United States

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.



AMA Research Challenge 2024 

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

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AMA Research Challenge 2022

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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.

The Patient Said What?!? Now, what do I say? – How to Address in-the-moment Patient/Family Explicit Bias Towards Clinical Team Members.

Background
Penicillin is the most common drug allergy. While up to 20% of the population may acquire the penicillin allergy label in their lifetime, more than 90% can safely receive it, leading to unnecessary use of higher order antibiotics The PEN-FAST tool is a validated clinical decision rule used to identify low-risk penicillin allergies. By teaching antibiotic stewardship and use of this tool, we can promote better patient and public health outcomes. 

Methods
A 1-hour teaching module on penicillin allergy and antibiotic stewardship was given as a new curriculum during a fourth-year undergraduate medical education capstone course (N=136). Survey data was collected using Qualtrics and analyses performed in Excel. Pre- and post-surveys were linked using unique codes without any identifying information.

Results
Data collection included both qualitative and quantitative measures, including 5-point Likert scales and multiple-choice questions. There was a statistically significant increase (p<0.05) in student-reported comfort with recognizing anaphylaxis and using the PEN-FAST tool in clinical settings, familiarity with the PEN-FAST tool and antibiotic stewardship, and level of understanding of the process of penicillin allergy de-labeling. There was also significant improvement in performance on calculating PEN-FAST score and identifying next steps in penicillin allergy de-labeling (from 31.2% and 39.0% correct to 66.7% and 59.3% correct, respectively).

Conclusion
While our sample size was small, we implemented effective teaching of both antibiotic stewardship and PEN-FAST clinical tool use. Students self-reported increased comfort and familiarity and demonstrated knowledge application on quantitative assessment. The results suggest that this teaching module successfully met its learning objectives and future work will consist of building on this content and extending dissemination.

Penicillin Allergy and Antibiotic Stewardship: Training Medical Students to Apply the PEN-FAST Tool 


Background
Virtual Reality (VR) technology is a valuable tool for teaching procedural skills. VR allows students to develop skills in a realistic but controlled setting, and as a self-contained teaching module, could reduce instructor burden. Many researchers have explored the use of VR in educational environments and demonstrated that VR training may be comparable to traditional in-person instruction. The goal of this study was to demonstrate the feasibility of using VR technology to teach central venous catheter (CVC) insertion to medical students.

Methods
Ten fourth-year medical students were randomized into two groups: 1) standard curriculum or 2) standard curriculum plus a VR module. The standard curriculum consisted of instructional literature, a video describing CVC placement, and practice on a mannequin. All subjects completed a pre-study questionnaire which recorded their demographic data, history of VR and video game use, and self-perception of procedural ability. Participants in the VR group were assessed on CVC placement on a mannequin before and after completing the VR module. While the VR group completed the simulation, the control group was allowed to re-review the instructional material before being assessed on CVC placement. Then, all subjects completed a post-study questionnaire. 

Results
There were no differences in any baseline characteristics including years of clinical experience, prior CVC experience, or VR familiarity. Similarly, there were no differences in any procedural metrics, such as completion time, between groups or in the VR group crossover analysis. The VR group rated their system as significantly easier to use than the standard group rated the mannequin. Further, using a system usability scale (SUS), the VR system was found to be superior. Specifically, VR participants thought the system had well-integrated functions and was less cumbersome than the mannequin. Lastly, the VR group matched the standard group regarding improved comfort with placing a central line. Both groups rated their comfort significantly higher on the post-survey compared to the pre-survey. 

Conclusion
In conclusion, an instructional VR module can be a valuable addition for teaching CVC placement at the medical student level. The VR system ranked higher on the SUS compared to the mannequin, in fact, its score was slightly better than that of an inhaler as defined by previous literature. Medical students thought that the VR was easy to use, had streamlined functionality, was less cumbersome than a mannequin and improved their comfort placing a CVC. 


Leveraging Virtual Reality in Medical Education: The Feasibility of Using Virtual Reality Simulations for Teaching Medical Students Central Venous Catheter Placement

Background
Though rare, power outages in the operating room happen, perhaps at increased frequency due to more extreme weather related to climate change. These situations are dangerous and anesthesiologists must be prepared to manage them. However, evidence suggests that anesthesiologists are insufficiently prepared to manage a power outage and 85% desire more training. This problem could be solved during residency, yet many programs overlook power outage training. Thus, the objective of this study was to fill this training gap by designing a power outage simulation for anesthesiology residents and then assess whether the simulation improved confidence in power outage management.

