41. Advancing Innovation in Medicine: Expanding the Physician’s Toolbox (02:54)

Date:
2021-04-22
Main contributors:
Guckien, Zoe, Woloshuk, Andre, Patel, Neal, Sivaprakasam, Andrew, Warrick, Adam, Garcia, Luis
Summary:
Introduction/Background: Health care professionals and health professions students are at the forefront of patient care and therefore witness patients’ unmet clinical needs on a daily basis. However, health professionals and students often lack the tools, training, or opportunity to solve these problems. Medical education rightfully prepares medical students to be skillful clinicians, but lacks curriculum to foster entrepreneurial and innovative skill sets that are increasingly important in the evolving medical landscape. Study Objective: The Advancing Innovation In Medicine (AIM) student group was founded with the goal of providing an outlet for students with an interest in medical innovation to gain hands-on experience for future careers as physician-innovators. Methods: AIM uses a two-fold approach to engage its members, including yearly longitudinal innovation projects and instructional workshops. Longitudinal innovation projects are intended to develop skill sets in 1) problem identification 2) brainstorming/ideation 3) idea validation and 4) prototyping. Instructional workshops are planned to provide students with complementary, practical knowledge to support future ventures in topics such as circuit analysis, 3D printing, intellectual property, customer discovery, and career development. Results: Innovation projects allow for interactive collaboration on real-world health care problems identified through AIM members and physician partners at IUSM. In the 2019-2020 academic year, AIM members ideated, prototyped, and presented a neonatal resuscitation device to address inefficiency and design flaws in currently available technology. Example past instructional sessions include 3D printing and circuit analysis workshops to build skills directly applicable to longitudinal projects. Additional workshops in topics such as an entrepreneurial careers in medicine panel and a how-to-brainstorm seminar were conducted to prepare members for their future careers. Conclusions: By engaging students in this innovation-centered curriculum, AIM’s goal is to empower its members to address health care problems at early stages in their careers and use their passion and curiosity to impact the future of health care. In the future, AIM hopes to form partnerships with academic and healthcare institutions across Indiana to create multi-disciplinary student design teams to tackle health care problems and foster innovative thinking within medical education.

43. 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.

44. 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.

45. 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.

46. 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.

49. 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.

50. 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.

51. 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.

53. Metacognition in the Middle: Mismatch between Anticipated and Actual Exam Grades of Allied Health... (03:00)

Date:
2021-04-22
Main contributors:
Cale, Andrew, McNulty, Margaret
Summary:
Introduction: Accurate evaluation of one’s knowledge and performance is a key metacognitive skill critical to success in the classroom. Students who lack this skill may over-estimate their knowledge and under-prepare for exams, resulting in poor academic performance. Therefore, the purpose of this study was to assess the ability of allied health students to evaluate their exam performance in an anatomy course to identify which groups, if any, need support with this skill. Methods: In an IRB-approved study, first-year physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students (n=129) participated in a doctoral-level anatomy course. This course covered human anatomy through asynchronous lectures and synchronous virtual labs (due to COVID). Students’ anatomical knowledge was assessed via four exams throughout the course. Prior to the start of the course and again at the end, students were invited to complete a de-identified pre-survey including the Metacognitive Awareness Inventory (MAI), a 52-item survey that assesses metacognition. Throughout the course, students were asked to reflect on their exam performances (anticipated grade, actual grade, and satisfaction) using a modified Likert scale. For analyses, students were divided into terciles based on their mean combined exam performance. Reflections and MAI scores were then compared across terciles in SPSS using Kruskal-Wallis H test. Results: Average exam scores of high (93%±2.0), middle (86%±2.7), and low-performers (74%±4.6) were significantly different from each other (p<0.01). A total of113 (88%) and 59 (46%) students completed the pre- and post-surveys, respectively, resulting in 52 matched pairs (40%). Overall, students significantly improved their metacognition (p<0.01). Reflection participation ranged from 67% to 97%. When asked how their actual grade measured against their anticipated grade, high- and middle-performers’ anticipated grades were similar to each other but significantly higher than those of low-performers (p<0.01 for three exams). High-performers reported significantly greater exam satisfaction than middle- and low-performers on two exams (p<0.01). The performance terciles scored similarly across all metacognition subcategories in the post-survey except declarative knowledge, the factual knowledge of structures and concepts that provides the foundation for higher-order thinking (p=0.01). Conclusion: In this study, middle-performers appear to have the greatest mismatch between their anticipated grade, actual grade, and exam satisfaction when compared to high- and low-performers. These students anticipate strong exam performances, but appear to fall short, leaving them less satisfied. This metacognitive disconnect may be related to how students evaluate their knowledge. Students seem to evaluate their progress based on their declarative knowledge, which may not accurately represent their ability to apply that knowledge. Significance: Metacognitive activities that improve student self-evaluation skills should be implemented in anatomy courses to minimize the metacognitive disconnect between anticipated and actual exam performance.

