2023 AAMC Western Group Collaborative Spring Conference

Background and/or theoretical framework and importance to the field
The disproportionate lack of Spanish-speaking (SS) physicians in U.S. regions with many SS residents emphasizes the need for increased medical Spanish education. While many schools offer Medical Spanish courses, our co-curricular, simulation-based program (Konexión Paciente/KPAX) aims to optimize learner engagement and outcomes through longitudinal integrated design, provision of feedback using validated assessment instruments, and incorporating issues of equity and inclusion.

Design
KPAX is a student-designed optional program that complements the formal clinical skills curriculum. Learners participate in simulated Spanish-language patient encounters adapted from institutionally-validated, English curricular material. Students are assessed on linguistic adaptability, attention to health disparities, and empathy, in addition to clinical skills proficiency. Feedback is provided based on standardized patient checklists for Spanish-language communication, general communication, and task-specific clinical skills, as well as narrative comments from physician facilitators.

Outcomes
Students reported greater self-efficacy and comfort in SS encounters after participating in KPAX. Participants also scored significantly higher than nonparticipant peers on general communication skills in a subsequent English curricular OSCE encounter assessing clinical content addressed in a pilot KPAX session (p< 0.001), suggesting that program benefits may extend beyond language skills.

Innovation's strengths and limitations
KPAX provides opportunities to engage in higher-order language utilization and emphasizes patient-centeredness and linguistic/ethnocultural diversity in healthcare delivery. Further investigation is needed to address how baseline clinical skills proficiency affects acquisition of language-associated skills, as well as to define the developmental arc of Spanish-language care provision as a competency. The evolution of student performance on the assessment instruments over the course of the program is currently under investigation.

Feasibility and generalizability
KPAX empowers future clinician-leaders to care for the SS community. The program can be adapted for any language community at institutions with simulation capabilities, using existing curricular materials.

References
Dragan, A. The Importance of Addressing Linguistic Ethno‐cultural Diversity in the Delivery of Public Health Services: a Literature Review. 2009 Dec; Region of Peel Public Health. Accessed Oct 28, 2022. https://tinyurl.com/53hc9mhx.
Flores-Rodarte J, Topmiller M, Jabbarpour Y. Distribution of Spanish-Speaking Family Physicians, 2013-2019. Am Fam Physician. 2022 Jun;105(6):654-655. PMID: 35713629.
Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities. JAMA Intern Med. 2014;174(2):289–291. doi:10.1001/jamainternmed.2013.12756
Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education. Health Equity. 2019 Jul 1;3(1):312-318. doi: 10.1089/heq.2019.0029. PMID: 31294243; PMCID: PMC6615346.
Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Teaching Medical Spanish to Improve Population Health: Evidence for Incorporating Language Education and Assessment in U.S. Medical Schools. Health Equity. 2019 Nov 1;3(1):557-566. doi: 10.1089/heq.2019.0028. PMID: 31701080; PMCID: PMC6830530.

Moving the needle: Changing the culture around professionalism for faculty as evaluated by medical students

Rationale
Professionalism is an integral aspect of physician growth and development and a core competency in medical education. Clinical experiences and faculty role models are the most powerful determinants of professional behaviors and values in the practice of medicine.1,2 Yet, with significantly greater stress placed on clinical faculty in the last 25 years, there has been increasing concern over an erosion of the attitudes and behaviors of practicing physicians and the resulting negative impact on the professional development of medical students and resident physicians3. Given its importance, faculty professionalism is assessed annually in the American Association of Medical Colleges graduate questionnaire (AAMC GQ) survey of fourth year medical students, providing medical education leaders with data on their performance compared to medical schools nationally, as well as year-over-year trends.
Many schools struggle with faculty professionalism data that is reported through the GQ and their students’ perception of a poorly perceived professional clinical environment. The three schools presenting at this session have received low learning environment scores at different times and have employed interventions to change the culture at their institutions, with varying success, to address the underlying root causes.
In this session, we will discuss overall challenges of addressing the learning environment and faculty professionalism. After that, each student will report its GQ data, root causes identified, and interventions to address those root causes. After the presentations, participants will break out into small groups and, using a structured guide, review data from their own schools as well as interventions that have been tried to address those issues. Participants will come together at the end for a facilitated discussion to summarize their conversations and discuss ideas and opportunities to bring to their home institution to improve the learning environment.

