United States

Medical law is a subset of the legal system that dictates appropriate medical practice, regulations, and the rights and responsibilities of healthcare professionals and their patients. As the relationship between medicine and law becomes increasingly complex, many medical students report negative perceptions of the legal field and feel unprepared to handle medical-legal issues upon entering their clinical rotations and residencies. The aim of this literature review was to provide an overview of medical student understanding of medical law as well as the current status of medical-legal education in the United States. 

A PubMed search revealed 3,483 papers that were sorted for relevance and the citations of relevant papers were also reviewed. A total of 38 studies were included and evaluation yielded three main themes that were explored in depth. The first theme was that medical students and residents report feeling unprepared to handle legal aspects of healthcare. Surveys regarding medical student perceptions of the legal field unveiled the second theme which describes students as having generally negative feelings and attitudes toward law, although students acknowledged the importance of medical law in healthcare. The last theme was described by studies determining that introducing medical-legal courses to current medical school curricula would benefit students and have a positive impact on their perceptions of the legal field. 

More must be done to evaluate and reform current medical curricula to produce legally competent and confident physicians. The Liaison Committee on Medical Education in the United States should take the lead and add medical-legal education to their standards for accreditation that are annually released.

AMA Research Challenge 2022

Incorporating Medical Law into Medical Education Curricula: A Literature Review

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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.


Background Traditionally, hands-on procedural training during pre-clerkship education has been limited. Students transition from the classroom to the wards with limited procedural skills. As a result, students navigate their first clerkships with anxiety about being unprepared. In response, we hosted an in-person event, the Medical School Convention (MSC), to help the first-year medical students acclimate to procedural skills they will use shortly in their core clerkship training. 

Methods An in-person targeted simulation curriculum was launched at a large, private allopathic medical school to help improve medical students' self-perceived efficacy before starting clerkships. The objective was to provide medical students with a small group, hands-on clinical and procedural skills practice to better prepare them for clinical clerkships. Six relevant skills often not included in the traditional medical school curriculum were selected for the training, each being taught at a separate station. The stations were: oral presentations, suturing, venipuncture, intubation, ultrasound, and trauma assessment. A curriculum and training course was created for each of the skills. Following the skills training, students were offered an anonymous post-survey assessing comfort and self-perceived competency with the skills taught at the stations they attended. This study was deemed exempt by the Institutional Review Board. 
Descriptive statistics were obtained for all variables. Survey responses were analyzed using paired t-tests to compare pre-training and post-training responses. A p-value of < 0.05 was considered statistically significant. 

Results In the posttest survey, 95.1% of students reported that this workshop helped them feel more confident in clinical scenarios. Additionally, 100% of students reported that they would recommend this workshop to other medical students. Although not statistically significant, there are appreciable differences in students’ perceived confidence (2.8 vs. 3.2, p=0.537) and clinical self-efficacy (5.3 vs. 6.3, p=0.998) pre-and post-training, respectively. 

Conclusion The Medical School Convention provided valuable insights regarding medical students' self-reported preparedness for the wards. Through our brief one-day course, we identified some knowledge gaps regarding procedural skills and ways to address them. We conclude that more hands-on skills training should be integrated into all medical school curricula before students begin clerkships to help increase their self-confidence.

Medical School Convention: An Innovative Model to Prepare Medical Students for Clerkships

Medical Specialty Speed Dating: Does It Work?

Background: There is a paucity of research regarding the perceptions and potential behavioral changes of the medical students that will be taking the USMLE as a pass/fail examination. We sought to assess medical student perceptions of the USMLE Step 1 transition to pass/fail and evaluate differences in extracurricular participation between pass/fail Step 1 students and scored Step 1 students.

Methods: Sixty-eight US medical schools were invited to participate in an anonymous survey. Self-reported extracurricular activities during the first year of medical school were compared between Step 1 pass/fail students (S1PF) and Step 1 scored students (S1S) with a chi square test.

