United States

Background
Pathway programs have been successful in diversifying the physician workforce, which leads to improved quality of care for all patients. These programs are a key component in advancing equity in medical education to students from various backgrounds. While pathway programs develop a student’s professional skills, they also foster a sense of community that supports learning and growth. Despite the value of community in pathway programs, little qualitative research has explored its impact on pre-medical students. This study examines how the sense of community cultivated within a premedical pathway program influences students’ trajectories toward a career in medicine.

Methods
An in-depth focus group was conducted with 23 students who participated in a structured premedical pathway program. Using Social Cognitive Theory as a conceptual framework, we employed a deductive qualitative approach to thematic analysis and investigated how the social factors within the program affected a student’s sense of self-efficacy. Two independent researchers coded the transcript and identified core themes related to the students’ experiences of community within the program.

Results
Thematic analysis revealed five major themes: “Confidence/Empowerment,” “Professional development,” “Embodied mentorship,” “Shared experience,” and “Structured support.” The average inter-rater agreement was 87.36%. The most common theme that emerged was “Support,” with 21 references, followed by “Shared experience,” with 13 references. Students described the community fostered by the program as a meaningful source of comfort, encouragement, and guidance–particularly in navigating the challenges of the medical school application process. Overall, students were motivated and more confident in their ability to successfully pursue a career in medicine. 

Conclusion
Pathway programs offer more than professional development; they also build communities where students with shared goals and lived experiences can develop a lasting support system. Our analysis of the pre-medical pathway program highlights how this sense of belonging fosters peer mentorship, resource-sharing, and confidence in navigating the medical school application process. As admissions become increasingly competitive, these social resources are essential to increasing the representation of a diverse student body in medicine. Our results further illustrate the value of pathway programs and their place in advancing equity in the future physician workforce. 



AMA Research Challenge 2025 

Fostering Belonging and Career Confidence Through Community in a Pre-Medical Pathway Program

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AMA Research Challenge 2023

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Background
Students from marginalized backgrounds are underrepresented in higher education, including healthcare.1 Representation in medicine can decrease health disparities through increased trust, patient-centered care, and better treatment adherence.2,3,4 Systemic barriers like cost, lack of social support, lack of mentorship, and lack of career navigation knowledge, prevent marginalized persons from pursuing medicine.5 Encouraging marginalized high schoolers to pursue medicine is shown to help to minimize the disparity and further diversify representation in medicine.6,7 Compton Unified School District (CUSD) teachers revealed a scarcity of medical opportunities for their students. CUSD serves 100% minority students and 46% are economically disadvantaged.8 Literature has shown mentorship programs, medical school field trips, and near-peer teaching decrease barriers.7,9,10 Utilizing these strategies, we created a single event field trip for Los Angeles students to explore medicine. A survey was issued to high school and medical students to measure the effects on barriers and to obtain feedback.

Methods
High school students from CUSD were invited to David Geffen School of Medicine. Pre-medical undergraduates led the students through a tour of UCLA. Physicians hosted conversations during lunch. Medical students led hands-on, small group (1.8 student: 1 medical student) workshops including ultrasound, suturing, vital signs, and simulated patient interviews. After participating in the program, both high school and medical students completed an anonymous survey with Likert Scale (0-4), free-text, and multi-select questions. Data were evaluated with paired two-tailed t-tests and descriptive analysis.

Results 
Twenty-nine high school students and twelve medical students completed the survey. Amongst the high school students, there were statistically significant increases in desire to pursue a career in medicine (3.103, 3.414; p=0.0099) and perceived opportunities to pursue medicine (3.138, 3.517; p=0.0027). Perceived barriers had a significant decrease (2.207, 1.862; p=0.0098). The most common barriers identified were feeling unqualified compared to peers (51.7%; 15) and cost of education (55.2%;16). There was no change in self efficacy (3.103, 3.276; p=0.057). The event had high satisfaction by both high school (93%, 3.51土0.62) and medical students (100%) with requests to host event again.

Conclusion 
Field trips are effective tools for Los Angeles-area high school students from marginalized backgrounds to explore medicine and decrease barriers. The mutual satisfaction from medical student-run events for high school students make this program sustainable. Future projects aim to create a more longitudinal partnership with CUSD.

1. Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. Executive summary. Washington, DC: AAMC; 2019.
2. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/AJPH.2015.302903
3. Smedley BD, Stith AY, Nelson AR, eds. Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003. https://www.ncbi.nlm.nih.gov/books/NBK220354/
4. GlobalData Plc. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. Washington, DC: Association of American Medical Colleges; 2024.
5. Joseph J, Dao D, Hwang SM, et al. Perceptions of barriers and facilitators to becoming a medical professional among underrepresented undergraduate and postbaccalaureate learners. Mayo Clin Proc Innov Qual Outcomes. 2021;5(2):347-358. doi:10.1016/j.mayocpiqo.2021.01.003
6. Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban or rural areas in the United States: a systematic literature review. Acad Med. 2016;91(9):1313-1321. doi:10.1097/ACM.0000000000001203
7. Mayrath M, Fontanez D, Abdelbaset F, et al. Increasing diversity in the physician workforce: pathway programs and predictive analytics. Acad Med. 2023;98(10):1154-1158. doi:10.1097/ACM.0000000000005287
8. Compton Unified School District. Accessed June 22, 2025. https://www.usnews.com/education/k12/california/districts/compton-unified-112290
9. Abdulrazzak A, Chandler A, Lu R, et al. Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students. J Osteopath Med. 2021;121(12):883-890. doi:10.1515/jom-2021-0125
10. Patel SI, Rodríguez P, Gonzales RJ. The implementation of an innovative high school mentoring program designed to enhance diversity and provide a pathway for future careers in healthcare related fields. J Racial Ethn Health Disparities. 2015;2(3):395-402. doi:10.1007/s40615-015-0086-y

Mini Med School: A Medical Student Community Outreach Program for High School Students in LA

Author: Sirlin Kaur
Co-author: Joanna Appel 
Project Title: The Impact of Racial Bias Discussions on Medical Students' Educational Experiences and Perceptions of Patient Care: A Cultural Humility Perspective

Introduction: This study examines the impact of discussions on racial bias and racial equity on medical students' personal experiences, perceptions of race in healthcare, and approaches to patient care. 

Method: The study design involved semi-structured interviews with first-year medical students at the University of South Carolina School of Medicine who completed a reading assignment of Dorothy Roberts' "Fatal Invention" and participated in small-group discussions during orientation. These activities provided a platform for students to engage deeply with the material and reflect on their own biases, enhancing their educational experiences and informing their future approaches to patient care. 

Results: Utilizing the Cultural Humility Framework, we explore how these educational activities fostered self-reflection, awareness of power imbalances, and institutional accountability, ultimately shaping students' readiness to provide equitable and inclusive patient care. Student responses illuminated their ever-evolving perspectives on the issue of racial bias in medicine and how that affects their interactions with patients as medical students and future physicians. The impact of the study was summarized into 5 categories including personal experience with racial bias, experiences in medical school, perceptions of race and racial bias, perceptions of the impact of race on healthcare, and approach to patient care. Each category was then contextualized within the Cultural Humility framework. 

Conclusion: Our findings underscore the importance of incorporating racial bias education into medical curricula to prepare future healthcare providers to recognize and address biases, thereby improving patient outcomes and fostering trust within minority communities. Medical students should be encouraged to engage in continuous, lifelong self-reflection to challenge their own biases and assumptions with the support of academic institutions to foster this goal and promote equity and inclusion.

The Impact of Racial Bias Discussions on Medical Students' Educational Experiences and Perceptions of Patient Care

Background
Although several MD programs emphasize basic sciences, clinical skills, and biomedical research, very few prioritize health policy and the business of medicine. The executive board of the Healthcare Delivery Interest Group (HDIG) at the Medical College of Georgia (MCG) implemented the Healthcare Equity Case Competition in partnership with the University of Aberdeen (UofA) to address this gap through international collaboration. This report describes this educational initiative, initial participant feedback, and future opportunities for growth. 

Methods
The HDIG executive board developed a case about the hypothetical repeal of the Affordable Care Act (ACA), prompting teams to propose an alternative model for the United States' healthcare system, addressing cost, accessibility, effectiveness, insurance market stability, and transition for individuals previously covered by the ACA. The complexity of the case required students to examine global health systems and leverage existing knowledge from their own national frameworks. HDIG deliberately paired MCG and UofA students within each team. Students gave oral presentations at their respective institutions through a Teams meeting, enabling synchronous sharing with the partner institution. 

