A Pre-Clerkship Medical Education Elective as Catalyst for Student Learning, Faculty Teaching, and Curricular Improvement.

Recent reviews of student-as-teacher programs call for early, longitudinal, and timely training in both learning principles and applied teaching skills. We describe a longitudinal elective for pre-clerkship students that includes interactive meetings addressing a range of theoretical and practical teaching topics and the tools needed to conduct medical education research.

Addressing Implicit Bias in First-Year Medical Students: a Longitudinal, Multidisciplinary Training Program.

BACKGROUND: Studies show that implicit bias among healthcare providers contributes to health disparities. Despite this knowledge, most medical school curricula lack formal methods for assessing and reducing implicit bias among medical students. PURPOSE: The purpose of this study was to create a longitudinal, multidisciplinary training program for first-year medical students to reduce implicit bias toward skin tone, to increase awareness of personal bias, and to measure changes in bias after a targeted intervention. METHODS: First-year medical students participated in a three-part implicit bias training program that included visits to an art museum, a lecture on medical anthropology, and an interactive sociological discussion about bias in medical research. A control group did not participate in the training. All participants took the Harvard Implicit Association Test for Skin Tone and completed a questionnaire assessing awareness of implicit bias before and after the study activities were administered. RESULTS: All participants indicated a bias toward light skin tone. In addition, a stronger bias score in the pre-test correlated with a stronger belief that the scores were inaccurate. Neither the experimental group nor the control group demonstrated a significant change in implicit bias, but the experimental group trended toward a decrease in bias. Power analysis suggested that significant results may have been obtained with a larger sample size. All participants indicated an awareness that implicit biases affect the provision of healthcare. When prompted to reflect on these biases, the experimental group provided richer, more detailed personal accounts of implicit bias in the healthcare environment after participating in the study. CONCLUSIONS: First-year medical students who participated in this study were aware that implicit bias affects the provision of healthcare and therefore plays a role in perpetuating health disparities. However, they were less able to recognize bias in themselves. Providing opportunities for medical students to recognize and confront their own implicit biases is an important goal. This study suggests that a longitudinal, multidisciplinary curricular approach to building awareness and reducing implicit bias can produce promising results in medical students. We anticipate that further development and refinement of curricular activities may lead to significant results.

Utilizing visual art to enhance the clinical observation skills of medical students.

BACKGROUND: Clinical observation is fundamental in practicing medicine, but these skills are rarely taught. Currently no evidence-based exercises/courses exist for medical student training in observation skills. AIM: The goal was to develop and teach a visual arts-based exercise for medical students, and to evaluate its usefulness in enhancing observation skills in clinical diagnosis. METHODS: A pre- and posttest and evaluation survey were developed for a three-hour exercise presented to medical students just before starting clerkships. Students were provided with questions to guide discussion of both representational and non-representational works of art. RESULTS: Quantitative analysis revealed that the mean number of observations between pre- and posttests was not significantly different (n=70: 8.63 vs. 9.13, p=0.22). Qualitative analysis of written responses identified four themes: (1) use of subjective terminology, (2) scope of interpretations, (3) speculative thinking, and (4) use of visual analogies. Evaluative comments indicated that students felt the exercise enhanced both mindfulness and skills. CONCLUSION: Using visual art images with guided questions can train medical students in observation skills. This exercise can be replicated without specially trained personnel or art museum partnerships.

Brief intervention effective in reducing weight bias in medical students.

