United States

Background
Several residency advisor opinion pieces have been published on the transition of the USMLE Step 1 exam from a numerical score to pass/fail since January 2022. However, there have been few assessments of medical student perspectives. The impact of this change on minoritized medical students including those from racial/ethnic backgrounds underrepresented in medicine (URiM; Black/African American, Hispanic/Latinx, American Indian/Alaska Native, and Pacific Islander/Native Hawaiian), LGBTQ+, or first-generation college students is poorly understood. The decision for this scoring transition was multifactorial, including a potential to increase medical student well-being and diversity and inclusion in residency selection. We investigate the impact of the pass/fail Step 1 scoring on wellness, career planning, and resource access from a medical student perspective with comparisons between minoritized and represented students.
Methods
Medical students at a single LCME accredited institution who had completed the USMLE Step 1 exam in 2022 or 2023 and received a pass/fail score were recruited for this study. Participants completed a 27-question anonymous electronic survey and were asked to self-report demographics, sense of wellness, career planning, and access to study resources during their dedicated study period. Statistical analyses with chi-squared tests were conducted using R.
Results
There were 128 eligible study participants; 55 identified as minoritized, including URiM (18.0%), LBGTQ+ (19.5%), or first-generation college student (25.0%). Overall, 66.4% of students felt that the change to pass/fail scoring improved student wellness in their class. However, 28.9% reported that it also affected their interest or confidence in pursuing certain specialties, and 75.8% reported feeling pressured to pursue more research and extracurricular activities. Many students (49.2%) reported “poor” or “terrible” wellness while preparing for the exam, including URiM (69.6% vs. 44.8%, p=0.054) and all minoritized students (58.2% vs. 42.5%, p=0.114) compared to their respective counterparts. Minoritized students (38.2% vs. 19.2%, p=0.029), especially URiM (52.2% vs. 21.9%, p=0.007), were more likely to report poor financial access to exam preparation resources compared to their respective counterparts. 
Conclusion
Although generalizability is limited by sample size at a single institution, a large proportion of medical students continue to experience poor wellness while preparing for the pass/fail Step 1 exam. Minoritized students, especially those URiM, report more financial barriers in accessing resources for Step 1 preparation. The scoring transition has heightened uncertainty regarding how to prepare for residency. It is imperative that medical schools expand career advising efforts and continually update recommendations to ensure adequate preparation for residency applications.

AMA Research Challenge 2023

Perspectives on the Pass/Fail USMLE Step 1: Comparisons between Minoritized &amp; Represented Students

Perspectives on the Pass/Fail USMLE Step 1: Comparisons between Minoritized & Represented Students

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Students from historically marginalized backgrounds have fewer role models and less access to resources that might spark their interest in healthcare careers. Medical students who engage 6th-12th grade students in discussion about careers in health will increase future applicant diversity. 


Medical students from the University of Utah School of Medicine visited 18 public middle or high school classes in the Salt Lake City valley. There were 201 participants total who ranged in age from 12 to 18 years old. 16% of participants reported that they had at least one parent who did not graduate high school. 60% of participants reported that they did not have an immediate family member employed in health care. 58% of participants were from families of low income. Presentations on various medical specialties were given to educate the participants on the different careers available in the medical field. Activities such as ultrasonography, blood pressure measuring/interpretation, MOCA exams, and proper stethoscope usage were also conducted to give participants hands-on experience of what clinicians do on a daily basis. Question-and-answer discussions were led at the closure of the presentation to help provide mentorship to participants interested in going into the medical field. A survey was handed out to each participant to compare their level of interest in pursuing a career in medicine prior to and after the session. 


As a result of the sessions, there was a 17.9% increase among participants who were interested in pursuing a career in medicine.


82.9% of participants either agreed or strongly agreed that the sessions were effective in helping them learn about careers as a clinician. Among high school participants, 90.9% reported that the sessions were effective in helping them learn about careers as a clinician. In contrast to middle school participants, only 75% reported that the sessions were effective.


