Effect of COVID-19 Curriculum Changes on Medical Student Exam Performance: A Case Series.

BACKGROUND: The COVID-19 pandemic caused medical schools to convert to an online format, necessitating a swift change in medical education delivery. New teaching methods were adapted, with some schools having greater success than others. Kirk Kerkorian School of Medicine (KSOM) employed a small-group interactive learning style that consists of eight or fewer medical students and one faculty mentor engaging in group problem-based learning (PBL) twice weekly. This style had clear signs of struggle with a significant decrease in exam performance. Rocky Vista University College of Osteopathic Medicine (RVUCOM) employed a large-group didactic lecture style that consisted of one faculty mentor lecturing hundreds of medical students in a pre-recorded setting five times weekly. This style had greater success with its curriculum adaptation leading to minimal effect on their exam performance. This study aims to investigate whether the type of medical school curriculum (small-group interactive vs. large-group didactic) impacts student exam performance during online learning transitions forced by the COVID-19 pandemic. METHODOLOGY: KSOM and RVUCOM students were grouped into above-expectations and below-expectations categories based on each institution's standardized exam performance metrics. Independently sampled t-tests were performed to compare groups. KSOM was classified as a small-group interactive curriculum through its heavy reliance on student-led PBL, whereas RVUCOM was classified as a large-group didactic curriculum through its extensive proctor-led slideshow lectures. RESULTS: KSOM's transition to online PBL resulted in fewer students scoring above the national average on the National Board of Medical Examiners (NBME) exams compared to previous cohorts (55% vs. 77%, respectively; N = 47 and 78; P < 0.01). RVUCOM's transition to online large-group lectures yielded no significant differences between students who performed above expectations and students who performed below expectations between their cohorts (63% vs. 65%, respectively; N = 305 and 300; P > 0.05). CONCLUSIONS: KSOM's COVID-19 cohort performed significantly worse than RVUCOM's COVID-19 cohort during their medical school organ-system exams. We believe that the small-group learning at KSOM is less resilient for online curricula compared to the large-group didactics seen at RVUCOM. Understanding which didactic methods can transition to online learning more effectively than others is vital in guiding effective curriculum adjustments as online delivery becomes more prominent.

Disadvantaged Students Utilize School Campus and Its Resources More Than Non-disadvantaged Students.

Introduction Disadvantaged populations were disproportionately affected by the COVID-19 pandemic, both in the medical and educational settings. Lower-income families often do not have a laptop/desktop computer, adequate internet connection, or a dedicated study space. This unfortunately contributed to poorer academic performance during distance learning. To combat this, the Kirk Kerkorian School of Medicine (KKSOM) did not close down campus during the pandemic. This study analyzes the utilization of campus and live Zoom lectures by KKSOM students and its impact on educational outcomes. Methods We sent an Institutional Review Board (IRB)-approved survey to KKSOM students and asked about study locations, Zoom lecture attendance, and relationship quality during the pandemic. The class of 2024 had a unique experience as they were first-year students during the start of the COVID-19 pandemic and the transition to online learning. However, they always had access to campus and technological resources. We compared the survey scores from a Qualtrics electronic survey and the National Board of Medical Examiners (NBME) scores of students who self-indicated disadvantaged status, first-generation, underrepresented minority, and lower socioeconomic status to those who did not meet these criteria. Data analysis was done using SPSS software version 28.0.1.1 (IBM Corp., Armonk, NY). Results  First-generation students studied on campus more frequently than their counterparts (31% versus 20%, p < 0.05) and less at home in general (55.4% versus 67.5%, p < 0.05). Lower socioeconomic status (SES) students attended live Zoom lectures more often as well (56.6% versus 43.1%, p < 0.05). Lastly, no significant differences were found between disadvantaged and non-disadvantaged groups for the class of 2024 in the NBME exam scores or relationship quality scores. Conclusion Our results suggest that students from disadvantaged backgrounds spend more time studying on campus than at home. Additionally, during the COVID-19 pandemic, they attended live Zoom lectures more often than their non-disadvantaged counterparts. Access to campus was not restricted for KKSOM students during the pandemic. This may be one explanation for the lack of disparity between disadvantaged and non-disadvantaged students with regard to academic performance and relationship quality. This makes a strong argument for the importance of campus accessibility for the success of students, especially those from disadvantaged backgrounds.

Exploring Anki Usage Among First-Year Medical Students During an Anatomy & Physiology Course: A Pilot Study.

