What Makes a Near-Peer Learning and Tutoring Program Effective in Undergraduate Medical Education: a Qualitative Analysis.

Peer tutoring can benefit both learners and peer teachers that are distinct from the learning that occurs in expert-guided learning environments. This study sought to evaluate the peer tutoring program at a large public medical school to determine the strengths and weaknesses of a near-peer tutoring program and its benefits beyond students' typical classroom-based learning. This was a survey-based study of learners and tutors participating in the peer tutoring program. Fifty-six learners and 20 tutors participated in the survey; most learners received tutoring in the preclinical phase of the curriculum. Narrative responses were thematically analyzed to identify themes for both groups. Learners' responses about the benefit of the near-peer tutoring program were in three primary categories: creating a safe learning environment, direct coaching skills, and pitfalls around the need for individualized direction. Tutors' responses about what made a successful tutoring relationship centered around crucial activities used to engage with learners, beneficial intrinsic qualities of learners such as motivation, and qualifications of tutors that were most helpful such as knowledge base. Peer tutoring programs should emphasize individualized feedback for learners that focuses on metacognitive, content-based, and socio-emotional support. In doing so, such programs can provide a well-structured approach to improve learner success. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01680-0.

Clinical Educator and Student Perceptions of a Weekly Observed Practice Activity Evaluation Tool.

BACKGROUND AND OBJECTIVES: Clinical teachers (or preceptors) have expressed uncertainties about medical student expectations and how to assess them. The Association of American Medical Colleges (AAMC) created a list of core skills that graduating medical students should be able to perform. Using this framework, this innovation was designed to provide medical students specific, progressive clinical skills training that could be observed. METHODS: We used the AAMC skills to develop observable events, called Observed Practice Activities (OPAs), that students could accomplish with their outpatient preceptors. Preceptors and students were trained to use the OPA cards and all students turned in the cards at the end of the rotation. RESULTS: Seventy-nine of 115 preceptors and 80 of 149 students completed evaluations on the OPA cards. Both students (60%) and preceptors (70%) indicated the OPA cards were helpful for knowing expectations for a third-year medical student, although preceptors found the cards to be of greater value than the students. CONCLUSIONS: The OPA cards enable outpatient preceptors to document student progress toward graduated skill acquisition. In addition, the OPA cards provide preceptors and students with specific tasks, expectations, and a template for directly observed, competency-based feedback. The majority of preceptors found the OPA cards easy to use and did not disrupt their clinical work. In addition, both students and preceptors found the cards to be helpful to understand expectations of a third-year medical student in our course. The OPA cards could be adapted by other schools to evaluate progressive skill development throughout the year.

Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices.

Artificial Intelligence (AI) has long promised to increase healthcare affordability, quality and accessibility but FDA, until recently, had never authorized an autonomous AI diagnostic system. This pivotal trial of an AI system to detect diabetic retinopathy (DR) in people with diabetes enrolled 900 subjects, with no history of DR at primary care clinics, by comparing to Wisconsin Fundus Photograph Reading Center (FPRC) widefield stereoscopic photography and macular Optical Coherence Tomography (OCT), by FPRC certified photographers, and FPRC grading of Early Treatment Diabetic Retinopathy Study Severity Scale (ETDRS) and Diabetic Macular Edema (DME). More than mild DR (mtmDR) was defined as ETDRS level 35 or higher, and/or DME, in at least one eye. AI system operators underwent a standardized training protocol before study start. Median age was 59 years (range, 22-84 years); among participants, 47.5% of participants were male; 16.1% were Hispanic, 83.3% not Hispanic; 28.6% African American and 63.4% were not; 198 (23.8%) had mtmDR. The AI system exceeded all pre-specified superiority endpoints at sensitivity of 87.2% (95% CI, 81.8-91.2%) (>85%), specificity of 90.7% (95% CI, 88.3-92.7%) (>82.5%), and imageability rate of 96.1% (95% CI, 94.6-97.3%), demonstrating AI's ability to bring specialty-level diagnostics to primary care settings. Based on these results, FDA authorized the system for use by health care providers to detect more than mild DR and diabetic macular edema, making it, the first FDA authorized autonomous AI diagnostic system in any field of medicine, with the potential to help prevent vision loss in thousands of people with diabetes annually. ClinicalTrials.gov NCT02963441.

Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program.

BACKGROUND AND OBJECTIVES: Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents. METHODS: Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed. RESULTS: Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs. CONTROL: 53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items. CONCLUSIONS: The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.

Resident wellness behaviors: relationship to stress, depression, and burnout.

BACKGROUND AND OBJECTIVES: Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS: Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS: Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS: At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.