46% of participants identified as Hispanic or Latino, 5% of participants identified as African American, 11% of participants identified as Asian or Pacific Islander, 1% of participants identified as Native American or Alaskan Native, 33% of participants identified as Caucasian, and 4% of participants identified as other.


Direct peer-to-peer mentoring improves student perceptions regarding accessibility and interest of a healthcare career. Conducting community outreach and consistently analyzing the way we talk about health careers to students will populate a strong, diverse applicant pool for admission into health science fields. Diversity will contribute to a rich student/physician experience and equip them with the perspectives and skill sets needed to advance health equity, reduce health disparities, and meet the needs of our changing community.


Increasing Student Interest in Health Careers among Diverse Populations

Background: Food insecurity is an issue impacting the health and well-being of patients across the US. Patients experiencing food insecurity are at higher risk for poor health outcomes than those with food security. These findings support the need for engagement with this pillar of social determinants of health (SDoH) in the medical school curriculum. The preclinical curriculum affords limited opportunities for medical students to engage with SDoH, specifically food insecurity, in an experiential learning model. This pilot project sought to create a learning opportunity that challenged existing perspectives on the experience of being food-insecure while promoting awareness of existing patient resources in Vermont.

Methods: Modeled after the Food Research & Action Center's (FRAC) SNAP Challenge, the Larner College of Medicine (LCOM) Eat on SNAP Challenge invited the medical community to eat on Vermont's SNAP-allotted budget of $6/day for one week. Participants were encouraged to attend educational events, including community resources, service opportunities, strategies for clinical practice, and research. We utilized pre-and post-participation survey data to assess knowledge and understanding of community resources and the experience and impact of food insecurity on VT patient populations. 

Results: Of the pre-event survey respondents (n=24), 52% identified as male, and 62% identified as white. 81% of respondents had never received SNAP benefits in the past. 37% of respondents believed SNAP was "slightly effective," while 33% were unfamiliar with the SNAP program at all. Of the post-event survey respondents (n=11), 78% had
participated in the Challenge, and 88% of post-event respondents answered "possibly to definitely yes" when asked if they would participate in this event next year. Importantly, using a scale from 0 to 100, we asked how strongly people felt that LCOM should add more information to the curriculum on food insecurity and resources, and the responses had a mean of 90 (SD= 11.80, n=7).

Conclusion: This pilot program identified gaps in medical student knowledge and experience with food insecurity, both personally and academically. The program provides an experiential educational opportunity to better engage with patients on food insecurity and effective mitigation strategies within patient care. Our survey results identified medical students' desire to learn more about food insecurity in their preclinical curriculum. Despite the limited sample size of this study, this pilot program exemplifies an opportunity for medical schools to implement programming for their students to engage with SDoH health outside the classroom and within the community.


Eat on SNAP Challenge: Food Insecurity Awareness and Education Week

Purpose: The adoption of artificial intelligence (AI) in image generation raises concerns regarding potential bias, as these technologies may not be reflective of the underlying population in the images they generate. Our study investigates whether AI-generated images of medical students accurately represent the diversity of the current student population.

Methods: Using the DALL-E (Open AI) image generation algorithm, we created 300 images with the text prompt "medical student." These images were independently analyzed by two researchers for demographic indicators including sex, race/ethnicity, age group, setting, and attire. We summarized the results with descriptive statistics and subgroup analyses were performed to analyze differences in portrayals based on student sex and race/ethnicity. The demographic proportions in the virtual cohort of images was graphically compared with AAMC medical school enrollment data of actual medical students.

Results: Of the 300 generated images, 227 (76%) were females and 223 (74%) were White, indicating over-representation compared to actual medical school demographics. Images of Black and Latino/Hispanic students were more commonly depicted in scrubs compared to White students, who were often portrayed in white coats or collared shirts (p=0.002). No representation was found for Native American/Alaskan Native or Native Hawaiian/Pacific Islander students.

