed in the experts’ review meeting. The raters judged “thoughts” had a different meaning than “feelings”. Japanese experts advised that the translation “感想” has a nuance of both “feeling and thought”. This issue was related to linguistics and the Japanese translation was not changed; all three Japanese SBE experts assessed it as “acceptable”.
However, the Japanese experts stated that Japanese people are not accustomed to verbalizing and sharing feelings publicly and that expressing one's feelings in public is sometimes perceived negatively. Referring to these cultural insights, the translation was revised to "どんな感じですか？" and was re-translated by DeepL to "How's it going? "; another alternative was the same expression as the original PEARLS terminology; "How are you feeling?". American experts assessed the final DeepL BT as acceptable. This Harmonized translation has a broader connotation than the original and is generalizable in the Japanese context.

Limitations: Only short phrases were translated. Lack of established guidelines or standards for conducting a back-translation assessment precluded comparison to a “gold standard” for educational cultural adaptation or validity. A professional translator was not involved in the process.

Discussion: The 5-step Translation process effectively guided detection and adjudication of discrepancies to create a harmonized translation. The next steps are to establish measures of educational effectiveness of translated material.

Introduction: The COVID-19 pandemic has severely affected medical training with social distancing requirements posing a barrier to in-person teaching and face-to-face interaction between medical students, residents, and attendings. It remains unknown whether a virtual learning format can effectively improve medical knowledge and decrease social isolation. The University of Hawaii Family Medicine Residency Program created a Virtual Morning Report (VMR) as a regular online gathering space and evaluated whether it improved clinical training and addressed social needs for learners and educators.

Objectives:
1. Evaluate the educational effectiveness of a virtual format for morning report.
2. Assess the impact of a virtual gathering space on wellbeing for learners and educators.
3. Identify participant preferences for online vs in-person format of educational sessions going forward.

Methods: Our community-based residency program hosted VMR 3 times weekly featuring interactive, case-based discussions (30 mins) facilitated by students, residents, and attendings. Attendance was voluntary and included community physicians. We administered an anonymous survey to measure participants’ improvement in medical knowledge and wellbeing. The survey instrument was developed by the authors and reviewed by resident and faculty stakeholders. A secondary outcome was participant preference for the future format of morning report.

Results: 21 residents, 10 students, and 5 attending physicians completed the survey (N = 37). Of the 37 participants (90% response), 87% reported that improving medical knowledge was a moderately or extremely important reason for attending VMR. Attending VMR resulted in perceived improvement of medical knowledge moderately or a great deal overall (78%), specifically in the areas of generating differential diagnoses (88%) and work-up (88%), but less so for history/exam skills (47%). With respect to impact on wellbeing, results were more mixed with 62% reporting improvement in wellbeing as an extremely or moderately important reason for attending VMR. The reported effect on social isolation from participants was less pronounced with just 30% reporting that VMR improved their overall wellbeing moderately or a great deal. When asked about specific areas of wellbeing, participants reported a greater degree of improvement in enjoyment of medicine (54%) and connecting with residents (57%) compared to connecting with faculty (44%) and increasing morale (38%). All participants expressed a preference for either a blended (78%) or entirely virtual (22%) format going forward.

Discussion: Participants reported perceived improvements in medical knowledge by attending Virtual Morning Report when COVID-19 restrictions reduced in-person teaching. While online socialization helped to improve wellbeing and increase a sense of connection for some participants, the majority did not report an improvement. A limitation of the study was that the components of wellbeing listed were chosen as the most relevant by the authors and other elements may be missing. Best practices for a successful VMR include hosting on a regular schedule, encouraging interactivity, focusing the teaching on key take-home points, and making the learning environment safe and fun. Given the strong preference for a completely virtual or blended format, more intentional efforts are needed to optimize online gathering to address the social and wellbeing needs of clinicians during this time of social isolation.

Target Audience: Medical educators and learners in any discipline at any level.

Introduction: The SARS-CoV-2 (COVID) pandemic made it necessary for medical schools to integrate online learning into the delivery of curriculum involving cadaveric-based gross anatomy instruction and dissection, which may benefit post-COVID instruction.

