Impact of Virtual Interviewing on Time and Financial Costs for NRMP© Applicants: Did Regional Campus Students Save More?

Background and Objectives: The sudden change from in-person to remote interviews by the National Residency Matching Program© (NRMP©) in 2020 was expected to result in significant financial and time savings for applicants. This project aimed to compare savings before and after the 2020-2021 interviewing season reported by students graduating from our institution’s regional and main campuses. Methods: Data were collected over a six-year period at a Midwestern medical school. Each year, approximately 120 main campus and 75 regional campus students are surveyed regarding specialty choice, number of applications and interviews, time, and expenses to complete the NRMP. Chi-square and t-tests were used to determine statistical differences by campus and by specialty in savings during the 2020-21 interviewing season compared to the previous five years. Results: Data were provided by 957 students. The response rates were 81.5% (regional) and 82% (main campus). Compared to the previous five years, in 2021 main campus students saved $3,990 (79.9%) and regional campus students saved $2,789 (77.1%). The previous highly significant differences in expenses between campuses ($1,386 ± $243) dropped to $185 (p = 0.3). On both campuses, applicants to non-primary care specialties saved more than their classmates applying to primary care. The largest average saving was reported by non-primary care applicants on the main campus ($4,207) and the smallest by regional applicants to primary care ($2,328). Main campus applicants reported saving 13.1 and regional campus 15.4 days interviewing in 2021. The smallest average time saving was reported by main campus applicants to non-primary care (12.7 days) and the largest (16.2 days) by regional campus applicants to primary care. No significant changes occurred in number of applications, interviews, or Match outcomes in 2021 compared to previous years. Conclusion: Prior to 2021, students from our institution’s regional campus reported lower costs and similar interviewing time than their peers on the main campus. Cost and time were significantly decreased in 2021 for both regional and main campus students applying to any specialty and differences between campuses reduced to non-significant levels. The number of applications, completed interviews, and Match outcomes remained similar to previous years. Changes to the NRMP© incorporating remote interviewing may reduce applicant costs by 80% and provide up to two weeks of available curricular time in the senior year of medical school.

Considerations for Selecting Applicants to Rural Medicine Programs

The selection of medical students destined for rural practice is important in order to help provide access to care for the 20% of the US population who live in rural America. Knowing which medical school applicants will go into rural practice is an inexact science, although the objective predictive characteristics of future rural doctors are well known and evident in the literature. The role of rural program directors is to identify which applicants will likely choose a FM residency, done primarily by identifying which rural predictive characteristics the applicants possess. Admissions committee members are not expected to determine the likely practice locations of rural applicants, and need only have the responsibility of determining which applicants should become physicians.

Ultrasound Curriculum Integration Review and a Survey of its Utility in Regional Medical Campuses

to guide procedures. As the technology becomes more portable and affordable, schools have increasingly utilized this technology in training physicians. Ultrasonography may be especially useful in rural settings to fill the limitations that rural hospitals have in terms of imaging. The mission of many regional medical campuses is to train physicians to work in rural or underserved communities. Given this goal, we wanted to explore how regional medical campuses are utilizing ultrasound preclinically and determine the best approach for developing a standardized ultrasound curriculum, keeping regional medical campus resources in mind. A literature review of medical schools’ preclinical ultrasound curriculum was completed, and information was collected regarding curriculum programming, faculty, assessment, and student feedback. Based on data from this search, a fourteen question Qualtrics survey was sent out to regional medical campuses with questions regarding the use of ultrasound in their own preclinical curriculum. Of the 11 campuses that responded, 10 (90.9%) indicated that they include ultrasound in their curriculum. Respondents from nine of these schools progressed through the survey and information regarding topics covered in ultrasound curriculum, teachers of curriculum, patients used, ultrasound equipment used, and assessment of student knowledge all varied among medical campuses. The data suggested that regional medical campuses are focusing on similar aspects of ultrasound curriculum however, a standardized curriculum does not currently exist to ensure that all students are receiving similar ultrasound training.