Learning Objectives
• Review the quality improvement approach and interventions that have been shown to be effective at improving professionalism at UC Davis, UC Riverside, and UC San Diego
• Develop a list of high-impact interventions that can be utilized to improve professionalism in the learning environment at your institution
• Describe your approach to implementation of interventions unique to your institution and ways in which these incidents can be shared with the broader educational community

Session Plan
• 10 minutes: Describe why changing professionalism outcomes is a “wicked problem”
• 24 minutes: Review the approach and adoption of interventions at UC Davis, UC Riverside, and UC San Diego where these institutions have strived to improve culture of professionalism (8 mins each)
• 30 minutes: Breakout sessions where participants discuss professionalism challenges at their home institutions and brainstorm interventions to improve their culture.
• 25 minutes: Plenary group discussion to identify consensus approaches and opportunities to enact culture change

Products/materials
• PPT

Experience
• Mithu Molla MD – Director of the Learning Environment, Co-Chair Learning Climate Committee, UCD SOM
• Sharad Jain MD – Associate Dean for Students, Co-Chair Learning Climate Committee, UCD SOM
• Mark Servis MD – Vice Dean for Medical Education, UCD SOM
• Christina Granillo, PhD - Director of Academic Success, Chair of the Grievance Committee and co-Chair of our Learning Environment Council
• Michelle Daniel, MD, MHPE, FACEP - Vice Dean for Medical Education, Professor of Clinical Emergency Medicine UC San Diego SOM
• Emma M Simmons MD, MPH – Senior Associate Dean of Student Affairs, UC Riverside SOM

Bibliography
1- Orit Karnieli-Miller, PhD, et al. Medical Students’ Professionalism Narratives: A Window on the Informal and Hidden Curriculum. Academic Medicine, Vol 85, No.1/January 2010
2- Inui TS, et al. A Flag in the Wind: Educating for Professionalism in Medicine. Washington DC: Association of American Medical Colleges; 2003.
3- Swick H, et al. Teaching Professionalism in Undergraduate Medical Education. JAMA, September 1, 1999- Vol 282, No.9
4- Binder R, et al. Preventing and Managing Unprofessionalism in Medical School Faculties. Acad Med. 2015;90:442-446.

The problem-based learning (PBL) curriculum is the core learning modality for medical students at the University of Hawaii John A. Burns School of Medicine. Students are first introduced to PBL in MD1 Health and Illness, where they are provided learning tools that complement PBL that solidify the concepts covered in this curriculum. Case mapping, one of the learning tools, is an active form of learning where students make decisions to construct a map that organizes information by grouping facts and concepts. This modality prevents linear focus by illustrating relationships between concepts through cross-links, utilizing higher order learning than rote memorization alone, and fosters self-directed learning. Case mapping has been found to be effective in promoting critical thinking that translates into clinical and diagnostic reasoning.

Thus, our aim was to introduce case mapping as a supplementary learning tool to evaluate its utility and efficacy for medical students in a PBL curriculum.

This study collected data from first year medical students (n=57) at the John A. Burns School of Medicine. Students received an instructional session on case mapping and its application to PBL. Following this, students were assigned to construct their own map on the pertinent concepts involving the differential for sore throat and Streptococcal pharyngitis. This assignment was followed by an anonymous, voluntary questionnaire inquiring about their opinions of the value and benefit of case mapping.

The results showed that students found case mapping to be beneficial in finding correlations between clinical concepts and aided in the retention of biological and clinical learning issues. Students also reported that an electronic based unlimited whiteboard was conducive in the construction of a case map.

In conclusion, case mapping is an effective learning tool that reinforced active learning that was beneficial in first year medical students introduced to a PBL curriculum. While students found case mapping to be an effective tool, responses demonstrated that more time was spent constructing case maps rather than focusing on content of the learning issues. However, with more exposure to the learning tool and unlimited whiteboard program, students could potentially overcome this learning curve associated with its initial use in medical education. While this study showed how case mapping can be used as a learning tool in the pre-clinical phase of medical education, there is potential to examine its utility in the clerkship phase as a method of organizing learning through patients.

