United States

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.


AMA Research Challenge 2023

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

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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.

Assessing Medical Students' Understanding of Fertility and Infertility: Implications for Physician Well-being and Reproductive Health

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

**Abstract:**



The Neurological Examination: Overcoming Language Barriers to Increase Access to Patient-Directed Neurologic Care


Background
Extensive research has been done on the necessity of DEI in the medical profession, particularly its benefits in increasing cultural awareness in physicians. However, there is very little in the literature about how medical students and new trainees’ view DEI events put on in medical schools, and the impact of these events in their personal journey towards becoming well-rounded physicians. This research study serves to examine the impact of DEI training in medical schools from the perspectives of medical students and first year residents. 

Methods
A cross sectional survey of medical students and first-year residents was conducted. A 17-question survey was constructed using a Likert-type Scale (Figure 1). The survey was disseminated via email, and on messaging platforms commonly such as discord and GroupMe. Survey results were stratified into three parts-exposure to DEI events and medical students and resident responses respectively. Statistical analyses were performed on these data sets via two sample t-tests and Pearson correlation coefficients. 

Results
Data analyses of student responses showed positive correlations between DEI events and improved cultural awareness and confidence in caring for diverse patient populations. On the other hand there was a negative correlation between DEI training and its usefulness in the post-graduate training setting. This seems to suggest that while medical students feel DEI events may be beneficial to their training, that impact is greatly diminished during residency training. 

Conclusion
The impact of DEI on medical student and resident training is a challenging parameter to quantify. However the efficacy of these events in medical training must be elicited to understand which events have more impact on the trainees, and which might better serve them as they provide optimal, culturally sensitive, patient-centered care. The goal is to provide medical trainees with the necessary DEI tools to care for a wide variety of patients, and to produce well-rounded physicians with whom patients can better relate.

Medical Students and Residents’ Perspectives on the 
Impact of Diversity, Equity and Inclusion Events during Medical Training

Background 

Despite the prevalence of sexual health-related issues, only half of medical schools in the United States necessitate formal education in sexual medicine. The lack of standard guidelines leaves trainees unprepared to handle sexual health, undermining the quality of overall healthcare.1 This deficit disproportionately impacts women, gender minorities, and the LGBTQIA+ community. 

To address this, we developed a structured, week-long educational initiative, 'Sex Positivity Week' (SPW). This student-led program aimed to address these gaps in formal curriculum, focusing on sexual health of marginalized communities. 



Methods 

SPW is a week of student-run and professional-taught workshops and lectures on topics including birth control, gender and sexual diversity, sexually transmitted infections, sex work, mental health, and anatomy. 

One week before SPW 2022, preclinical students were invited to complete a voluntary, anonymous survey that utilized a 6-point Likert scale (strongly agree to strongly disagree) to assess self-reported comprehension of sexual health and positivity before and during medical school. After SPW 2022, students were sent the same survey with additional questions about SPW 2022’s impact. Data was analyzed with SPSS.   



Results 

In the first survey, 79% of students reported not having an LGBTQIA+ inclusive education prior to medical school, and 34.2% and 55.2% of students felt uninformed about women’s sexual health and non-heteronormative sex, respectively. 

Responses reflected perceived inadequacy of the required curriculum. 62% of students agreed the curriculum failed to make them feel knowledgeable about sexual health needs of LGBTQIA+ patients, and 78.2% and 65.6% of students disagreed that the curriculum educated them on non-heteronormative sex practices and female patient needs, respectively. 

Following SPW, 96% of students agreed they learned more about sexual health from SPW than from the required curriculum . 94% and 96% of students agreed SPW made them feel more knowledgeable about women’s health and LGBTQIA+ sexual health topics, respectively. Furthermore, 96% of students reported they felt more comfortable speaking about LGBTQIA+ sexual health topics, and 94% of students agreed they felt more comfortable discussing birth control options with patients. 



Conclusion 

Medical students report poor understanding of LGBTQIA+ and female sexual health before medical school. This poor understanding persists with current curriculum standards. Following SPW, students felt more knowledgeable about sexual health and more comfortable discussing it. This study identifies a gap in medical school education regarding sexual health of LGBTQIA+ and female populations, and an improved reported understanding of these topics following implementation of inclusive sexual health education delivered through SPW. 







References: 



Beebe S, Payne N, Posid T, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med. 2021;18(12):1998-2004. doi:10.1016/j.jsxm.2021.09.011

Improving Future Provider Understanding of LGBTQIA+ and Women’s Health Through a Novel Curriculum Enhancement Model for Sexual Health Education in Medical School

Background
Trauma-informed care (TIC) is an approach that assumes every patient has probably experienced some traumatic event in their lifetime. Studies have shown that 63% - 89% of people living in the United States have experienced at least one traumatic event in their lifetime, which is evidence that supports the importance of this assumption. TIC is also an approach that recognizes common signs and symptoms of trauma that a patient may present with, such as dissociation, hypervigilance, or self-harm. Furthermore, TIC acknowledges that past traumas could still influence patients' current lives regarding their mental, physical, social, emotional, or spiritual well-being. For example, trauma can lead to the development of post-traumatic stress disorder (PTSD), which has been associated with an increased risk of chronic mental and physical health conditions such as substance use, depression and anxiety, diabetes, and cardiovascular disease. Trauma-informed care integrates these ideas and overall knowledge of trauma into practice and policy so that practitioners can proactively avoid retraumatizing patients while providing patients with the care they need.

Methods 
To promote the use of trauma-informed care by medical students at the University of Cincinnati College of Medicine (UCCOM), we decided to incorporate it into the preclinical curriculum. We revised the instructional packets used to teach physical exam skills to first-year medical students within the clinical skills course. These revisions included revised informational packets that included suggestions for how to drape patients during exams, how to approach sensitive topics or exam maneuvers, and other TIC practices. At the beginning of the academic year, first-year students were asked to respond to the statement “I feel confident in my ability to provide trauma-informed care.” Responses were based on a 5-point Likert scale from strongly agree (5) to strongly disagree (1). 

Results
After the introduction to TIC through the clinical skills course materials, the number of students who responded “agree” or “strongly agree” (likert rating of 4 or 5, respectively) increased from 20% to 76%. Additionally, the number of students who responded “disagree” or “strongly disagree” (likert rating of 2 or 1, respectively) decreased from 57.5% to 16%. The average rating increased from 2.45 to 3.76.

Conclusion
Students reported overall increased confidence in their abilities to provide trauma-informed care after exposure to TIC practices and suggestions during their preclinical courses. Based on these results, we intend to continue the integration of TIC into the preclinical curriculum for the upcoming academic year and hope to elicit more student feedback using existing evaluations collected by UCCOM for further improvement.

Next from AMA Research Challenge 2023

Use of a discussion provoking board game for revealing privilege