Results: Between 8/25/2021-11/16/2021, 341 students started the survey and 277 (81.2%) completed the survey. One hundred two (36.8%) were S1S and 175 (63.2%) were S1PF, of which 87 (49.7%) had completed at least one year of medical school. We found mixed results on whether students would prefer Step 1 to be pass/fail or scored. The majority felt the transition would disadvantage students from “lower ranking” medical schools. Regarding the transition, the majority of S1PF reported more anxiety related to Step 2, extracurricular activities, and the
residency application process. There were no significant differences between S1S and S1PF students for participation in volunteering, teaching, and research, but a significant increase was observed in how many leadership positions S1PF students applied to and obtained during their first year of medical school (p < 0.001 and p = 0.011, respectively).

Conclusion: To our knowledge, this is the first study analyzing the perceptions and possible behavioral changes of medical students who will be taking Step 1 as a pass/fail examination. The reported increase in anxiety among pass/fail students should be addressed by medical education professionals and merits discussion of curricular remodeling. The transition creates an opportunity to redefine the residency application process allowing holistic evaluation of students which can confer advantage to those from “lower ranking” schools.

Medical Student Perceptions of the USMLE Step 1 Transition to Pass/FailScoring

Native Hawaiian and Pacific Islanders Fail to Match Previous 15-Years of Underrepresented in Medicine Growth in Graduate Medical Education Residency Training Programs

According to the National Residency Matching Program in 2022, 631 pathology positions were offered. In total, 248 MD seniors applied and filled 36.6% of these positions. To bolster medical students' interest in pathology, a medical school pathology interest group organized a multi-day activity to introduce rising second-year medical students to pathology as a career. Five students completed both pre- and post-activity surveys assessing their knowledge of pathology as a specialty. All five students had a BA/BS degree as their highest level of education. Only one student indicated that they had previously shadowed a pathologist as a medical laboratory scientist for a duration of four years. Two students indicated that they were interested in internal medicine, one indicated radiology, one forensic pathology or radiology, and one was undecided. During the activity, students biopsied tissue from cadavers in the gross anatomy lab. Following the biopsies, students participated in the standard tissue processing by shadowing a histotechnologist. Under the guidance of a pathologist, students microscopically examined slides and discussed the clinical findings. Post-activity survey results indicated that participation increased their knowledge of pathology as a career with a median increase of 0.8 points (range: 0.2 to 1.6) on a 5-point Likert scale. Students also indicated that their participation increased their knowledge of pathology skills and techniques – median increase of 1.2 (range: 0.8 to 1.8). This activity can be implemented by medical educators to increase exposure of medical students to pathology as a career with the benefit of increasing student knowledge in the specialty.

Pathology Education Project: A Pilot Program to Spark Student Interest in Pathology as a Career

Background
Effective patient education can help achieve better clinical outcomes. A patient who is active and engaged in their care can better manage their condition at home, especially when monitoring a chronic illness. Meaningful patient education is an important skill in the professional formation of physicians, yet little is known about medical students’ perceptions and implementations of best strategies for effective patient education.
Methods
All second-year Wayne State University School of Medicine students (n = 298) were invited to complete an online survey regarding their opinion on the most important strategies for successful patient education. The survey asked participants to rank the following strategies from most (1) to least (8) effective: providing written patient education materials in numerous languages, patient teach-back, provider empathy, patient motivation, education follow-up, patient health literacy levels, social determinants of health barriers, and other.
Students then completed a patient education module, which involved groups of 5-6 students creating a visual education tool for a specific chronic illness and target patient population. Groups first attended a faculty presentation on their chosen chronic illness, then wrote an abstract and designed a final product under the guidance of a senior medical student or physician mentor. After this module, all second-year students were invited to complete a post-survey regarding the patient education strategies they felt accurately characterized their project. 111 students completed the pre-survey, and 67 students completed the post-survey.
Results
Before completing the module, students ranked patient teach-back (mean score of 3.07), provider empathy (3.11), and patient motivation (3.49) as the top strategies for effective patient education. After the module, students identified social determinants of health barriers (mean score of 3.36), patient health literacy levels (3.54), and patient motivation (3.55) as the three strategies that best characterized their chronic illness project.
Conclusion
In a course assignment, undergraduate medical students utilized different patient education strategies from those they initially identified as most effective, indicating a dissociation between their mental framework and application of practices in patient education. These results reveal the need for more comprehensive pre-clinical medical education in implementing effective patient education strategies.