Results
In total, 39 students from the Medical College of Georgia and 11 University of Aberdeen students participated in the MCG x UofA Healthcare Equity Case Competition. To analyze whether the competition met its educational objectives, a feedback questionnaire was distributed to all participants, using a 10-point rating scale (1 = least satisfied, 10 = most satisfied). The responses indicated that the event was valuable to the education of the medical students who participated. Students reported international collaboration and faculty mentorship as key to their understanding of the case objectives. Among 24 respondents, paired t-tests demonstrated statistically significant improvements (p<0.05) in self-perceived understanding of the US healthcare system, comparative healthcare models, global health equity, and public health policy. Free-response questions provided insight into changes that could be implemented to increase efficiency for future events.

Conclusion
Unlike other cross-institutional initiatives, this competition incorporated students from different countries within the same teams, requiring the cooperation of diverse knowledge bases and perspectives—an intentional challenge that enriched learning but necessitated coordination. Logistical barriers like costs, time zones, and curricular differences may limit scalability. This event provides a replicable framework for other institutions to utilize integrated international teams as a means of incorporating health policy topics into a comprehensive curriculum that extends beyond the classroom.

Reimagining U.S. Healthcare: A Student-Led, Transatlantic Case Competition on Health Policy

Background
Simulation in surgical education is of growing interest across medical schools. Barriers to implementation include resources like infrastructure, materials, and physician time. Based on previous surgery clerkship feedback, we aimed to create a multicomponent didactic session for the surgery clerkship. Session goals included developing surgical skills and encouraging student participation in surgical care. We hypothesized that the session would be highly valued by medical students on their surgery clerkship.
Methods
Using simulation trainers provided by the Department of Surgery for resident and fellow education, a single two-hour hands-on didactic session of knot tying, fundamentals of laparoscopic surgery (FLS), and focused assessment with sonography for trauma (FAST) was created for third-year medical students during their surgery clerkship. Session facilitators included 3 attending surgeons, 3-4 residents, and 1 fourth-year medical student. Students were surveyed on their experience using a 5-point Likert scale, pick all that apply, and free responses. Likert scale perception decision was determined relative to weighted mean.
Results
Most respondents highly praised the didactic. Knot-tying respondents reported that it helped them appreciate that their skills had improved (81%, n=37) and that they needed more practice to become proficient (59.4%, n=37). FLS respondents recognized they needed more practice to become proficient (78.9%, n=19) and that practicing on a laparoscopic trainer could be helpful in their training (73.7%, n=19). FAST respondents reported that practicing ultrasound with peers was helpful (81%, n=38) and that they could incorporate ultrasound skills in their careers (75.8%, n=38). Regarding session takeaways, 75% of free responses noted that the experience offered an opportunity to practice and develop valuable practical skills (n=20). The most common free response feedback was that respondents wished to spend more time on FLS and FAST (39.1%) (n=23).
Conclusion
Under the leadership of surgical faculty and residents, the use of available training resources led to a highly valued didactic session by students. This highlights the potential utility of simulation in medical student surgical education. Two of six yearly clerkship cohorts have participated, and data collection is ongoing. Future investigations will explore how these sessions shape preparedness for surgical rotations, overall clerkship experience, and perception of surgeons.


The Benefits of a Multicomponent Didactic Session for Surgical Clerkship Students

Background
The lymphatic system plays a vital role in fluid homeostasis, immune surveillance, and lipid transport from the gastrointestinal tract. It is implicated in the pathophysiology of numerous conditions, including lymphedema, cancer metastasis, autoimmune diseases, and infectious processes. Despite this, prior analyses of undergraduate medical curricula have identified is proportionate underrepresentation of lymphatic system content relative to other organ systems.
This educational gap may contribute to decreased physician confidence in recognizing and managing lymphatic disorders, potentially delaying diagnoses or misdirecting treatment early in clinical careers. The aim of this study was to assess the current scope, quality, and perceived adequacy of lymphatic system education in U.S. allopathic medical schools.

Methods
An IRB-approved, anonymous 10-minute survey was distributed to medical students and faculty at U.S. allopathic medical schools. Questions assessed time spent on lymphatic system education, teaching methods used, perceived quality of instruction, and confidence in managing lymphatic disorders. A separate subset of the survey was administered to faculty to evaluate institutional curricular practices and perspectives. Data was analyzed using descriptive statistics and thematic
analysis.

