United States

Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). 

Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. 

Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. 

Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.

AMA Research Challenge 2022

Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder

Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
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Ricardo Correa, MD, EdD
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Stuart M. Greenstein, MD
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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

### Sponsor
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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

Objective: The impact of social media (SoMe) has been magnified in the COVID-19 era with virtual interviews becoming the new normal. Residency programs that effectively utilize SoMe have the potential to distinguish themselves and improve their resident recruitment. The platforms also give programs an opportunity to connect with applicants they otherwise might have limited ability to reach prior to the interview season. We sought to evaluate the presence of SoMe across diagnostic radiology residency programs and determine how they effectively leveraged these platforms in resident recruitment. 

Methods: A list of diagnostic radiology residency programs within the United States was obtained from the American Medical Association (AMA) FREIDA Residency Database. A subsequent search for the presence of Twitter, Facebook and Instagram was performed for each of these programs. For programs that did not have a dedicated residency SoMe account, the department account was used in lieu if the authors appreciated residency-related content being commonly shared. The authors then tabulated the presence of each radiology residency program on the aforementioned SoMe platforms. Further analysis was then done to determine the year of creation of the account (if available on the platform), the total number of Twitter followers, the total number of Instagram followers, and the total number of Instagram posts. Descriptive statistics with Microsoft Excel was performed to analyze the data.

Results: Based on the analysis, the most utilized SoMe platform by radiology residency programs was Twitter (61.73%), followed by Instagram (47.45%), and then Facebook (37.76%). Given that Twitter was the most utilized, further analysis was done to evaluate the total number of followers and the year of account creation. The results showed that the average program had 1081 ± 1438 followers and the mean year of creation was the year 2017 ± 2.6.

Conclusion: Social media is an effective tool to disseminate information efficiently and effectively to prospective residency candidates. It is important that those involved in graduate medical education stay up to date with current and future trends in social media while simultaneously maintaining an active professional presence on these platforms.

“From Rads to Riches” – How Radiology Effectively Utilizes Social Media in Residency Recruitment

Background: Virtual anatomy modules are convenient for students to complete, but their utility compared to traditional in-person anatomy didactics is unclear. Additionally, the recent demand for remote-learning materials has provided an advantageous opportunity for our institution to develop and assess the efficacy of online modules to teach pre-clerkship anatomy. Our aim was to develop, deploy, and evaluate the utility of Online Radiographic and Cadaveric Anatomy (ORCA) modules for teaching anatomy.

Methods: We created online renal, pulmonary, and cardiovascular anatomy modules that incorporated pictures of cadaveric prosections, 2D models, and radiographic images to teach principles of anatomy for first-year medical students (MS1) at Paul L. Foster School of Medicine. Efficacy of our online modules was assessed through pre- and post-module tests. Additionally, voluntary surveys were administered to students to assess their opinions on this type of learning experience.

Results: Out of 116 students in the MS1 class, 77 completed the renal module, 85 completed the pulmonology module, and 47 completed the cardiovascular module. Pre- and post-module assessments showed that of the 77 MS1s who completed the renal module, 53% scored an 80% or higher on the post-module quiz, and 14% scored a 20% or lower. Additionally, of the 85 students that completed the pulmonary module, the percentage of students who scored 80% or above on the pre- and post-test were 25% and 47%, respectively. Post-unit surveys indicated that 70.2% of MS1s found the modules useful for teaching principles of anatomy, 54.1% feel confident applying their knowledge of anatomy to answer clinical vignettes, and 70.6% wanted similar modules in the future.

Conclusion: The results of this study suggest that ORCA modules may be helpful in teaching anatomy; however, additional studies are needed to assess whether they significantly improve test performance. Furthermore, a majority of MS1s found the modules to be useful for learning principles of anatomy, feel confident applying their knowledge to vignettes, and want similar modules for future anatomy units.

Learning Anatomy Using Online Radiographic and Cadaveric Anatomy (ORCA) Modules

Background
Live interactive patient cases have shown to be a valuable resource in medical education. Previous studies have shown that using patients as teachers helps students develop clinical reasoning, motivates students to learn, and has important educational benefits; however, there is limited research on medical student feedback for these patient cases. Therefore, the objective of this study is to evaluate second year medical students’ (MS2) perceptions on interactive patient encounters during the teaching of the skin and rheumatology course (BMS6635).

Methods
Following the completion of the BMS6635 course, MS2s completed a survey on their experience from four to five interactive patient cases at University of Central Florida College of Medicine from 2016-2022. The interactive cases involved patients with diagnoses of systemic lupus erythematosus, psoriatic arthritis, dermatomyositis, scleroderma, and pyoderma gangrenosum. All MS2s enrolled in BMS 6635 were included. Statistical analysis was performed on survey responses. 