Methods
Our team designed a high-fidelity power outage simulation for PGY-3 and PGY-4 anesthesiology residents. The simulation case involved an intraoperative power loss during an inguinal hernia repair of a patient under general anesthesia. This scenario took place within a simulated operating room at an academic simulation center and included a mannequin as the patient under general anesthesia, a surgeon actor, and a simulation specialist. After the simulation, a debriefing focused on power outage management specifics was led by an anesthesiology faculty member. Once debriefing concluded, the residents completed five-point Likert scale surveys to assess before and after confidence in several aspects of intraoperative power loss management including operating room management, monitoring vital signs, and patient disposition planning. Data were analyzed using a two-tailed paired t-test.

Results
Twenty-two anesthesiology residents completed the simulation over two years. Residents' mean confidence in managing a patient in the operating room during a power outage improved by 1.23 points (p=0.001), confidence in monitoring vital signs during a power outage improved by 1.37 points (p=0.001), and confidence in planning appropriate patient disposition during a power outage improved by 0.88 points (p=0.001). After the simulation, 100% of residents strongly agreed or agreed that they could confidently manage a patient in the operating room during a power outage, compared to just 45.5% before the simulation.

Conclusion
It is essential to address anesthesiologists’ desire for further power outage training and this simulation seems to fill the power outage training gap. After participating, residents felt confident in their power outage management skills. Other residency programs may consider implementing this simulation. A limitation of the study is that it relied solely on self-reported measures to ascertain simulation effectiveness; thus, future research could involve conducting objective performance assessments such as standardized tests or direct observation of clinical practice.

Power Outage: A Simulation Case for Anesthesiology Residents

Background: The decision to undergo labor epidural analgesia (LEA) is a significant aspect of childbirth planning for many pregnant individuals. With the rise of social media, platforms like Instagram, Facebook, and Twitter have become popular sources of information and personal narratives. These platforms provide a space for patients, healthcare professionals, and organizations to share educational content, personal experiences, and professional advice. However, the influence of these social media posts on the decision-making process of expectant mothers regarding LEA remains unclear. In this study, we intend to report the recent trends in online portrayal of LEA and the entities posting this content.

Methods: Public posts on Instagram, Facebook, and Twitter made between 1/1/2022 and 12/31/2022 using the search terms #epidural, #naturalbirth, and #unmedicatedbirth were categorized. Data was collected by three independent reviewers, each focusing on one platform. Posts were categorized by media type, perspective (patient, family/friend, physician, etc.), timing (prepartum, peripartum, postpartum), and tone (persuasive positive, persuasive negative, reflective, neutral). Data analysis was performed using Microsoft Excel to identify patterns in how social media content influences the choice to undergo labor epidural analgesia.

Results: It was found that on Twitter and Facebook, patients were the primary perspective (60% and 59%, respectively), and the tone was mainly reflective (67.7% and 54.9% respectively). For Instagram, doulas yielded the majority perspective (30.4%) while the tone remained neutral (52.9%). Posts on all three forms of social media occurred overwhelmingly in the postpartum period. Reviewers searched for the maximum number of results yielded by each search term, with Instagram generating the most results concerning #unmedicatedbirths. In contrast, Facebook and Twitter results were mainly obtained using the search term #epidural.

Conclusion: This study indicates that social media platforms have distinct user demographics and tones when discussing labor epidural analgesia. Facebook predominantly features postpartum patient perspectives with a reflective tone, suggesting it serves as a platform for sharing personal experiences post-childbirth. Instagram, dominated by doula perspectives, provides neutral and reflective content, highlighting a more balanced view on epidural use. Twitter, similar to Facebook, primarily features patient perspectives with reflective posts in the postpartum period. The variation in content and tone across platforms highlights the need for targeted educational strategies to address the diverse audiences and their preferences on social media. These insights can help healthcare professionals better understand and engage with expectant mothers considering labor epidural analgesia.

