United States

Medical students have reported higher rates of stress and depression compared to their age-matched peers, which worsen while studying in isolation for high stakes examinations such as the United States Medical Licensing Examination (USMLE) Step 1. Medical schools should therefore implement and evaluate additional support offerings to improve the student experience during this time. We implemented a support framework, titled Step-Up, to directly address isolation for students studying for Step 1 in the winter of 2021-2022. This included multiple group, individual, and email interventions. Students were asked to self-report wellness and connectivity before and during Step 1 studying, levels of satisfaction and usefulness of the resources offered. As expected, self-reports of wellness and connectivity worsened during Step 1 study. Many interventions had low uptake. Students reported highest satisfaction with and usefulness of weekly emails and near-peer tutors. Our data show that near-peer tutoring and regular support emails are successful interventions to help mitigate the worsening wellness and increased isolation medical students experience during Step 1 studying. It also examines multiple other interventions that educators may wish to study further, or not include due to lack of uptake or benefit.

AMA Research Challenge 2023

Step-Up to Address Step 1 Anxiety and Improve Wellness

poster

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#### Event Details

The 2023 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. **Log in at any time throughout the event to:**

* **View posters and presentations** on a variety of topics and specialties
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At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges, and compete to win a $10,000 grand prize sponsored by Laurel Road. 

### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters, score posters in the semifinals (an AMA member exclusive opportunity) and attend education sessions with experienced physicians to learn tips to advance your research and career. 

Background
Research is a cornerstone of medical education, and demonstration of aptitude in this area is necessary to fulfill the general competencies identified by the ACGME. As such, research opportunities for medical students should be available, accessible, and fulfilling. However, a variety of reasons exist that hinder the ability of medical students to achieve their desired and essential experiences in clinical and/or laboratory research. These impediments can lead to student dissatisfaction and less competitive residency applications. 

Methods
We conducted a cross-sectional survey of University of Massachusetts (UMass) Chan Medical School students to better understand the current state of student research. Current and past research participation was collected, including the number of projects and weekly commitment. A Likert scale was used to query students’ perceptions regarding importance of participating in research, ease of accessing and applying to research opportunities, and barriers to research opportunities. Student satisfaction with access to research opportunities was ranked from 1-10 (least-most satisfied). This survey was approved by the UMass Chan Medical School IRB (STUDY00000459). 

Results
Overall, 108 students (16.7% of all UMass medical students) completed the survey, of which 63 (58.3%) were pre-clinical students. Most students (88.9%) responded that scholarly activity was ‘slightly important’ or ‘very important’, but only 61.1% of students reported involvement in a scholarly project. 51% of students responded that research opportunities are ‘somewhat’ or ‘very difficult’ to access. Mean satisfaction with access to research was 4.4 +/- 2.6. The three most common selected barriers to research activity were difficulty finding research project listings (64.8%), not having enough time available (45.4%), and trouble contacting investigators (42.6%). 

Conclusion
Students recognize the importance of scholarly activity during medical education in molding their professional and academic identity, and in improving their residency competitiveness. However, gaining access to opportunities can be difficult. Despite UMass Chan Medical School being amongst the top 25% of institutions in terms of research output per student, we identified a significant opportunity to improve student satisfaction in medical education through research. While it would be difficult to address some barriers, such as available time for medical students, improving accessibility of opportunities and communication represent targets for countermeasures. We recently secured funding to establish resident liaisons within clinical departments and a Drupal server to create a research listing database called 'UMatch'.

Facilitating Medical Students in Pursuit of Scholarly Activity: A Quality Initiative Using A3 Problem Solving to Improve Student Resources

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

**Abstract:**



Stop the Bleed Training’s Effects on Preclinical Medical Students’ Confidence and Willingness to Intervene in a Hemorrhage Situation

