End of Life Virtual Reality Training: Medical Student Increased Empathic Ability

Introduction It is unclear if medical student empathy declines by third year of clinical rotation trainings. Desensitization throughout the first two years may lead to decreases in empathy as a coping mechanism to avoid burnout in the clinical years. This study determined if self-assessed empathy increased after conducting an Embodied Labs, Inc. end of life virtual reality (VR) experience. Methods Mixed methods, quantitative/qualitative, research were applied for University of New England (UNE) College of Osteopathic Medicine (COM) 2nd year medical students (N=174). They completed the 3-part 30 minute Clay Lab VR experience. UNE IRB approved pre/post-tests focused on empathy. Data were collected using RedCap. Closed questions were analyzed applying frequency analysis and paired-sample t-test through excel. Open-ended questions were analyzed through N-VIVO 12+. Results The data included pre/post-tests from 146 students volunteers. Results indicated statistical significance (P=.01) in all closed questions except for question 7 (What is your view of conducting a full code on a patient with a DNR? (P=.14). The greatest difference seen between pre (23.97% agree or strongly agree) and post-test (64.38% agree or strongly agree) data was for question 3 (I gained knowledge about what hospice is by embodying Clay in this virtual reality lab); P= .00. Three qualitative themes included: Impact, Empathy, EOL Knowledge. Conclusion This VR Lab experience increased self-assessed empathy at the time of Clay Lab completion; however, enduring empathy and learning about hospice/EOL has not been measured. Further research is suggested to determine the longitudinal impact of virtual reality education.

Medical/Pharmacy Students Interprofessional Older Adult Medication Interactions/Contraindications Project

The University of New England College of Osteopathic Medicine (UNECOM) Geriatrics Education Mentors [GEM] program, established in 2014, pairs UNECOM students with older community living adults. GEM assignments focus on health review, medical humanities, and geriatrics training. Each year approximately 90 older adults participate in GEMs. In 2019, the GEM program was expanded with Geriatrics Workforce Enhancement Program (GWEP) grant funding to: include first year medical students, include 2 additional assignments (4 assignments over 10 months to 6 assignments over 18 months), and to create interprofessional student collaboration. In the new GEM Assignment 4: Medication Interactions/Contraindications, UNECOM students with their GEM compiled details on the GEM’s medication list (prescriptions, herbal, OTC); one of 4 Ms of Age Friendly Health Care. UNECOM students (84 pairs) were then assigned to UNE School of Pharmacy (SOP) students (42 SOP students had 2 UNECOM pairs) to conduct a “Lexicomp” (App) medication interactions and Beers Criteria review. UNECOM students documented findings with the SOP student partner; discussed the processes of review with their GEM and the resultant findings; documented the GEM’s questions and how the UNECOM student answered those questions; and discussed next steps for the GEM regarding options for different medications - especially follow up with their prescribing physician(s) for any noted interactions/contraindications. For GEMs with few medications, a mock medication list was assigned to ensure student experiences with medication reviews and GEM discussion. Although time intensive preparation is required, UNECOM & SOP students attained significant learning as did the GEM mentors.

Predictors for Actual COVID-19 Vaccine Uptake and Intended Booster Dosage among Medical Students of an Osteopathic Medical School in New York

Exploring future physicians’ attitudes toward vaccination is crucial as physicians’ recommendation is the top predictor for individuals to receive vaccines. This study explored the uptake of COVID-19 vaccines and the intention for future booster dose uptake among students at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM). Predictors for actual vaccine and intended booster uptake were also examined. An electronic survey was distributed to Osteopathic Medical Students (OMS I-IV) in the Spring of 2021. A total of 1331 students received the survey, with 316 responses received (24%). In total, 95.3% (301/316) of the respondents reported that they already received vaccines, while 3.1% (13/316) reported that they had not yet received a vaccine. Moreover, 88.9% of the respondents (281/316) were in favor of a booster dose, which was a strong predictor for actual vaccine uptake. We identified that the Asian race, pharmaceutical mistrust, building immunity via vaccines, adequate vaccine testing, and willingness to get non-U.S. manufactured vaccines are the most significant predictors for willingness to accept a booster dose. A very high COVID-19 vaccine uptake among NYITCOM OMS was found in our study. The study also observed a high acceptance of an additional dose of the COVID-19 vaccine in the future.

