United States

Background
One of the manifestations of the long-standing call for increased diversity and recruitment of underrepresented racial/ethnic minorities in medicine (URMiMs) are pre-medical pathway programs. One such program is the Bridge to Medicine (BTM) program, which boosts knowledge in healthcare careers and provides academic resources to URMiM high school students (HSS). While other pathway programs have demonstrated efficacy in promoting career awareness and equipping students with professional developmental skills, there are fewer programs and studies that evaluate the impact of these programs on students’ career-related perceptions and interests. Our study hypothesized that the BTM program would improve measures of career certainty and decision among URMiM HSS.
Methods
Career perceptions and interests in the STEMM field were evaluated using the Career Decision Scale (CDS), Career Thoughts Inventory (CTI), STEM Semantics Survey, and STEM Career Interest Survey (STEM CIS). Correlational analyses and MANOVAs were performed to evaluate differences between scores of career indecision and uncertainty across demographic variables.
Results
Correlational analyses and descriptive statistics revealed short-term successes in improving career certainty and decision. However, MANOVA’s revealed differences in race, gender, and grade level post participation in the BTM program.
Conclusion
Various measures of career certainty and decision CTI and CDS subscales highlighted significant changes in student career perceptions from the start to the end of the BTM program with an overall increase in career interest and certainty and decrease in career indecision by the end of the BTM program. Significant differences in CTI CA scores across racial/ethnic groups highlight the discrepancy in career uncertainty within students of racial/ethnic minority groups and the lack of consideration of systemic barriers that likely underlie these differences in career perceptions. 


AMA Research Challenge 2022

Assessment of Career Perceptions and Beliefs among Racial/Ethnic Minority Pre-Medical High School Pathway Program Participants

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Charles Lopresto, DO

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Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


poster

Barriers to Providing Obstetrical Care for Refugees: A Single Institution Experience

Background
Key elements necessary in contemporary health professions education to align training with demands of the evolving health care system include: 1) interprofessional practice opportunities, 2) service learning, 3) opportunity for longitudinal care and chronic disease management, and 4) quality improvement training. While interprofessional education and patient centered medical homes (PCMH) are a focus for academic medical centers, meaningful multidisciplinary practice experiences with continuity are elusive due to challenging logistics, funding, and faculty incentive alignment. 

Methods
Leveraging partnerships with our academic health system and community partners, we developed an interprofessional clinic at the university affiliated student-run free clinic. Sustainability is achieved through the development of the Interprofessional Continuity of Practice Experience (ICOPE), which is a longitudinal program aimed at establishing an educational home for students providing care in a PCMH to individuals with complex medical and social needs. Students participate on a team in an interprofessional, outpatient, service-learning experience managing patient panels. Partnering with the academic enterprise and incorporating ICOPE into each program’s core curriculum facilitated support for faculty teaching time. Administrators appreciate the innovative concept of value-added medical education whereby students provide value and capacity to the health system through educational activities.

Students are assigned to one of five clinics for the academic year. Faculty mentors from Clinical Laboratory Sciences, Dietetics, Occupational Therapy, Pharmacy, Respiratory Care, the Schools of Medicine and Nursing, and Social Work partner with students to care for uninsured patients. Pre-clinic huddles create space for interdisciplinary collaboration and workshops facilitated by faculty members introduce students to key concepts like social determinants of health and provider wellness.

Results
In its first year of operation, ten interprofessional faculty and over 40 students provided free care to approximately 35 uninsured patients per clinic session. With the university’s support, ICOPE will engage over three times as many students in year two. This interprofessional experience provides longitudinal, chronic disease management in an outpatient setting while students establish relationships with patients, peers, and mentors from multiple disciplines.

Conclusions
The ICOPE program embeds students in a service-learning, interprofessional patient-centered medical and educational home through the deployment of value-added educational principles and innovative partnerships.


Building an Interprofessional Practice and Educational Experience to Provide Care to the Uninsured

Introduction: Needs assessment approaches are evolving to operationalize diversity, equity, and inclusion (DEI) climate and gaps in academic medicine. While efforts to address gaps exist at the level of residency training, validated institutional tools to identify areas for improvement may not capture the unique nature of individual clinical learning environments. Our goal was to create a targeted survey using eight DEI constructs outlined by the Association of American Medical Colleges.

