United States

Title: Validating the Utility of Standard Operating Procedures In a Student-Run Free Clinic
Background: Student-Run Free Clinics are common at medical schools across the country. These clinics face unique challenges with continuity due to annual changes in leadership. In this pilot study, we aimed to stabilize the leader transition process by creating standard operating procedures (SOPs) for each position in the MedZou Specialty Clinic.
Methods: MedZou Specialty Clinic SOPs for 2021 and 2022 were assessed via survey. Participants rated quality of SOPs and their self-assessed preparedness. All ratings were measured on a scale from 1 to 5, with 1 representing the lowest quality or least prepared and 5 representing the highest quality or most prepared. An optional free-response was also included.
Results: In 2021, only 7 of 11 student leaders received a SOP during training. Upon study completion in 2022, all 11 incoming student leaders received a SOP. There was an observed increase in average quality (P&lt;.001) and self-assessed preparedness (P= .006) between cohorts.
Conclusion: Providing SOPs during the MedZou training period correlated with increased satisfaction and confidence in incoming student leaders. Implementation of SOPs for all MedZou clinics may be helpful for creating smooth transitions for future leaders.

AMA Research Challenge 2022

Validating the Utility of Standard Operating Procedures in a Student-Run Free Clinic

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#### Event Details
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Ricardo Correa, MD, EdD
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Stuart M. Greenstein, MD
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Stephanie Strohbeen, MD
 
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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

### Sponsor
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Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


Title: Validating the Utility of Standard Operating Procedures In a Student-Run Free Clinic
Background: Student-Run Free Clinics are common at medical schools across the country. These clinics face unique challenges with continuity due to annual changes in leadership. In this pilot study, we aimed to stabilize the leader transition process by creating standard operating procedures (SOPs) for each position in the MedZou Specialty Clinic.
Methods: MedZou Specialty Clinic SOPs for 2021 and 2022 were assessed via survey. Participants rated quality of SOPs and their self-assessed preparedness. All ratings were measured on a scale from 1 to 5, with 1 representing the lowest quality or least prepared and 5 representing the highest quality or most prepared. An optional free-response was also included.
Results: In 2021, only 7 of 11 student leaders received a SOP during training. Upon study completion in 2022, all 11 incoming student leaders received a SOP. There was an observed increase in average quality (P<.001) and self-assessed preparedness (P= .006) between cohorts.
Conclusion: Providing SOPs during the MedZou training period correlated with increased satisfaction and confidence in incoming student leaders. Implementation of SOPs for all MedZou clinics may be helpful for creating smooth transitions for future leaders.

poster

Background: The rising prevalence of physician burnout in recent years has drawn significant attention. The COVID-19 pandemic has resulted in additional strain on healthcare staff working tirelessly for extended hours, amplifying physical exhaustion and emotional stress levels. Physicians in training (residents) have been considered to be at increased risk of burnout, even before the pandemic. With limitations in social interactions and travel restrictions, the possibility of interventions to prevent burnout has significantly reduced. We conducted a study to assess the impact of the COVID19 pandemic on self-reported burnout among internal medicine residents at our hospital.

Methods: The Oldenburg Burnout Inventory was used as the screening tool. Residents filled out a mid-year questionnaire in December 2019 [pre-COVID period] and in December 2021 [COVID period]. The survey was voluntary, anonymous, and confidential. The inventory included a total of 16 questions divided into disengagement and exhaustion categories. Residents scored the questions between 1 through 4 [strongly agree to strongly disagree]. Overall, burnout scores were characterized as high [score >2.17], medium [1.0-2.17], and low [<1] for the disengagement category. In the exhaustion category, burnout scores were characterized as high [>2.57], medium [1.67-2.57], and low [<1.67]. The degree of burnout among residents before and during the COVID pandemic was compared based on cohort/ level of training. pre-COVID pandemic and during the pandemic. A higher score indicated suggested more burnout among residents. The one-way ANOVA test and unpaired T-test were used for statistical analyses, as appropriate.