Results
700 surveys were completed following the interactive patient encounters. 90% of participants answered that they enjoyed the interactive patient cases. 92% of students agreed that the patient cases were an appropriate learning experience for their education. 76% of students agreed that the patient encounters helped them retain knowledge of the diseases. However, only 36% agreed that the number of patients in the patient cases should be increased. From 2016 to 2022 there has been a slight decrease in enjoyment in the interactive patient cases over time (97%, 88%, 93%, 94%, 86%, 81%, p<.001, respectively per year). From 2016 to 2022, there was a slight decrease in students agreeing that the patient cases were an appropriate learning experience in their education (98%, 92%, 94%, 95%, 93%, 84%, p=.001, respectively per year).

Conclusion
While there may have been a slight decrease in positive feedback in interactive patient cases, patient cases are a valuable resource in medical education and should be integrated in medical curricula. Students enjoyed the patient cases, believed they were an appropriate learning addition to their education, and aided in retention of material.

Second Year Medical Student Feedback on Live Patient Cases in the Skin and Rheumatology Course

Background
The use of race as a biological construct without proper social, political, and historical context is dangerous and can lead to the perpetuation of racism and racial and ethnic health disparities.1–4 The goal of this project was to assess the ways in which race and ethnicity are presented in the Foundations of Medicine and Health pre-clerkship curriculum at Case Western Reserve University School of Medicine and appreciate ways in which the curriculum could improve to be more structurally competent.

Methods
This project began by creating ten learning objectives to guide instructors and students on the skills and knowledge necessary to promote race and ethnic diversity in medicine. We systematically reviewed 398 lectures with 20,630 slides across six basic science integrated blocks from 2020-2022 looking for the following terms: race, ethnicity, black, white, asian, hispanic, native American, racial, or photos of people of color. Each lecture PowerPoint was reviewed for the relevant terms and images; and the following information was recorded for each reference: faculty author, block, lecture title, number of slides in that lecture that mentioned key
terms, topic covered in the lecture that included race-ethnicity, application of the term (e.g risk, diagnostic), and areas for improvement.

Results
The results of this project were the creation of 10 learning objectives that are consistent withmCultural Competence Education for Medical Students guidelines AAMC standards. Curricular examination identified 245 slides across ninety lectures in the 2020-2022 preclinical curriculum that mention race, ethnicity, black, white, Asian, Hispanic, Native American, racial, or contain photos of racially and ethnically diverse people. Of the 245 slides reviewed, 220 slides (89%)
mentioned key terms as biological constructs without proper mention of structural factors.
Conclusion
The results of this project are in alignment with previous literature on the subject.17
Added context should be included throughout all the preclinical curriculum to ensure that students are prepared to effectively care for individuals from a variety of races and ethnic backgrounds. Moreover, medical education still lacks a concise and direct way to discuss race and ethnicity. The learning objectives created in this project offer a framework on how to make discussion on race and ethnicity in medicine relevant, accurate, and solution oriented.

An institutional evaluation of race and ethnic diversity in pre-clerkship lectures

Background: Physicians regardless of specialty will encounter patients who have experienced addiction, making addiction medicine training vital. Unfortunately, medical schools devote little time to addiction-related training, with many students graduating without adequate knowledge or skills to treat patients with substance use disorders (SUD).

Methods: Michigan State University (MSU) created a pilot 4-week addiction medicine elective for PGY-1 students with the goal of increasing student’s knowledge, awareness, and skills in assessing patients with SUD. The Addiction Medicine Student Interest Group (AMSIG) was created to implement additional foundational principles. The 4-week elective was developed and made available to students online, including asynchronous modules, small and large group meetings, clinical cases, and expert and patient interviews. Utilizing these methods allowed for a broader reach and appealed to multiple learning styles. AMSIG held several events beginning with a de-stigmatization campaign where people-first language was emphasized. Other events included a patient panel, and naloxone and buprenorphine educational sessions.

Results: 36 PGY-1 students at MSU-CHM (MSU College of Human Medicine) completed a baseline attitudes survey in May 2021. An overwhelming majority of students “agreed” or “strongly agreed” that physicians who diagnose SUD early improve the chance of treatment success (89%), family involvement is a very important part of SUD treatment (97%), SUD is treatable (92%), alcohol use disorder is treatable (97%). The majority “disagreed” or “strongly disagreed” that once a patient is abstinent and off all medication for their SUD, no further contact with a physician is necessary (100%), a patient with SUD who has relapsed several times probably cannot be treated (100%), a patient with a SUD cannot be helped until they hit “rock bottom” (94%). The de-stigmatization campaign had 21 participants, the patient panel had 30 attendees, the naloxone training was overwhelmingly popular with 66 participants, and the buprenorphine session had 26 participants.