Objectives: As medical schools worldwide condense the preclinical phase of medical education, it is increasingly important to identify resources that help medical students retain and employ the medical information. One popular tool among medical students is an application called Anki, a free and open-source flashcard program utilizing spaced repetition for quick and durable memorization. The purpose of this study is to determine how variable Anki usage among first-year medical students throughout a standardized anatomy and physiology course correlates with performance. Methods: We designed a novel Anki add-on called "Anki Stat Scraper" to collect data on first-year medical students at Kirk Kerkorian School of Medicine during their 8-week anatomy and physiology course. Anki users (N = 45) were separated into four groups: Heavy (N = 5), intermediate (N = 5), light (N = 16), and limited-Anki (N = 19) users, based on the time each student spent on the flashcard app, how many flashcards they studied per day, and how many days they used the app prior to their anatomy and physiology exam. A 14-question Likert scale questionnaire was administered to each participant to gauge their understanding of Anki and how they used the app to study. Results: Heavy and intermediate Anki users had higher average exam scores than their counterparts who did not use Anki as a study method. Average exam scores were 90.34%, 91.74%, 85.86%, and 87.75% for heavy, intermediate, light, and limited-Anki users respectively (p > 0.05). Our survey demonstrated that Anki users spent an average of 73.86% of their study time using Anki, compared to an average of 36.53% for limited-Anki users (p < 0.001). Conclusion: Anki users did not score significantly higher compared to limited-Anki users. However, survey responses from students believe that Anki may still be a useful educational tool for future medical students.

The Emotional Impact of Educational Productivity Videos on YouTube: A Global, Cross-Sectional Survey.

Introduction YouTube is the most popular video-sharing website, and many students use it as a resource to find educational content. One type of video category is "productivity," in which the creator teaches viewers how to lead a more productive lifestyle by sharing ways to maximize studying, reshape daily habits, or set achievable goals. Little research has been conducted on whether these videos actually promote positive or negative feelings among viewers. Methods A survey was created through Qualtrics and shared through YouTube and Instagram. The survey asked about exposure to productivity videos and also asked individuals to share their experiences with consuming productivity-related educational content on YouTube. Survey items asked students to rate the helpfulness of these videos and share their feelings about the content. Respondents were asked to share whether YouTube videos on productivity made them feel anxious, motivated, inspired, neutral/indifferent, or inadequate. Participants were also asked to rate how helpful they found productivity videos on YouTube (1-10, with 10 being most helpful). The survey included free response sections to assess viewers' perceptions and attitudes toward productivity videos. Results The cross-sectional survey amassed 595 responses across 60 countries, with 364 responses coming from individuals within the United States. Of the respondents, 397 of the respondents were female, 177 were male, and 21 preferred not to say or identified as non-binary. The average age of participants was 22 years; 79 were in high school, 174 were in college, 223 were in medical school, and the remainder identified as "other" (graduate school, gap year, etc.). Of the 595 completed responses, 494 reported watching videos on YouTube related to improving productivity; when asked how these videos made them feel, 127 participants answered "anxious," 357 answered "motivated," 308 answered "inspired," 95 answered "neutral/indifferent," and 97 answered "inadequate." When rating how helpful they found these videos (1-10), an average score of 6.8 was recorded. Conclusion Most viewers feel motivated or inspired by productivity videos on YouTube. Based on the free responses provided by survey participants, productivity videos can be made more effective by showing more relatable routines and demonstrating what viewers should do when goals are not met.

Medical Students' Socioeconomic Status and Academic Performance in Medical School.

Background Students from lower socioeconomic groups tend to underestimate their chances of acceptance to medical school and their likelihood of success once admitted. Objective The objective of this study is to determine if socioeconomic disadvantage status is linked to lower medical college admission test (MCAT) scores and academic performance in medical school. Methods Using the Association of American Medical Colleges (AAMC) education/occupation (EO) indicator, we compared economically disadvantaged students to students with no financial disadvantage on the MCAT, Phase 1 National Board of Medical Examiners (NBME), United States Medical Licensing Examination (USMLE) Step 1, Phase 2 NBME, and USMLE Step 2 test scores. Results Medical students in the disadvantaged group scored significantly lower on the MCAT than students with no financial disadvantage. The disadvantaged group showed a non-significant lower trend in performance until USMLE Step 2. Conclusions Applicants from lower socioeconomic backgrounds may perform lower on their MCAT and early medical school benchmark exams, but they appear to catch up with and even surpass their peers on their USMLE Step 2 examination.

College competitiveness and medical school exam performance.

