Improving Student Confidence With Electronic Health Record Order Entry

Introduction: Despite near-universal utilization of electronic health records (EHRs) by physicians in practice, medical students in most ambulatory settings gain limited experience with placing EHR orders. In this study, an individual preceptor site investigated the usefulness of a targeted curriculum in improving students’ EHR confidence and clinical reasoning skills. Methods: Family medicine clerkship students assigned to one community health center were invited to participate in this prospective, survey-based study. In their first week, students observed a preceptor performing EHR tasks. For the remainder of the 4-week clerkship, students utilized decision support tools, assigned a working diagnosis, entered unsigned orders in the EHR, proposed an assessment, and discussed a plan with a preceptor. Students completed weekly questionnaires to self-report confidence across several EHR domains while preceptors synchronously evaluated students’ accuracy with entering orders correctly. Results: From February 2017 to March 2020, all 49 eligible students completed the study. One hundred percent of students reported that placing EHR orders was beneficial to their medical education. The difference over time in learner confidence with placing EHR orders was statistically significant across every domain (eg, writing prescriptions, ordering labs and imaging). Preceptors’ evaluations of students’ accuracy with placing orders also showed significant improvement between each week. Conclusion: Clerkship-wide EHR training may be limited by multiple sites with multiple EHR products. This pilot study suggests that committed faculty at an individual preceptor site can offer a targeted curriculum to help students develop EHR confidence. We propose other preceptors similarly offer students this opportunity to maximize clerkship education.

Effect of a required online graded curriculum in the clerkship years on medical student national standardized examination performance

Context Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. With the graduating class of 2017, A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) began requiring additional online curricula for all clerkship courses. Objectives To determine whether third year and fourth year students receiving ATSU-SOMA’s online curricula during core clerkships performed better overall on national standardized examinations than students from previous years who had not received the curricula, and whether scores from online coursework correlated with outcomes on standardized examinations as possible early predictors of success. Methods This retrospective cohort study analyzed existing data (demographics and assessments) from ATSU-SOMA classes of 2017–2020 (curriculum group) and 2014–2016 (precurriculum group). The effect of the curriculum on national standardized examinations (Comprehensive Osteopathic Medical Achievement Test [COMAT] and Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) was estimated using augmented inverse probability weighting (AIPW). Correlations between assignment scores and national standardized examinations were estimated using linear regression models. Results The curriculum group had 405 students with a mean (standard deviation [SD]) age of 25.7 (±3.1) years. Two hundred and fifteen (53.1%) students in the curriculum group were female and 190 (46.9%) were male. The precurriculum group had 308 students (mean ± SD age, 26.4 ± 4.2 years; 157 [51.0%] male; 151 [49.0%] female). The online curriculum group had higher COMAT clinical subject exam scores in obstetrics and gynecology, osteopathic principles and practice (OPP), psychiatry, and surgery (all p≤0.04), as well as higher COMLEX-USA Level 2-Cognitive Evaluation (CE) family medicine and OPP subscores (both p≤0.03). The curriculum group had a 9.4 point increase in mean total COMLEX-USA Level 2-CE score (p=0.08). No effect was found for the curriculum overall on COMAT mean or COMLEX-USA Level 2-Performance Evaluation scores (all p≥0.11). Total coursework scores in each core clerkship, excluding pediatrics, were correlated with COMAT mean score (all adjusted p≤0.03). Mean scores for five of the seven assignment types in core clerkships, excluding evidence based medicine types, were positively correlated with COMAT mean scores (all adjusted p≤0.049). All assignment types correlated with COMLEX-USA Level 2-CE total score (all adjusted p≤0.04), except interprofessional education (IPE). Conclusions Results from this study of 713 students from ATSU-SOMA suggested that our online curriculum supplemented clinic based learning during clerkship courses and improved student outcomes on national standardized examinations.

Promoting Regional Campus Excellence: The Scholarly Concentrations Program at Indiana University School of Medicine