Objectives: The purpose of this study was to assess the perceptions of a unique student cohort arising from the COVID pandemic with respect to gross anatomy instruction. The hypothesis tested was that the medical student class of 2023’s perceptions concerning the delivery of gross anatomy education, as well as its educational significance, would differ between students that elected to dissect (D) compared with those who did not (N).

Methods: A survey was conducted at the conclusion of the 2020 medical gross anatomy course at JABSOM, and 79 medical students responded to questions about the usefulness of anatomy, preference of lectures (slide decks without lectures, in-person lectures, live online lectures, and pre-recorded lectures) and dissection laboratories (no lab, live online labs, class in-person labs, and hybrid labs). The preference levels were assessed by Likert scale (highest, high, low, lowest), from which binary scale results (high or low) were also analyzed. Fisher’s exact tests were used to examine differences in survey responses between D (n=40) and N students (n=39). Open-ended questions were used to probe these perceptions.

Results: D students rated gross anatomy’s usefulness more positively than N students (overall 87%; D 100%, N 74%, p<.001). More N students considered that anatomy dissection should be elective (overall 68%; D 38%, N 100%, p<.001). Overall, the students’ preference levels were high for live online lectures and pre-recorded lectures, and low for slide decks without lectures and in-person lectures. Pre-recorded lecture was rated the most valued, notably by D students (overall 80%; D 90%, N 68%, p=0.03), while slide decks without lecture was rated the lowest lecture-based modality (overall 80%; D 90%, N 68%, p=0.03). More than 90% of responses to open questions about the usefulness of pre-recorded lectures were positive.
Hybrid lab was the most preferred laboratory type (high preference levels: overall 82%; D 72%, N 79%, p=0.02). No lab was least preferred and more disfavored by D students (overall 79%; D 90%, N 67%, p=0.01). Through open questions, most D students responded positively (95%) and had no regrets dissecting (86%).

Discussion: Most students found dissection to be a useful educational activity. The benefits for students who elected to dissect included more opportunities to ask questions to instructors, better visibility of structures, and flexibility with dissection time. Students who did not elect to dissect felt safe during a pandemic, spent more time with loved ones, and had less financial burden commuting to school.
The results show a strong contrast in that in-person lectures and slide decks without lectures were not preferred compared to live online lectures and pre-recorded lectures. Students expressed that watching lectures at their convenience benefited anatomy comprehension since more time was available to prepare rather than pursuing dissection immediately after a lecture traditionally.
Among the methods for laboratory instruction experienced, the only significant preference was that no lab was the least preferred by the overall class. Although D was more extreme in opinion, N showed a similar trend with a large majority opting against no lab. A small minority of N did express regret not being to dissect during the unit, whether for academic or camaraderie-building benefit.
Future work will be directed at assessing student perceptions concerning use of online technology as supplemental instruction for gross anatomy.

Introduction: The HEADSS assessment is a medical interviewing tool used by physicians to obtain a psychosocial review of systems on adolescent patients. HEADSS is an acronym for the following important topics to be covered in the medical interview of an adolescent: Home, Education, Activities/Employment, Drugs, Suicidality and Sex. An in-person simulated patient experience using this tool was implemented during the MD1 course for JABSOM MD classes in 2016 as part of a student-led curricular development. At the time, the experience was perceived by both learners and volunteer “patients” to be of value for medical education. However, since 2020, the COVID-19 pandemic has required this experience be held over Zoom as a simulated telehealth patient encounter. This project aimed to assess whether this patient experience is still perceived as being useful for medical student education when conducted online.

Objective: The purpose of this study was to assess the utility of a simulated telehealth patient encounter in increasing medical students’ knowledge of the HEADSS assessment and medical interviewing skills.

Methods: After completing a 10-minute simulated telehealth patient encounter conducted over Zoom, first-year medical students were asked to complete a survey regarding their knowledge and opinions about the HEADSS assessment, medical interviewing, and telehealth both before and after the simulated experience.
Simulated patients were volunteer second-year medical students who had participated in the same simulation activity the year prior. Volunteers received a 1.5 hour training session and were provided a general script/scenarios to refer to during the encounter. First year students were first introduced to the HEADSS model through their curriculum and were asked to independently review the components of the model prior to the simulation. During the activity, students were asked to step in the role of a physician and could customize their application of the HEADSS model; while actors were instructed to respond in the way an adolescent would as suggested by the guidelines provided during training.
The primary objective of the simulation was to provide the first year students with the opportunity to practice establishing rapport with and collect a history from an “adolescent” patient through the use of open-ended questions and the HEADSS model.