Effect of a standardized patient encounter on first year medical student confidence and satisfaction with telemedicine

Context Although the coronavirus 2019 (COVID-19) pandemic has accelerated the use of telemedicine platforms across the country, medical students may lack confidence in their ability to conduct satisfactory patient encounters and practice clinical medicine through telemedicine. Objectives To evaluate the role of a standardized patient encounter on first year medical student confidence and satisfaction in using telemedicine. Methods One hundred and sixty two first year medical students recruited from Edward Via College of Osteopathic Medicine-Carolinas campus were surveyed on their confidence and satisfaction with using telemedicine platforms before and after conducting a patient encounter. Participant confidence and satisfaction were assessed with a five point Likert scale: “not confident,” “a little confident,” “somewhat confident,” “confident,” and “extremely confident.” Results Of 162 students, 103 (63.6%) completed the preencounter survey and 74 (45.7%) completed the postencounter survey. Before the standardized patient encounter, 37 participants (35.9%) reported that they were “a little confident” and 20 participants (19.4%) reported that they were “not confident” in their ability to conduct a patient interview using a telemedicine platform. Following the encounter, 24 students (32.4%) reported feeling “somewhat confident”, and 32 (43.2%) reported feeling “confident” in their ability. Conclusions Medical students’ confidence and satisfaction with telemedicine improved after a standardized patient telemedicine experience in this study. This experience allowed students to practice the unique skills required for telemedicine. Medical schools might consider adding a telemedicine curriculum and standardized patient experiences in the undergraduate medical setting.

The Prevalence of Vitamin D Deficiency in Impoverished Communities in Northern Lima, Peru

Context: Vitamin D deficiency is a global concern. There are many factors that affect the levels of vitamin D including demographics, gender, skin pigmentation, geographic location, and body mass index (BMI). In Lima, Peru, vitamin D levels may be influenced by ethnicity, socioeconomic status, overcrowded conditions, air pollution, and chronic disease status. Objective: The purpose of this cross-sectional study was to measure the prevalence of vitamin D deficiency and insufficiency in a sample of impoverished adults living in northern Lima. It was hypothesized that more than 40% of the study sample would have deficient levels of vitamin D. The Endocrine Society defines deficient levels asbeing < 20 ng/mL of 25(OH)D3, insufficient being 21–29 ng/mL of 25(OH)D3. Methods: In June 2016, a Global Health team from Ohio University Heritage College of Osteopathic Medicine provided medical clinics in impoverished communities in northern Lima. From a random sample of consenting adults, finger stick capillary blood samples were applied to Whatman protein saver cards and subsequently dried.Dried blood samples were punched, extracted, and analyzed by liquid chromatography tandem mass spectrometry. Participants had BMI measured as well. Results: 25(OH)D3 samples were obtained from 144 adults, 116 (80.6%) women, 20 (13.9%) men, 8 (5.6%) unspecified gender, age range of 18–94 with a mean of 39 years. In 66 patients (45.8%), 25(OH)D3 was deficient. In 74 patients (51.4%), 25(OH)D3 was insufficient. In 4 patients (2.8%), 25(OH)D3 was sufficient. For the women, 57 (49.1%) were deficient, 56 (48.3%) insufficient. For the men, 7 (35%) were deficient, 13 (65%) insufficient. Mean BMI was 27.3, with a range of 17.3–43.3; 40.3% were overweight and 23.6% were obese. No relationship between vitamin D levels and gender was identified (p = 0.203). There was no significant association betweenBMI levels and vitamin D levels (p = 0.418). Conclusions: In this sample, nearly one half of those tested had deficient levels of 25(OH)D3, with the vast majority (97%) having less than sufficient levels. This study population also demonstrated an average BMI of 27.3. Further study is needed to clarify the role of vitamin D as a therapeutic and its relationship with BMI.

Physician Beliefs Concerning Structural and Institutional Racism in Health Care

Perceived discrimination in medical settings remains prevalent within the U.S. health care system. However, the details of these experiences and their associations with perceived quality of care are not well understood. This study evaluates any potential difference in African Americans' systemic health care discrimination and Latinx perceived by African American and Latinx patients and physicians. The New England physician alumni from the University of New England College of Osteopathic Medicine were sent surveys. Two hundred fifty-one practicing physicians' responses to the 2018 study address their beliefs toward African Americans and Latinx' racism within the health care system. High scores indicate more significant perceived discrimination among these groups. Physicians have lower discriminatory belief scores across gender, patient racial distribution and specialty.