Perceptions and Implementations of Best Practices in Patient Education among Second-Year Medical Students 

Background: Orthopaedic surgery remains one of the most competitive residencies in the Match, with 1,470 applicants and only 875 positions in 2022. With the novel change in the USMLE Step 1 to pass/fail, other metrics may be emphasized more in the applicant selection process. Social media and professionalism on aways (auditions) are possibly even more important now when screening which medical students are invited to interview. This study provides an assessment of which metrics could potentially be used by program directors (PDs) and assistant program directors (APDs) in the orthopaedic residency selection process. It compares PD/APD, resident, and medical student views on social media and professionalism.

Methods: Three REDCap surveys were created and sent to orthopaedic surgery residency PDs/APDs across the U.S., residents of all postgraduate years, and more than 600 diverse medical students. Two-sample t-test, Wilcoxon rank-sum test and ANOVA were conducted to test the hypothesis that there would be one or more mean differences between PD/APD, resident, and medical student views on social media and professionalism.

Results: A total of 182 responses were recorded, including from 24 PDs/APDs (n=24 programs), 12 residents (n=7 programs) and 146 medical students (n=1 program), with 16 U.S. states represented. Residents (83.3%) thought professionalism should be an even more important selection metric utilized by PDs/APDs with the novel change in Step 1 going to pass/fail. One hundred percent of residents and 70% of medical students thought professionalism issues on aways were reasons for applicants not to be selected compared to professionalism on social media and interviews. The similarity between PD/APD and resident views was significant regarding social media being used as a selection factor (P=.03).

Conclusion: Medical students’ professionalism on aways will potentially be more emphasized in the orthopaedic residency selection process now with the change in the USMLE Step 1 to pass/fail. A prospective medical student’s social media is utilized by some PDs/APDs and residents in the applicant selection process. Care should be taken to maintain exemplary professionalism on all accounts.


Social Media and Professionalism in the Orthopaedic Residency Selection Process

Background: Sex- and gender-based medicine (SGBM) aims to understand how sex and gender affect
human disease. Despite efforts since the 1990s, fewer than 20% of medical schools have an integrated
SGBM curriculum (Jenkins et al, 2016). The Sex and Gender Health Collaborative (SGHC), part of
AMWA, aims to mobilize trainees to create a publicly available resource of educational material that will
help to expand awareness of SGBM and to bridge the gap in traditional medical education curricula.

Methods: The pilot phase involved 9 students who designed innovative educational materials to

highlight sex and gender differences not traditionally emphasized in medical education. Post-
surveys were administered, evaluating the effect of participating in the initiative. In the second

phase, we recruited 205 trainees and paired them with physician experts to produce factsheets, slide sets,
and videos to highlight sex and gender differences for 64 common medical conditions. We have
completed a pre-survey of these students to evaluate their awareness of and attitudes around SGBM and
will administer another survey after project completion to evaluate if the project achieved its aim. The
efficacy of the educational material created will also be evaluated.

Results: Pilot data show that all students strongly agreed participating in the project increased their
knowledge of sex and gender differences in medicine and created connections to others with similar
interests. Preliminary data from the second phase show that while 96.5% of trainees agree that

individualizing medical care according to sex and gender is important for patient care, only 66% self-
reported they were knowledgeable about sex and gender differences in medicine. 52.5% of 122 medical

student participants do not have a SGBM curriculum in their medical schools.

Conclusion: Overall, results from the first phase indicate that this project is a feasible and effective
way for students to increase their knowledge of SGBM and form a network of like-minded trainees and
physicians. Preliminary data from the second phase highlight that students recognize this gap in medical
care and education. Ultimately, we hope this student-led initiative will advance SGBM education
nationally to improve awareness and promote change in clinical practice.