Background- Drawing is a form of active learning that enhances knowledge and increases retention. In human anatomy education, drawing allows for the artist to use their creations to form clinical correlations and expand their clinical knowledge. Previous studies demonstrate that incorporating art in anatomy sessions improves visual learning, engagement, and complex content understanding. Multiple exposures to art led to further comprehension of the material, demonstrated by the comparison of pre and post session assessments. However, to this day, cadaver-based learning is well known as the gold standard in anatomy education. This study intended to determine whether instructional based drawing increases knowledge and long-term retention of anatomy material, compared to a standard cadaveric-based anatomy lab session.
Methods- Participants were given an initial demographic assessment. Four sessions were held to simulate medical anatomy laboratory coursework. Topics included arterial flow, venous drainage, the nervous system, and skeletal myology. Participants were second-year medical students. All participants first attended an instructor-led station in which pre-selected structures were identified on a prosected cadaver. The control group then participated in an exercise in which certain structures in the cadavers were pinned and identified, and the study group participated in an instructor-led drawing exercise. At each session, participants completed a pre-assessment (ten questions) and immediate post-session assessment (five questions). Six-weeks later, participants completed a second post session assessment (five questions) to assess long term retention. These assessments were curated from standardized and validated questions.
Results- There were 15 participants, with most participating in more than one session. Data was pooled across the four sessions with a total of n=34 including repeated participation. There were no statistically significant differences between the control and study group for the pre-, immediate post-, and 6-week post-assessments. The control and study groups both significantly improved from the pre-assessment to immediate post-assessment (p<0.001, p<0.001) and to the six-week post-assessment (p<0.001, p=0.003).
Conclusion- Utilizing art as a cadaver-based study strategy was found to be as effective as the gold standard cadaver-based teaching. Incorporating art into medical anatomy curricula can further enhance understanding, knowledge, and retention.

Do art and anatomy be-lung together? Using drawing to increase anatomical 
knowledge and retention for medical students.

Background: The objective of this research is to identify current best practices for United States medical schools looking to implement evidence-based Cultural Competence Curricula (CCC). The Liaison Committee on Medical Education requires medical students to demonstrate cultural competence upon graduation to ensure future physicians are prepared to provide quality care to diverse groups. CCC is commonly defined in a medical context as the knowledge, skills, and attitudes conducive for cross-cultural communication. However, there’s an abundance of methods for planning, implementation, and assessment of CCC that make determining a best model difficult. 

Methods: We conducted a scoping literature review to determine the current state of CCC in U.S. medical schools. We collected data on the details of the curricula described in 77 papers, which was used to find patterns related to curriculum structure, evaluation, and study design.

Results: Our results illustrate the prevalence of structure styles conducive for high-order learning, including longitudinality, integration, incorporation into clinical training, and experiential learning. The most common method for evaluating student learning was student self-evaluation with few programs performing reevaluations or utilizing patients as evaluators. Of knowledge, attitudes and skills, skills were least evaluated.

Conclusion: Collected data reveals gaps in CCC regarding evaluation and execution while also revealing learning models that suggest positive efficacy. Characteristics of schools with positive evaluations include maximized quantity of structural components, higher quality of evaluation, and connection with the local community. It seems that longitudinal, non-passive learning in integrated courses evaluated via experimental and quasi-experimental study designs produce more reports of success. Overall, in an increasingly cross-cultural world, it is imperative that we support educators in ensuring that students become effective and benevolent healthcare providers for diverse groups.

What Works? A Scoping Review of Implementation and Evaluation Frameworks for Cultural Competence in U.S. Medical Education

Background
Research is recommended in medical training and residency, as per the Accreditation Council for Graduate Medical Education (ACGME). This not only encourages academic interests among residents but also helps them adopt evidence-based approaches while treating patients. Early research training has been linked to continued scholarly work and informed career choices. However, many medical students and residents focus more on non-hypothesis-driven research, likely due to inadequate technical support and low interest. We have developed an OpenAI GPT3-based web application called AutoAnalyze to address this issue. 
Methods
The program was created using Visual Studio Code, and the code was written with Python, along with Streamlit and a variety of visualization packages. For ad hoc visualization, additional programs are invoked de novo by user input. Application programming interfaces (APIs) for OpenAI ChatGPT3.5 were integrated for activation depending on specific user feature choices. Custom prompts and APIs enabled highly focused functionality, with coding details available on 
GitHub repository under the MIT licence: https://github.com/DrDavidL/auto_analyze.Streamlit.io hosts the application on a public site: https://data-auto-analysis.streamlit.app/.
Results
AutoAnalyze simplifies the technical aspects of hypothesis-driven research, making it easy to conduct research using pre-coded options or via natural language inputs. With AutoAnalyze, users can perform data exploration, missing data imputation, and data visualization. Additionally, it generates publication-worthy images like bar charts, pie charts, scatterplots, and principal component analysis with just a few clicks. AutoAnalyze also provides teaching pearls on visualization techniques and summarizes relevant statistics in table format. AutoAnalyze can perform machine learning analytic methods like logistic regression, decision trees, random 
forests, gradient boosting machines (GBMs), and support vector machines (SVM) to perform predictive analysis in an easy-to-comprehend user-friendly format. It does this without requiring the user to type in any code or understand a computer programming language. Furthermore, the chatbot teacher feature enables users to probe data or learn data science using regular English words and sentences.
Conclusion
Overall, AutoAnalyze represents an efficient solution to address the inadequate technical support for medical research challenges medical students and residents face. It has the potential to increase their research interest in academic medicine.