Results
A total of 201 respondents completed the survey. When asked about dedicated instructional time on the lymphatic system—defined as total hours across lectures, small groups, or clinical case discussions—35% reported 3 hours, 25% reported 2 hours, and 11% reported only 1 hour of iinstruction. Only 2% reported 5 or more hours. Most instruction was lecture-based (54%), with limited use of small groups (21%) or clinical case discussions (18%). The perceived quality of lymphatic education was rated as "poor" or "fair" by 54% of respondents, with only 14% rating it as "good" or "excellent." Confidence in managing lymphatic disorders was low: 63% reported feeling "not confident" or "slightly confident" in recognizing and treating these conditions. Additionally, 51% reported no formal assessment of lymphatic knowledge in medical school. Among 23 faculty respondents, over 75% rated current lymphatic instruction as inadequate and reported that it is rarely formally assessed.

Conclusion
These findings highlight a significant gap in lymphatic system education across U.S. allopathic medical curricula, suggesting a need for increased instructional time, integration into clinical cases, and inclusion in clinical skills training and formal assessments. Given the lymphatic system's role in diverse pathologies, targeted curricular reforms are warranted to better prepare future physicians
to diagnose and manage lymphatic disorders.

Assessing the Gaps: Lymphatic System Education in U.S. Allopathic Medical Curricula

Background: Success in transcranial microsurgery and endoscopic skull base surgery is predicated on one’s knowledge in surgical neuroanatomy. While graphic depictions aim to present the 3D anatomy, technical skills must be developed through hands-on practice. To address this, a dedicated microsurgical neuroanatomy laboratory—the first of its kind in Indiana—was established in 2025 at the Indiana University School of Medicine. Led by the senior author, the lab promotes surgical artistry through anatomical precision, repetition, and interdisciplinary collaboration. The objective of this study is to describe the inception and collaborative development of a skull base
lab at Indiana University.

Methods: The lab has been supported through personal funds and industry support. As a joint effort between the Departments of Neurological Surgery and Otolaryngology, fellows were selected from an international pool of applicants. Each fellow received a latex-injected, alcohol-preserved head and had full access to complete neurosurgical equipment, Mayfield headrests, endoscopes, microscopes, drills, aspirators, and professional photography equipment. Daily dissections followed a stepwise approach, with each step captured by high-resolution 2D/3D
images and photogrammetry. Media acquired from the lab was later combined with surgical videos so that the understanding of the microsurgical anatomy can be translated into the operating room. Weekly neuroanatomy meetings were also held to foster peer learning and mentorship.

Results: In its first year, the lab is set to train seven international fellows, with fellowships ranging from 3-12 months. The overlapping time period between the fellows facilitates international dissemination of ideas and techniques. Dissections encompassing open and endoscopic skull base approaches of the anterior, middle, and posterior fossa were performed. The present fellows report significant improvements in 3D orientation, technical confidence, and surgical fluency.

Conclusion: The IU microsurgical neuroanatomy lab offers a transformative and internationally collaborative model for neurosurgical education. The lab merges anatomical precision, simulation, and mentorship to prepare the next generation of neurosurgeons.

The Indiana University Microsurgical Neuroanatomy Laboratory: A Training and Innovation Center

Background:
Medical students experience greater rates of psychological issues, including burnout and anxiety, which may have lasting effects on their future careers. To help address this increased risk, California Northstate University College of Medicine introduced a 4th year Wellness elective, which combines elements of mindfulness meditation, physician compassion and communication training, leadership training, and humanities in medicine. This study evaluated the impact of this course on the levels of burnout, self-compassion, and anxiety of medical students.

Methods:
A survey was administered to 4th year students, both those enrolled in HLT810 and those not taking the course. The survey consisted of demographic questions as well as measurements for burnout, self-compassion, and anxiety. The survey was given prior to beginning the course and again after it was completed. The Oldenburg Burnout Inventory was used to measure student burnout, exhaustion, and disengagement. The Self-Compassion Scale was used to evaluate self-compassion, self-judgment, mindfulness, and self-kindness. The General Anxiety Disorder-7 questionnaire was used to measure anxiety levels. For students who took the elective, two-tailed paired t-tests were performed to assess for differences in these metrics before and after completing the course, with p < 0.05 being significant. Unpaired t-tests were used to compare students who did not take the course to students who completed the course.

