42. An Investigation of the Metacognitive Awareness of Postbaccalaureate Premedical Students at India... (02:58)

Date:
2021-04-22
Main contributors:
Craven, Da'Quan, Byram, Jessica
Summary:
Background and Aims: Medical school curriculum is tasked with producing lifelong self-directed learners, a set of characteristics requiring strong metacognitive skills. Metacognitive skills directly impact students’ metacognition, which is their ability to understand and regulate their own thinking and learning. It may then be postulated that metacognition may be key in distinguishing students that require a post-baccalaureate program from those that do not. Metacognition has two critical domains: metacognitive knowledge and metacognitive regulation, each of which contain multiple subprocesses. Metacognitive knowledge includes knowing strategies for learning, when to use those strategies, and knowing oneself as a learner. Metacognitive regulation includes strategies for planning, monitoring, evaluating, and debugging learning strategies. Therefore, the purpose of this study is to investigate: 1) the impact of a graduate Team-Based Learning (TBL) course on students’ metacognitive awareness, and 2) the relationship between metacognition and course performance. Methods: Students enrolled in a TBL graduate histology course at Indiana University took part in this study. Students completed a 19-item Metacognitive Awareness Inventory (MAI) at the beginning (MAI1) and end of the semester (MAI2). The MAI has two domains, Knowledge (8 items) and Regulation (11 items), where items are rated on a 5-point scale from “not at all typical of me” to “very typical of me.” Free response questions asked about knowledge and study abilities, plans for studying in histology and how study skills and abilities have improved across the semester. Finally, students completed a voluntary reflection about their examination performance after the first unit exam. Differences between MAIs were investigated using a Wilcoxon signed-rank test. Spearman's correlations explored the relationship between MAI and final course grades. MAI free responses and exam reflection were analyzed using thematic analysis. Responses were coded using a conceptual framework of metacognition based on processes of knowledge and regulation. Results: Thirty-one (94%) students completed both MAIs. There were no differences between MAI1 and MAI2 scores and there was no relationship between MAI1 or MAI2 and final course grades. The Wilcoxon test demonstrated a significant difference between the Knowledge and Regulation domains for MAI1 (p=0.002) and MAI2 (p=0.001) where students reported the items in the Knowledge domain were more typical of them than items in the Regulation domain. There were no differences across the domains between the two time points. Students reported initial hesitation and difficulty with learning histology content in a lecture-free, flipped classroom approach. Students discussed plans for approaching studying, but many reported modifying study strategies throughout the semester. However, few students discussed active learning strategies that would allow them to evaluate and assess their knowledge prior to assessments. Conclusion: While the MAI failed to demonstrate any improvement in metacognition, students reported an increase in their ability to adapt their study strategies to the content and learning materials. Differences in knowledge of cognition and regulation suggests educators in TBL classrooms may need to provide students with additional resources and strategies to regulate their learning. Future studies aim to investigate the validity of the MAI for measuring metacognition in anatomy courses.