Conclusion: Our study reveals significant disparities in the representation of demographic groups in AI-generated images of medical students, indicating potential bias in these technologies. These biased portrayals could perpetuate existing stereotypes and hinder diversity efforts. Future research should aim to further identify and address these biases to promote more equitable applications of AI tools.

Portrayal of Medical Students in Artificial Intelligence Generated Images

Background 
Over 100 million people around the world have been forcibly displaced, yet U.S. medical students and residents feel unprepared to provide culturally sensitive care to immigrants and refugees. This curriculum designed for preclinical students was developed to fill curricular gaps in training students and providers to serve culturally diverse patients both locally and abroad. 

Methods
Objectives were developed from the Physician Competency Reference Set (PCRS). The small-group format that took place over two 4-hour sessions featured interactive sessions with local refugee community leaders, interpreters, ethicists, and healthcare providers. Topics addressed included global refugee context, resettlement, culturally sensitive care, and skillful interpreter utilization. Course content for the second year was expanded and restructured based on feedback from the first year. Course evaluations were supplemented in the second cohort with anonymous pre-post evaluation measures of knowledge, attitudes, and behaviors mapped to PCRS competencies. Fifty nine students participated in the course over two years, and 94.9% (n=56) students completed required classroom evaluations. During the second year, 60% (n=21) of the 33 students who were invited to complete optional supplemental pre/post evaluations did complete the surveys. Survey results were analyzed with a wilcoxon signed-rank test. 

Results
Students reported high course satisfaction: 88% would recommend it to another student (n=57). 63% of students reported increased interest in pursuing a career caring for refugees. 100% of students intend to use skills learned in the course in future practice. Pre-post evaluation (n=21) demonstrated improved student understanding of refugee resettlement (p<0.001), refugees' unique health needs (p=0.01), and ethical issues encountered in refugee care (p=0.001). Confidence increased in caring for refugees in the healthcare setting (p = 0.002) and using an interpreter (p = 0.001). Pretest student ratings were high for questions regarding understanding how social determinants of health affect health outcomes, and interest in pursuing a career caring for refugees, immigrants, or limited English proficiency patients. This introduced a ceiling effect, limiting the ability of pre-/post-testing to detect improvements in these domains. 

Conclusion
This course improved student understanding, attitudes, and skill confidence across multiple domains of established curricular competencies for future healthcare providers. Course materials and evaluation methods may be adapted by other professional schools to advance educational opportunities encouraging culturally sensitive care for diverse populations across the globe.

A novel medical student course builds student understanding, attitudes, and skills in refugee health

Background
Medical school involves a rigorous curriculum to train future physicians, yet many programs do not emphasize issues specific to the care of marginalized populations. Little research has examined medical student confidence in serving such populations prior to entering clinical rotations. A student-run elective was created to provide enhanced didactic and hands-on diversity training to interested first and second-year medical students. Students engaged with lectures on health disparities faced by marginalized communities and then applied learning clinically in standardized patient encounters.
Methods
A pre- and post-test Likert-style survey was administered to assess perceived clinical confidence, competence, and skill working with populations covered in the elective - lesbian, gay, and bisexual; transgender; of color; with mental disabilities; with physical disabilities; English as Second Language (ESL); female; with sexually related issues; with history of trauma/abuse. XX students completed the survey at both time points. Results were de-identified for data analysis.
Results
Prior to the course, the average self-reported confidence working with marginalized communities was 2.91 (1 – “completely unconfident” to 5 – “completely confident”) with a mode of 2 (unconfident). Lowest confidence was reported with transgender patients and patients with mental disabilities. Competence and skill were similarly surveyed with averages of 2.74 and 2.52, respectively, with modes of 3 (neutral).
Following the course, average self-reported confidence had increased to 4.02 with a mode of 4 (somewhat confident). Post-course confidence increased in working with transgender patients by 88%, with patients with mental disabilities by 62%, with ESL patients by 60%, and with traumatized/abused patients by 48%. Self-reported competence and skill levels increased to averages of 3.54 and 3.46, respectively.
Conclusion
This elective sought to enhance medical students confidence, competence, and skill in working with marginalized patient populations. Preliminary results suggest that awareness of and exposure to issues specific to these populations demonstrated improvement in all three domains.