A Student-Directed Community Cardiovascular Screening Project at a Regional Campus

Introduction Cardiovascular disease (CVD) is an important threat to public health, especially in rural communities. Clinical medical students at a rural regional campus can be a valuable resource to plan and implement CVD risk factor case finding project in the host community. Methods Directed by a representative county advisory council and supervised by a regional dean, clinical medical students designed and implemented CVD screenings at several public locations, recording health history and measurements of blood glucose, total blood cholesterol, and blood pressure. Those screened with abnormal readings were directed to definitive care including the local student-directed free clinic. Students were surveyed using a Likert scale before and after participation to assess their confidence in executing a community health project. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interest. Results Over a period of almost two years in 2017-2019, 572 participants were screened. The demographics reflected those of the entire county, except screening was focused on adults. High blood pressure was found in 43%, high glucose in 28%, and high cholesterol in 48%. These values were similar to published countywide prevalence proportions. The student pre- to post- increase in confidence was remarkable (p< 0.000). Conclusions Our results show that regional campus medical students directed by a representative county advisory council and supervised by a regional dean can successfully implement a community CVD screening effort. The students also expressed a dramatic increase in their confidence in designing and implementing such a project. Lessons learned are shared for consideration by those at other regional health campuses.

Does empathy really decline during residency training? A longitudinal look at changes in measured empathy in a community program

Introduction Some studies, most cross sectional and urban, have shown a decline in empathy during residency training prompting medical educators to consider changes in curriculum or training environment. Our aim was to determine if there was a decline using a longitudinal, paired annual empathy measure across three years of a family medicine residency in a rural community hospital. Methods We administered a validated measure from 2015 through 2020 and of the 116 opportunities for survey completion, 112 from 48 residents were available for scoring. We also asked our residents to rank 10 factors that affected their empathy scores. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interest.. Results With a response rate of 97%, we found no statistically significant decrease in our resident scores across the three years. Scores after our PG-1 year were significantly lower than two previous comparable studies. The longitudinal, paired study design revealed very wide ranges among individual residents even when group means indicated a statistical difference. Residents also differed widely on their rankings of factors that could affect the score, with only outlook on life showing a narrow range and high ranking. Conclusions The very wide range of individual paired scores as well as the broad range of factors the residents thought affected their scores indicate that empathy is a very individual concept. Some of our residents actually increased scores leading to resilience and others declined toward cynicism. Those seeking to make changes to curriculum or training environment to facilitate empathy during residency should consider this diversity of individual resident training experience.

COVID-19 Impact on Regional Medical Campus Education: Student Perspectives

Due to social distancing precautions and the desire to protect clinical learners, the COVID-19 pandemic forced medical schools everywhere to implement more distanced and virtualized learning in their educational curriculums. More specifically, at the University of Kansas School of Medicine-Salina, a regional medical campus, the impact of some of these changes were also seen and felt. The purpose of this study was to investigate the downstream effects of these curriculum changes from the perspectives and opinions of medical students attending a regional medical campus. To explore the study purpose, a mixed-methods, cross-sectional study that used an online survey with closed and open-ended questions was used. Additionally, because of unique curriculum characteristics depending on the year of the student, 1st and 2nd year students (phase I) were asked slightly different questions than students in their 3rd and 4th years (phase II). Closed-ended questions asked students about lecture experience, clinical learning development and time, study time, exam performance, collaborative learning experiences, and socialization/interactions with colleagues. Students answered in range of -3 to +3, negative numbers meaning a detrimental impact (or decrease in study time), and positive numbers being beneficial impact (or increase in study time). Open-ended questions asked students about improvements that could be made, unique class circumstances during the pandemic and any other relevant impact not covered in closed-ended questions. For phase I students, lecture experience, study time and exam performance resulted in no impact. However, collaborative learning and socialization with colleagues did result in a detrimental impact that was significant. For phase II learners, clinical skills development, time spent in clinical skills development and socialization with colleagues were detrimentally impacted. However, the amount of time spent on studying increased and exam performance benefited. These findings suggest that pandemic-related curriculum changes impact learners differently depending on the phase of medical they are in. There are no conflicts of interest by either of the authors. This study has been approved by the University of Kansas Medical Center Institutional Review Board.

Do Rural Longitudinal Integrated Clerkships Impact Choice of Residency Type and/or Permanent Community Practice in Surgery?

Purpose: Rural general surgery experiences during medical school appear to have influenced the decision of prospective general surgery applicants to pursue residency programs that provide rural surgery opportunities. This is an analysis of a single cohort, rural-focused, longitudinal integrated clerkship to determine if there is an association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Methods: An institutional database of de-identified, self-reported data was reviewed to identify rural-focused longitudinal integrated clerkship alumni who matched into a surgical residency program. Findings: Of the seventy-five alumni who chose a surgical residency program, 40 (53.3%) matched into a university-affiliated residency program, and 32 (42.6%) matched into an independent-academic program. There was no association between type of residency program and completion of a rural-focused longitudinal integrated clerkship. Conclusions: A rural-focused longitudinal integrated clerkship can help increase the rural physician workforce within both the state and region of the sponsoring institution. To facilitate heightened interest in rural general surgery, these types of programs should continue to be promoted.