43. An Online Bootcamp Improved MS4 Confidence in Ultrasound Performance (02:52)

Date:
2021-04-22
Main contributors:
Shanks, Anthony, Darwish, Audrey, Sharifi, Mitra, Rouse, Caroline
Summary:
Introduction/ Background: Bootcamps serve to prepare graduating medical (MS4) students with specialty-specific skills for residency. The knowledge and confidence to perform common tasks can ease the transition from student to intern. In the specialty of Obstetrics and Gynecology, there are recommended ultrasound (US) milestones for Level 1 to Level 4 residents. A goal of a preparatory bootcamp is to provide skills and confidence to perform at Level 1 on Day 1 of residency. Traditionally bootcamps have occurred in person, however the COVID pandemic forced a pivot from in-person US training to online interactive didactic sessions. It is unclear if the online didactics are as effective as in-person simulation in developing confidence in US training for future OBGYNs. Study Objective: Our objective was to determine if our interactive, online US bootcamp was as effective as in person training in developing confidence in graduating medical students entering into OBGYN residency. Our hypothesis is that in-person training will be more effective in developing confidence in these tasks. Methods: A two hour lecture provided by Maternal-Fetal Medicine faculty was developed based on US Milestones in the Residency Training Program Consensus Report (Abuhamad 2018). The lecture utilized Nearpod, an interactive online software, and was delivered via Zoom. Thirteen MS4 students completed an anonymous survey on their ability to obtain images based on US Milestones following completion of the lecture. Self-reported confidence on a Likert scale (1-10: 1-3 if unable to obtain to images, 4-6 acquisition with assistance and 7-10 able to obtain and interpret) was reported. Mean scores were calculated for MS4 students for each US milestone. MS4 confidence was compared to PGY1 resident confidence 6 months into their intern year. PGY1 residents all underwent in person simulation training and didactic training from the same MFM faculty that provided the bootcamp. PGY1 residents underwent the same survey as MS4 and descriptive analysis and independent t test were performed with SPSS 27. Results: 13 MS4 students took part in the curriculum and all completed the post course survey. 5 MS4 students had taken an US elective prior to the bootcamp. Confidence was highest for fetal presentation (mean 7.6) and amniotic fluid (5.8). Confidence was moderate for the components of a growth US (biparietal diameter 6.1, abdominal circumference 5.7, femur length 5.7). There was no overall difference in confidence between MS4 students who completed an additional US elective compared to those who did not. Eight PGY1 interns completed the confidence survey. MS4 students who completed the online bootcamp had a slightly higher mean confidence level (5.1) as compared to PGY1 at the 6 month mark of their training (4.5, p 0.049). Conclusions: An interactive, online didactic US curriculum was associated with increased confidence in MS4 students as compared to PGY1 residents. Our findings provide reassurance that an interactive, online resource can be an efficacious way to provide instruction on traditionally hands-on skills. Future directions will include a blend of interactive, online didactics with US-simulation to improve bootcamp training.

44. Barriers in LGBT Health Education: Assessing Medical Student Willingness to Inquire About Sexual,... (02:52)

Date:
2021-04-22
Main contributors:
Newsom, Keeley D., Carter, Gregory A., Hille, Jessica J.
Summary:
Background: In order to address LGBT+ health disparities, a growing number of medical schools are implementing preclinical training on inquiring about the sexual orientation (SO) and gender identity (GI) of patients. It has been suggested by the Institute of Medicine that consistently inquiring about and documenting SOGI data in electronic medical records will both provide more accurate epidemiological data and allow for more patient-centered care, thus improving the health of gender and sexual minorities. Objective: Currently unknown is whether current curricular strategies used to teach medical students to inquire about and document SOGI are effective as students progress through their training and prepare to enter residency. Methods: An online survey was made available to second-, third-, and fourth-year medical students (MS2, MS3, and MS4, respectively) at a large Midwestern medical school. Respondents were asked whether they consistently inquired about the SOGI of their patients. For those that indicated they do not ask about SOGI, we asked for reasons they did not ask. Frequency of asking about SOGI and reasons for not asking were analyzed using chi-square analyses as a function of year in training. Results: 364 respondents completed the survey. Frequency of asking about SO significantly decreases each year of training (MS2, 92.8%; MS3, 82.2%: and MS4, 52.7%), and frequency of asking about GI significantly decreases after the second year of training (MS2, 69.9%; MS3, 40.6%; and MS4,26.4%). Reasons that significantly increase as training progresses include believing SOGI is irrelevant to encounters, limiting inquiring to patients with sexual health complaints only, and negative influence from their attendings. Conclusion: As medical students progress into the clinical years of their training, they are less likely to continue asking their patients about SOGI and more likely to cite negative influence from their attending and question the relevance of obtaining SOGI from their patient. This study suggests that medical institutions should consider extending LGBT+ health discussion into clinical years and including attending physicians in these discussions.