BACKGROUND: Medical students are exposed to a growing number of obese patients in clinical encounters. Many medical students harbor negative attitudes and stereotypes regarding obese patients, which lead to negative interpersonal behaviors. This study pilot tested the effectiveness of an educational intervention in reducing bias toward obese patients. METHODS: Second- and third-year medical students (n=64) watched a 17- minute video, "Weight Bias in Health Care," and participated in interactive discussion to share experiences with encountering obese patients. The Beliefs About Obese Persons (BAOP), Attitudes Toward Obese Persons (ATOP), and Fat Phobia Scales (FPS) were administered before and after intervention. Change in mean scores from before to after the intervention was tested for statistical significance using the paired samples t test. General linear models were used to examine associations of subject characteristics with mean scores for each scale. RESULTS: The intervention increased beliefs that genetic and environmental factors play an important role in the cause of obesity as opposed to lack of personal control (mean BAOP increased from 16.53 to 19.27). It also decreased students' negative stereotypes regarding obese patients (mean FPS decreased from 3.65 to 3.45). There were independent associations of subject characteristics with post-intervention ATOP scores, with more positive attitudes in younger, male, and white participants. CONCLUSIONS: Implementing a short educational intervention was effective in improving medical students' beliefs and stereotypes regarding obese patients. This widely accessible and easily replicable program can serve as a model and springboard for further development of educational interventions to reduce weight bias among medical students.

Teaching medical students how to teach: a national survey of students-as-teachers programs in U.S. medical schools.

PURPOSE: A number of U.S. medical schools started offering formal students-as-teachers (SAT) training programs to assist medical students in their roles as future teachers. The authors report results of a national survey of such programs in the United States. METHOD: In 2008, a 23-item survey was sent to 130 MD-granting U.S. schools. Responses to selective choice questions were quantitatively analyzed. Open-ended questions about benefits and barriers to SAT programs were given qualitative analyses. RESULTS: Ninety-nine U.S. schools responded. All used their medical students as teachers, but only 44% offered a formal SAT program. Most (95%) offered formal programs in the senior year. Common teaching strategies included small-group work, lectures, role-playing, and direct observation. Common learning content areas were small-group facilitation, feedback, adult learning principles, and clinical skills teaching. Assessment methods included evaluations from student-learners (72%) and direct observation/videotaping (59%). From the qualitative analysis, benefit themes included development of future physician-educators, enhancement of learning, and teaching assistance for faculty. Obstacles were competition with other educational demands, difficulty in faculty recruitment/retention, and difficulty in convincing others of program value. CONCLUSIONS: Formal SAT programs exist for 43 of 99 U.S. medical school respondents. Such programs should be instituted in all schools that use their students as teachers. National teaching competencies, best curriculum methods, and best methods to conduct skills reinforcement need to be determined. Finally, the SAT programs' impacts on patient care, on selection decisions of residency directors, and on residents' teaching effectiveness are areas for future research.

Creative group performances to assess core competencies in a first-year patient-centered medicine course.

INTRODUCTION: A novel assessment of systems-based practice and practice-based learning and improvement learning objectives, implemented in a first-year patient-centered medicine course, is qualitatively described. METHODS: Student learning communities were asked to creatively demonstrate a problem and solution for health care delivery. Skits, filmed performances, plays, and documentaries were chosen by the students. Video recordings were reviewed for themes and the presence of course competencies. RESULTS: All performances demonstrated not only the index competencies of team work and facilitation of the learning of others, but many other core objectives of the course. The assignment was rated positively both by the faculty and the students, and has been added to the assessment modalities of the course.

Academic Support Services in U.S. and Canadian Medical Schools.

BACKGROUND: Academic support services play a critical but largely undocumented role in helping medical students meet the challenges of the curriculum. PURPOSE: To determine the prevalence of academic support programs in medical schools, and to find out how these are conceptualized and implemented. METHODS: Questionnaires were sent to medical schools in the US and Canada. Questions addressed specific services, providers, and funding. RESULTS: The survey was returned by 86 of the 135 (67.7%) schools. Almost all (95.3%) provide academic support in the first two years, and a large majority in third (82.6%) and fourth (79%) year. Great variability exists in the infrastructure and funding of the programs, and in the training of the providers. CONCLUSIONS: Academic support is common, but has broad interpretation; services are varied. Programs are conceptualized differently, some to provide specific assistance to pass courses, and others for skill development, to enhance self-directed, life-long learning.