Results: 75 responses were obtained during the pre-COVID period, and 43 responses were obtained during the COVID period. Comparing the first-year trainees [PGY1], pre-COVID and during COVID, there reported more burnout [p<0.0001] during the COVID pandemic. During COVID, first-year trainees [PGY1] reported significantly more burnout as compared to PGY2 [p=0.025] and PGY3 [p=0.0018] trainees with higher burnout scores. The level of burnout was not statistically significant between PGY2 and PGY3 trainees [p=0.95]. In the disengagement category, The residents scored highest in questions concerning disengagement over time, the question being if this was the only type of work they can see themselves doing. In the exhaustion category, residents reported that they felt tired before arriving at work and needed a longer time to relax to feel better after work. They felt worn out easily quickly, not having enough energy for leisure activities.

Conclusion: The data suggest that there is comparably more burnout among PGY1 with learning a new healthcare system and electronic medical records(EMR)s, adjusting to new work schedules and living conditions as possible contributing factors. In comparison, concern for future career/fellowship applications is a potential source of concern for PGY2. Our observation of increased burnout among the current PGY1 who started their training during the pandemic raises questions about how well they were prepared to face a healthcare crisis. Meanwhile, during their second and third years of training, residents have gathered more skills and knowledge which enhance their resilience and ability to cope with unprecedented demands on the healthcare system.

A Comparison of Burnout Among Internal Medicine Residents in Different Post-Graduate Years of Training in a Community Hospital During the COVID-19 Pandemic

Background: Supplementary medical school learning resources, including textbooks, United States Medical Licensing Examinations (USMLE) preparatory materials, and internet searches have all been shown to lack equitable representation of brown and black skin images. This creates a knowledge gap for learners and decreases providers’ confidence managing skin disease in all populations. Subsequently, patients with non-white skin experience delayed or missed diagnoses, which contributes to known skin health disparities. Here, we aimed to create a standardized course auditing system to assess the use of brown and black skin images in the preclinical medical education.

Methods: We performed a cross-sectional audit of the 2020-2021 preclinical curriculum at the University of Pittsburgh School of Medicine (UPSOM). All human images in the learning material for 34 first- and second-year medical school courses were analyzed. Skin color was categorized as light/white, medium/brown, and dark/black using the Massey-Martin NIS Skin Color Scale.

Results: In total, 1,660 unique images were analyzed; 71.3%, (n=1,183) were light/white, 16.1% (n=267) were medium/brown and 12.7% (n=210) were dark/black. Dermatologic images of skin, hair, nail, or mucosal disease made up 62.1% (n=1,031) of the images and 68.1% (n=702) of the dermatologic images were light/white. Images of infectious diseases were more frequently presented in darker skin colors (χ2(2) = 15.46, p<.001). 

Conclusion: White skin was the standard used for visual learning images. These results further substantiate the lack of representation of brown and black skin in medical education. Using our efforts as a model, we propose guidelines to achieve visual learning equity. First, institutions should create a taskforce to implement a similar course auditing system. Medical school educators should be informed to present skin conditions on a spectrum of skin colors (white, brown, and black skin) to demonstrate differences in disease manifestations based on constitutive skin type. Resources with high quality images of brown and black skin should be made accessible for editing learning material. Course content should be audited regularly with feedback and support given to instructors. It is paramount that we analyze and revise our medical school curricula to ensure the next generation of physicians are educated to care for all patients.

Achieving Visual Learning Equity: A Course Auditing System of Skin Color of Images in Preclinical Medical Education

Addressing Instances of Racism, Discrimination, and Microaggression in Medical Education in Puerto Rico: A Symposium in Diversity, Equity and Inclusion

Background 

While the number of medical school applicants has increased, disparities among underrepresented groups in medicine continue to widen. Previous research has examined medical school applicants; however, limited literature examines the medical school re-applicant population. This study compares first-time applicants (FTA) to re-applicants (RA) from 2014 to 2022 by race/ethnicity. 