Conclusion: Early supplementation of the medical school curriculum with addiction medicine training can boost students’ confidence in their ability to assess patients with SUD. Moving forward, the goal is to share what MSU-CHM has learned from the elective and AMSIG. Our hope is that other medical schools will incorporate these principles into their curriculums.

Beyond the Curriculum: Equipping Medical Students to Respond to the Opioid Epidemic

Background
Violence by patients and families against healthcare providers has long been a documented problem among healthcare professionals, and medical students are no exception. There is existing evidence of the effectiveness of verbal de-escalation to prevent violence and restraint. However, most medical schools do not offer de-escalation training, and most health system employers don’t have training or policies about managing aggressive behaviors. 
Methods
A group of researchers worked with medical college faculty and resources to develop a one-hour verbal de-escalation training for students based on the 10 de-escalation principles outlined in Project BETA and delivered the class to fourth-year students. During and after class, surveys were distributed to students for reflection and to assess the efficacy of the educational intervention. There were 158 recorded responses to the survey of 192 students in the graduating class.
Results
Overall, 82% of respondents thought that the course was at least somewhat of a good use of their time, and 97% of respondents felt that they would be successful in their attempts to de-escalate a patient after participating in the class. Students reported learning about de-escalation tools that will be useful, and that violence and the use of restraints are preventable with verbal de-escalation. Although most students reported increased confidence in de-escalation after participating in the course, it is unclear whether the topics in this course are readily applied to real-life situations; a limitation of the data collected.
Conclusion
Although a one-hour course is a strong step in teaching students about de-escalation, de-escalation is a learned skill that takes practice. Regular intervals of de-escalation learning throughout medical training would be ideal for the continued retention of information and practice of its use.


De-Escalation Training in Medical Students

Spaced-repetition and active retrieval-based practices consistently demonstrate improvement in cognition and retention of a large volume of information. Anki is an application that capitalizes upon these techniques and is increasingly utilized by medical students for exam preparation. While both spaced-repetition and active retrieval have been shown to improve long-term memory, there is little research on using Anki supplementary to medical curricula. This study examines how Anki utilization affects performance on standardized exams alongside analyzing individual Anki statistics to track markers of quality usage. Secondary goals include a qualitative assessment of the Anki, including its effect on student test confidence and preparedness.

In July 2021, medical students received training on using Anki alongside longitudinal support throughout the year. Following completion of Boonshoft School of Medicine academic curricula, data was obtained from the exams: Origins, Host and Defense (H&D), Staying Alive (SA), and the Complete Basic Science Exam (CBSE). Variables included: (1) student generated information from individual Anki-user statistics, submitted via Qualtrics; (2) nationally standardized exams stored in the Department of Medical Education; and (3) Qualtrics surveys on perceived ease-of-use at course end points.

Of the 130 students from the Class of 2025, 78 students reported using Anki for at least one of the exams, and 52 students were not in any of the four datasets. MCAT scores were used as a controlling measure when analyzing test scores to diminish confounders of natural intelligence and test-taking ability. Anki users scored significantly higher (95% CI) across all for exams: Origins (6.37%; p<0.001); H&D (6.15%; p=0.002); SA (7.01%; p<0.002); and CBSE (12.9%; p=0.003). Additionally, students who reported higher confidence or Anki dependency performed significantly better on the CBSE (ANOVA p=0.008, R2 = 74.8%).

Students more dependent on Anki performed significantly better on standardized examinations. Of interest, Anki efficacy was more pronounced in exams requiring greater bouts of knowledge, emphasizing the importance of long-term retention practices for board exams. In summary, greater integration, training, and longitudinal support of Anki may improve foundational biomedical knowledge and standardized exam scores.

From Short-Term Memory to Long-Term Knowledge: A Modified Learning Approach to First-Year Medical Education

Abstract Title: From Stage to Clinic: The Implementation of the Theater of Oppressed in Medical Education

Background
Structural and social determinants of health (SSDOH) studies are an essential part of medical education. Previous work has demonstrated increased awareness and reflexivity of SSDOH topics among students. This skill, however, does not always translate into a tangible behavioral change. The complexity of SSDOH does not lend itself well to didactic teaching styles or even traditional active learning modalities like TBL and CBL. These approaches often lead to SSDOH being presented as a laundry list of problems rather than a multifaceted problem originating from societal systems of power. Theater of the Oppressed is a pedagogical method derived from Brazilian theatrical studies. In Theater of the Oppressed, the actors and audience work together to practice action-based change that stimulates critical observation and representation of reality, as well as allow for the envisioning and production of conscientious and concrete actions. Theater of the Oppressed has great utility in medical education and opportunity to incite behavioral change. 