Diversity and inclusion in clinical practice enhancement course: an educational intervention to increase medical student clinical confidence working with underserved communities

**Scoring is only possible in the semifinals hall**

**Abstract:**



OrthoReach: A Resident-Led Pilot to Develop an Orthopaedic Surgery Pipeline Program for Underrepresented Minorities in Chicago Increased Participant Interest in Orthopedics 


Background
Strong leadership skills are essential to career advancement and professional fulfillment. Although more than 50% of medical students today are women, a small minority of leadership positions in healthcare are held by women.
In addition to the lack of women in leadership, female physicians earn 27.7% less than their male colleagues and encounter hostile work environments with sexual harassment, underrepresentation, and unconscious bias that creates a glass ceiling and lower satisfaction in the workplace. Women face underrepresentation in national medical specialty societies and are less likely to be promoted to professor or department chair. Furthermore, a lack of female mentors perpetuates this cycle of underrepresentation and leaves female medical students without adequate resources to excel in their careers.
We designed a comprehensive healthcare-oriented professional development program that provides students with the tools, resources, and strategies necessary to advance as leaders. Piloted in January 2023, the Women in Leadership (WiL) program selected a cohort of 30 female and male medical students and was subsequently integrated as a permanent part of the medical school curriculum.
Methods
Five sessions were included in the program: Female Leadership in Healthcare Panel, Art of Communication, Professionalism and Gender Issues, Financial Compensation, and Building Confidence. Speakers included professors of medicine, CEOs, hospital administrators and more. Each session included lectures as well as interactive workshop time for participants to implement their newly acquired skills. Students completed both pre and post surveys to assess confidence in leadership ability, networking, and likelihood of incorporating leadership into their future career based on a Likert scale and to gather free response feedback.
Results
Participants reported an increase in confidence, networking ability and likelihood of incorporating leadership into their future careers. 89% of students responded that they saw themselves incorporating the skills they learned “often” or “always” in their future careers.
Participants reported “developing a deeper understanding of gender barriers in healthcare,” “learning about growth opportunities within medicine,” recognizing “the significance of clear communication in the workplace,” and “the importance of work life balance” when considering careers.
Conclusion
Our study demonstrates the ability of a female-centered leadership program to impart a thorough understanding of the leadership landscape onto students through a lens of gender equity and to cultivate skills students can use to combat gender biases in healthcare. Future directions include increasing the cohort size and adding more interactive workshops.

The Future is Female: The Design of a Women’s Leadership Program within a Medical School Curriculum

There are increasing calls for inclusion of education on medicine during the Holocaust in medical school curricula. Furthermore, curriculum outcomes of Holocaust in medicine have been understudied. This research describes the outcomes of a Holocaust and medicine educational program featuring a study trip to Poland, which focused on pervasive physician complicity during the Holocaust as well as exemplars of moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The study trip included tours of key sites and museums as well as meeting with a Holocaust survivor, lectures from historians, reflective writing, and group discussions. In depth interviews and reflective writings were analyzed using techniques derived from grounded theory. Themes resulting from the analysis centered on greater understanding of the relationship of bioethics and the atrocities of the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the roles played by dehumanization and medical power during the Holocaust and their contemporary manifestations, and the power of presence and experiential learning for bioethics and humanism education and professional identity formation. These findings evidence the significant impact of the experience and validate the pedagogical strategies, suggesting broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students.including development of moral courage and professional virtues that transcend the workplace which is of keen interest in medical education for ethical, humanistic patient care, research, and public policy.