Methods 

Historical data was requested and acquired for RA and FTA by race/ethnicity (Alone or in Combination) from the AAMC matriculation file. In total, 411,770 applicants between 2014 and 2022 were analyzed by race/ethnicity, respectively. Of those applicants, there were 302,345 (73.4%) FTA and 109,425 (26.6%) RA. Descriptive statistics were calculated. 

Results 

The percentage change from 2014 to 2022 for FTA amongst these groups was: American Indian/Alaska Native (AI/AN): +51.8%; Asian: +53.3%; Black/African American (B/AA): +88.2%; Hispanic/Latino/Spanish Origin (H/L/SO): +70.9%; Native Hawaiian/Other Pacific Islander (NH/OPI): +36.8%; White: +16.7%; Other: +29.3%. The percentage change from 2014 to 2022 for RA amongst these groups was: AI/AN: +58.4%; Asian: +40.0%; B/AA: +73.4%; H/L/SO: +50.8%; NH/OPI: +68.2%; White: +13.0%; Other: +7.9%. 

Towards the end of the reporting period, there are similar upward trends for FTA who identified as Asian, B/AA, H/L/SO, and White. This was not seen for the FTA amongst other racial/ethnic categories, which were relatively stable over time (AI/AN, NH/OPI, Other). When examining RA, there is a similar upward trend towards the end of the reporting period among those who identified as Asian, B/AA, and White. There was no upward trend amongst those who identified as H/L/SO even though there was an increase in applicants. The other groups trended stable over time (AI/AN, H/L/SO, NH/OPI, Other). 

Conclusion 

Racial/Ethnic disparities persist among reapplicants to medical school. Without remediation, this concerning gap will continue to result in lower numbers of H/L/SO matriculants, who are key to creating diverse, equitable, and inclusionary systems of health care. Future research should use qualitative methods to explore barriers to and reasons for not reapplying, as well as include a larger number of schools across geographical regions. Future studies should also include focus on interventions to improve opportunities for reapplicants to be admitted to medical school successfully.

An Analysis of U.S.Medical School Re-Applicants by Race/Ethnicity

Background: Given the increasing impact artificial intelligence (AI) has in the field of medicine, physician leaders have called for AI education in medical training, even at the undergraduate medical education level. This study aims to assess the perceptions of US medical students on AI in medicine and to survey the most preferred teaching methods and AI topics. 

Methods: A mixed-methods survey was sent to all 169 US MD/DO schools asking for help with survey distribution in May 2021. Thirteen 5-point Likert scale questions assessed the perceptions of medical students about AI in medicine. We also asked how many hours students want to spend learning about AI per month. Next, we asked students to select their preferred learning modalities and AI topics. Finally, we included a free response section to capture any additional thoughts. 

Results 390 medical students (age: 26 ± 3) from 17 US medical schools participated in the survey. 351 (90%) agreed that “AI will take a significant role in medicine” and 347 (89%) “want to learn what medical students should know about AI.” Furthermore, only 60 (16%) agreed that learning about AI will significantly detract themselves from the existing medical school curriculum. 197 (52%) chose to spend 1-2 hours per month to learn about AI, while 123 (33%) chose 3+ hours. Despite this, only 34 (9%) said that their school has opportunities to learn about AI. Considering this knowledge, the most popular learning modalities students preferred were short lectures (264, 70%), preclinical electives (180, 48%), and Q&A panels (167, 44%). The three most popular AI topics are fundamental concepts of AI (247, 65%), when to use AI (227, 60%), and the pros and cons of AI (224, 59%). Also, 23 free text responses were received with a mix of opinions on the extreme ends. 

Conclusion: US medical students understand and are excited for the potential impact of AI in medicine. Current resources on AI are insufficient in medical school curriculums. Formal curricular offerings on the basics and the clinical utility of AI are good first steps to teach medical students about AI.

Artificial Intelligence Education in Medical School: What do Students Want to Know?

