United States

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 &lt; 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.

AMA Research Challenge 2022

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

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.

poster

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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.


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.

The Hidden Curriculum: Student Lessons from the Medical Anatomy Laboratory from 2018 to 2021

The IKIGAI: Well-being and Identity Formation for Medical Students

Abstract Title:
The Impact of Integrating Mindfulness into the Healer’s Art course at University of Michigan Medical School: a Feasibility Study.

Background
Nearly half of medical students in the United States suffer from burnout – a triad of emotional exhaustion, depersonalization, and decreased personal accomplishment. These higher rates are associated with increased likelihood of leaving medical school, suicidal ideation, and lower patient satisfaction. Mindfulness practice such as yoga and meditation is a potential intervention found to reduce stress levels and burnout among healthcare workers . Integrating mindfulness practices during pre-existing courses within medical education is a potential intervention to prevent burnout. 
Methods
We evaluated the impact of introducing mindfulness practices (meditation and yoga) into the 2022 Healer’s Art elective course at University of Michigan Medical School. Half of the medical students were randomized into a meditation class (n=11) while the other half were randomized to a yoga class (n=12) for the third session. Students were given a pre-course survey to assess baseline measures of mindfulness, burnout, and energy levels, adapted from Maslauch’s Burnout Inventory and the Five Facet Mindfulness survey. Pre- and post-mindfulness session surveys were administered to the students, with a 100% participation completion rate.
Results
The yoga intervention resulted in a statistically significant increase in energy (26% increase) and breath awareness (13% increase) outcomes. Simultaneously, the meditation intervention resulted in a significant increase in mindfulness (22% increase). Both of our interventions were found to be statistically significant to decrease burnout among participants (14% and 10%, respectively). 95% of students expressed that mindfulness practices should be incorporated into future Healer’s Art courses. 
Conclusion
Our feasibility study evaluated the impact of offering a mindfulness course for medical students enrolled in the Healer’s Art elective. In summation, students in both the meditation and yoga groups had reported decreased levels of burnout, although there was no significant difference between the two groups. Thus, perhaps the type of mindfulness practice did not matter as much as the act of doing a mindful practice. In addition, the vast majority of students recommended mindfulness practices continued to be offered into future Healer’s Art courses. Based on our results, medical students’ mental health would likely benefit from integrating mind-body practices into the Healer’s Art course. 


The Impact of Integrating Mindfulness into the Healer’s Art Course at University of Michigan Medical School: A Feasibility Study

Background: Medical students can experience declines in empathy during training, especially in their third year.1,2,3 These declines correlate with several factors that contribute to burnout.3 At the Medical University of South Carolina, expressive writing modules were created to help clinicians address burnout. Yet these modules were not made available to health science students, who may benefit from expressive writing as part of self-care. This quality improvement project utilized a 6-week program informed by the Pennebaker Method4 to assess the impact of these writing modules on resilience, self-compassion, and self-efficacy in third-year medical students.
 Materials/Methods: Students from the third-year College of Medicine class self-identified their willingness to participate in this 6-week assessment project. The Connor Davidson Resiliency Scale Short Form 10 and the Generalized Self-Efficacy Scale were administered pre and post intervention to investigate changes in resilience and self-efficacy. After submitting pre-intervention surveys, students completed weekly expressive writing modules for 5 weeks and answered open-ended responses about each writing experience. These open-ended responses underwent 1) qualitative analysis and 2) quantitative content analysis using text-mining software, KhCoder.

Results: The Connor-Davidson Short-Form 10 showed a significant improvement in resilience 
(p = 0.015) between pre and post intervention. The Generalized Self-Efficacy Scale showed significant reduction in anxiety (p = 0.04589). Qualitative analysis revealed that students found value in writing from others’ perspectives, reflecting on gratitude, reconnecting to purpose, and reaffirming professional identity. KHCoder data supported these findings.

Conclusion: These expressive writing modules may help students gain new perspectives on professional identity, past challenges, past successes, and future growth at a pivotal time in their training. Doing so can support resilience, self-compassion, and self-efficacy. Two limitations of the project were the small sample size (N=14) that reduced its power. An assessment with a larger sample of students, including a control group, would provide more robust data on the value of these modules.

References:

1. Andersen, F.A., et al. Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC Med Educ. 2020; Feb 17; 20(1):52. doi: 10.1186/s12909-020-1964-5. 

2. Hojat, et al. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med. 2020; 95: 911-918. 

3. Neumann, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011; 86 (8): 996-1009.

4. Pennebaker, J.W. & Smyth, J. Opening up by writing it down: the healing power of expressive writing (third edition). New York: Guilford. 2016.

Next from AMA Research Challenge 2022

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