54. MS4 Satisfaction with an Online Ultrasound Elective as an Alternative to Clinical Experience (02:36)

Date:
2021-04-22
Main contributors:
Shanks, Anthony, Baugh, Kyle, Darwish, Audrey, Sharifi, Mitra, Rouse, Caroline
Summary:
Introduction/Background: A fourth year (MS4) elective in OBGYN Ultrasound has traditionally been offered as a month-long rotation. MS4 students shadow Maternal-Fetal Medicine physicians and enhance knowledge with clinical exposure. Historically, the rotation provides adequate understanding of US in pregnancy. However, the COVID pandemic forced clinical experience to be replaced with virtual learning. To ensure MS4 students still had an opportunity to learn about US in pregnancy, a virtual, online curriculum was created. Using Kern’s six-step approach to curriculum, we developed a month-long OBGYN US virtual experience to replace clinical interaction. It is unclear if this transition was associated with high MS4 satisfaction. Study Objective/Hypothesis: To determine if converting a traditional hands-on ultrasound (US) elective to an online course for MS4 students was associated with course satisfaction. Methods: Kern’s six-step approach to curriculum building was utilized to create a virtual course in US for MS4 students. This online course was created in Canvas based on US Milestones in the Residency Training Program Consensus Report (Abuhamad 2018). Self-directed modules and quizzes were created and administered weekly. Additionally, a weekly hour-long session using Nearpod technology – an interactive online website – was utilized to enhance instruction. Students completed an anonymous survey on Qualtrics at the completion of the elective. Satisfaction on a Likert scale of 1-7 was reported. Descriptive analysis and ANOVA were used when appropriate with SPSS 27. Results: Nine MS4 students completed the course from May-July, 2020. Satisfaction was high for the course overall (mean 6.11, SD 1.96). Nearpod lecture (6.89, 0.31), Canvas modules (6.7, 0.47), and weekly quizzes (6.78, 0.42) were all rated highly with no statistically significant difference between the methods of instruction. Formative feedback from participants found the course material and Nearpod highly engaging. More students were able to complete the virtual class (9) compared to historical attendance of one student per month (3). Conclusions: An online US elective was associated with high satisfaction from participants. The course served as an adequate substitute for participants during COVID restrictions and allowed for greater enrollment. Future directions include integrating this online module with in-person clinical experience.