Methods: We developed under IRB exemption a survey containing 25 questions scored on a 7-point Likert scale (7=strongly agree to 1=strongly disagree) and two free text response questions. Respondents could indicate inability to evaluate an item (4=neither agree nor disagree). After a DEI principles lecture, residents were invited to voluntarily complete an anonymous survey which only requested training level and gender preference. Survey was disseminated online using Survey Monkey. Item response across PGY status and gender preference was assessed using Chi Square with 2-sided p-value Bonferroni corrected respectively at .017 and .05. Association of item responses within each construct (internal validity) was assessed using Cronbach alpha. Variance in construct explained by item response (construct validity) was quantified as R2 (fractional proportion) computed using confirmatory factor analysis. Positive sentiment was quantified (%) using aggregated “strongly agree,” “agree,” or “somewhat agree” responses. Free text responses underwent parsing and filtering. Statistical analyses were performed using JMP Pro 16.2 (SAS, Cary, NC).

Results: Among 38 resident physicians, 32 (84%) completed the survey distributed across PGY-1 (6 females, 7 males), PGY-2 (4 females, 5 males) and PGY-3 (3 females, 6 males). One resident didn’t indicate PGY status or gender preference. Item response analyses revealed positive sentiment, internal validity and average construct validity respectively within DEI constructs “common purpose” (94%, 0.89, 0.95); “Access to opportunities (90%, 0.63, 0.80); “cultural competence” (85%, 0.43, 0.76); “trust” (87%, 0.59, 0.89); “state of belonging” (89%, 0.73, 0.84); “appreciation of individual attributes” (93%, 0.28, 0.74); and “respect” (93%, 0.56, 0.76). “Equitable rewards and recognition” construct included a single question with favorable sentiment of 78%. Overall positive sentiment was 89% with Cronbach alpha and R2 respectfully ranging from 0.74 to 0.95 and R2 0.13 to 0.96. Text mentions corroborated item responses regarding favorable diversity with some gaps in equity and inclusion. 

Conclusion: Approaches to improve DEI within residency training should be tailored to characterize context specific sentiment that operationalizes needs to be improved.

Development and Design of an Assessment Tool to Improve Diversity, Equity and Inclusion in Graduate Medical Education

Background: Finances, time, transportation, connections, and confidence are just a few of the barriers to becoming a doctor. PhysioCamp is a nonprofit that aims to address these barriers and provide resources to foster future healthcare workers within three groups: K-12; undergraduate; and graduate students. 

Methods: PhysioCamp has held hundreds of hours of K-12 sessions, including virtual discussions on healthcare topics and in-person hands-on activities with anatomic models, preserved donor organs, and simulation equipment. Pre-health undergraduates took on volunteer roles or additional responsibilities as year round virtual interns. The role of graduate students included leadership of the sessions and oversight of volunteers and interns. For the past five years, medical students have worked with PhysioCamp to ensure continuity of leadership and partnership within the local Greenville, NC community. First and second year medical students lead in-person sessions, and transition to virtual leadership in third and fourth years of schooling.

Results: Periodic assessments of K-12 students, parents, and volunteers are performed to audit the impact of sessions. Results from K-12 student and parent surveys showed increased interests in the healthcare field, exposure to unfamiliar healthcare topics, and knowledge of making healthy foods and exercise choices. Survey results from undergraduate and graduate volunteers highlighted the importance of small group learning and hands-on activities to the success of the sessions.
The internship program was added in 2019 to aid in long term retention and mentoring of pre-health students. Since the start of the program, 99 interns have been onboarded, 67 of whom are still active within PhysioCamp. Interns reported they valued mentoring, advising and unique interactions with medical students. Many interns have now entered graduate school in healthcare fields, such as physician assistant and medical school.

Conclusion: Promoting early interest and mentorship contribute to a student’s academic success and career path. PhysioCamp provides longitudinal exposure to health science education from kindergarten to graduate school. Interns and graduate students also gain experience in leadership and mentorship. Sessions are a beneficial resource to the community and act as a place for K-12 students and undergraduate interns to cultivate their academic interests with mentors in the field.

Development and Institution of PhysioCamp: Providing a Community Resource

Abstract Title: 
Disability Connect: A Unique, Peer-to-Peer Mentorship Program at the University of Michigan Medical School (UMMS)

Background: 
Mentorship programs supporting underrepresented racial/ethnic minority students at the University of Michigan exist and improve representation in academic medicine. No program or literature currently exists for near-peer, medical student-only mentorship programs for those who identify as having a disability, at UMMS or nationally. There is a need for such mentorship, given the rise in disability disclosure occurring throughout medical schools nationally. Disability Connect aimed to fill this void.

Methods: 
Disability Connect is a voluntary, near-peer mentoring program, started in Fall 2021 at UMMS, that pairs medical students with disabilities and chronic illnesses with student mentors that share similar life experiences and can help them navigate their medical school experience. The program is student-run and intentionally separate from the university given researched obstacles/conflicts with disability disclosure. Students interested in the program were subsequently contacted and asked to categorize how they would identify their disability from a list of options which included: neurocognitive/neuropsychological, chronic illness, auditory, learning, and mobility/physical; If students felt willing to share, free text was available for students to describe their disability to aid in the pairing of mentor/mentees relationships. 

