United States


Transgender, nonbinary, and gender nonconforming [TNGNC] patients experience high rates of healthcare discrimination. Fear of discrimination may lead to delays in seeking healthcare and thus poorer health outcomes. Asking for a patient’s pronouns contributes to an inclusive environment, yet little is known about teaching and encouraging this practice among medical students. This study aims to characterize the attitudes and practices of pronoun use of students after implementing a standard pronoun curriculum.

We distributed a survey assessing attitudes toward and frequency of pronoun use to 310 students who completed a standardized pronoun curriculum and trained at continuity clinics. Attitudes (strongly disagree, disagree, agree, strongly agree) and frequencies (never, sometimes, often, always) were scored one to four respectively. T-tests determined factors’ associations with support of including pronoun training in the clinical curriculum [pronoun curriculum], support of asking pronouns in new patients encounters [standard pronoun use], and the frequency students asked patients’ pronouns [student pronoun use]. Factors included student age, gender, and whether the student had ever experienced pronoun use creating a better patient experience [positive patient encounter]. 

The response rate was 32.1%. 54.5% of students reported never asking for pronouns. Common limiting factors were identified as: patient perceived as unreceptive (33.9%) and forgetting (18.4%). Cisgender women compared to cisgender men showed more support for the pronoun curriculum (3.42 vs 2.95, p=0.0062) and standard pronoun use (3.20 vs 2.83, p=0.0398) but no increased frequency of student pronoun use. No respondents self-identified as TNGNC. A positive patient encounter was associated with greater support of the pronoun curriculum (3.57 vs 2.82, p=0.0001) and standard pronoun use (3.43 vs 2.61, p=0.0001) as well as higher student pronoun use (1.90 vs 1.34, p=0.0005). Age showed no significant associations. 

Despite being educated on pronoun use’s importance in gender-affirming care, the majority of medical students in this study reported never asking pronouns, largely limited by perceptions that a patient would be unreceptive. The only factor associated with both favorable attitude and increased student pronoun use was a positive encounter. This likely represents bidirectional causality as asking pronouns is permissive to positive encounters, and these positive experiences further encourage asking. To apply this, educating standardized patients to communicate positive experiences may encourage future pronoun use. Future directions may include implementing and assessing this curriculum change.

AMA Research Challenge 2024 

Assessing attitudes and practices of second-year medical students asking for patients’ pronouns in clinical encounters

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Abstract Title: Assessing the Effectiveness of the Larner College of Medicine's SNAP Challenge

Background: Food insecurity is a critical public health issue in the United States. Despite the essential role of the Supplemental Nutrition Assistance Program (SNAP) in mitigating food insecurity, many medical professionals lack a deep understanding of its challenges and benefits. The Larner College of Medicine's SNAP Challenge aimed to bridge this gap by having participants live on the average SNAP benefit for Vermont for one day and participate in a week-long series of events addressing food insecurity. This study evaluates the effectiveness of the SNAP Challenge in enhancing Medical Students' and Staff's knowledge and attitudes towards food insecurity.

Methods: Data were collected before and after the challenge and associated events from 36 medical students and one staff member. Surveys assessed five areas on a Likert-scale: understanding of food insecurity, awareness of available resources, empathy towards individuals facing food insecurity, confidence in navigating food insecurity resources, and agreement with the adequacy of SNAP benefits. Descriptive statistics, Welch's t-tests, linear regression, and visualizations were completed using R (version 4.0.5). Participants also provided qualitative feedback on the SNAP Challenge through open-ended survey questions addressing their experiences, learning outcomes, and suggestions for improvement.

Results: The SNAP Challenge significantly improved participants' understanding (mean increase from 2.70 to 3.41, p = 0.0095), awareness (mean increase from 2.50 to 3.53, p = 0.0078), and confidence (mean increase from 2.70 to 3.59, p = 0.0151). Linear regression analysis showed that post-intervention survey time was a significant predictor of higher scores in understanding (β = 0.71, p = 0.012), awareness (β = 1.01, p = 0.008), and confidence (β = 0.85, p = 0.010). Qualitative analysis revealed that participants found planning meals and avoiding hunger to be the most challenging aspects of the SNAP Challenge, and they highlighted the extensive planning required to eat nutritiously on a limited budget.

