A Virtual Patient Encounter to Promote Integration in a Preclinical Case-Based Learning Session.

In medical education, virtual patients increase the realism of learning in a safe environment. We added an integrated learning event using a virtual patient to integrate patient history taking into a preclinical basic science course. Herein, we describe the process and our overall satisfaction with the virtual patient encounter.

To What Extent Do Faculty and Students Believe that Team-Based Learning Supports Important Goals of Undergraduate Medical Education?

The Western Michigan University Homer Stryker M.D. School of Medicine (WMed) utilizes team-based learning (TBL) heavily in the preclinical curriculum. The purpose of this study was to understand to what extent faculty and students believe the use of TBL supports important goals of undergraduate medical education. Lack of buy-in to the efficacy of TBL by students and/or faculty as well as differences in how faculty and students believe TBL supports the goals of UME would likely decrease the effectiveness of the TBL implementation. A set of fourteen goals for medical education that may be supported by TBL was identified from the TBL literature, interviews with WMed faculty, and focus groups with WMed students. A survey was then developed to ask students and faculty about whether TBL supports each goal as well as how important each goal is to medical education in general. The survey was distributed to the entire graduating classes of 2021, 2022, and 2023 (127/239 = 53% response rate), and all basic science faculty (11/11 = 100% response rate) in the Biomedical Sciences Department. Overall, there was large agreement between instructors and students about the goals that are supported by the use of TBL, with statistically significant differences (p < 0.01) for two of the fourteen goals. To increase student buy-in, a recap of 2-3 high yield concepts and how those concepts are relevant for the clerkships in years 3 and 4 could be helpful. For faculty buy-in, clinical and basic science faculty should be encouraged to receive formal TBL training. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01632-8.

Use of the Team-Based Learning Readiness Assessment Test as a Low-Stakes Weekly Summative Assessment to Promote Spaced and Retrieval-Based Learning.

Spaced learning and retrieval-based learning are two powerful learning tools that have repeatedly been shown to be effective learning strategies. Team-Based Learning (TBL) is a collaborative learning and teaching approach that is evidence-based and promotes active learning. To combine these learning strategies, we designed a TBL-centered preclinical curriculum that uses the readiness assurance test (RAT) as a low-stakes weekly summative assessment to promote spaced learning and retrieval-based learning. Since student preference for massed learning over spaced learning is well established, a TBL-centered curriculum designed to encourage spaced and retrieval-based learning may be beneficial to student learning.

Effectiveness of instructor-guided independent learning in comparison to traditional didactic lecture in the preclinical medical curriculum: A retrospective cohort study.

Introduction: To create time for learner-centered forms of active learning in the classroom, didactic lectures are being replaced with instructor-guided independent learning (IGIL) assignments that students complete on their own outside of the formal educational setting. The effectiveness of IGIL assignments in supporting learning across the preclinical medical curriculum when applied to all learners in the same class of students has not been examined. Further, we have examined this performance across three class cohorts. Methods: In this retrospective cohort study, we compared student performance on questions from both IGIL assignments and didactic lectures that were items on the end-of-course summative examinations. Data were analyzed from three classes of graduating students in each of the 14 courses that comprise our preclinical medical curriculum. Results: The results of this study suggest that IGIL assignments were as effective as didactic lectures in supporting student learning in our preclinical medical curriculum. Importantly, IGIL assignments supported learning for both low and high performing students. Conclusions: Students can effectively learn from IGIL assignments when the assignments are well-designed and their importance in the curriculum is emphasized.

The Value of Longitudinal Integrated TBLs and How to Create Them.

To mimic the experiences clinicians have with patients, longitudinally integrated team-based learning application exercises involving a group of patients who reappear across multiple courses in an integrated organ system-based curriculum were created to illustrate the multisystem nature of pathology. The aim of these cases was to provide student-centered learning opportunities that demonstrate how organ systems are interconnected in injury and disease and illustrate how a longitudinally integrated series of team-based learning activities can be woven throughout the preclinical curriculum.

Student Perceptions of a Novel Approach to Promote Professionalism Using Peer Evaluation in a Team-Based Learning™ Setting: a Quality Improvement Project.

Development of professional behaviors, including communication and interprofessional collaboration, is an important competency during medical school that is difficult to teach in the classroom. We developed an approach to peer evaluation for use in Team-Based Learning that has two novel components: inclusion of a non-numeric sliding scale ranging from "apprentice" to "expert" to assess professional development on a continuum, and incorporation of a structured face-to-face feedback session. Students liked the format of the face-to-face feedback session, felt it gave them an opportunity to better understand their peers' comments, and thought it was more effective than the anonymous written evaluation tool.

Involving a real patient in the design and implementation of case-based learning to engage learners.