45. COVID-19: Rural vs. Urban Knowledge and Actions (02:56)

Date:
2021-04-22
Main contributors:
Shanks, Anthony, Miller, Reese, Swiezy, Sarah
Summary:
Introduction: COVID-19 is unique in that it has been the first global pandemic to occur in the context of a public media and social media environment that is more sprawling and vast than ever. Throughout the pandemic, people have craved continuous updates--seeking information and advice to stay safe. The combination of large, wide-reaching media networks, demand for news, and the nebulous and ever-changing nature of COVID-19 has created a vacuum for information and misinformation alike to get sucked into TV news stories, Facebook posts, twitter feeds, and web pages the world over. We want to know how this information is being processed, internalized, and turned into actions in the US communities that it is reaching. Nearly 60 million Americans live in rural areas (compared to 250 million urban-dwelling Americans). Rural Americans are a significant minority that is chronically under-studied and burdened with the weight of other peoples’ stereotypes. While we know that urban and rural communities tend to seek different sources of information and oftentimes have polarizing worldviews, it is imperative, in this time in which we all must work closely together to stem the spread of COVID-19, that we understand the similarities and differences in the ways that urban and rural individuals seek, understand, and implement health-related information. Study Objective/Hypothesis: We will answer the following questions: Are there differences in the types of sources that rural vs. urban individuals are using to gather their COVID-19 information? And, in what way is the information that these communities receive being translated into actions to keep themselves healthy and stop the transmission of the virus? We hypothesize that rural and urban individuals obtain their health information from different sources. We hypothesize that the health-related behaviors an individual has taken during the pandemic (such as quarantining, wearing a mask, washing hands more often) is directly related to the source of information he/she trusts, and therefore, will be different among rural vs. urban individuals. Methods: Our study employs a survey disseminated via Qualtrics at family practice clinics in rural and urban areas of Indiana. Through a microresearch grant from Rural PREP we are able to offer participants $5 gift cards for answering questions about the sources they use to get their health information, how much they trust those sources, and how their health behaviors have changed since the pandemic began.  Results: Data collection began in Feb. 2021 and is ongoing Conclusions: Rural and urban communities and individuals function in mostly separate spheres, despite the substantial interconnectedness of modern public and social media. In order to work together, we must construct studies to understand these differences. Our public health campaigns and education cannot afford to disregard rural communities due to lack of understanding of their unique cultures and differences from urban communities. Our lives literally depend on providing accurate, focused, and targeted information to all Americans. To do this, we must know about and leverage trusted sources in individual communities to provide up-to-date, scientific information and to correct misconceptions wherever they exist.

48. Increasing Early Exposure to Laparoscopy: A Cost-Effective Trainer Designed for Medical Students (02:46)

Date:
2021-04-22
Main contributors:
Cross-Najafi, Arthur , Athanasiadis, Dimitrios, Stefanidis, Dimitrios
Summary:
Increasing Early Exposure to Laparoscopy: A Cost-Effective Trainer Designed for Medical Students Intro: Previous studies have shown that exposing medical students to laparoscopy early in their training may inspire them to pursue a surgical career. Commercial laparoscopic trainers provide robust training platforms for surgical residents but are expensive and not easily available to medical students who wish to become familiar with laparoscopic surgery techniques such as through Fundamentals of Laparoscopic Surgery (FLS). In this study we assessed the feasibility of constructing an inexpensive, easily reproducible laparoscopic trainer to train medical students to proficiency in FLS. Methods: Construction materials for the trainers were readily available at common retail stores. The box component of this trainer was produced using 1/2-inch and 3/4-inch plywood, 3/4-inch screws, Velcro, super glue, and Peltex Ultra Firm (c). The electronic components of this trainer included a 24-inch Dell monitor, HDMI to VGA adapter, Logitech C615 Portable Webcam, HDMI cord, and Dell Inspiron laptop. The proposed trainer does not include the laparoscopic instruments or task trainers. Power drill and saw are optimal for trainer construction. Cost calculation excludes laptop. Students were then trained to proficiency on FLS tasks using the laparoscopic trainers. Results: The complete laparoscopic trainer (including monitor) was produced for less than 300 dollars. We have produced 2 complete trainers on which 5 students were trained to proficiency in FLS. Feedback on the training experience from students was positive, with a slightly larger monitor cited as the main difference from the commercial trainer setup. Conclusion: The laparoscopic trainer described here was an effective tool for training medical students in FLS. Built with inexpensive, readily available construction materials and functionality for multiple training tasks, it is a highly cost-efficient approach to administering FLS training. Anticipated future applications for the trainer include implementation of surgical education research and expansion of medical student exposure to basic laparoscopy.