Methods
To create a pilot test of the Theater of the Oppressed in medical education, a focus group was held with current medical students to assess what SSDOH topics they were interested in, or felt they were lacking in their medical education. These topics were used to write a five-person scene featuring an oppressor, a victim, and several bystanders. Volunteer actors rehearsed the scene and practiced improvised situations prior to the pilot session. 

Results
Second through fourth year medical students watched a live scene depicting the relationship between an oppressor and victim. Using previous knowledge of SSDOH and existing interpersonal communication skills, after the scene students were able to switch with an actor to try and alleviate the oppression. This engaged students in SSDOH discussion and allowed for the practice of tangible intervention. 

Conclusion
Theater of the Oppressed has a large utility in improving SSDOH medical education. Future installments will use a Likert scale and free response questions to survey participants before and after a session. The survey will evaluate for general understanding of SSDOH, perceived ability to alleviate health inequities, and overall benefit of Theater of the Oppressed in medical education.


From Stage to Clinic: The Implementation of Forum Theatre In Medical Education

Background:
Hearing loss affects 1.6 billion people, making it the third most common disability worldwide. Patients who can hear are approximately 2 times more likely to secure primary care appointments than those who are deaf and communicate via American Sign Language (ASL). Compounding factors such as inadequate sign language interpreter services and the COVID-19 pandemic have exacerbated the existing healthcare service disparities received by the deaf population. Additional studies show that despite having similar health insurance coverage percentages (Deaf=96% covered; Hearing=94% covered), deaf patients rated their doctors as having lower patient-centered communication skills than those who hear (Deaf patient centered communication satisfaction mean=60.99 [SD=25.89]; Hearing patient centered communication satisfaction mean=82.25 [SD=21.14]; t test=16.97, P value<.001). Despite this, there is still a lack of formal training for frontline health professionals working with this disadvantaged population. 

Methods
The dire need for ASL interpreter services can be alleviated by introducing an ASL elective to medical school programs and other health professional school curriculums. Language electives, including medical Spanish, are currently offered by 78% of 125 U.S. medical schools in response to the growing Spanish-speaking population, yet very few medical programs offer an elective to teach ASL. Our proposed ASL elective would be modeled similarly to current language electives to confront this seemingly timeless disparity.

Results
Through collaboration with local ASL community centers, including churches and colleges, health professional programs across the nation can develop a 4-week ASL elective through clubs or service-learning projects. Offering such an elective would ultimately help produce better prepared future healthcare professionals, especially those interested in ENT, audiology, and primary care specialties.

Conclusion
The Americans with Disabilities Act (ADA) mandates equal access and effective communication to all patients, especially those with disabilities; however, ASL interpreter services are not readily available or reimbursed by all healthcare systems and insurances. Furthermore, the COVID-19 pandemic enforced mask mandates which prevents deaf patients from reading lips, thus hindering one of few alternative communication methods apart from ASL. The call for reformation in the medical healthcare system to alleviate the perpetual struggles of the deaf population is one that needs to be heard now.

Health Care Disparities Among the Deaf Call for Health Professional Education Reformation

Abstract Title:
Image Quality Assessment in Point of Care Ultrasound Education
Background
Our aim was to provide a high-quality POCUS education program for hospitalists at the Jesse Brown VA hospital. That entailed providing a valid and consistent way of tracking the progress of our learners throughout the program, for which image quality assessment was one of the main metrics. Literature review demonstrated a gap in evidence-based methods for doing so, which is why we believe our findings are invaluable for the advancement of POCUS education.
Methods
A group of 25 ultrasound images was shared with our 3 educators for quality measurement on a numerical scale. First, each educator independently scored the images based on clinical gestalt. A second round of image scoring was done where the educators were provided a rubric to independently score images based on orientation, gain, plane, depth, and visible structures. A debriefing session was then done to clarify how each of the educators perceived and utilized the rubric after which a third and final round of image scoring was done. The educators were blinded to their colleagues’ grading submissions until the end of the 3 rounds.
Results
The intraclass correlation coefficient (ICC) was 0.589 for the first round of scoring. After adding the rubric, the ICC rose to 0.752 (28% increase). The ICC further increased to 0.862 after the debriefing session was done on using the rubric. The calculated Conbrach’s alpha for internal consistency was 0.811.

Conclusion
There is a significant improvement in the ICC after implementing the rubric, and again after the debriefing session was conducted. This implies a higher consistency in the feedback learners receive on their images from the different educators when using an agreed-upon rubric to track their progress. 
The rubric was also successful in grounding the educators to focus on the innate image quality attributes first, and then to provide feedback on the clinical utility of the entire study of images a learner has submitted for a given patient. We were thus able to independently score technical skills for image acquisition while fostering the learner’s clinical skills of interpreting such images to guide their use of ultrasonography in clinical practice.

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