Critical Reflection and Place Based Medical Education in Bioethics, Humanism, and Professional Identity Formation: The Impact of a Study Trip to Auschwitz

Background: National data demonstrates that on average, people are treated differently by doctors based on their gender. Unfortunately, this impacts the quality of care patients receive thereby altering health outcomes. This variation ranges from how seriously a patient’s pain is perceived to whether “unusual” signs of a myocardial infarction are noted. Even though the origin of this problem is often subconscious rather than malicious, it is our duty as future healthcare providers to ameliorate implicit gender biases in order to provide patient centered, equitable care. 

Methods: Two medical students under the guidance of two faculty members piloted a mandatory implicit gender bias curricular thread designed for preclinical years. The thread is composed of eight 15-minute sessions spanning the course of two years. The objective is to note if a sensitive topic such as implicit bias is better addressed in shorter, repetitive bursts by peers versus a hypothetical formal alternative led by faculty; and if a peer-led structure designed to remove power differentials and concerns over grades leads to more impactful education and growth. Session content ranges from real case studies within the medical school to bystander training aimed at preparing students to be allies during their clinical rotations. After each session, a survey is distributed to garner feedback and gauge the impact of the curriculum.

Results: Post-presentation survey data demonstrated that 86.1% of students (n=453) preferred to hear these presentations from peers alone, 1.8% preferred an option presented by both peers and faculty members, 6.8% had no preference, and 5.3% preferred an option taught by faculty members alone. Another survey question asked students to rank the statement “I gained something valuable from this presentation” on a scale of one to ten with one signifying “strongly disagree” and ten signifying “strongly agree.” For the first presentation, the average rank for the session was 6.9, the median was 7 and the mode was 10. For the second presentation, the average rank for the session was 8.4, the median was 9, and the mode was 10. 

Conclusion: Findings suggest that peer-to-peer teaching may be an effective model to ameliorate implicit bias in healthcare by leveraging the unique perspective that students develop throughout their pre-clinical and clinical experiences. This innovative approach can be further extended and tested throughout medical training for a wider reach.


Implicit Gender Bias: Development of a Peer-led Curriculum for Pre-clinical Years

Background: The body and life individuals are born into comes with specific privileges. When

considering another’s plight, one must acknowledge one’s own inherent privileges and put them aside to gain a better understanding of the other person especially in the field of medicine. During the wake of the racially charged social unrest experienced in recent years, we sought to find a platform for openly discussing privilege with students, faculty and staff in our medical school. The goal of this work was and is to prepare healthcare providers to appreciate their privilege and better understand the diversity of lived experiences in society. When facilitators create a safe environment where participants with different lived experiences can ask questions of others, game-based simulations can drive sensitive social discussions and allow players to view how social injustices give some people privilege over others.


Methods: The Reality Check: The Game of Privilege board game was found to be a viable solution to this identified need. Play sessions were facilitated with faculty, staff and students in groups of 5-6 members (n=43). Special care was taken to create a safe space for mistakes such as an inappropriate use of a term. Each player was given a set of circumstances cards that included a particular socioeconomic status, sexual orientation, race and gender identity. Players assumed the role of these circumstances as they played. After each session, a facilitated focus group was used to debrief, and input was collected via an anonymous survey.


Results: Feedback and facilitator notes were reviewed for themes and ideas for refining future play sessions. General feedback from participants was positive with most openly agreeing the game should be played more often and incorporated into the formal curriculum. Topics discussed in the debriefing centered on the questions members of one group had about another but were uncomfortable asking in an open environment. Participants commented on the complexity of privilege and circumstance and how the game allowed them to explore the impact they can have on individuals and communities.
Follow-up survey response rate was 35%.



Conclusion: Privilege is a point of misunderstanding in general society with most not recognizing their own level and sources of it. Using a tabletop game such as described here, facilitators were able to create a safe setting for learners of all types to gain an appreciation for another’s lived experiences, so they felt free to ask questions and share ideas.



Next from AMA Research Challenge 2023

Increasing Student Interest in Health Careers among Diverse Populations