Results: 
In our pilot launch, a school-wide email was sent, and we received a total of 17 responses in October of 2021. With a student body of 684 students, this equates to 2.48% compared to the most recently calculated national average of 4.58% of medical students who disclose a disability. Of the 17 responses, every category listed in our methodology was represented by at least 1 program participant. 1 student unenrolled in the program. Of the final 16 students, 10 pairings were made. Students were told to expect a 6-month follow-up survey.

Conclusion: 
Data surrounding the importance of mentorship programs is clear, especially among students who have historically been excluded from pursuing higher education. At the 6-month interval, we will assess program effectiveness via validated mentorship evaluation tools with all program participants; Future direction of this program will be tailored based on feedback and student needs however with an increase in students from UMMS requesting accommodations rising from 0.7% to 13.6% since 2017, our programming has drastic implications for the culture of our healthcare system.


Disability Connect: A Unique, Near-Peer Mentorship Program

Background
Disparities in the diagnosis of skin conditions in the United States have long disadvantaged people of color. Addressing healthcare inequities through education is vital to improving quality of care. Pre-clinical medical curriculum introduces students to skin disorders through lectures. Classic clinical presentations are described using key phrases or “buzzwords” in vignettes; however clinical image exposure introduces the visual diagnostic and pattern recognition skills used in real healthcare settings. Past studies have shown that medical graduates do not feel adequately prepared in dermatology overall and struggle to recognize lesions equally in darker skin. Most skin lesions initially present to primary care physicians, emphasizing the need for improved training for non-dermatologic specialties beginning with undergraduate medical education. 

Methods
Participants were recruited from students at the end of pre-clinical skin curriculum. They completed a needs assessment showing eleven different skin disorders that included two clinical images each, one in darker skin and one in lighter (Fitzpatrick IV-VI vs. I-III), with no vignettes. The disorders were chosen based on the American Academy of Dermatology’s recommended medical student curriculum, USMLE Step 1, and prevalence according to a previous study assessing most common skin disorders in African American, Asian or Pacific Islander, Caucasian, and Hispanics of any race. Participants were asked to identify the images from a list of possible answers. The study assessed if students were able to visually recognize skin disorders and if any disparities exist concerning skin of color.

Results
Students demonstrated overall proficiency in visual diagnosis; however, students did not reliably recognize squamous cell carcinoma, eczema, and Stevens-Johnson Syndrome in darker skin. Conversely, they were less able to recognize basal cell carcinoma and tinea versicolor in lighter skin. Overall, students demonstrated lower scores for recognition of nine of the assessed disorders in darker skin.

Conclusion
The current pre-clerkship curriculum does not adequately prepare medical students to recognize skin disorders in darker skin. We believe that curriculum change should include more diverse visual representations and specific instruction concerning how the appearances of these disorders may vary depending on skin color, to better prepare medical students to care for the entire patient population.

Disparities in Visual Diagnosis in Diverse Skin Following Pre-Clerkship Medical Curriculum

Diversity and Inclusion Content Presented on US Primary Care Residency Program Websites

Background
Recent CDC data indicates that opioids account for nearly 71% of all drug overdose deaths. The COVID-19 pandemic has exacerbated recent efforts to curtail opioid overdoses. To prepare future clinicians to recognize and treat opioid overdose victims, it is imperative to provide hands-on training and equip medical students with naloxone in our communities. Secondarily, near-peer teaching in medical education consistently shows benefits to learner and instructor yet is underutilized due to logistical challenges. 
Methods
Pre-clerkship students participated in a 1-hour workshop that consisted of an inpatient simulated opioid overdose using high-fidelity mannequins followed by hands-on naloxone training with demos. Students received a two pack of Narcan nasal spray to keep with them following the workshop for emergencies. Pre- and post-tests/surveys were administered including the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS). Descriptive statistics and paired t-tests assessed for significant differences. Qualitative analysis incorporated Glaser's constant comparative method to identify themes.
Results
In total, 193 medical students participated in the workshop and 70 students completed the pre/post surveys. Results from the OOKS survey demonstrated significant gains in knowledge (percent correct, 76% versus 82%, p<0.05) and significant improvement in overall attitudes (OOAS) towards opioid overdoses [3.5 versus 4.2, p<0.001, (1=completely disagree, 5= completely agree)]. Themes from open-ended questions included how the hands-on instructions made students feel comfortable with using naloxone in real-life situations and the effectiveness of the training by a peer medical student with previous EMS training.
Conclusion
Our results demonstrate that a hands-on workshop focused on opioid overdose recognition and management significantly improved students’ knowledge of and attitudes towards opioid overdoses. This 1-hour workshop can be implemented by other programs to help combat the current opioid epidemic by increasing the number of healthcare trainees and clinicians trained in opioid overdose management. Additionally, based on the positive response regarding learning from an experienced peer, continued efforts to implement near-peer teaching within the medical school curriculum can be fruitful for knowledge acquisition and interprofessional collaboration, particularly by capitalizing on the unique backgrounds of students.