Results:
There were no significant differences in anxiety levels, self-compassion, and burnout between students who completed the HLT810 elective and those who did not. However, for the students who completed the elective, there were significantly lower total burnout and disengagement scores after taking the course (p = 0.043 and p = 0.034, respectively), as well as significantly higher self-kindness, humanity, and mindfulness scores (p = 0.00254, p = 0.0162, and p = 0.0396, respectively). These students also had significantly higher total self-compassion scores after completing the course (p = 0.0122). For students who did not take the course, engagement scores were significantly higher after the course concluded (p = 0.024) but there were no other findings of significance.

Conclusion:
Students who completed HLT810 had statistically significant decreased levels of burnout and as well as increased self-compassion after taking the course. While additional investigation is needed due to the small sample size (n = 38), these findings suggest that a 4th year wellness elective course may offer meaningful benefits for medical student well-being.

The Effects of Mindfulness and Wellness Curriculum on Burnout, Self-Compassion, and Anxiety

Background
Patients increasingly consult online resources and Artificial Intelligence (AI) chatbots for medical information. However, post pandemic aggravation of medical misinformation and recent blossom of AI has raised concerns about the quality and comprehensibility of such sources. Adequate, easy to understand, and accurate patient education is crucial in procedural outcome and prognosis, especially for procedures that warrant meticulous postoperative management, such as tracheostomy.
Methods
We evaluated five popular and high-ranking AI chatbots - ChatGPT, DeepSeek, Google Gemini, Microsoft Copilot, and Grok 3 - alongside responses from a senior otolaryngologist, addressing 12 Frequently Asked Questions (FAQs) on tracheostomy care. FAQ selection was guided by a combination of search-listening tools (Google Trends, KeywordsPeopleUse, AlsoAsked, AnswerThePublic, Kwrds.ai), manual Google searches, and clinician input to reflect authentic patient language. Three blinded, board-certified otolaryngologists independently rated each response’s accuracy, clarity, relevance, completeness, usefulness, and reference reliability using the Quality Analysis of Medical Artificial Intelligence (QAMAI), a standardized instrument developed to assess AI-generated contents. Overall preferences and reasons for suboptimal response ranking were also assessed by reviewers. Readability and descriptive text analysis were evaluated using Textstat and Natural Language Toolkit library in Python (Python Software Foundation), employing Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics.
Results
Across the 12 FAQs, there were no significant differences in accuracy between AI-generated and otolaryngologist-generated responses. Google Gemini has higher overall preference and QAMAI score compared to Microsoft Copilot (p<0.05). In terms of completeness, Gemini (p<0.001), DeepSeek (p<0.05), Grok 3 (p<0.05), and ChatGPT (p<0.05) outperformed the otolaryngologist, and each provided content deemed of “good quality” by QAMAI standards. However, Gemini has the reading time (p<.001), highest word (p<.001), long word (p<.001), and difficult word counts (p<.001). Readability analyses revealed that all models have high reading level of at least 10th-13th grade. Inter rater reliability among the three reviewers was 78%.
Conclusion
AI chatbots are a promising tool for accurate, on-demand, and comprehensive health information for patient and families considering or managing tracheostomy care. Google Gemini demonstrated strength in content completeness and overall preference, highlighting the potential of AI to supplement time-limited physician-patient interactions. However, all AI and otolaryngologist generated responses surpassed the American Medical Association’s recommended 6th grade reading level, indicating a need for readability optimization. Future studies should focus on refining the readability of AI-generated content and assessing patient preferences across models. 


The Role of Artificial Intelligence in Addressing Patient Inquires on Tracheostomy Care

BACKGROUND: Surgical education often relies on costly task trainers or two-dimensional surgical videos. Photogrammetry, the process of constructing three-dimensional (3D) models from two-dimensional (2D) images, offers a cost-savings solution while providing a customizable 3D surgical experience. This technique for building photogrammetry-based 3D models allows for the creation of virtual teaching modules and aimed to enhance options for surgical education. While photogrammetry has been used to build models for teaching anatomy, its application in procedural simulation remains limited. Additionally, open carpal tunnel release (OCTR) achieves outcomes comparable to the endoscopic approach, yet virtual reality (VR) training simulations for this open technique have not been explored. This study introduces a low-cost VR OCTR surgical teaching module using photogrammetry to explore production feasibility and educational value across surgical disciplines.

