Comparison of Clerkship Directors’ Expectations of Physical Examination Skills with Point-of-care Ultrasound Skills Using the RIME Framework

Background: The expectations of point-of-care ultrasound (PoCUS) in undergraduate clerkship at the University of Ottawa has not been described. We compared clerkship directors’ expectations of physical examination skills with PoCUS skills, before and after completing the clerkship rotation. Methods: A pilot-tested, expert developed, bilingual on-line survey consisting of 15 questions was sent to all clerkship directors (23) in December 2019. The survey included questions regarding the expectations of medical students with respect to physical examination and PoCUS using the RIME Framework: none, reporter, interpreter, manager, educator. Results: The response rate was 60.9% (14/23). With regards to physical exam skills, 82.8% of directors had no expectations or expected students to be reporters when starting clerkship. At graduation, 77.5% of directors expected students to be interpreters, managers, or educators. For PoCUS, 100.0% of directors had no expectations or expected students to be reporters when starting clerkship. At clerkship completion, 33.0% of directors felt that students should be interpreters or managers for PoCUS skills. Conclusions: Clerkship directors have low expectations of PoCUS skills for entering and graduating clerks when compared with their physical examination skills despite formal pre-clerkship PoCUS objectives. Enhanced communication and targeted education of directors could improve the PoCUS curriculum.

Evaluating the efficacy of self-study videos for the surgery clerkship rotation: an innovative project in undergraduate surgical education

Background: Educational videos have become valuable resources and can address some of the pitfalls of traditional learning. To ensure clerkship students have adequate exposure to curriculum objectives, a series of objective-aligned self-directed learning video podcasts covering core surgical concepts were developed by medical students and surgical residents. The objective of the study was to evaluate the efficacy of the video podcasts in the surgery clerkship rotation. Methods: Nineteen video podcasts were created, housed at www.surgicaleducationportal.com, and distributed to third-year medical students completing their surgical clerkship. A 10-question multiple-choice quiz was administered before and after students viewed each video, and they were also asked to complete a satisfaction survey. Results: A total of 302 paired pretests and posttests were completed. There was a mean increase of 2.7 points in posttest scores compared with pretest scores (p < 0.001). On a Likert scale from 1 to 5, with 5 being excellent, students rated the usefulness of the videos as 4.3, the quality of the content as 4.3 and the quality of the video as 4.2. Ninety-eight percent of students would recommend these videos to their classmates. Conclusion: Video podcasts are an effective modality for engaging medical students and may improve standardization of learning during their surgical clerkship.

Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study

Background Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. Methods We analyzed changes in self-entrustment ratings of students and the supervisors’ ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. Results EPA 1 (“Take a patient’s history”), EPA 2 (“Assess physical & mental status”) and EPA 8 (“Document & present a clinical encounter”) were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors’ ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. Conclusions Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students’ development toward self-entrusted, indirect supervision levels.

Residency redeployment during a pandemic: Lessons for balancing service and learning

Medical students often have difficulty selecting a residency training program. The internal medicine clerkship rotation occurs primarily on the general internal medicine ward, making it difficult for students to experience the breadth of IM subspecialties prior to making career decisions. Herein, we describe a two-week student-led program (IMED: Internal Medicine Enrichment and Development) designed to give interested pre-clerkship students an overview of the internal medicine subspecialties in order to broaden their understanding of the opportunities within the field. We believe that medical students across the country would benefit from such exposure in order to make more informed decisions about residency.

Internal Medicine Enrichment and Development: A summer exploration program for pre-clerkship students

Medical students often have difficulty selecting a residency training program. The internal medicine clerkship rotation occurs primarily on the general internal medicine ward, making it difficult for students to experience the breadth of IM subspecialties prior to making career decisions. Herein, we describe a two-week student-led program (IMED: Internal Medicine Enrichment and Development) designed to give interested pre-clerkship students an overview of the internal medicine subspecialties in order to broaden their understanding of the opportunities within the field. We believe that medical students across the country would benefit from such exposure in order to make more informed decisions about residency.