BACKGROUND: In medical school, students are tested through periodic USMLE Step 1 and 2 examinations before obtaining a medical license. Traditional predictors of medical school performance include MCAT scores, undergraduate grades, and undergraduate institutional selectivity. Prior studies indicate that admissions committees might unfairly discriminate against applicants who graduated from less competitive universities. However, there is limited literature to determine whether those who attended competitive colleges perform better on USMLE Step 1 and 2 examinations. OBJECTIVE: The purpose of our study is to determine if students who attended competitive undergraduate colleges outperform those who did not on medical school benchmarks. METHODS: We defined a Competitive College as having greater than 10% of its student body scoring 1400 or higher (on a 1600 scale) on the SAT. If this criteria was not met, colleges would be categorized as Non-Competitive. Descriptive statistics and unpaired t-tests were calculated to analyze average test scores on the MCAT, Phase 1 NBME, USMLE Step 1, Phase 2 NBME, and USMLE Step 2. RESULTS: Our findings suggest there are no statistically significant differences between students who do or do not attend competitive undergraduate colleges on these medical school benchmark examinations following the MCAT. CONCLUSION: Admissions committees should use this data to aid in their student selection as our research indicates that institutional selectivity accurately predicts MCAT scores, but not performance on standardized medical school examinations once admitted.

Exploration of the Role of Relationships and Virtual Learning on Academic Performance and Mental Health.

Background The coronavirus disease 2019 (COVID-19) pandemic caused medical schools to rapidly transition to online/distance learning. Online learning is often associated with poor academic performance, mental health, and student-to-faculty relationships. The purpose of this study is to determine if correlations exist between academic performance, mental health, study location, and student/faculty relationships among medical students. Methodology First-year medical students received a survey asking them to reflect on their study location, mental health, and student/faculty relationships during the COVID-19 pandemic. Second- and third-year medical students received a similar survey asking them to reflect on their experiences from the perspective of their first year of medical school (pre-pandemic). The first five exam scores were gathered for all participants. Pearson's correlation coefficient was calculated between all variables. Results Academic performance was found to be positively correlated with both mental health (R = 0.215, p = 0.016) and relationships among students (R = 0.0259, p = 0.004), while negatively correlated with the percentage of time spent studying at home (R = -0.185, p = 0.039). Mental health was additionally found to be positively correlated with relationships to faculty (R = 0.230, p = 0.01) and relationships to students (R = 0.245, p = 0.006). Conclusions Academic performance and mental health are correlated with relationships and study location. These correlations may explain the negative outcomes associated with online learning in medical education.

Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report.

The agrammatic or nonfluent variant of Primary Progressive Aphasia (nfvPPA) is a form of Frontotemporal Dementia (FTD) that is characterized by progressive language dysfunction, poor sentence construction, and low verbal fluency. Individuals with nfvPPA have intact insight into their decline, which may manifest as frustration and hopelessness, and show signs of impulsivity and disinhibition. Little is known about suicide risk in this patient population. Here we describe a case of an 84 year-old male with nfvPPA who, over the course of his care, experienced a decline in language and motoric functioning which coincided with increasing irritability and impulsivity. Despite this significant decline, he denied depressive symptoms or showed any suicidal tendencies, and he seemed to be looking forward to future events. His suicide, committed with a handgun during what appeared to be a rather innocuous trip to the garage, came as a significant shock to his spouse, family, and his clinical care team. To our knowledge, this is the first reported case of completed suicide in a patient with the nfvPPA subtype of FTD. Though this patient demonstrated demographic risk factors for suicide (advanced age, retired military veteran with easy access to firearms) there is a lack of data regarding how FTD may have contributed. Retained insight especially seems to be a risk factor for suicide across all forms of dementia. Impulsivity may be key when considering suicidality amongst FTD patients. Additionally, this case demonstrates the importance of addressing gun safety as there are few guidelines around gun ownership in this patient population.

The Impact of COVID-19 on Academic Performance and Personal Experience Among First-Year Medical Students.

Background: The COVID-19 pandemic forced medical education to rapidly transition from in-person learning to online learning. This change came with learning difficulties, social isolation, limited student/faculty relationships, and decreased academic performance. Objective: The purpose of this study is to determine if academic performance, study habits, student/faculty relationships, and mental health were different in first-year medical students (class of 2024) during the COVID-19 pandemic compared to pre-COVID cohorts. Methods: In April 2021, a survey was sent to first-year medical students at the Kirk Kerkorian School of Medicine at UNLV asking them to reflect on their experiences during the COVID-19 pandemic including study environment, mental health, and relationships with peers and faculty. A similar survey was sent to second- and third-year medical students (classes of 2023 and 2022) asking them to reflect on similar experiences during their first year of medical school. Exam scores for the first five exams were gathered and compared between first-, second-, and third-year medical students. Results: One hundred twenty-five students responded to the survey (81% of first-year students, 75% of second-year students, and 55% of third-year students). During the COVID-19 pandemic, first semester students did not score above the national average as much as first semester students pre-COVID (55% vs. 77%). Students during the pandemic studied at home more than previous cohorts. Mental health and relationships were all rated significantly lower among first semester students during the COVID-19 pandemic. Conclusions: Significant differences were found in first semester student experience and academic performance during the pandemic compared to pre-COVID cohorts.