Rationale:
Health Professions Education (HPE) programs are diverse and founded with varied goals, missions, and pedagogical approaches. Navigation of this complex system requires an understanding of the components and connections that form HPE programs. Educators need shared maps that match this system to facilitate communication, progress, and efficiency.
Systems maps are useful for describing shared mental models and delineating educational processes and goals; they are particularly effective for revealing unproductive tendencies toward siloing. In ‘The Seven Silos of Accountability,’ Joshua Brown presents a model of accountability silos in higher education that is applicable to HPE. The seven silos are assessment, accreditation, institutional research, institutional effectiveness, program evaluation, educational measurement, and higher education public policy. Specialized stakeholders may lack understanding of this broad network, leaving leadership in the difficult position of ‘pulling it all together’ with limited backup and support.
One approach for enhancing integration, communication, and efficiency across silos is visualizing components of systems as a mechanism for identifying and solving system-level challenges. These visualizations result in a process map that reflects the terrain of an organization called an Organigraph. Organigraphs are practical tools that can be used to orient those new to HPE, facilitate systems-level improvements, and identify opportunities to streamline effort and innovation.
In this panel, members of four institutions will present an emerging collaborative effort to support HPE programs. We have designed an organigraph of the common organizational silos in UME as well as a user-sourced, interactive visualization of organizational silos to aid in orientation to HPE programs.

Learning Objectives: 61 words
At the end of this session, participants will be able to:
Identify three advantages of visualizing an organizational process map of the Health Professions education.
Describe three examples of how a systems approach can address silo-driven challenges in the academic program environment.
Demonstrate how systems visualization tools can be used to map accreditation needs across silos.
Discuss pain points of silos in a Health Professions education context and reflect on systems-based solutions.

Session Methods and Format: 109 words
Introduction and definition of 1) Silos in medical education, and 2) Organigraphs, followed by a presentation of current silos in UME, including examples of use cases from multiple institutions. (25 minutes)
Interactive reflection on silos in HPE: Structured large group discussion. (15 minutes)
Presentation of 1) an Organigraph that maps the silos and shows how they interact in the functional landscape of UME, 2) an interactive dashboard on these silos, and 3) how this visualization can be sourced by stakeholders. (25 minutes)
Interactive reflection on Organigraphs and visualization of silos in HPE: Structured large group discussion. (15 minutes)
Concluding remarks and Q&A session with the audience. (10 minutes)

Any personal story can become its own form of impactful long-lasting communication, with proper dissection. Knowing the anatomy of a story builds lasting impact from within–sharing personal stories in professional spaces at all levels of medical education is crucial to making the field more inclusive and diverse. It is not only empowering for the presenter, it begins to break down the institutional barriers and systemic issues that leave 28.8% of resident physicians (Mata, 2015) and 27.2% of medical students (Rotenstein, 2016) worldwide with depression or depressive symptoms. Physician burnout must be urgently tackled from several angles: one being storytelling as a vehicle to highlight meaningful ideas and lessons of personal triumph, social justice, and resilience.

Participants will receive a step-by-step guide to dissecting their own experiences, such that they can identify one important idea they feel is beneficial for others to learn through storytelling.

Research Statement/Research Question
Do self-paced polling questions in recorded lectures increase preclinical medical students' engagement and academic performance?

Background and relevance of the study
Engaging medical students in the curriculum may promote a deep approach to learning. However, class attendance is often low, and many students prefer recorded lectures. The shift to more online classes presents further challenges for student engagement. Self-paced polling with recorded lectures could increase student engagement in online education as well as address some students’ preference for recorded lectures.

Design and Methods
For second-year medical students, 148 audience response questions were given in three days. Participation in live or self-paced polling was incentivized with course points. With self-paced polling, students answered at their own pace while watching recorded lectures. Students who participated actively in all three days were subdivided into the Live group (2-3 days with live polling) and Self-paced (0-1 day with live polling) and compared to the Inactive group. Performance of the three groups was compared on seven examinations. Students also voluntarily answered: “How did the self-paced polling affect your experience with recorded lectures?”