The current landscape of urological undergraduate education in Canada

Introduction: Urological presentations are commonly seen in primary care and urologists are concerned that educational gaps exist in undergraduate curricula in Canadian medical schools. A pan-Canadian survey of undergraduate urology education directors (UUEDs) was used to determine the current status of undergraduate urology education in Canada. Methods: In the fall of 2018, a survey was administered to all 17 UUEDs representing every Canadian medical school. The survey assessed multiple factors, including the timing and duration of urologist-led instruction, the perceived adequacy of urological content in the curriculum, and the level of preparedness of graduating students. Results: The response rate was 100%. Variation in the duration (mean total instructional hours: 22.5±17.2 [5–75] hours) and timing of formal urological instruction was seen. The majority of schools covered core content areas, however, erectile dysfunction, uro-trauma, and pediatric urology topics were under-represented. One school had a mandatory urology clerkship rotation (one week), while the other 16 schools offered a selective, with 24.3% of students completing this experience. The majority of UUEDs (64.7%) believed the curricular time devoted to urology was inadequate, 29.4% felt that their graduates were unprepared to diagnose and treat common urological problems, and 76.5% strongly agreed or agreed that a national urology curriculum would be useful. Conclusions: There was significant variability in the duration of instruction and delivery of urological topics in Canadian medical schools. There was a perceived need for more urological instruction by most UUEDs, who welcomed a more standardized national curriculum as a strategy to address this need.

Academic Detailing From Medical Students: Part of a Plan to Emphasize Feedback in One Clerkship

Introduction: Medical schools have an enduring need to provide ongoing faculty development and to foster educational alliances between teachers and learners, so that feedback provided to learners is both frequent and of high quality. We hypothesized that medical students trained as academic detailers with a mission to increase the emphasis on feedback could serve in this role during our clerkship, while still being evaluated as students in our clerkship rotation. Methods: The family medicine clerkship at Mayo Clinic School of Medicine launched a revised curriculum in 2016 in which students were taught how they might build an educational alliance with preceptors, were taught characteristics of high-quality feedback, and practiced requesting more useful feedback when initial quality was poor. After utilizing a clerkship-specific curriculum with small group sessions on receiving feedback, and training students and preceptors on the SNAPPs model, students were then directed to request feedback from their preceptors and model successful feedback conversations for preceptors. The study evaluated the medical students’ summative evaluations to compare the rate from the preintervention year (2015-2016) and the intervention year (2016-2017) at which preceptors added comments on students’ use of feedback. Results: Preceptors’ written comments about students seeking feedback increased at about a four-fold rate (74.4% vs 18.8%, P&lt;.001) after implementing a suite of changes to our clerkship curriculum. Conclusions: Using medical students to change preceptor behaviors was an important part of our suite of interventions. This intervention directed preceptor attention toward our instructional goal of increased medical student feedback.

P139: The use of simulation in emergency medicine UGME clerkship education: A quality improvement initiative

Introduction: Simulation is becoming widely adopted across medical disciplines and by different medical professionals. For medical students, emergency medicine simulation has been shown to increase knowledge, confidence and satisfaction. At the University of Ottawa Skills and Simulation Centre, third-year medical students participate in simulated scenarios common to Emergency Medicine (EM) as part of their mandatory EM clerkship rotation. This study aims to evaluate simulation as part of the EM clerkship rotation by assessing changes in student confidence following a simulation session. Methods: In groups of seven, third year medical students at the University of Ottawa completed simulation sessions of the following: Status Asthmaticus, Status Epilepticus, Urosepsis and Breaking Bad News. Student confidence with each topic was assessed before and after simulation with a written survey. Confidence scores pre- and post-simulation were compared with the Wilcoxon signed rank test. Results: Forty-eight third years medical students in their core EM clerkship rotation, between September 2017 and August 2018 participated in this study. Medical student confidence with diagnosis of status asthmaticus (N = 44, p = 0.0449) and status epilepticus (N = 45, p = 0.0011) increased significantly following simulation, whereas confidence with diagnosis of urosepsis was unchanged (N = 45, p = 0.0871). Treatment confidence increased significantly for status asthmaticus (N = 47, p = 0.0009), status epilepticus (N = 48, p = 0.0005) and urosepsis (N = 48, p &lt; 0.0001). Confidence for breaking bad news was not significantly changed after simulation (N = 47, p = 0.0689). Conclusion: Simulation training in our EM clerkship rotation significantly increased the confidence of medical students for certain common EM presentations, but not for all. Further work will aim to understand why some simulation scenarios did not improve confidence, and look to improve existing scenarios.