Conclusion: The SNAP Challenge, coupled with a week of educational events, effectively enhanced participants' understanding, awareness, and confidence in addressing food insecurity. This demonstrates the value of experiential learning as an educational tool in medical training. While empathy and perceptions of SNAP adequacy did not significantly change, the challenge highlighted the importance of sustained interventions to influence deeper empathetic responses and perceptions of food assistance programs. These findings support the integration of experiential learning in medical education to better prepare future healthcare professionals to advocate for and support patients experiencing food insecurity.


Assessing the Effectiveness of the Larner College of Medicine's SNAP Challenge

Introduction: Since 2022, an annual inter-institutional multispecialty interest group retreat and coaching [Virtual Translational Learning and Coaching (VTLC)] program, currently funded by the AMA at Meharry Medical College, has been executed to improve recruitment and alleviate some of the root causes of an ineffectual transition to residency as well as factors impacting recruitment of medical students (MS) to competitive specialties. A survey was carried out to record participants’ perceptions, looking back after graduation or post-match [GPM of the VTLC program]. 




Methods: A survey was given to students who completed the VTLC retreats in 2022 and 2023. Frequency analysis was performed on survey responses. R version 4.3.2 and SPSS version 29 were used to conduct all analyses. 




Results: The retreat was sent to 98 participants from the previous retreats who were GPM or post-match from the medical school program. There was an overall 30% response rate. The perception of GPM was that the VTLC retreat should continue annually to benefit the upcoming medical students (86%); provided information from trusted or reliable source (72%); put an emphasis on growth instead of a fixed mindset (76%); increased awareness of external residency requirements (76%); and increased the awareness of the competitiveness of specialties (79%). GPM felt that the VTLC retreat, with respect to orphan status (lacking academic residencies at home institutions), provides some initial benefits that are otherwise not very easily accessible to students without an academic speciality residency program in their institution (72%); because of emphasis on personal goals (i.e. obtaining a residency position) made them more engaged with medical school activity (65%); helps with the alignment between the goals of UME(all student match) and GME (best students match) by increasing exposure to various specialties so that students can have more choices (63%); 62.5% of GPM reported they were still in touch with their mentor, 82.75% reported they received good career advice, 79.3% reported they were made aware of research opportunities, and 69% increased their individual goal-setting skills. For the GPM that attended brief large coaching classes, their perception was that the coaching class helped increase self-reflection (72%); increased individual goal setting skills (69%); improved self-assessment skills (65%); improved communication skills (65%); and increased self-directed learning skills (62%). 



Conclusion: Overall perceptions were that the VTLC program was beneficial and had a positive effect on GPM participants in the medium term. Longer term studies are necessary to further evaluate this program. 


Assessing the Medium-Term Perception of Medical Students of an Interest Group Coaching Program

Background
An estimated 27.6 million people are victims of human trafficking worldwide. In 2021, the U.S. National Human Trafficking Hotline received 10,359 reports of human trafficking. Victims of human trafficking may be forced into labor, sex trafficking, or involuntary domestic servitude, often enduring severe physical, psychological, and emotional trauma. Traffickers frequently target the most vulnerable, exploiting their lack of resources, stability, or support networks. Due to the complex and critical needs of trafficking victims, healthcare professionals play a vital role in identifying and providing care to these patients. However, many healthcare professionals may feel unequipped or insufficiently trained to identify signs of trafficking and provide resources to those seeking care. This gap in knowledge and training can result in missed opportunities to offer support and resources to victims seeking care.

Methods
In collaboration with the University of Miami’s THRIVE clinic, medical students developed educational resources and compiled them as a module delivered through the Canvas e-learning platform. This module includes an educational seminar, a trauma-informed physical exam guide, local and national resource links, and an optional 20-question quiz. Participants receive a certificate upon module completion. The module is available year-round, with regular reminders sent to encourage participation. Additionally, a clinical advisor and yearly selected student moderators ensure the module remains updated with current information.

Results
Currently, 194 medical students and 78 employees (faculty and staff) are enrolled in the course, with an average quiz score of 98%. Feedback from initial implementation surveys indicated enhanced participant confidence in identifying human trafficking survivors, knowledge of local resources available to survivors, and a greater understanding of the importance of human trafficking training.