Results
127/165 (77.0%) students used self-paced polling. 46 students were Inactive. 60/119 active students primarily used self-paced, and 59 used live polling. The Self-paced group performed significantly better than the Inactive group only on the fourth examination after incentivized, self-paced polling was made available. 115/127 (90.6%) students made positive comments about self-paced polling, while 12 (9.4%) were negative. In the positive comments, students expressed their emotional (n=59), behavioral (n=34), or cognitive (n=39) engagement.

Conclusions
Self-paced polling questions in recorded lectures enhanced students' emotional, behavioral, and/or cognitive engagement with course material and improved examination performance.

Significance
Medical educators can use self-paced polling to enhance student engagement and academic performance. Future studies should replicate and extend findings, with a focus on the impact of self-polling on deep and strategic approaches to learning and long-term retention.

Careers in Medicine® (CiM) is a comprehensive career planning and advising program sponsored by the AAMC. Established in 1999, CiM works with school liaisons to support medical student career decision-making. CiM empowers students with information to make sound career decisions by helping them identify career goals, explore specialty, and practice options, and prepare for residency. The purpose of this poster is to increase awareness amongst liaisons and students alike of the value of CiM and the many tools and resources CiM provides members throughout this process.

Learning objective 1:
After reviewing the poster, participants will have a better understanding of the resources that CiM provides students and advisors to help enable and prepare them for the career advising process.

Learning objective 2:
After reviewing the poster, participants will be able to describe the historical and current use of CiM that highlight the value and benefits of CiM for career advising for students and advisors, alike.

Learning objective 3:
After reviewing the poster, participants will be able to list the four-year, four-phase developmental framework that informs CiM and the resources we provide.

Research Statement
To evaluate family medicine residents’ interest in providing LARCs in future practice and identify barriers to LARC training in residency.

Background and relevance of the study
Long-acting reversible contraception (LARC) such as implants and IUDs are highly effective birth control methods and use has been increasing over the past several years [1,2]. Physicians’ ability to offer LARCs is important for patient access. However, a 2014 national study showed that few family medicine physicians offer implants (11%) or IUDs (19.7%) overall, and male physicians are much less likely to provide LARCs than females [3], despite LARC training being a recommended part of family medicine residency training by the American Academy of Family Physicians[4].

Design and Methods
Residents received general contraceptive and LARC training in their continuity clinics, OB/GYN rotations, and electives at Planned Parenthood. A cross-sectional anonymous online survey was sent to all residents at our family medicine residency program in May 2021, and simple statistics were used for analyses.

Results
All 21 residents (100%) completed the survey. Most considered it “very important” for family medicine physicians to provide implants (86%) and IUDs (81%). However, female versus male residents reported much higher rates of being “very likely” to provide implants (91% vs 30%) and IUDs (91% vs 20%) in their future practice. The most common barrier (“moderate” or “significant”) to LARC training was lack of time (81%). Other barriers included too few patients requesting LARCs (76%) and doing initial contraceptive counseling but placement done by different clinician (57%).

Conclusions
Most residents considered LARC training and placement to be very important for family physicians, but interest in providing LARCs was significantly higher amongst female versus male residents.

Significance
Gender differences with regards to interest in provision after training needs to be evaluated on a national scale. Major barriers which need to be addressed are that LARC placement takes time and requires a higher volume.

Research Statement
In this pilot, we evaluated family medicine residents’ and attendings’ beliefs about the importance of home BP monitoring and how often they recommended home BP checks to patients.

Background and relevance of the study
In the US, 88 million adults have uncontrolled hypertension (HTN). The American Heart Association strongly recommends home blood pressure (BP) monitoring for patients with HTN to improve BP control and as a result, overall health. Therefore, teaching residents about home BP monitoring is key.

Design and Methods
The University of Hawaii Department of Family Medicine and Community Health surveyed residents and attendings anonymously online in May 2022 about their beliefs and practices regarding patients’ home BP monitoring.

Results
A total of 26 clinicians (20 residents, 6 attendings) participated (response rate 79%). Nearly all (92%) felt it was important for patients to check home BPs although most (77%) reported that fewer than half of their patients with HTN did so. Despite this, only some respondents reported always asking patients with HTN to check home BPs even for their patients with poorly controlled (58%) or newly diagnosed (46%) HTN.

