United States

Author name(s) and title(s):
Benjamin Johnson BS; Varun Rao, BS; Genaro DeLeon, MS

Background
Medical education currently stresses the importance of being aware of healthcare disparities and barriers to care through reflection papers and discussions. While these assignments play a valuable role in shaping awareness of social determinants of health awareness in future physicians, real action to combat these issues are often sidelined until students complete their education. Through Hoosier Health Hub a student led, pro-bono consulting group, students partnered with Super Shot, a local Fort Wayne, IN vaccine clinic for the underinsured and uninsured to gather information on reasons for missed vaccine appointments in hopes of putting a system in place that improves no-show rates. 

Methods
Hoosier Health Hub and Super Shot met together to discuss no show rates and current reminder processes in place. It was decided that Hoosier Health Hub could help Super Shot if more information was known about why patients missed their appointments and how they would prefer to be reminded. Hoosier Health Hub created a survey to be administered to patients who had no showed that was geared at understanding any barriers to arriving at appointments, difficulty scheduling, and preferred methods of communication for reminders. A group of first and second year medical students from Indiana University School of Medicine comprised the team. In their own time, students administered the survey, then compiled and analyzed the data. The information gathered was presented in a meeting with Super Shot over a zoom meeting.

Results
While Hoosier Health Hub did not seek IRB approval for the research of this project, Super Shot was pleased with the information we were able to provide them about their patient population. 

Conclusion
Student led pro-bono consulting is a direct way for students to actively address inequalities in healthcare. This project proved valuable to medical education by allowing students to learn first-hand how to help health care programs that are created to help those who are underinsured or uninsured who many times fall through the cracks of American health care. Valuable information was provided for Super Shot that lead the organization to ask for an on-going partnership to continue to survey their patient population so that they can continue to improve operations and meet the needs of their patients. American medical education could be enhanced by adopting a more hands on approach to addressing the needs of local communities while simultaneously providing students with valuable perspective that they can carry into their future practice. 


AMA Research Challenge 2022

Pro-Bono Student Consulting Project Addressing Patient No-Show Rates for Underinsured and Uninsured Populations

Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
The 2022 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. Log in at any time throughout the event to:
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges and compete to win a $10,000 grand prize sponsored by Laurel Road.
 

#### Attend Live Forums
**Oct. 20, 6 — 7 p.m. Central**
 **How to plan a career in academic medicine** 
 Learn how to plan a career in academic medicine and get your questions answered. [Access Here](https://underline.io/events/363/lounge)
 
 **Speakers**
![](https://assets.underline.io/uploads/markdown_image/1/image/d5adb133dfc58eb0a6d469e9cedcd5d4.jpg)
Ricardo Correa, MD, EdD
![](https://assets.underline.io/uploads/markdown_image/1/image/5f9437ab87861538bf02b9ca7c0d926e.jpg)
Stuart M. Greenstein, MD
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Stephanie Strohbeen, MD
 
 **Oct. 22, 11 a.m. — Noon Central**
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 **Speakers**
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Jessica Li, MD/PhD Candidate
![](https://assets.underline.io/uploads/markdown_image/1/image/9950ef2e0237f54cb3d8280334d42491.jpg)
Charles Lopresto, DO

### Sponsor
AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on Dec. 7 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)

**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use the link below to register for free if you have not already done so:**

https://www.ama-assn.org/about/events/ama-research-challenge

Registration Is Required

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


poster

Background
Race in medical education is often used as a proxy for a genetic ancestry or is otherwise lacking vital social or epidemiological context. As a result, medical training can reinforce false beliefs about race as a biomedical rather than social category. One study found that half of all trainees surveyed believed Black people possess less sensitive nerve endings, thicker skin, and more coagulable blood than White people. Yet, it remains unclear when such views arise and how they endure over time. The rationale for this study is to analyze medical students’ perception of race at two time points in the pre-clerkship phase and to explore strategies for instilling a holistic understanding of race and ethnicity in preclinical curricula.