Conclusion
To effectively support trafficking patients, healthcare professionals require training to identify signs of trafficking and respond in a sensitive and effective manner. Enhanced training programs are essential for empowering providers to combat human trafficking. Educational resources available through e-learning platforms can benefit medical students, faculty, staff, and other professionals seeking to enhance their knowledge. These courses include modules, seminars, and information on national and local support services. Creating and implementing these courses is straightforward and cost-effective, allowing for trackable progress. However, a current challenge lies in the optional nature of the courses, leading to lower completion rates. Despite this, adopting these courses is feasible and sustainable, providing a comprehensive approach to training healthcare professionals. The goal is to develop a CME-accredited course for professionals to meet Human Trafficking training requirements in states where mandated.

Awareness to Action: Equipping Healthcare Professionals Against Human Trafficking

Background: Female representation in medicine has surged in recent years, yet balancing career aspirations with family planning remains a formidable challenge. Understanding how fertility planning influences career decisions among medical professionals, particularly female physicians, is crucial for optimizing workforce dynamics and individual well-being.

Objective: This study aimed to assess the impact of fertility planning on career choices among medical professionals, identifying influencing factors such as specialization, practice setting, and work-life balance.

Methods: A survey was administered to residents and fellow physicians across various specialties at Cedars-Sinai Medical Center. Data on demographic characteristics, career status, childbearing considerations, workplace support, infertility diagnosis, and fertility preservation exploration were collected and analyzed.

Results: Among the 91 participants, a majority were female (62.6%), with diverse racial backgrounds. Family planning significantly influenced career trajectories, leading to extended career breaks (23.1%), delays in fellowship (18.7%), and specialty switches (14.3%). Participants indicated a median ideal of 2 children. Among the 12 individuals who had children, the median age for their first child was 31.5 years. A significant proportion anticipated or experienced the need to delay childbearing due to career considerations (75.4% and 66.7%, respectively). Dissatisfaction with workplace support for family planning was prevalent (79.1%), despite high interest in fertility benefits (92.6%).

Conclusion: Fertility planning exerts a profound influence on the career decisions and well-being of medical professionals, particularly female doctors. Addressing workplace support gaps and implementing supportive policies are imperative to mitigate the negative impact of fertility-related challenges on career trajectories and individual well-being.

Family Planning and Career Trajectories in Medicine

Abstract Title: 
Identifying Creator Goals and Takeaways from an Antiracism Medical Education Podcast 

Background
The Clinical Problem Solvers Antiracism in Medicine (CPSolvers ARM) Podcast series was created in 2020 to equip listeners at all training levels with the consciousness and tools to practice antiracism in their clinical careers. Compared to other forms of information sharing within academia like conferences and journal publications, podcasting is accessible, entertaining, and allows for an increased degree of nuance. The ideation, planning, and question development for each episode is extensive and involves numerous group discussions as well as a deep dive into relevant peer-reviewed literature and lay press discourse. The goal of this research is to ascertain and clarify the takeaways, intentions, and goals of the podcast from the perspective of its creators. 

Methods
A focus group was conducted with the podcast’s creators. Creators are defined as individuals who have hosted and designed/led at least one CPSolvers ARM Series episode. Participants were recruited via email and were sent a waiver of documentation of consent. The focus group was conducted over zoom with a moderator. In the focus group, participants were asked about the goal of the podcast, their motivators for joining the team, things they have learned from working on the podcast, and what they hope listeners take away from the podcast. The interview audio transcript was then deidentified and extracted for themes by two different reviewers using Dedoose. The reviewers then consolidated their codes with associated representative quotes to generate a joint codebook and to determine overarching themes. 

Results
A total of four out of the eight eligible active podcast creators were present for the focus group. Four key themes were extracted with associated representative quotes. The themes include: Democratizing Antiracism Knowledge, Generative Paradigmatic Shifts in Antiracism Education, Novel Coalition and Community Building, and Theory to Praxis. 

Conclusion
The key themes extracted from the focus group suggest that from the creator’s perspective, key goals of the CPSolvers ARM podcast include making well-researched knowledge about antiracism in medicine more accessible to health care professionals, pushing medical education to include topics of antiracism and health equity more systemically and rigorously in learner curriculums, and encouraging education that stimulates learners towards action. Additionally, creators highlight the community and coalition-building aspect of the podcast as a major personal benefit. This provides insight into the thought process behind an antiracism medical education podcast and highlights the benefits of such a project to both creators and listeners alike.


