United States

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.

2023 AMA Research Challenge

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

poster

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**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.



Use of a discussion provoking board game for revealing privilege

Background
The Independent Student Analysis (ISA) is a student-led survey required by the Liaison Committee on Medical Education (LCME) during their site visit conducted every eight years. Wayne State University School of Medicine (WSUSOM) recently completed their LCME site visit in April 2023. While data from the January-March 2022 ISA was presented to the LCME committee, the WSUSOM Student Senate recognized the need to obtain continuous student feedback on the various aspects of WSUSOM. Therefore, the ISA Committee was formed to gauge student needs with annual surveys. Two student organizations, Mothers in Medicine (MnM) and the Institutional Justice and Inclusion Subcommittee of Senate (IJI), turned to the ISA Committee for support. The ISA Committee leveraged their December 2022 survey to garner student opinion about these organizations’ proposed policies.

Methods
The ISA Committee created a new version of the ISA that was distributed to the student body between December 1-22, 2022 on New Innovations. The aforementioned two policy recommendations were included as questions. MnM’s policy advocated for excused time off for students experiencing birth or adoption and increased resources such as test-taking accommodations. IJI’s policy allocated 3 days/year to be used for religious holidays not covered by the student calendar. Students were asked to demonstrate their satisfaction with the proposed policies on a 5-point Likert scale ranging from “very satisfied” to “very dissatisfied.”

Results
A total of 963 students from all four classes answered the question supporting the religious accommodation policy, with 93.5% of respondents selecting either “satisfied” or “very satisfied.” Similarly, of the 961 students answering the question supporting the parental accommodation policy, 92.8% of respondents selected either “satisfied” or “very satisfied.” These results demonstrated how valuable the two organizations’ policies would be to the student body.

Conclusion
The overwhelming support for these two measures demonstrated the need for both parental and religious accommodations at WSUSOM. The ISA committee shared a report of the results with the WSUSOM administration. The committee also encouraged student leaders to work with administration to implement the two new policy proposals through communication and further advocacy. In future iterations of the ISA survey, the committee will continue to include input from various student organizations aimed at improving wellness in medical education. The ISA aims to be a vehicle to promote diversity and equity by providing a tangible display of student support for the various initiatives advocated by the WSUSOM student body.


Promoting student-led wellness policies in medical education with the independent student analysis

Background: Many post-graduate masters’ programs have been shown to benefit pre-medical students upon entering medical school, but there haven’t been any investigations into the improvement of medical knowledge with shorter, more concise programs tailored to the expectations and responsibilities of a medical student. A common trend in today’s medical school application process is first to obtain a master’s degree. Although this displays to medical programs the dedication, knowledge, and academic maturity of the applicant, these programs have narrow scopes of learning and have become a financial burden. The goal of the IMPRESS (Introduction to the Medical Profession: a Rotation to Empower Students) program was to expose pre-medical students to the academic and professional life of medical students, teaching both skills and knowledge to help increase their understanding of medicine. 

Methods: We collected data from 11 underrepresented undergraduate students from the inaugural class of the IMPRESS program. These students were exposed to a 4-week long course that involved clinical skills, research, and didactics. Prior to the start of the program, each student completed a pre-test, which assessed their level of clinical and medical knowledge. They were not given the answers and they didn’t have access to the questions after taking the pre-test. They subsequently completed the same test at the end of the program. 

Results: The median pre-test score was 54.5% (IQR 15.9%) and the median post-test score was 63.6% (IQR 6.8%), the p-value is calculated to be 0.01 using the Wilcoxon signed rank test. The median score increased by 9.1% following the four-week program.

Conclusion: Our findings show that exposing a student to a wide variety of medical school-based learning opportunities increases their medical knowledge in a short period of time. The benefit of the program is not limited to medical knowledge, but also exposes the students to clinical, practical, and research experience.


Impact on medical knowledge after an immersive pathway program for the underrepresented community

Abstract Title: Addressing a key gap in medical school curriculum: Promoting education on care of patients with intellectual and developmental disabilities at UMass Chan Medical School
Background: The population of individuals living with an intellectual or developmental disability (I/DD) in the U.S. has been increasing with advances in health care, but many medical schools are just beginning to train physicians on how to care for this growing population. These patients will inevitably navigate numerous medical offices, including primary care offices, specialty clinics, and the inpatient wards. Medical schools across the country have started to incorporate education on caring for individuals with I/DD into the core curriculum, and in 2022, the UMass Chan Medical School partnered with Operation House Call (OHC), a program under the Arc of Massachusetts, to establish integrated education on this topic.