Methods
First-year medical students at Medical College of Georgia completed a nine-question survey in September 2021 that called for Likert scale and short-answer responses. Data was deidentified, descriptive statistics were performed in Qualtrics, and responses were analyzed qualitatively in NVivo by coding keywords to identify relevant themes. Repeat survey is to be administered to same cohort in September 2022 followed by voluntary post-survey focus group.

Results
Likert (1 – 5) data indicates students (n = 97) moderately believe in a biological basis for race (3.45 ± 1.19) and somewhat believe in biological difference as a causal factor for racial health disparities (2.80 ± 1.18). Qualitative responses showed that 37 students believe race is relevant to diagnostic reasoning, while 50 students believe considering race can introduce anchoring and other biases.

Conclusion
Preliminary findings suggest students lack a cohesive understanding of race and ethnicity in the context of medical science. Though many responses view race through a social lens, responses overall tilt toward a biological lens. Limitations thus far include inability to determine underlying intent or seek clarification of ambiguous responses. Recently adopted policy at the AMA has called for eliminating race-based medicine, while select institutions and specialty societies have elected to remove racial multipliers from clinical algorithms (e.g. MDRD eGFR equation). Potential avenues for innovation in preclinical curricula include incorporating holistic competencies regarding race into problem-based learning, focus groups, and curriculum townhalls.


Researching and Remedying Perceptions of Race in Preclinical Medical Education

Background: In recent years there has been increased recognition regarding the importance of social determinants of health (SDOH) on health outcomes. Although SDOH awareness is already incorporated into medical education, there is a lack of comprehensive tools available to assess SDOH understanding, attitudes, and application in medicine (Samouei 2020). By determining the limitations in current medical education, this study aims to address shortcomings in SDOH education to provide optimal care to patients from diverse backgrounds by meeting their individual needs. 

Methods: Participants completed a pre-survey prior to the intervention.​ Participants were then presented with an educational PowerPoint on the social determinants of health. Post-presentation, participants were divided randomly into small groups to discuss 3 different cases incorporating SDOH​. Afterward, they completed a post-survey. 

Results: Participants are statistically significantly more comfortable talking with their future patients after the session on 10 out of 12 topics (the exceptions are gender identity and sexual orientation). These improvements remain significant on 6 topics (i.e., the community they practice, access to care, food insecurity, healthy diet, homelessness, and intimate partner violence) even after multiple comparison corrections using Benferroni procedure. 

Conclusion: The current study provides evidence that residents benefit from the inclusion of SDOH specific education in their curriculum as shown by our quantitative assessment. 

Social Determinants of Health Awareness in Emergency Medicine​

Background
The Caring for Communities of Color Conference (CCCC) is an annual student-led initiative that aims to educate healthcare trainees in health justice principles, expose them to primary care careers, connect them to clinicians in the field, and build a network of providers centering the health needs of communities of color. Developed to address gaps in medical school curricula regarding primary care and health advocacy for minoritized patients, the CCCC provides a unique approach to addressing healthcare disparities: shared learning through engagement with experts in the community.

Methods
Conference Organization: Conference objectives were defined as: research in partnership with communities, increased exposure to primary care careers, and serving communities of color in specialty professions. Fifteen second-year medical students developed virtual workshop content, sought out speakers, participated in social media marketing, designed survey tools to evaluate the impact of workshops, and obtained funding. 

Survey: Pre- and post-conference surveys were designed to evaluate changes in racial justice competency and awareness of primary care professions before and after the conference. Survey questions consisted of Likert scale responses, free-response, and demographic questions. All participants received the pre- and post-surveys via email. Both surveys received IRB exemption. 

Funding: Funding was provided by student organizations at the medical school.