Real patients offer unique opportunities to develop authentic, engaging, and transformative learning experiences for students. Patients are widely employed to teach clinical and interpersonal skills in the clerkship phase of their medical education (M3-M4), but have not been extensively included in the preclinical curriculum (M1-M2) when students are focused on acquiring foundational biomedical science knowledge. To maximize learning and help students connect foundational and clinical science concepts to real-world clinical problems, we involved a real patient in the creation and implementation of a case-based learning (CBL) activity in our preclinical curriculum. Using the patient's narrative as a framework, the CBL addressed relevant aspects of physiology, pathophysiology, anatomy, pharmacology, and nutrition, as well as clinical care decisions, health literacy, and medical ethics. The intervention was implemented with the 2019 and 2020 graduating medical school classes during the Gastrointestinal Systems course in the second year of our curriculum. The results of a survey revealed that, overall, a majority of the students agreed or strongly agreed that the activity increased engagement in class, increased the depth of discussion within their teams, increased the depth of discussion between teams, helped students to apply basic science concepts to the clinical material in the case, helped students better understand the disease processes described in the case, enhanced awareness of the complexity of patient care, provided an authentic learning experience, and elicited a feeling of empathy.

A Simulated Case of Acute Salicylate Toxicity From an Intentional Overdose.

Introduction: Salicylate poisoning is a serious toxicologic problem with a complex pathophysiology that requires prompt diagnosis and action for a favorable outcome. A simulated experience in the evaluation and management of an aspirin-overdose patient allows learners to construct a differential diagnosis from an array of symptoms and signs, analyze a mixed acid-base disturbance, and explore the multistep management of this disorder. Methods: This simulation exercise was designed for second-year medical students. At the start of the session, teams received a 10-minute introduction to the activity. Upon entering a room in a simulated Emergency Department, teams had 15 minutes to complete a focused history and physical exam of the patient, interpret arterial blood gas and basic metabolic panel data, and administer treatment based on key findings and a presumptive diagnosis. The scenario was followed by a 90-minute facilitated debriefing session. An alternative 45-minute debriefing guideline is also included. Results: Students voluntarily completed a 13-question, 5-point Likert-scale survey about the educational exercise immediately following the session. They evaluated the preparatory materials and briefing, the simulation scenario, the usefulness of the debriefing, and their confidence in their understanding of salicylate poisoning following the session. Students reported a favorable response to the overall experience and the debriefing, as well as an increase in confidence following the session. Discussion: This simulation exercise was successful in exposing students to the clinical presentation of salicylate toxicity and giving them the opportunity to apply and synthesize basic science knowledge during the scenario.

A Multipatient Simulation Session: Evaluation of Six Simulated Patients with Different Shock Syndromes.

INTRODUCTION: This multipatient simulation exercise was designed for second-year medical students to illustrate the four different categories of shock (hypovolemic, cardiogenic, obstructive, distributive) during a single simulation session. The comparative design of this simulation was intended to help students develop a conceptual framework for diagnosing and treating each type of shock. METHODS: Students worked together in teams of five under specified time constraints to solve six simulated shock cases. The simulation exercise was implemented with a class of 60 second-year medical students. Teams collected key history and physical findings, established a working diagnosis, and administered treatment within an 8-minute window for each simulated patient. Following the simulations, a 90-minute facilitated discussion prompted students to compare and contrast the diagnoses and the basic management strategies for different types of shock using a preformatted shock evaluation matrix designed for the event. RESULTS: The students applied basic science knowledge to the simulated clinical scenarios to diagnose the class and etiology of shock for each patient. The teams' ability to diagnose class of shock was better than their ability to determine the etiology. Students completed a voluntary evaluation of the educational exercise immediately following the simulation. DISCUSSION: The unique, comparative design of this simulation provides educational value by exposing students to the various patterns of the four classes of shock in a single simulation session, presenting realistic clinical cases, and demonstrating the importance of teamwork in a time-pressured environment.

A brief simulation intervention increasing basic science and clinical knowledge.

BACKGROUND: The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. PURPOSE: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. METHODS: This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l=515) and the intervention group received lecture plus a simulation exercise (n l+s=1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. RESULTS: Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). DISCUSSION: Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

Angiotensin II-dependent growth of vascular smooth muscle cells requires transactivation of the epidermal growth factor receptor via a cytosolic phospholipase A(2)-mediated release of arachidonic acid.

Angiotensin (Ang) II stimulates vascular smooth muscle cell (VSMC) growth via activation of cytosolic phospholipase A(2) (cPLA(2)), release of arachidonic acid (ArAc) and activation of mitogen-activated protein kinase (MAPK). The mechanism linking AT(1) receptor stimulation of ArAc release with MAPK activation may involve transactivation of the epidermal growth factor receptor (EGFR). In this study, Ang II increased phosphorylation of the EGFR and MAPK in cultured VSMC and these effects were attenuated by the cPLA(2) inhibitor arachidonyl trifluoromethyl ketone (AACOCF(3)), and restored by addition of ArAc. Ang II- or ArAc-induced phosphorylation of the EGFR and MAPK were abolished by the EGFR kinase inhibitor AG1478. Ang II or ArAc also stimulated VSMC growth that was blocked by AG1478 or the MAPK kinase (MEK) inhibitor PD98059. Thus, it appears that the cPLA(2)-dependent release of ArAc may provide a mechanism for the transactivation between the AT(1) receptor and the EGFR signaling cascade.