Identifying Creator Goals and Takeaways from an Antiracism Medical Education Podcast

Background: India has significantly improved Infant mortality since its independence, reducing it from 146 per 1,000 live births in 1950 to 20 per 1000 live births in 2020. Despite this, India continues to face a critical shortage of neonatologists and neonatal intensive care resources, contributing to persistent challenges in reducing neonatal mortality rates. 
Methods: Data from the National Medical Commission (N.M.C.), the National Board of Examinations in Medical Sciences (NBEMS), and the government of India were analyzed to quantify the supply of neonatologists and neonatal intensive care seats across India. Data from the Royal College of Pediatrics and Child Health, Bliss for premature/sick babies, and the National Resident Matching Program were also examined for international comparisons. 
Results: India currently offers 138 seats in Neonatology, mainly 103 Doctorate of Medicine (D.M.) and 36 Diplomate of National Board (DrNB) seats, catering to approximately 24 million annual births. This leads to a ratio of 5.75 seats per million newborns, significantly lower than the optimal ratio observed in developed nations like the United States, which offers 84.7 seats per million newborns. Substantial inter-state variations were also observed. 
Conclusion: Extending the grandfather clause for pediatric professors by an additional decade would lead to increased neonatologists currently while mandating the establishment of neonatology departments as the fourth unit in medical colleges with at least 200 or 250 MBBS seats could potentially increase the number of neonatology seats to 390, substantially improving the neonatologist-to-neonate ratio to 16.25 per million newborns.


India's Neonatal Care Landscape: Workforce Challenges, N.M.C. Guidelines, Solutions, and State Government's Role in a Low-Resource Country

Implicit bias happens automatically and without intention. Nevertheless, these thoughts affect a person’s judgements, considerations, and behaviors. It is well-demonstrated in the literature that physicians experience implicit bias toward their patients, which in turn contributes to health inequities. However, there is little research conducted on patients’ implicit bias towards their physicians. Previous studies report no statistical difference in patient satisfaction when controlled for physician gender, despite evidence from opposing studies that identify female physicians as establishing more patient-centered care. This spurs a clinically relevant discussion surrounding bias in patients’ evaluations. There are limitations in collecting this data, as patients must be in a controlled environment, yet unaware of the research being conducted. As a result, Objective Structured Clinical Examinations (OSCEs), in which medical students are graded and receive feedback from Standardized Patients (SPs), lend an ideal environment to study patient implicit bias. Our study examines the implicit bias of SPs toward their student doctors based on gender during OSCEs. Data from Kansas College of Osteopathic Medicine’s SP student doctor evaluations, obtained in OSCEs, was acquired and de-identified. Consent from SPs to conduct this research was obtained, yielding 576 comments for 90 first-year medical students across 8 OSCEs. A direct content analysis was performed on these comments. Guided by prior literature surrounding patients’ perception of physicians, feedback was coded into five categories: compassion, demeanor, communication, comfort delivery, and physical appearance. Within each category, feedback was further coded by male or female student doctor gender and positive or negative feedback sentiment. A chi-squared test for independence was performed on data in each category to explore the hypothesis: 

H0: There is no association between medical student gender and simulated patient feedback sentiment. 

HA: There is a significant association between female gender and positive feedback sentiment. 

Results displayed a significant association between female student gender and positive SP feedback regarding compassion (p = 0.017), as well as a significant association between female student gender and negative SP feedback regarding physical appearance (p = 0.038). There was no significant association found between medical student gender and SP feedback regarding student demeanor, communication, or comfort delivery. These findings aid understanding of how physicians’ genders correlate with patients’ perceptions of them, and which characteristics in a clinical encounter can be leveraged to significantly impact this impression.

Simulated Patient Implicit Bias of Medical Student Gender

Background: Studies have shown that the absence of skin color representation in health science education leads to diminished patient outcomes for these populations. As awareness of this issue grows, literature has emerged to analyze these discrepancies. Expanding teaching images to include a diverse range of all skin types is crucial for promoting equal representation in education. 
Objective: This study aims to assess skin color representation in pediatric nursing practitioner (PNP) education through a systematic analysis of eight commonly used nursing textbooks. 
Methods: Eight commonly referenced nursing textbooks were analyzed, given their established use in PNP education. Textbooks were coded for skin color representation by two investigators trained in skin phototyping. Coders used the widely accepted phototyping scale, the Fitzpatrick Scale (range I-VI). Teaching photographs were defined as all photos, including human skin, that provided insight into a disease, diagnostic technique, or concept. Two individual coders coded and documented data, ensuring each coder was blinded to the overall results. 
Results: Textbooks were included based on the presence of teaching images involving human skin that were not black and white. Of the eight textbooks selected, five were considered given these criteria. A significant proportion of chapters demonstrated skin color underrepresentation. However, chapters addressing conditions of abuse, neglect, and stigmatized social issues displayed a disproportionate representation of skin of color. 
Conclusion: These findings highlight the importance of enhancing equitable representation in nursing educational resources while collaborating with health science institutions to establish clear, standardized metrics for future implementation. Including skin tone diversity in health science education materials is necessary to ensure clinicians have the knowledge and training to provide all patients with the highest level of care.