Results: A total of 75 responses were obtained from a single medical school first year class. Over 82% of students responded “Strongly Agree” to the statement that the simulated experience helped to increase their understanding of the components of the HEADSS assessment. When compared to students’ responses before experiencing the simulated activity, there was significantly higher agreement with statements regarding 1) ability to select the appropriate types of questions to ask from the HEADSS assessment (p<0.001); 2) appreciation of the importance in balancing the medical interviewer’s agenda with that of the patient’s (p<0.001); and 3) importance of telehealth as a means for communicating with patients about their emotional health or mindset (p=0.001). The simulated activity did not have a significant impact on students’ perceptions of the importance of the role of telehealth in the future of medicine (p=0.288). Overall, 92% of students responded “Strongly Agree” to the statement that this activity should be continued for future medical school students.

Discussion: The results support the use of simulated patient activities as an effective teaching tool for clinically relevant/applicable models such as the HEADSS model as well as the fundamentals for medical interviewing. In comparison to their knowledge of the HEADSS assessment prior to the activity, the majority reported that the simulated activity did in fact increase their familiarity with the model. The majority of the students also noted that the simulation addressed an important component of medical interviewing – specifically the importance of balancing the agenda of the medical interviewer with the agenda of the patient. Overall, the results suggest that simulated patient activities delivered via videoconference technology can be useful for the specific topic used in this study and could therefore serve as an effective learning tool for other medical school curricula. Future studies could include expanding this experience to other medical schools, and also utilizing the simulated telehealth patient activity exercise to teach other medical communication skills.

Target Audience: Medical Educators and Medical Students

Introduction: The United States Medical Licensing Examination (USMLE) Step 1 has historically been a high stakes exam, as residency programs use the Step 1 score, along with other factors, to screen and select medical students for residency positions. JABSOM students must take Step 1 before staring third year clerkships. Upon the onset of COVID in 2020, JABSOM permitted students to take Step 1 into their first semester of clerkships. While there have been studies on the effects of moving Step 1 post-clerkship, there are no studies in the literature on how Step 1 performance is affected if moved into the first semester of the clerkship year. Step 1 will now be pass/fail, but an examination into whether or not delaying Step 1 into the first clerkship semester has implications on performance will be useful should a future COVID wave cause similar testing site closures. This knowledge would be particularly helpful for students who are at risk of failing Step 1.

Objectives: The purpose of this study was to assess whether Step 1 performance varies based on the time elapsed up until the end of the first semester of clerkship year.

Methods: The study included USMLE scores from 64 JABSOM students who took Step 1 in 2020 who were not on extended leave. Regression analysis via Minitab software was used to assess whether or not variation in Step 1 scores could be explained by Step 1 timing, after accounting for standardized test taking ability for which Step 2 Clinical Knowledge (2CK) score was adopted as the closest proxy.

Results: The average Step 1 score was 238 (sd=15). The average and median days elapsed from the initial Step 1 exam period was 46 (sd=41) and 29. Regression analysis showed that Step 1 score significantly (p<0.0005) decreased based on days elapsed from the initial Step 1 exam period but there was no statistical significance (p<0.065) after accounting for Step 2CK score.

Discussion: This study indicates that students with lower Step 1 scores tended to be students with later test dates into the first semester of clerkship but that once standardized test taking ability was accounted for, with Step 2CK being the closest proxy, there was no effect of timing on Step 1 score. It’s likely that students who anticipated lower Step 1 scores, based on practice exams for instance, chose later dates for their Step 1 exam. This would explain why Step 1 score was significantly related to Step 1 date before Step 2CK was taken into account. Current literature indicates that delaying Step 1 post-clerkship is a better or non-inferior approach but does not address the impacts on Step 1 performance that slight delays in Step 1 timing have had during COVID or in general. This study suggests that Step 1 performance is not affected by time taken into the first semester of third year clerkships. Should another COVID wave cause JABSOM to allow students to again take Step 1 into the first semester of third year, students can feel comfortable delaying their exam into the third year if circumstances require it.

Target Audience: Advisors, Medical Students