The Effect of Educational Social Media on the Choice to Undergo Labor Epidural Analgesia

Introduction: Specialty-specific student interest groups have become stepping stones in medical schools to facilitate student engagement within focused areas of medicine1. However, research on the impact of cardiology interest groups on students’ career interests remains limited. Our study compares the number of students interested in pursuing a career in cardiology with the perceived source of interest across medical students along with student involvement with Cardiology Interest Group (CIG) events and membership. 
Methods: A questionnaire was administered to all Albany Medical College M.D. Program students graduating in 2024, 2025, 2026, and 2027 over two weeks. Participants voluntarily reported their CIG membership, involvement level, and interest in cardiology as a career. Likert scores and percentages were used for comparison among the cohorts (2024-2027) and between preclinical (2026-2027) and clinical students (2024-2025).
Results: A total of 129 participants from the graduating classes of 2024, 2025, 2026 and 2027 voluntarily completed the survey assessing their baseline and degree of involvement in CIG as well as corresponding source of and overall interest in cardiology as a career. 39% percent of students in classes 2026/2027 considered a career in cardiology as compared to 5% of students within classes 2024/2025 (P<0.001). Similar significance was seen in the difference between the class of 2026/2027 and 2024/2025 in attributing interest to CIG, representing 13% and 3%, respectively (P<0.001). The 26/27 cohort was more likely to have attended a CIG event compared to the class of 2024/2025 (P<0.001). An overall influence of CIG on cardiology as a speciality was significantly more predominant within the preclinical classes as compared to the clinical class (P<0.001).
Conclusion: Our study demonstrates CIG’s substantial role in fostering student interest and engagement in cardiology careers. Limitations of our study may be seen in the classes of 2024/2025 being further into clinical years and thus potentially having a narrowed scope of specialty interest at the time of completing the survey. The overall impact of CIG was illustrated most within the classes of 2026/2027 having CIG during preclinical years, as compared to classes of 2024/2025 who did not. These findings highlight the importance of a Cardiology Interest Group in didactic years for fostering interest and potential careers in the field of cardiology.

The Impact of a Cardiology Interest Group (CIG) on Medical Student Interest in a Cardiology Career

It is no secret that social media has taken the world by storm in the past two decades. It have come to the point where people now turn to social media for their health information. TikTok has especially become a popular search engine for young people seeking dermatologic advice. In the study we analyzed the existing content on TikTok regarding vitiligo treatment to determine the source of the videos and the top treatments recommended for vitiligo treatment on the app.

DermTok: Vitiligo Treatment

Background
Out-of-hospital, life-threatening emergencies are increasingly prevalent. In the United States, it is estimated that over 50,000 cardiac arrests occur annually in public settings and that one in 50 individuals are susceptible to anaphylaxis. Last year, 81,083 Americans died from opioid overdose and over 600 mass shootings occurred in the United States. The public expects medical providers, especially physicians, to possess the skills and competencies to effectively intervene in such emergencies. However, undergraduate medical education rarely provides adequate, lifesaving care training to medical students. To address this curriculum gap, we surveyed the need for out-of-hospital, lifesaving care training in undergraduate medical education and implemented a hands-on training curriculum.

Methods
We conducted a needs assessment survey to examine the lifesaving care proficiencies of medical students at a large academic medical center. Surveys consisted of multiple-choice and Likert scale questions regarding student confidence to intervene independently during out-of-hospital emergencies, perform cardiopulmonary resuscitation (CPR) and utilize an automated external defibrillator (AED), pack a penetrating wound, apply a tourniquet, use an epinephrine autoinjector, and administer naloxone. Additional questions assessed medical student opinions on whether the current curriculum had prepared them to perform lifesaving interventions. Descriptive analysis of quantitative survey data was performed to determine the percentage for each response.

Results
Of the 55 medical student respondents, only two (3.6%) felt extremely confident in their abilities to independently respond to an out-of-hospital emergency, while 35 (63.6%) were not at all or minimally confident in such scenarios. Furthermore, 28 students (50.9%) felt confident performing CPR or using an AED, 15 (27.2%) felt prepared to apply a tourniquet, ten (18.2%) to pack a penetrating trauma wound, 41 (74.6%) to use an epinephrine autoinjector, and 27 (49.1%) to administer naloxone. Lastly, 54 students (98.2%) agreed that all physicians should possess the skills to provide lifesaving care during out-of-hospital emergencies, 53 (96.4%) hoped to learn such skills, and five (9.1%) believed the medical school curriculum adequately prepared them for out-of-hospital emergencies.


Is There a Doctor On Board? The Need for Lifesaving Care Training in Medical School
Curricula

Background: Mass casualty incident (MCI) training effectively increases trainees' knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM (Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms.

Methods: Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of <0.01 significant to correct for multiplicity using the Bonferroni method.

Results: Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, and understanding of emergency medical service training/transportation, as well as increased confidence in participating in an MCI (all p < 0.001).

Conclusions: Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models' ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

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

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