Methods: After an OHC educational program was piloted as an elective course at UMass in 2021, it was fully integrated into the curriculum for first-year medical students in 2022 with multi- departmental financial support. The OHC experience includes three key components: (1) a large group didactic session on caring for patients with I/DD (2) a virtual home visit to a patient with I/DD and his or her family (3) an open-ended reflection submitted to a shared forum.

Results: OHC is now a required program for UMass Chan medical students and will continue for future classes. The program is currently being evaluated via analysis of recurring themes and trends in student reflections. Our team is currently developing a standardized survey to evaluate students’ knowledge development, attitudes, confidence in working with people with I/DD, and overall satisfaction with the experience to optimize the current curriculum.

Conclusion: OHC is undergoing formal evaluation with pre and post survey analysis for the upcoming academic year to assess student attitudes and perceptions before and after participating in the new curriculum. Post experience surveys are beginning to be analyzed for common themes from the 2022-2023 academic year. There are plans to convert to an in-person home visit model for the 2023-2024 academic year, and to include a final group session for reflection and discussion to the curriculum.

Addressing a key gap in medical school curriculum: Promoting education on care of patients with intellectual and developmental disabilities (IDD)

Background: Trauma informed care (TIC) is an approach to clinical care centering how trauma affects patients, especially those in marginalized communities. TIC has been shown to improve psychobehavioral outcomes and increase trust between patients and clinicians. Despite the evidence for TIC’s role in patient-centered care, there is a gap in teaching TIC within medical education, particularly with an intersectional lens. To address this, we sought to develop, implement, and evaluate a TIC elective course. 

Methods: Through literature review and collaboration with faculty and community experts in TIC, we identified six intersectional topics for the 8-week course: sexual assault/trafficking, domestic violence, healthcare-induced trauma, state sanctioned violence, displacement trauma, and neighbourhood violence. Each class focused on one topic, with the first and last class consisting of an introduction to a trauma-informed care framework and medical student presentations, respectively. Teaching methodologies included traditional lecture, restorative discussion circles, and a case-based learning format incorporating dialogue with faculty/community TIC experts. 15 preclinical medical students participated. A nested mixed methods approach was used to evaluate the elective. Quantitative data included pre/post surveys with Likert-type questions on trauma-informed care knowledge and attitudes (Attitudes Related to Trauma-Informed Care, ARTIC). Qualitative data was collected through a focus group nested at the end of the course to explore students’ perspectives on the elective. 

Results: There was a significant increase of 29.0% in mean self-reported knowledge of TIC (p<0.001). There was a significant increase of 7.4% in ARTIC scores (p<0.05). Four themes emerged from focus group analysis: (1) need for consistent TIC teaching, practice, and assessment in primary medical education curricula, (2) importance of learning an intersectional TIC framework for understanding and responding to trauma, (3) appreciation for an interactive case-based discussion format and use of restorative circles, and (4) balance of teaching from academic medical faculty and community TIC experts. 

Conclusion: Evaluation of this skills-based, community-oriented TIC elective course showed improvement in medical students’ TIC knowledge and attitudes. Students shared positive feedback regarding the pedagogical approach utilized. They emphasized the need for this intersectional approach to TIC as a required part of medical education. The efficacy of TIC incorporation in medical education may be improved through use of more interactive teaching styles and an intersectional framework, with multiple opportunities to practice TIC skills. This may ensure that students can successfully utilize TIC in patient interactions now and in the future.

Transforming Medical Education: 
Intersectional Approaches to Trauma-Informed Care

Infertility impacts 1 in 4 female physicians which is twice a s high in comparison to the women in the general population. As the proportion of women in the medical workforce
continues to rise, it becomes crucial to address reproductive health issues for female physicians. This study aims to a s s e s s medical students' knowledge of fertility, risk factors for infertility, and available treatment options.

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

Next from 2023 AMA Research Challenge

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