Conclusions
Although 92% of family medicine residents and attendings in our clinic felt that checking home BPs was important for patients with HTN, less than 60% always asked their patients with HTN to do so.

Significance
This disconnect between clinicians’ beliefs and actions in encouraging patients to check home BPs must be addressed to improve care for patients with HTN.

Research Statement
We piloted an initiative for residents and attendings to prescribe or hand out free home blood pressure monitors to patients with hypertension in our residency clinic and evaluated the barriers encountered.

Background and relevance of the study
In the US, hypertension (HTN) affects 47% of adults and contributes to 670,000 deaths yearly. Due to Covid, telehealth has become widely adopted and patients’ ability to monitor home blood pressures (BP) is critical.

Design and Methods
Starting in April 2021, the University of Hawaii Department of Family Medicine and Community Health clinic encouraged clinicians to prescribe or give free home BP monitors to patients with hypertension. In May 2022, clinicians completed an anonymous survey about barriers to home BP monitoring.

Results
A total of 26 clinicians (20 residents, 6 attendings) participated (response rate 79%). Most respondents reported that home BP monitoring improved patients’ BP (69%), medication adherence (58%), and engagement (69%). The major barriers to home BP monitoring were: insurance did not cover BP monitor (81%), BP monitor cost (73%), difficulty prescribing monitor (69%), patient not interested (50%), and BP monitor hard to use (31%). Many (63%) reported difficulty getting BP monitors covered by insurance.

Conclusions
Our clinicians felt that home BP monitoring improved patients’ treatment and control of HTN. However important barriers remain including difficulty with insurance coverage, cost, and prescribing of BP monitors along with lack of patient interest even when free BP monitors are available.

Significance
Identifying barriers to home blood pressure monitoring could help other programs or institutions anticipate and pre-emptively address such difficulties and thus have better success with providing blood pressure monitors to their patients with hypertension.

Improving the experience of minority students and students of color in medical school is a vital, ongoing process. Recurrent mistreatment is significantly associated with burnout among students; burnout and reduced mental quality of life (QOL) can be exacerbated by differences in race and ethnicity (1, 2). In particular, minority students cite feelings of isolation and cultural communication differences as factors that impede forming connections with their peers and contribute to distress (2). Efforts led by medical school administration including Equity, Diversity, and Inclusion or Minority Affairs departments are cited as ineffective by students for a variety of reasons, including lack of access and applicability to all students (2, 3). Thus, student-led measures to counteract inter-student mistreatment and increase cultural competency are increasingly valuable.

This project first seeks to evaluate how patterns of mistreatment and anti-racism efforts at the University of Utah over four years have improved (or remained the same) in response to administrative efforts. Second, it evaluates the efficacy of student-led Professionalism and Diversity Committee (PDC) initiatives at SFESOM in improving cultural competency among the first-year class of 2026.

Student mistreatment and anti-racism efforts at the Spencer Fox Eccles School of Medicine (SFESOM) were evaluated longitudinally from 2019-2022 through the deidentified Independent Student Analysis survey (mean completion rate across questions and years 79%, mean number of responses 401 per year). Students were asked to rank the effectiveness and accessibility of anti-racism and anti-mistreatment measures and provide written feedback.

Overall satisfaction with anti-racism efforts and diversity are decreased in second- and third-year medical students as compared with first- and fourth-years; overall satisfaction with anti-mistreatment efforts are decreased in third- and fourth-years, reflecting a shift from classroom to clinical work. Satisfaction with anti-racism measures has increased, while satisfaction with anti-mistreatment measures have decreased, from 2019 to 2022. Evaluation of the student-led PDC workshop in direct response to this feedback is conducted through a secondary, deidentified study survey, currently in progress.