Results
The inaugural conference occurred from August 31-September 2, 2020 with interactive workshops, dialogues with clinicians and patients, and a call-to-action. Speakers included 49 health professionals and over 400 participants nationwide. Participants included students in social work, public health, nursing, and medicine.

The pre-conference survey was administered to 400 individuals with a response rate of 40%. Data demonstrated that 60% of participants felt they did not have the skills necessary to care for communities of color in their line of work (n=160). The post-conference survey data were insufficient (n=15), but qualitative comments demonstrated that participants improved their knowledge and comfort in caring for communities of color. 

Conclusion
The CCCC expands upon the traditional confines of knowledge-sharing regarding health justice work in medical school curricula through collaboration and inter-professionalism amongst healthcare providers, students, and community activists. A 2021 conference has since been held.

The Caring for Communities of Color Conference: A Collaborative Approach to Address Healthcare Disparities

Background
As an increasing number of medical students identify as transgender, more students are facing the ethical dilemma of deciding if, when, or how to disclose their gender identities within medical spaces such as school, work, and social media. Many allies are unaware of the risk-benefit analyses these students constantly undertake while working in a historically transphobic field. To whom do transgender students ‘owe’ disclosure and what impact does disclosure have on students and those around them? While there is no moral right or wrong with regards to personal disclosure, learning about the ethical dilemmas transgender students face when it comes to disclosure decisions and how these dilemmas affect transgender student recruitment, retention, and overall wellbeing can teach allies how to best support transgender students in their disclosure journeys.

Methods
Using convenience sampling, a total of 15 transgender medical students were recruited for open-ended interviews in which they shared their disclosure journeys over 4 years of medical school. Thematic analysis identified common themes in response to the following questions: 
1) When in medical school does the question of disclosure arise?
2) What influenced your disclosure decisions?
3) What was the impact of your decision?
4) How could allies best help you in your disclosure journey?

Results
Resultant themes were utilized to create an educational module consisting of 4 representative hypothetical scenarios transgender students may experience over 4 years of medical school paired with discussion on the potential impacts of no, partial, and full disclosure. The scenarios and guided discussions illustrate how various supportive behaviors from allies can powerfully impact transgender student recruitment and retention, transgender health education and equity, community solidarity, moral injury and burnout, and health and healthcare overall. 

Conclusion
Transgender medical students often experience similar ethical dilemmas when deciding how ‘out’ to be in medical school. A greater awareness and understanding of these dilemmas can guide ally interventions to reduce the burden of disclosure on transgender students and promote transgender student recruitment, retention, and wellbeing that positively impacts medical education and practice for all involved.

The Ethics of Disclosing Ones Identity as a Transgender Medical Student

Context: Some racial and ethnic groups are underrepresented in the medical field because they face unique barriers to admission to medical school. One admission requirement that can present a barrier for applicants is the physician letter of recommendation (PLOR). Undergraduate students report confusion with the application process and lack of mentorship to be one of their biggest challenges to becoming a doctor. It is especially challenging to those who already have limited access to practicing physicians. Therefore, we hypothesize that in the presence of a PLOR, the diversity of students who apply and matriculate into medical school will be decreased. 
Objective: To determine if a relationship exists between a PLOR requirement for the medical school application and proportion of underrepresented in medicine students applying and matriculating to that school.
Methods: A descriptive study was conducted using data published by the American Association of Colleges of Osteopathic Medicine Application Services (AACOMAS) on the race and ethnicity of applicants and matriculants to osteopathic medical schools during the years 2009-2019. In total, 35 osteopathic schools with 44 campuses were included in the study. Schools were grouped based on whether they required a PLOR. For each group of schools, descriptive statistics were performed for the following variables: number of total applicants, class size, application rate per ethnicity, matriculation rate per ethnicity, number of applicants per ethnicity, number of matriculants per ethnicity, and percentage of student body per ethnicity. The Wilcoxon rank-sum test was used to detect differences between the two groups. Statistical significance was assessed at the α = 0.05 level.
Results: Schools that required a PLOR showed decreases in both class size and number of applicants across all races and ethnicities. Black students showed the greatest difference between groups and were the only ethnicity to show significant reductions across all outcomes in the presence of a PLOR. On average, schools that required a PLOR have 37.3% (185 vs 295; p<.0001) less Black applicants and 51.2% (4 vs 8.2; p<.0001) less Black matriculants. 
Conclusions: This study strongly suggests a relationship between PLOR’s and decreasing racial and ethnic diversity in medical school matriculants, specifically the Black applicants. Based on this result, it is recommended that the requirement of a PLOR be reconsidered for osteopathic medical schools.