49. Integrating Cultural Humility into Safe Sleep Counseling: A Pediatric Resident Simulation (07:26)

Date:
2021-04-22
Main contributors:
Moore, Chelsea, Sui, Htayni, Scott, Emily, Byrne, Bobbi, McHenry, Megan
Summary:
Introduction: Co-sleeping is a common practice across cultures; however, this puts infants at risk for unintentional suffocation and sudden infant death syndrome. In the Burmese culture, co-sleeping is common and viewed as a way to strengthen family ties. Pediatricians often struggle to engage in patient-centered conversations about infant sleep practices with non-English speaking families. Cultural humility is a critical skill for physicians to utilize when approaching conversations with diverse patient populations. The focus of this study was to evaluate the effect of a patient simulation scenario on self-perceived cultural humility and preparedness to counsel on safe sleep across cultures in pediatric residents. Methods: In this cross-sectional study, second- and third-year pediatric residents at a large academic institution took part in a co-sleeping patient simulation. This simulation scenario was developed in partnership with a local Burmese refugee organization, a medical director of a large newborn unit, and an experienced simulation instructor. Qualitative interviewing performed among Burmese families with young children identified that infant sleep practice was a topic in which they experienced conflicts with their children’s physicians. The simulation scenario provided residents the opportunity to interact with a Burmese woman acting as the mother of an infant who practiced co-sleeping. The Multidimensional Cultural Humility Scale (MCHS) was administered to residents prior to and immediately after the simulation. The MCHS measures cultural humility using a 6-point Likert scale, ranging from 6 “strongly agree” to 1 “strongly disagree,” with an overall higher score indicating higher levels of cultural humility. Three items were reverse-coded. Additional questions regarding changes to knowledge and preparation in engaging in co-sleeping conversations across cultures were included. Quantitative data collected from the surveys were analyzed using descriptive statistics and paired t-tests. Free-text comments were reviewed. Results: Of the 57 second- and third- year eligible residents, all engaged with this study. Fifty residents completed both the pre-and post-session surveys, and 7 residents only completed the post-session survey. Overall, the mean score of the MCHS significantly increased after the simulation (mean of 66.78 vs 77.12; p-value<0.001), indicating an increase in cultural humility. After participating in this scenario, all participants agreed that they felt being more prepared to have conversations about co-sleeping, with 51% (28/56) strongly agreeing with this statement. Also, all participants agreed that they felt more prepared to engage in difficult conversations with a diverse patient population and all agreed that they learned valuable skills to improve care for future patients, with 27% and 32%, respectively, strongly agreeing with these statements. Comments regarding the scenario noted an appreciation for learning more about the Burmese population and understanding new approaches for safe sleep counseling. Discussion: After participating in this patient simulated scenario, cultural humility increased in pediatric residents. All residents reported feeling better prepared to counsel on co-sleeping because of this scenario, as well as learning skills to engage in difficult conversations with diverse patient populations. Topics such as cultural humility can be incorporated into simulation-based medical education to help improve care in diverse patient populations.

50. Investigating the Prevalence of Impostor Phenomenon in Medical Students (02:59)

Date:
2021-04-22
Main contributors:
Henninger, Lauren, Lewellen, Courtney, Richey, Kristin
Summary:
Advising high-ability students facing Imposter Syndrome/Phenomenon (IS/IP) requires a special skill set. As undergraduates, high-ability students may feel like the big fish in a small pond. When they enter medical school, they are suddenly an "average" sized fish. This transition can create an identity crisis as students "lose" part of who they were and might fear that someone will discover their secret. The Lead Advisors and Learning Strategist at the IU School of Medicine have developed, implemented, and improved their strategy focused on building connection through belonging and reducing IS to best work with these students. In this presentation, we will focus on the transition our students encounter entering a new arena and the obstacles they may face for the first time. The literature demonstrates that imposterism can impact student wellbeing and rate of burnout.