Works Cited
Cook, A. F., Arora, V. M., Rasinski, K. A., Curlin, F. A., & Yoon, J. D. (2014). The prevalence of medical student mistreatment and its association with burnout. Academic medicine : journal of the Association of American Medical Colleges, 89(5), 749–754. https://doi.org/10.1097/ACM.0000000000000204
Dyrbye LN, Thomas MR, Eacker A, et al. Race, Ethnicity, and Medical Student Well-being in the United States. Arch Intern Med. 2007;167(19):2103–2109. doi:10.1001/archinte.167.19.2103
Fried, J. M., Vermillion, M., Parker, N. H., & Uijtdehaage, S. (2012). Eradicating medical student mistreatment: a longitudinal study of one institution's efforts. Academic medicine : journal of the Association of American Medical Colleges, 87(9), 1191–1198. https://doi.org/10.1097/ACM.0b013e3182625408
Williams D. R. (2018). Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors. Journal of health and social behavior, 59(4), 466–485. https://doi.org/10.1177/0022146518814251
Haviland, M. G., Yamagata, H., Werner, L. S., Zhang, K., Dial, T. H., & Sonne, J. L. (2011). Student mistreatment in medical school and planning a career in academic medicine. Teaching and learning in medicine, 23(3), 231–237. https://doi.org/10.1080/10401334.2011.586914

Purpose: Implement a new method to locate School of Medicine graduates that replaces direct surveys to graduates and does not rely on hospital lists.

Background: The tracking of graduate locations for the University of New Mexico (UNM) School of Medicine (SOM) has adapted methods and increased its scope over the past years. Annually, the Office of Program Evaluation, Education and Research (PEAR) at UNM SOM publishes a Location Report presenting the statistical overview of UNM-trained physicians practicing in New Mexico. This overview provides valuable information to the legislature and supports internal initiatives. In the past, graduates were surveyed directly and lists were requested from the state’s hospitals. Over time, graduates became non-responsive and obtaining physician lists became progressively more problematic.

Method: The process involves obtaining data from internal offices, the state medical board, the Centers for Medicare & Medicaid Services National Plan and Provider Enumeration System (NPPES) National Provider Index (NPI) registry, and additional online resources. Data points are recorded in a database. The database queries use multiple data points to confirm record validity.

Outcomes: With this strategy, every graduate is represented. By storing additional data, the soundness of a “match” increases.

Strengths and Limitations: Reporting on additional public and internal data helps with data requests and supports other SOM offices. Most data used is public information. This method minimizes errors in name-matching. Rules have to be determined to handle common issues like multiple locations and retirement.

Feasibility: To do this method, you only need to obtain a list of graduates and a state’s medical board list of currently licensed physicians. NPI and other state license data is available online. Because many licensing boards have searchable profiles of their licensees, and the NPPES NPI is used by many health professions, this method could be expanded beyond physicians to track other health professions.

Health professions schools are moving toward implementing competency-based education, and interprofessional education (IPE) provides an opportunity to achieve critical competencies within healthcare teams. While there are several established IPE competency frameworks (1,2), schools often need to adapt these frameworks to align with their desired IPE program outcomes. Additionally, schools must determine appropriate milestones according to the developmental trajectory for these competencies. Finally, robust instruments are required to operationalize a longitudinal program of assessment.

In this small group discussion, the presenters will describe their experience developing and implementing a longitudinal program of assessment for a competency-based IPE curriculum, including establishment and iterative refinement of competencies and milestone language, as well as how assessment modalities were selected. This will then serve as a springboard to engage the audience in creative solutioning to address the challenges inherent in this process at their home institution and beyond.

Clinical reasoning is a critical competency for the practice of medicine; however, existing methods of assessment often are unable to provide learners with sufficiently detailed or actionable feedback to guide performance improvement. While there is interest in adapting or creating new forms of assessment to address this challenge, resource constraints may preclude individual institutions from developing or implementing innovative solutions. The National Board of Medical Examiners (NBME) thus established the OSCE for Clinical Reasoning Creative Community in order to leverage experience and expertise across multiple medical schools. Participating institutions are partnering closely with NBME assessment experts to generate and pilot solutions for clinical reasoning assessment challenges, via a structured, evidence-centered design process.

In this small group discussion, the presenters will describe their experience participating in the Creative Community thus far, including key learnings and themes related to clinical reasoning assessment and barriers to innovation. The presenters will then engage the audience in a conversation about their initial reactions to the process and preliminary output of the Creative Community, as well as solicit ideas for how to maximize the value and generalizability of this work for their own institutions.