Increasing Interest in Medical Research and Academic Medicine With Auto Analyzer; an OpenAI GPT-3-Based Web Application

Parental Leave Experience for Academic Neurology Faculty at 19 Academic Centers

The integration of point-of-care ultrasound (POCUS) curricula in undergraduate medical education has become increasingly common over the last decade. Many studies have shown the benefits of POCUS curricula on improving medical student performance on assessments including anatomy exams and objective structured clinical examinations. However, there is substantial variation of POCUS curriculum across U.S. medical schools, and of the schools with an approved POCUS curriculum, few have longitudinal four-year programs with tailored projects geared to prepare medical students for residency. Specifically, a recent study emphasized the necessity of future studies assessing student evaluations in clerkships with significant POCUS use. Although many specialty programs include POCUS competencies as part of their residency milestones, ultrasound is not considered a required entrustable professional activity (EPA) to graduate medical school, which poses a challenge for rising residents in POCUS-heavy specialties. Our focus is to identify the advantages of completing a four-year POCUS longitudinal curriculum, which includes a residency-specific project, in preparation for graduate medical education. We developed two IRB-approved surveys, one for medical students involved in ultrasound education and one for clerkship and residency directors at local clinical sites, to assess perceived preparedness for use of POCUS in students’ desired specialties. The students’ degree of involvement across all four years of undergraduate medical education was stratified and comparatively assessed to designated outcomes. Students were asked about degree of involvement in ultrasound curriculum, level of proficiency in various procedures, performance during clerkship rotations, and United States Medical Licensing Examination (USMLE) Step 2 scores. Clerkship and residency program directors were also asked about impact of ultrasound education on student performance during rotations and on performance during residency. Preliminary findings indicate residency directors strongly agree that ultrasound curriculum is beneficial to students’ clerkship experiences. Directors also indicate that residents who have completed ultrasound curriculum have advanced performance in their specialty and can better integrate bedside ultrasound results into patient care plans. For students, we expect that those who complete the four-year POCUS curriculum will perform the highest on all assessments and feel most prepared to enter their desired specialty residency programs. Some limitations to this study may include the period of time the longitudinal curriculum has been in place, thus limiting the number of students who have completed all program requirements. Overall, the longitudinal POCUS curriculum is expected to demonstrate an effective transition-to-residency model and encourage improvement of ultrasound education programs in other medical institutions.

A retrospective longitudinal cohort study of medical student ultrasound curriculum involvement in determining clerkship and post-graduate success

Background 
Doximity, a platform for healthcare professionals, aids residency applicants in program ranking decisions, despite debate over its rankings' reliability due to a lack of objectivity. Nevertheless, studies reveal that Doximity's Annual Residency Navigator Tool (DRN) rankings influence program selection. This study aims to analyze the impact of Doximity rankings on applicant decision-making.

Methods 
A systematic review guided by PRISMA was conducted and PubMed, Google Scholar, and Web of Science databases were queried to identify DRN-related articles. Covidence was used for screening. The review included studies evaluating DRN rankings' usage by residency applicants.

Results 
A total of 8 of 266 screened articles were included. Survey data were analyzed from 5,068 residency applicants: 22% emergency medicine, 16% general surgery, and 12% internal medicine. Common themes encompassed program DRN reputation importance (50%), calls for enhanced DRN objectivity (50%), and the significance of program online presence (38%) and applicants’ mentors (25%). Perceived Inaccuracies included DRN's survey sampling bias and construct validity.

Conclusion
Despite applicant perception of inaccuracy, DRN rankings influence program preferences and applicants’ residency program rank lists. This study recommends further research efforts on an objective ranking system for better applicant fit assessment.