Teleneurology Teaching Service at a Rural Regional Campus

Regional rural medical school campuses offer many opportunities for medical students to gain more hands-on experience, have more direct interaction with attending physicians, and cultivate a deeper understanding of challenges and opportunities specific to rural medicine. Some specialty services such as neurology are not available at these small regional campuses, and telemedicine technology can be a valuable tool to address this need. We report the implementation of teleneurology stroke consultation services as part of the third-year neurology clerkship at a regional medical school campus. We analyzed daily clinical notes and student satisfaction surveys. Students saw many common and important presentations of cerebrovascular events. Students worked as part of a multi-disciplinary care team while following these patients through their hospital course with effective instruction provided by remote stroke neurologists. All students strongly agreed that telemedicine was a positive component of the clerkship. We conclude that teleneurology is an effective way to provide inpatient neurology clinical exposure, especially when remote attendings have a strong screen presence and are enthusiastic about teaching. We believe these findings could be useful to other campuses considering similar teaching methods, as innovations in telemedicine continue to address challenges in medical education and clinical care. The authors have no conflicts of interest to report and the Baptist Health Madisonville Institutional Review Board found this study to be exempt.

Motivating Factors of and Perceived Barriers to Research at a Canadian Medical University with Regional Campuses: A Cross-Sectional Survey Study

Introduction Research training programs are an integral part of a well-rounded medical education. These programs help students contribute to medical knowledge, develop skills in critical evaluation and research dissemination, and they facilitate the training of our future medical researchers. Existing literature suggests barriers including lack of available time and access to projects may hinder a medical student’s research training. These barriers likely differ based on the medical school curriculum, and there exists limited data looking at these attitudes in Canadian students, students outside large academic centers or those in condensed programs. Given this, our study aims to further explore medical students' perceptions, perceived barriers of research in a three-year Canadian undergraduate medical school with regional campuses. Methods We conducted a cross-sectional survey of medical students (classes of 2019, 2020 and 2021) representing the main and regional campuses of the Michael G. DeGroote School of Medicine in Ontario, Canada to explore their attitudes towards research. Descriptive statistics were used to describe participant demographics, research background and attitudes towards research. Results Overall, 70.4% of students identified as being involved in a research project at some point during their medical school tenure. Motivating factors for research participation included the goal of obtaining a residency spot (63.0%), and interest in their research topic (74.7%). Barriers to research included perceived lack of available time (31.5%), and difficulty in finding a research project (44.5%). Perceived curriculum deficiencies included lack of education in research methodology and appraisal of scientific literature (93.2% and 89.0%, respectively). Lastly, regional campuses tended conduct their research outside of their home campus (43.6% vs 3.3%, p<0.0001). Conclusion The findings from our study highlighted the students’ attitudes towards research in a Canadian medical school that has multiple campuses and a shortened medical curriculum (3-year). It identifies potential areas of improvement from a student perspective, which can hopefully be utilized by medical educators to continue the improvement of medical trainee research training.

Vulnerable Patient Outreach Program (VPOP)

The COVID-19 pandemic has significantly disrupted many traditional patient care delivery models. To help meet patient needs, the Penn State Health Department of Family and Community Medicine started a medical student-run Vulnerable Patient Outreach Program (VPOP). This program pairs medical students with providers to address healthcare needs for the most vulnerable patients. At the program outset, a total of 125 patients were identified and 64 agreed to participate. All patients were over the age of 65 and had multiple medical comorbidities. This study reviews the impact of VPOP on the care of 34 participants. Each participant completed pre-structured satisfaction surveys over the phone. The results indicate a high degree (94%) of patient satisfaction. Patients were particularly comfortable communicating their health needs to medical students and specifically highlighted medical student professionalism. Medical students also found this program to be beneficial, citing an ability to help during pandemic times in a clinically meaningful way. The highly positive reactions from both patients and medical students suggest that outreach programs, like this one, are one way to meet the needs of vulnerable patients. These findings also suggest that, as a longitudinal experience beyond COVID-19, medical students may benefit from participation in vulnerable patient outreach programs.