Background
One of the manifestations of the long-standing call for increased diversity and recruitment of underrepresented racial/ethnic minorities in medicine (URMiMs) are pre-medical pathway programs. One such program is the Bridge to Medicine (BTM) program, which boosts knowledge in healthcare careers and provides academic resources to URMiM high school students (HSS). While other pathway programs have demonstrated efficacy in promoting career awareness and equipping students with professional developmental skills, there are fewer programs and studies that evaluate the impact of these programs on students’ career-related perceptions and interests. Our study hypothesized that the BTM program would improve measures of career certainty and decision among URMiM HSS.
Methods
Career perceptions and interests in the STEMM field were evaluated using the Career Decision Scale (CDS), Career Thoughts Inventory (CTI), STEM Semantics Survey, and STEM Career Interest Survey (STEM CIS). Correlational analyses and MANOVAs were performed to evaluate differences between scores of career indecision and uncertainty across demographic variables.
Results
Correlational analyses and descriptive statistics revealed short-term successes in improving career certainty and decision. However, MANOVA’s revealed differences in race, gender, and grade level post participation in the BTM program.
Conclusion
Various measures of career certainty and decision CTI and CDS subscales highlighted significant changes in student career perceptions from the start to the end of the BTM program with an overall increase in career interest and certainty and decrease in career indecision by the end of the BTM program. Significant differences in CTI CA scores across racial/ethnic groups highlight the discrepancy in career uncertainty within students of racial/ethnic minority groups and the lack of consideration of systemic barriers that likely underlie these differences in career perceptions. 


Assessment of Career Perceptions and Beliefs among Racial/Ethnic Minority Pre-Medical High School Pathway Program Participants

Barriers to Providing Obstetrical Care for Refugees: A Single Institution Experience

Background
Key elements necessary in contemporary health professions education to align training with demands of the evolving health care system include: 1) interprofessional practice opportunities, 2) service learning, 3) opportunity for longitudinal care and chronic disease management, and 4) quality improvement training. While interprofessional education and patient centered medical homes (PCMH) are a focus for academic medical centers, meaningful multidisciplinary practice experiences with continuity are elusive due to challenging logistics, funding, and faculty incentive alignment. 

Methods
Leveraging partnerships with our academic health system and community partners, we developed an interprofessional clinic at the university affiliated student-run free clinic. Sustainability is achieved through the development of the Interprofessional Continuity of Practice Experience (ICOPE), which is a longitudinal program aimed at establishing an educational home for students providing care in a PCMH to individuals with complex medical and social needs. Students participate on a team in an interprofessional, outpatient, service-learning experience managing patient panels. Partnering with the academic enterprise and incorporating ICOPE into each program’s core curriculum facilitated support for faculty teaching time. Administrators appreciate the innovative concept of value-added medical education whereby students provide value and capacity to the health system through educational activities.

Students are assigned to one of five clinics for the academic year. Faculty mentors from Clinical Laboratory Sciences, Dietetics, Occupational Therapy, Pharmacy, Respiratory Care, the Schools of Medicine and Nursing, and Social Work partner with students to care for uninsured patients. Pre-clinic huddles create space for interdisciplinary collaboration and workshops facilitated by faculty members introduce students to key concepts like social determinants of health and provider wellness.

Results
In its first year of operation, ten interprofessional faculty and over 40 students provided free care to approximately 35 uninsured patients per clinic session. With the university’s support, ICOPE will engage over three times as many students in year two. This interprofessional experience provides longitudinal, chronic disease management in an outpatient setting while students establish relationships with patients, peers, and mentors from multiple disciplines.

Conclusions
The ICOPE program embeds students in a service-learning, interprofessional patient-centered medical and educational home through the deployment of value-added educational principles and innovative partnerships.


Building an Interprofessional Practice and Educational Experience to Provide Care to the Uninsured

Introduction: Needs assessment approaches are evolving to operationalize diversity, equity, and inclusion (DEI) climate and gaps in academic medicine. While efforts to address gaps exist at the level of residency training, validated institutional tools to identify areas for improvement may not capture the unique nature of individual clinical learning environments. Our goal was to create a targeted survey using eight DEI constructs outlined by the Association of American Medical Colleges.