While Indiana University School of Medicine has had multiple regional campuses delivering the pre-clerkship phase of the education for 50 years, since 2008, all four years of medical education, including clinical, have also been available at the eight regional campuses statewide. While 67 percent of admitted students designate a preference for the Indianapolis main campus, 60 percent of students are assigned to a regional campus for pre-clerkship education. Of those, 32 percent chose to be at their assigned campus. Students are often not able to identify a compelling reason to choose a regional campus. Despite data to the contrary, including our own, a majority of students continue to believe the path to success is through the main campus in Indianapolis, and as a result, transfer to the main campus for clerkships. In 2019, the school launched a Scholarly Concentrations Program as a key strategy to address this problem. The program leverages the unique expertise and resources at its diverse campuses and shines a spotlight on them to attract and retain students at regional campuses through educational enhancement and engaged community scholarship. While still in pilot phase, significant progress has been realized. With faculty statewide, 11 concentrations launched in less than one year; 17 in two years. About 220 students are enrolled in concentrations statewide; about half at regional campuses. A special program through the admissions process resulted in 9 percent of the Class of 2024, with an average GPA of 3.8 and 512 MCAT, choosing to enroll at a regional campus and its associated scholarly concentration. Immediate plans revolve around supporting concentration growth, building systems and processes to support a sustainable program, and monitoring results of the three pilot phases to inform future development and implementation. In addition, students are being recruited to regional campuses through an Early Decision Program.

The virtualization of medical education in response to COVID-19: A Harvard and McGill pre-clerkship medical student perspective

In response to the spread of SARS-CoV-2 across North America in early March of 2020, Canadian and United States medical schools swiftly virtualized medical education for pre-clerkship students. With remote learning arrived novel challenges: barriers to students’ comprehension of course material, difficulties conveying the nuances of patient interaction, and social hardships hindering students’ continued progress. The 2020 Harvard-McGill Medical Student Exchange, a group of ten McGill University Faculty of Medicine and Harvard Medical School students, analyzed their institutions’ respective responses in the virtualization of medical education and their personal experiences with remote pre-clerkship education. The authors’ work provides insight into opportunities for mutual progress and cross-cultural exchange between Canadian and American medical schools, in the context of the COVID-19 pandemic. The authors detail potential changes to didactics, student research opportunities, support for students, and clerkship preparation that they expect would benefit pre-clerkship students in an ever-changing biomedical landscape. With gratitude toward their respective programs for their efforts in transitioning to virtual learning, the authors look toward a future of medical education increasingly interwoven with digital technology and responsive to social change.

The pre-clerkship medical student's experience during the COVID-19 pandemic: An international conversation with recommendations for progress

In response to the spread of SARS-CoV-2 across North America in early March of 2020, Canadian and United States medical schools swiftly virtualized medical education for pre-clerkship students. With remote learning arrived novel challenges: barriers to students’ comprehension of course material, difficulties conveying the nuances of patient interaction, and social hardships hindering students’ continued progress. The 2020 Harvard-McGill Medical Student Exchange, a group of ten McGill University Faculty of Medicine and Harvard Medical School students, analyzed their institutions’ respective responses in the virtualization of medical education and their personal experiences with remote pre-clerkship education. The authors’ work provides insight into opportunities for mutual progress and cross-cultural exchange between Canadian and American medical schools, in the context of the COVID-19 pandemic. The authors detail potential changes to didactics, student research opportunities, support for students, and clerkship preparation that they expect would benefit pre-clerkship students in an ever-changing biomedical landscape. With gratitude toward their respective programs for their efforts in transitioning to virtual learning, the authors look toward a future of medical education increasingly interwoven with digital technology and responsive to social change.

An Interactive Platform to Enhance Knowledge and Understanding of Ovarian Neoplasm: A Pilot Media Program to Standardize Clerkship Education

Clinical clerkships at Augusta University vary in level of student’s exposure to patients due to geographical locations of clerkships. Standardizing clerkship material will lead to more accurate patient diagnoses and treatment. This project describes the development of a pilot e-learning module to enhance clerkship experience through standardization of the media.

Perspective of nursing students on curricular training / Perspectiva dos discentes de enfermagem sobre o estágio curricular / Perspectiva de estudiantes de enfermeira em el práctica curricular

Objective: To characterize the curricular training in the Nursing Course of a public educational institution. Methods: descriptive exploratory study, whose the population was of 61 students who attended the 8th and 9th period and were enrolled in the curricular training. The sample consisted of 44 students, who agreed in answer a form with open and closed questions. Data were typed in Excel version 2010 and organized in tables and graphs. Results: Majority of students were females, with age between 21 and 26 years. The traineeship was conducted predominantly in hospitals. When asked about the physical infrastructure of the institutions in which they performed the stage (43.18%) reported that they were appropriate and (43.18%) reported partially adequate. Interpersonal relationships between students, teachers, health staff and patients were considered adequate. Regarding the safety of students in the development of practical activities on stage (55%) reported that developed the practices with safety, (43%) with partial security, and (2%) with insecurity. The majority reported that taught theoretical contents were partially applied on stage. Conclusion: The curricular training presented aspects that promote student learning, however there was a centrality of the hospital as a field of practice of curricular training. Keywords: Clinical Clerkship. Education Nursing. Nursing.