Student-led National Sex and Gender Education Initiative: an innovative model ofmedical education, scholarship, and mentorship

Background: Despite increasing female representation in General Surgery residency training programs, proportional improvement of female enrollment in surgical fellowships has yet to be quantified. We aim to assess if female enrollment in surgical fellowships has improved at an equivalent rate to General Surgery in 6 different surgical fellowship options after General Surgery. 

Methods: All data was collected from ACGME resources of active residents' characteristics. We collected self-reported gender data for General Surgery programs and surgical fellowships including Surgical Oncology, Pediatric Surgery, Critical Care Surgery, Plastic Surgery, Vascular Surgery and Thoracic Surgery from annual reports since 2013. As fellowship applicants come directly from the pool of General Surgery residents, we compared surgical fellowship data to General Surgery data from the equivalent year. Categorical analysis of gender enrollment between General Surgery and each surgical fellowship was performed for each year using Chi-squared analysis. 

Results: In all years examined, fellowships in Vascular Surgery, Thoracic Surgery and Plastic Surgery had significantly lower female enrollment in proportion to number of female General Surgery residents. Statistical output showed that proportional female representation even worsened in both Vascular and Thoracic fellowships in several studied years. In all years examined, Surgical Oncology, Pediatric Surgery and Critical Care Surgery had female enrollment that was not significantly different from the proportion of female General Surgery residents, indicating equitable and proportional enrollment. In fact, these fellowships each had one year where female enrollment was significantly higher than the proportion of female General Surgery residents. 

Conclusions: Surgical fellowships including Surgical Oncology, Pediatric Surgery and Critical Care Surgery had equitable enrollment of female surgeons over the past 10 years in proportion to representation in General Surgery. However, enrollment of female surgeons in Vascular Surgery, Thoracic Surgery and Plastic Surgery fellowships has not improved with the increase in female General Surgery residents. Our results suggest existence of persistent factors that prevent female enrollment in Vascular, Thoracic and Plastic Surgery fellowships. Our results also imply that these factors are not present in fellowships with equitable female enrollment, such as Surgical Oncology, Pediatric Surgery and Critical Care Surgery. 


Surgical fellowships demonstrate variable improvement in gender diversity despite more female General Surgery residents

Background
The COVID-19 pandemic has necessitated significant changes in medical anatomy laboratory instruction at many universities over the past 2 years. Much has been published regarding the use of technology to substitute for face-to-face instruction with anatomical dissection, yet the impact of this paradigm shift on the student experience has not been fully characterized. The objective of this study was to identify how medical student experiences in and perceptions of anatomy laboratory instruction have differed at the University of Louisville since 2018 through various modes of delivery (dissection, virtual, hybrid). 

Methods
A series of 4 focus groups for the medical Classes of 2022 (n=8), 2023 (n=6), 2024 (n=10), and 2025 (n=7) were convened to pose 4 open-ended questions about their classes’ unique anatomy lab experience. The Classes of 2022 and 2023 had a fully dissection-based lab, while the Class of 2024 had a fully virtual lab experience and the Class of 2025 had a hybrid lab. Student responses from each focus group were recorded, transcribed, categorized and patterns within the data were documented. Triangulation was utilized to validate observations: researcher observations, second observer observations, and member checking. 

Results
Four categories emerged from the thematic analysis of each of the 4 medical classes in this study. Themes for the Classes of 2022, 2023, and 2025 included humanistic lessons, teamwork, kinesthetic learning, and self-efficacy. The Class of 2024 instead focused on adaptability, anxiety about future patient encounters, concerns regarding anatomical orientation, and a sense of an incomplete learning experience; these themes resulted in negative emotional responses including feeling defeated, overwhelmed, frustrated, and unsupported. 

Conclusion
A comprehensive analysis of this focus group data provided valuable information on the numerous benefits of in-person, dissection-based anatomy lab instruction for first-year medical students.

Next from AMA Research Challenge 2022

Medical School Convention: An Innovative Model to Prepare Medical Students for Clerkships