56. Realistic Implementation of Metacognitive Activities in an Allied Health Anatomy Course (02:57)

Date:
2021-04-22
Main contributors:
Cale, Andrew, McNulty, Margaret
Summary:
Introduction: Metacognition, the ability to plan, monitor, and assess one’s understanding and performance, has been shown to improve student learning outcomes. Anatomy is often recognized as one of the toughest courses in professional health care curricula, and students enrolled in such courses could potentially benefit from metacognitive activities. Therefore, the purpose of this study was to explore the changes in metacognition of allied health students as they progress through a gross anatomy course. Methods: First-year physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students (n=129) participating in a doctoral-level anatomy course were invited to participate in this IRB-approved study. The course was conducted entirely online due to COVID and consisted of asynchronous lectures and virtual synchronous laboratory sessions. Students’ anatomical knowledge was assessed with four exams. At the beginning and end of the course, students were invited to complete a de-identified pre-/post-survey including the Metacognitive Awareness Inventory (MAI), a 52-item survey that assesses metacognition. Pre- and post-MAI scores were analyzed in SPSS using Spearman’s rho, Wilcoxon Signed Rank, and Kruskal-Wallis H tests. Throughout the course, students were then asked to participate in reflective discussion boards to encourage development of metacognitive skills. Topics included study strategies, comprehension monitoring, exam reflections, and advice for future students. Discussion board posts were thematically analyzed by two researchers, with coding disagreements discussed to consensus. Results: A total of 113 (88%) and 59 (46%) students completed the pre- and post-surveys, respectively, resulting in 52 matched pairs (40%). As a whole, students significantly increased their metacognition scores after completion of the course (p<0.01). Several specific findings were noted, for example that PA students were found to monitor their learning less frequently compared to PTs and OTs (p=0.03). Discussion board participation ranged from 97% to 22%, with a steady decline over time. Qualitative analysis of discussion board posts revealed students reported changing their study strategies the most between Exams 1 and 2, after which they relied on existing strategies. Students frequently cited time constraints, time management, and volume of material as major factors that made anatomy difficult to learn. Indeed, students understood the educational value of the discussion boards but chose not to participate to prioritize studying the course content. Conclusion: Overall, students were more receptive to metacognitive activities and modifying study strategies early in the course. As time progressed, receptiveness decreased, mainly due to time constraints. At this point, students tended to “double-down” on strategies that worked previously rather than continuously monitor and modify their approach to studying. Significance: To maximize effectiveness, metacognitive activities peripheral to the course content should be positioned early in the course when students are more receptive. Students will then be well-equipped to learn but can focus their limited time on course content.

58. Running a Race Without a Finish Line: COVID-19's Impact on Medical Student’s STEP 1 Experience (02:59)

Date:
2021-04-22
Main contributors:
Blaettner, Bianca S., Hoffman, Leslie A.
Summary:
Background: The USMLE STEP 1 exam is the first of three licensure examinations required to practice medicine in the United States. Typically taken in the spring of the second year of medical school, IUSM provides a six-week dedicated period, from late February to early April, for students to prepare for and complete STEP 1. However, on March 17, 2020, testing centers closed nationally as a result of the COVID-19 pandemic with no timeline for reopening. Study objective: The purpose of this study is to examine the impact that the COVID-19 pandemic and closure of testing centers had on IUSM students’ preparation for and performance on STEP 1. Methods: In fall 2020, a link to an anonymous Qualtrics survey was distributed to IUSM’s class of 2022 via the student newsletter. The survey asked students to report their stress levels prior to and after the closure of testing centers, and how they perceived that the postponement of their exam affected their STEP 1 performance. Official STEP scores were obtained from IUSM administration for the Class of 2021 and 2022 to compare average exam performance between the two years. Students were also asked open-ended questions about their concerns and anxieties regarding STEP 1 before and after the COVID-19 pandemic caused testing centers to close. Responses to open-ended questions were qualitatively analyzed to identify relevant themes. Results: We received 167 complete survey responses. Most students (78%) indicated that their stress levels increased after testing centers closed. Despite the increased stress levels, there was no significant difference between the average STEP 1 scores of students in the Class of 2022 (mean =234.4), who were impacted by the testing center closures, versus the prior year (mean=231.7; p>0.05). Students’ perceptions of their performance revealed that 41% (n=62) performed as expected on STEP 1, while 25% (n=38) reported scoring higher than expected, and 34% (n=52) scored lower than expected. Qualitative analysis of open-ended responses revealed that prior to COVID-19, students were most concerned about their STEP 1 score and its impact on residency options. Additionally, students were concerned with retaining the vast amounts of information and having enough time to study. After the testing center closures, concerns shifted towards a sense of uncertainty and the feeling of missing “peak” exam preparedness. Students also noted increasing burnout and difficulty maintaining motivation to study. Conclusions: Medical students who took STEP 1 during 2020 had a unique and unforgettable experience due to the COVID-19 pandemic. Students’ concerns and sources of anxiety shifted from receiving a competitive score to a sense of uncertainty and increasing burnout. Our findings indicate that COVID-19 did not negatively impact students’ STEP 1 performance compared to the prior year; however, our qualitative analysis suggests that COVID-19 had a negative impact on student's mental health and well-being, resulting in students entering their clinical rotations in a state of burnout and exhaustion. Further study is needed to determine the long-term impact of COVID-19 as these students complete their clinical rotations.