The Impact of the Phyician Letter of Recommendation on Medical School Admission Demographics

Background
Asylum seekers face significant and unique healthcare challenges, requiring healthcare practitioners specifically trained in caring for this patient population. However, there is limited understanding of medical students’ interest in and future ability to care for the population of asylum seekers in the United States. We aim to better understand U.S. medical students’ interest, experience, and knowledge in providing care for asylum seekers to inspire change in the ways in which medical schools introduce asylum seeker care to learners.

Methods
A 23-question survey was administered to U.S. medical students at four institutions with asylum programs affiliated with Physicians for Human Rights (PHR) from June 2020 to March 2021, querying various aspects of providing care to asylum seekers. 

Results
Of the approximately 2846 students who received the survey, 436 students (15%) completed it in its entirety. Most respondents desired training about caring for asylum seekers (91%). Over half (52%) rated their knowledge of asylum issues overall as “poor” or “none," and 73% thought their medical school's curriculum on asylum seeker health needed improvement.

Conclusion
This study demonstrated that medical students at schools with affiliated asylum clinics desire to care for asylum patients but feel unprepared to do so, highlighting an unmet need for formal asylum education in U.S. medical schools.

U.S. Medical Student Knowledge and Interest in Asylum Seeker Medical Care

Abstract Title: Urban Myths and Healthcare Disparities for Cardiovascular Care in Black Americans 

Background: Racially based cardiovascular care guidelines in the black population have been pervasive throughout clinical medicine and medical education. These guidelines have largely been based on several unproven recommendations indicating that black individuals have a genetic propensity for the development of hypertension due to chronic stress faced during the Atlantic Slave Trade. This research project aims to dispel antiquated theories regarding race and instead shed light on the importance of assessing social determinants of health (SDOH) and structural/political determinants that affect patient’s disease and outcomes. This education and awareness should begin early on in a physician’s training and continue throughout their career. 

Methods: A literature search was performed utilizing PubMed and Google Scholar with key phrases such as: “slavery hypothesis”, “cardiovascular disease in black individuals”, “salt retention in black individuals”, “eGFR in black individuals”, “hypertension racial guidelines”. There was no time frame that was exempt from the initial literature search. Exclusion criteria included exempting studies not performed within the United States. A possible limitation to this investigation was that specific studies were included such as the Jackson Heart Study, Evans County Cardiovascular and Cerebrovascular Study, and Charleston Heart Study rather than an extensive list of all historic studies. 

Results: The literature review revealed popularity in slavery hypotheses and natural selection theories regarding the significantly higher levels of cardiovascular disease in black individuals, especially in earlier studies conducted. There was a change in rhetoric from the initial studies completed between the 1960s and 1990s, with recent focus placed on socioeconomic status and lifetime discrimination. Other recent studies increased focus on comorbid risk while evaluating for etiologies for cardiovascular health in black americans. Recent findings have demonstrated that hypertension care in black patients should focus on racial disparities, discrimination, and societal inequities rather than innate genetic predispositions. 

Conclusion: It is critical to integrate SDOH, structural and political issues along with scientific research surrounding cardiovascular health in the black population. There is a significant need for early awareness in medical school and residency training to mitigate disparities in the diagnosis and treatment of cardiovascular diseases within this population. 





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