Joining forces to administer COVID-19 vaccines

The national vaccination effort for novel coronavirus 2019 (COVID-19) is among the greatest operational challenges America has ever faced, the success of which depends upon reaching communities across the United States. In this Commentary, the Executive Dean of Ohio University’s Heritage College of Osteopathic Medicine (OUHCOM) describes the logistics and processes of vaccine delivery at OUHCOM, both on campus and beyond. Among those logistical considerations is a partnership with the local health department and hospital system, as well as student involvement in vaccination efforts.

Early prediction of the risk of scoring lower than 500 on the COMLEX 1

Background The Comprehensive Osteopathic Medical Licensing Examination of the United States Level 1 (COMLEX 1) is important for medical students to be able to graduate. There is a glaring need to identify students who are at a significant risk of performing poorly on COMLEX 1 as early as possible so that extra assistance can be provided to those students. Our goal is to produce a reliable predictive model to identify students who are at risk of scoring lower than 500 on COMLEX 1 at the earliest possible time. Methods Academic data from medical students who matriculated at Rocky Vista University College of Osteopathic Medicine between 2011 and 2017 were obtained. Odds ratios were used to assess the predictors for scoring lower than 500 on COMLEX 1. Correlation with COMLEX 1 scores was assessed with Pearson correlation coefficient. The predictive models were developed by multiple logistic regression, backward logistic regression, and logistic regression with average scores in courses in the first three semesters, and were based on performances on the Medical College Admissions Test (MCAT) before admission, as well as students’ performances in preclinical courses during the first three semesters. The models were generated in about 82% of the student performance data and were then validated in the remaining 18% of the data. Results Odds ratios showed that MCAT scores and final grades in each course in the first three semesters were significant in predicting a score lower than 500 on COMLEX 1. Performances in third-semester courses including Renal System II, Cardiovascular System II, and Respiratory System II were most important in prediction. The three predictive models had sensitivities of 65.8 -71%, and specificities of 83.2 - 88.2% in predicting a score lower than 500 on COMLEX 1. Conclusions Lower MCAT scores and lower grades in the first three semesters of medical school predict scoring lower than 500 on COMLEX 1. Students who are identified at risk by our models will have a 65.8 -71% chance of actually scoring lower than 500 on COMLEX 1. Those students will have enough time to receive assistance before taking COMLEX 1.

Diversity in osteopathic medical school admissions and the COMPASS program

In the United States, the 37 colleges of osteopathic medicine and 154 schools of allopathic medicine face challenges in recruiting underrepresented minority (URM) applicants, and gaps in racial disparity appear to be widening. In this Special Communication, the authors describe a URM recruitment and support strategy undertaken in 2015 through a special interest group called Creating Osteopathic Minority Physicians who Achieve Scholastic Success (COMPASS) at the Touro College of Osteopathic Medicine—New York.

The Impact of an Educational Program on Medical Students’ Knowledge and Awareness of Elder Abuse

Objective: Approximately 1 in 6 adults 60 and older have experienced a form of abuse in the past year. Many cases remain under-reported due to lack of knowledge and awareness. This study created an educational program on elder abuse for medical students to determine if participation would increase knowledge and awareness of elder abuse. Methods: This study used a pre and post survey methodology to evaluate students’ knowledge and awareness of elder abuse before and after participating in this educational program. Sixty first and second year osteopathic medical students at the Edward Via College of Osteopathic Medicine, Carolinas Campus participated in this study. Students were emailed a pre-survey to evaluate their pre-existing knowledge and awareness. The survey was, previously created by the Student Training on Preventing Domestic Violence (STOP-DV) team using validated measures. Participants then attended educational events about various forms of elder abuse and recognizing its associated signs, and afterward completed the post-survey. The results were compared using t-tests to determine if there was a significant difference. Results: First and second year students differed significantly in pre-survey results of knowledge but not post-survey results. The results showed a significant difference in overall mean knowledge ( P-value < .001) and awareness scores ( P-value < .001) in all students. Conclusion: These results suggest education on elder abuse can enable future physicians to better recognize, understand, and support older adults regarding elder maltreatment.