Skin of Color Representation in Teaching Images in Pediatric Nursing Practitioner Textbooks

Background: Repeated large-scale studies have reinforced our understanding of smoking as the likely single most important modifiable risk factor affecting health and longevity. Although medical students receive instruction on how to navigate lifestyle change conversations with patients, specific education on how to perform smoking cessation counseling may be very minimal in the pre-clinical years. While the rates of smoking within the general US population have dropped to around 12% as of 2021, individuals undergoing substance use disorder treatment have rates of smoking as high as 80%. As New Orleans Bridge House (NOBH) works with individuals undergoing rehabilitation from substance use disorder, volunteers should be equipped to engage in smoking cessation discussions on every shift. Our analysis evaluates the efficacy of implementing a 15-minute pre-shift training on smoking cessation counseling for all medical student volunteers. 

Methods: The smoking cessation volunteer training takes place in the 15 minutes preceding the volunteer's shift. The on-shift leader first facilitates an open discussion on smoking cessation between all volunteers to gauge the level of knowledge and experience with the content. Focus areas are divided into cessation aids (ex., specific medications) and conversational techniques (ex. motivational interviewing). Next, an info sheet from NY.gov contains details about all FDA-approved pharmaceutical interventions for smoking cessation. The leader then guides all volunteers through a review of the information, ensuring to answer all volunteer questions. 4th year student volunteers were encouraged to provide advice based on their experiences in clinic rotations. 1st-year students are then encouraged to complete a 5-question electronic survey emailed one and three days after their volunteer shift. 

Results: Between 8/16/2023-9/27/2024, 45 responses were received from approximately 106 volunteers, yielding a response rate of 42%. 64% of students reported discussing smoking cessation with a patient during their shift. In response to whether the pre-shift discussion helped their ability to address this topic with patients, 62% answered “definitely yes,” and 26% answered “somewhat yes,” with no students reporting that the session was unhelpful. Out of the list of cessation aids discussed during the training, the three that students were least aware of were nicotine nasal spray (64% unaware), combination nicotine replacement therapy (45%), and nicotine lozenges (42%). 

Conclusion: The majority of medical student volunteers at NOBH engage in smoking cessation discussion with a patient during each shift. Nearly every surveyed volunteer believed they benefited from brief pre-shift training and the majority learned about at least one new cessation aid. Further investigation is needed to evaluate patients’ perceptions of these conversations and outcomes with regards to long term smoking cessation.

Smoking Cessation Counseling: 15-Minutes to Learn, A Lifetime to Master

Background
Bias incidents in health care harm everyone involved: clinicians, trainees, interdisciplinary team members, and patients. Clinicians who experience in-the-moment bias-related incidents from patients and their families endure professional and emotional repercussions. Previously published curricula addressed bias using didactics and small group discussions as teaching methods. Our communication course tackles the need to teach trainees how to respond to in-the-moment patient/family explicit bias-related incidents towards clinicians. Our course utilizes real-time simulation practice in culturally sensitive topics with communication skills to approach and address bias-related incidents.
Methods
We trained 13 Hospice and Palliative Care Medicine (HPM) fellows from three institutions. We created a two-hour-long virtual course divided into three parts: a brief didactic lecture, faculty demonstration of skills, and real-time learner practice with simulated patients. The skills taught included acknowledging the incident, challenging biased beliefs, naming common interests, and setting limits. Participants completed pre-course, and post-course surveys (immediate and two months).
Results
In the pre-course survey, all participants (13) expressed concerns about responding when a patient or family member says something biased. In the immediate post-survey, 100% (8/8) of respondents agreed that training is crucial. 87% (7/8) of participants reported increased self-confidence in addressing bias incidents based on skills developed in the course. Two months later, two participants reported using the skills learned at the communication course to address a bias-related incident.
Conclusion
The course improved the fellows' self-perceived ability and confidence in responding to bias-related incidents. After the training, the fellows applied skills learned in clinical settings.

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