METHODS: A VR OCTR module was created using photogrammetry to generate virtual hand and wrist models from intraoperative cadaveric dissections. Filming was conducted in an academic anatomy lab, demonstrating a five-step OCTR procedure on cadaveric right arms. Serial photographs were captured from multiple angles using a Nikon Z8 camera, with drapes placed to minimize visual distractions. 3D models were rendered via photogrammetry software and refined with open-source tools. The models were viewed through a Meta Quest 3 headset and the teaching module was narrated by a hand surgeon using the MedicalHolodeck Surgical and Anatomical VR application. Surgical trainees and faculty from plastic surgery, orthopedics, and neurosurgery provided feedback for further model development.

RESULTS: This VR module was built using accessible tools and software. High resolution photographs resulted in the anatomically accurate 3D models used to highlight essential anatomy and surgical landmarks in the teaching module. The seven-minute module was noted to be conceptually clear and appropriately concise. Feedback emphasized its usefulness in reinforcing anatomical knowledge, visualizing operative steps, and noting structures to avoid during surgery. In-house development of the modules highlights its customizability for institutional specific learning goals, cost-effectiveness and feasibility for broader institutional adoption, compared to commercial subspecialty specific private platforms for VR surgical training. These findings support the educational potential of photogrammetry-based VR and guide further pilot studies, expansion to medical students and an upcoming randomized trial comparing VR to standard 2D training.

CONCLUSION: Photogrammetry can produce low-cost 3D models for virtual reality teaching modules in surgical education and training. By leveraging accessible technology and cadaveric dissections, this method enhances educational access and sets the stage for wider implementation and outcomes-based research.


The Novel Application of Photogrammetry in Building Virtual Reality Modules for Surgical Education

Abstract Title: Reported Levels of Student Stress and Protective Nature of Resiliency Among First Year U.S. Medical Students - A Single Institution, Pilot Study

Background:
Medical training for M.D. candidates in the United States involves four years of combined didactic and clinical learning. Medical students often experience stressors related to academics and social life that can lead to burnout and clinical depression in medical school. This study aimed to identify key problem areas pertaining to stress and wellbeing among first-year medical students at one accredited M.D. institution by administering the Medical Student Stress Scale (MSSS), a survey that was calibrated and validated by researchers at a single institution looking to identify a precise measurement tool to evaluate medical student stress.

Methods
The MSSS, a 22-item questionnaire, was administered to first year medical students twice during 2024-2025 academic calendar, in the fall and spring. The MSSS questions were administered alongside a Brief Resilience Scale (BRS) and demographic questionnaire. The MSSS measures stress with a total score determined as a summation of the responses, where higher scores indicate greater stress. The BRS measures resiliency with a total score determined as a summation of the 6 item responses and can be categorized as being low (1-2.99), normal (3-4.3), or high (4.31-5).

Results
The overall response rate was 61% (107 out of 175) in the fall and 47% (87 out of 175) in the spring. Average student stress score in the fall and spring was 34.3 and 38.8, respectfully. The resiliency score in the fall and spring was 3.6 and 3.5, respectfully. The multivariable generalized linear model showed that student stress decreased by 10 points and 13 points with every 1-point increase on the BRS in the fall and spring, respectfully (p<0.001). Additionally, at both time points, males display a significantly lower estimated stress score than females (p=0.044 and p=0.016). In the spring, compared to students of Christian faith, Jewish students displayed an estimated 10-point increase in stress (p=0.024), and Islamic students displayed an estimated 17- point increase in stress (p=0.005). Additionally, students that reported they were low-income displayed an estimated 8-point increase in stress compared to non-low-income students (p=0.009).

Conclusion
The MSSS and BRS were feasible to implement and identified clear trends in stress based on demographic factors. High levels of stress are reported even early in the academic year suggesting the need for early and ongoing support. The second time point showed compounding effects, emphasizing the importance of longitudinal support. Resiliency emerged as a potential protective factor and a possible target for future interventions.

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