Feasibility of a Vertically Integrated Teaching Strategy during a Surgical Clerkship Event—Learning Methods Matter

Sound foundational knowledge improves disease conceptualization and clinical diagnosis. Vertical integration (VI) is an appealing educational strategy to refresh relevant pre-clinical information during clinical rotations. However, an optimal learning approach for this has not yet been established. We hypothesized that a small group collaborative discussion format might serve as an appealing learning method to deliver integrated material and increase retention. During AYs 2018/2019 and 2019/2020, our multidisciplinary team utilized a Colorectal Cancer workshop incorporating pre-clinical material for Y3 students on Surgical Clerkship. In search of an optimized way to deliver vertically integrated content, we alternately presented the workshop material either in a small group (SG) case-based collaborative format or as a standard-sized group (StdG) exercise. We achieved this by testing immediate and late (4-week post-event) recall and assessing student satisfaction with the VI strategy in both physical settings (StdG and SG). A total of 93% of participants considered VI-based training worthwhile, 96% reported an increased knowledge base and 93% would welcome similar VI events in the curriculum. Significantly more SG students than StdG (52% vs. 31%, p = 0.014) enthusiastically endorsed their event and would prefer to have future VI events delivered in the format they experienced (88% for SG vs. 42% for StdG) (p < 0.0001). Combined (immediate + late) recall scores were significantly better in SG versus StdG (p = 0.007), while the rate of attrition at 4 weeks did not differ significantly (p = 0.81). VI strategy successfully reactivated pre-clinical concepts, achieving both high content retention and learner satisfaction during this workshop. Students endorsed future VI events, especially when delivered in a case-based, interactive SG setting. Although resource intensive, a VI strategy employing a small-group collaborative learning method may be considered for broader curricular use in undergraduate medical education.

Competency-based time-variable training internationally: Ensuring practical next steps in the wake of the COVID-19 pandemic.

Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting time variability may be the largest hurdle to clear. Although it is true that an 'all or nothing' approach to CBTV training would require massive overhauls of both medical education and health care systems, the authors propose that training institutions should gradually evolve within their current environments to incrementally move toward the best version of CBTV training for learners, supervisors, and patients. In support of this evolution, the authors seek to demonstrate the feasibility of advancing toward the goal of realistic CBTV training by detailing examples of successful CBTV training and describing key features of initial steps toward CBTV training implementation.

The Clarion Call of the COVID-19 Pandemic: How Medical Education Can Mitigate Racial and Ethnic Disparities.

Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.