Ranking U.S. Medical Residency Programs: A Systematic Review and Critical Analysis of Doximity’s Annual Residency Navigator Tool

Background
Shortages in clinical skills faculty exist nationwide, affecting medical students' clinical skills education. Moreover, medical students have previously expressed that clinical supervisors may not fully understand their learning struggles due to the knowledge gap between them. Teaching assistants (TA) may help address both challenges. However, current literature on the efficacy of TAs in teaching clinical skills is mixed. Improving upon previous research, this study evaluates the viability of second-year medical students as clinical skills TAs by providing extensive, standardized retraining before near-to-peer instruction.
Methods
Six second-year medical students and six faculty taught physical examination techniques for the musculoskeletal system to 130 first-year medical students (M1). Prior to instruction, second-year TAs underwent retraining in physical examination techniques by a clinical expert, instructional videos, and standardized patients (SP). M1s were randomly assigned to be taught by either faculty or TAs each week. Each clinical skills session included the following: 1) pre-session study of physical exam instructional videos and protocol; 2) 20-minute large group demonstration conducted by a faculty expert with an SP; 3) one-hour deliberate practice on an SP with either a TA or faculty member (randomized 3-4 students per group); and 4) evaluations in randomized groups of 7-8 students co-led by a faculty member and TA. Faculty administered evaluations while TAs scored them based on predetermined criteria. Both faculty and TAs were blinded to whether M1s had been taught by faculty or TAs. Formative evaluations covered observation, palpation, and special tests, with a maximum score of 12 points and minimum score of 0. End-of-course OSCE scores were analyzed for differences among students receiving zero, one, two, three, or four TA-instructed sessions.
Results
No significant difference was found between evaluation scores of M1s taught by faculty and those taught by TAs across each week. During week one, faculty-taught M1s averaged a score of 10.38 while TA-taught M1s averaged 10.92 (p=0.064). In week two, both faculty-taught and TA-taught M1s scored 10.14 (p=0.99). In week three, faculty-taught and TA-taught M1s scored 11.06 and 10.56, respectively (p=0.13). In week four, faculty-taught M1s averaged 11.48 while TA-taught M1s averaged 11.37 (p=0.57). When stratified by number of TA-instructed sessions received, OSCE scores yielded no significant difference.
Conclusion
With proper training, near-to-peer TAs are competent clinical skills instructors. When access to trained faculty is limited, TAs may viably supplement faculty shortages without sacrificing quality of instruction.

Near-to-peer teaching assistants effectively supplement clinical skills instruction

Background
As physician shortages increase in the United States, many medical schools across the country have established regional medical campuses (RMCs) to increase class size. The University of Missouri-Columbia (MUSOM) created an RMC, the Springfield Clinical Campus (SCC), in 2016. All students spend the preclinical years at the central campus in Columbia, then either continue in Columbia or move to Springfield for the clinical years. 
Some research has been published on the correlation between RMC training and in-state postgraduate training. However, no publications have discussed the relationship between clinical RMC training and in-region postgraduate training. Geographic regions have become important for residency applicants in recent years as regional preferencing has been integrated into the ERAS application. For the 2022-2023 ERAS cycle, all specialties participated in geographic preferencing except for obstetrics and gynecology (OBGYN) and emergency medicine. This has changed for the upcoming 2023-2024 application cycle, in which OBGYN applicants are now encouraged to specify up to three preferred geographic regions. We collected data on whether central versus regional clinical campus was correlated to postgraduate training in an outside region prior to the implementation of geographic preferencing using OBGYN match results of graduates of MUSOM.

Methods
We utilized publicly available OBGYN match data from 2018-2023 for MUSOM. Residency programs were labeled by geographic region according to the regional designations utilized by the Electronic Residency Application Service (ERAS). A Fisher exact test was performed to calculate the two-tailed p-value comparing the proportion of students at each campus who matched in region versus out of region.

Results
In total, 34 students matched into OBGYN from MUSOM and elected to make this data public. Of these, 8 students attended the SCC and 26 students attended the central campus. At the SCC, 25% of students matched in region, while 75% matched out of region. At the central campus, 38% of students matched in region, while 62% matched out of region. There was no statistical difference between the campuses for the proportion of students matching in region versus out of region (p=0.6809). 

Conclusion
No difference was found between the RMC and central campus for the proportion of students matching in region versus out of region for OBGYN residency. Subsequent research following implementation of geographic signaling would likely be useful for elucidating trends among the campuses. Future studies may also investigate this correlation in medical schools with RMCs in which both preclinical and clinical years are completed at the RMC.


Next from AMA Research Challenge 2023

Facilitating Medical Students in Pursuit of Scholarly Activity: A Quality Initiative Using A3 Problem Solving to Improve Student Resources