Methods: We developed under IRB exemption a survey containing 25 questions scored on a 7-point Likert scale (7=strongly agree to 1=strongly disagree) and two free text response questions. Respondents could indicate inability to evaluate an item (4=neither agree nor disagree). After a DEI principles lecture, residents were invited to voluntarily complete an anonymous survey which only requested training level and gender preference. Survey was disseminated online using Survey Monkey. Item response across PGY status and gender preference was assessed using Chi Square with 2-sided p-value Bonferroni corrected respectively at .017 and .05. Association of item responses within each construct (internal validity) was assessed using Cronbach alpha. Variance in construct explained by item response (construct validity) was quantified as R2 (fractional proportion) computed using confirmatory factor analysis. Positive sentiment was quantified (%) using aggregated “strongly agree,” “agree,” or “somewhat agree” responses. Free text responses underwent parsing and filtering. Statistical analyses were performed using JMP Pro 16.2 (SAS, Cary, NC).

Results: Among 38 resident physicians, 32 (84%) completed the survey distributed across PGY-1 (6 females, 7 males), PGY-2 (4 females, 5 males) and PGY-3 (3 females, 6 males). One resident didn’t indicate PGY status or gender preference. Item response analyses revealed positive sentiment, internal validity and average construct validity respectively within DEI constructs “common purpose” (94%, 0.89, 0.95); “Access to opportunities (90%, 0.63, 0.80); “cultural competence” (85%, 0.43, 0.76); “trust” (87%, 0.59, 0.89); “state of belonging” (89%, 0.73, 0.84); “appreciation of individual attributes” (93%, 0.28, 0.74); and “respect” (93%, 0.56, 0.76). “Equitable rewards and recognition” construct included a single question with favorable sentiment of 78%. Overall positive sentiment was 89% with Cronbach alpha and R2 respectfully ranging from 0.74 to 0.95 and R2 0.13 to 0.96. Text mentions corroborated item responses regarding favorable diversity with some gaps in equity and inclusion. 

Conclusion: Approaches to improve DEI within residency training should be tailored to characterize context specific sentiment that operationalizes needs to be improved.

Development and Design of an Assessment Tool to Improve Diversity, Equity and Inclusion in Graduate Medical Education

Background: Finances, time, transportation, connections, and confidence are just a few of the barriers to becoming a doctor. PhysioCamp is a nonprofit that aims to address these barriers and provide resources to foster future healthcare workers within three groups: K-12; undergraduate; and graduate students. 

Methods: PhysioCamp has held hundreds of hours of K-12 sessions, including virtual discussions on healthcare topics and in-person hands-on activities with anatomic models, preserved donor organs, and simulation equipment. Pre-health undergraduates took on volunteer roles or additional responsibilities as year round virtual interns. The role of graduate students included leadership of the sessions and oversight of volunteers and interns. For the past five years, medical students have worked with PhysioCamp to ensure continuity of leadership and partnership within the local Greenville, NC community. First and second year medical students lead in-person sessions, and transition to virtual leadership in third and fourth years of schooling.

Results: Periodic assessments of K-12 students, parents, and volunteers are performed to audit the impact of sessions. Results from K-12 student and parent surveys showed increased interests in the healthcare field, exposure to unfamiliar healthcare topics, and knowledge of making healthy foods and exercise choices. Survey results from undergraduate and graduate volunteers highlighted the importance of small group learning and hands-on activities to the success of the sessions.
The internship program was added in 2019 to aid in long term retention and mentoring of pre-health students. Since the start of the program, 99 interns have been onboarded, 67 of whom are still active within PhysioCamp. Interns reported they valued mentoring, advising and unique interactions with medical students. Many interns have now entered graduate school in healthcare fields, such as physician assistant and medical school.

Conclusion: Promoting early interest and mentorship contribute to a student’s academic success and career path. PhysioCamp provides longitudinal exposure to health science education from kindergarten to graduate school. Interns and graduate students also gain experience in leadership and mentorship. Sessions are a beneficial resource to the community and act as a place for K-12 students and undergraduate interns to cultivate their academic interests with mentors in the field.

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