Effectiveness of a Naloxone Training Workshop and Opioid Overdose Simulation with Near-Peer Teaching

Background
One of the strategies to deal with the COVID-19 pandemic was Continuing Medical Education (CME) Online Courses with CME accreditation offered by various renowned universities and platforms for mass awareness and prevention regarding COVID-19 among healthcare professionals. This study was aimed to evaluate the practical significance of these courses in clinical practice and the effectiveness of these courses in revolutionizing and improving COVID-19 case diagnosis and management

Methods 
The multi-centric, cross-sectional study was conducted at various hospitals of Pakistan using a validated questionnaire that was filled by doctors and paramedics from 15th April 2021 to 20th May 2021. Snowball sampling was carried out by sending the questionnaire through social media platforms. We also reached out to the American Society of Microbiology to share the questionnaire with the doctors and paramedics who participated in their Online COVID course held in collaboration with NIH (National Institute of Health), Pakistan. The sample size was 225 and the data was assessed by IBM-SPSS version 26 where Chi-square test was applied to find out statistical significance.

Results
A total of 244 responses were collected from doctors and paramedics from different hospitals in Pakistan. The majority of participants attended the COVID awareness course by WHO, a COVID course by Harvard, and UHS Pakistan. 64.8% reported that the course was relevant to their current scope of practice and the information presented in the CME activity was balanced and free from commercial bias. We found that the courses contributed to the professional growth of the participants and also met their learning objectives. (Pearson’s Chi-Square, P-value <0.05) More than half of the participants reported that they’ll implement the knowledge gained from the courses in patient care. The rest of the participants required additional information and found a lack of PPE and COVID-19 diagnostic kits as perceived barriers in the implementation of acquired skills in practice. A significant number of participants reported that there is a need for new protocols, a more flexible system and New Online programs and Awareness campaigns regarding CME activity.

Conclusion
The online COVID courses proved to be effective in the prevention and awareness of the COVID-19 pandemic among doctors and paramedics.

Effectiveness of Online Covid Courses in Prevention and Awareness of Covid-19 Pandemic Among Doctors and Paramedics.

Background: 
Increasing application numbers constrain residency programs from conducting a holistic review of applicants. Pilot programs to improve holistic review are underway aimed at appraising applicants rapidly. Despite this, assessing narrative components of residency applications remains a bottleneck during applicant review, with many programs resorting to filters based on academic metrics and attributes to invite applicants that are known to have racial, gender, and other inequities. To address this gap and automate the process, the authors used natural language processing (NLP) to predict an interview invite based solely on their narrative experiences.

Methods: 
Narrative experience entries were extracted from 6500 residency applications across three application cycles (2017-2019) at one academic internal medicine program and paired with the interview invitation decision made by program directors. NLP was used to process the experiences’ entries; the importance of each word or phrase (called “tokens”) was calculated using the term frequency-inverse document frequency (TF-IDF). A logistic regression model was developed to determine words or phrases that predicted an interview invitation. Models were also built using structured application data such as USMLE scores and graduation year – either alone or combined with the NLP analysis. Model performance was evaluated on never-before-seen data using the area under the receiver operating characteristic and precision-recall curves (AUROC and AUPRC, respectively). The most influential words or phrases impacting interview invitation were examined.

Results: 
The NLP-only model had an AUROC of 0.79 and AUPRC of 0.48; phrases such as “student-run”, “pre-clinical clerkships”, “analyze data”, and “social determinants of health” increased the probability of receiving an interview invitation. Adding structured data significantly improved prediction, with an AUROC of 0.93 and AUPRC of 0.74. The variable representing the predicted probability based on NLP of the narrative experiences had the highest coefficient magnitude in this combined model. This emphasized the importance of experiences during the resident selection process.

Conclusion: 
To our knowledge, this is the first report on applying NLP to residency application materials to predict an interview invitation. NLP may provide a promising approach for a rapid holistic review and could advance the aims of equity and diversity in selection by expanding currently used metrics.


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