October 2024

Hello COMSEP!

Attached and below is the latest edition of our Journal Club.  

For this month’s journal club, the Survey and Scholarship Committee reviewed journal articles that used a survey in their methods. We hope this motivates you to submit questions to the annual survey for 2025 -https://www.comsep.org/annual-survey/. We will be opening up for submissions in early November. We also welcome anyone who wants to apply to be on the committee.

Enjoy!

Amit, Amy, Deborah, Emily, Jessica, Sarah


Across the digital divide

Faria I, Moura CB, Graner M, Campos LN, Gerk A, Bittencourt MM, et al. Online medical education: A student survey. Clin Teach. 2023;20(4):e13582. https://doi.org/10.1111/tct.13582

Reviewed by: Sarah Korte

What was the study question?

How did medical schools across the world restructure the delivery of medical education during the pandemic?

How was the study done?

The study team performed an international cross-sectional study in November 2020. The survey was first piloted in focus groups to ensure adequate comprehension.  The final survey had 37 multiple choice, check-boxes, and scale questions looking at demographic information and changes in education delivery methods.  Distribution was in REDCap to medical students across the world in four different languages. Statistical analysis included categorical variables for frequencies and one way ANOVA for differences.

What were the results?

A total of 1,746 complete survey responses were received and categorized according to country income status based on the World Bank 2021 classification.  The responses were from 79 different countries corresponding to 557 medical schools.  Almost all (91%) medical students reported in-person classes were suspended, ranging from 74% in low-income countries (LICs) to 93% in upper-middle-income countries (UMIC). Use of online learning increased from 36% to 93%, with live-streamed classes becoming the most used method. For students in clinical rotations, 89% reported they were paused. Online learning replaced in-person rotations for 32% of respondents from LICs versus 55% from high-income countries (HICs).

Technological and student-related barriers were more profound in LIC, with only 76% of students with internet access compared to 98% of HIC students. Almost half (43%) from LIC felt their internet connection was not sufficient for online classes compared to only 11% from HICs.\

How can I apply this to my work in education?

This study highlighted barriers that many students face, especially from LICs, with implementation of online learning content that exacerbate already existing inequities in medical education.  While most of us will not be practicing in a LIC, barriers do exist in our own institutions and as educators thus we have a responsibility to provide equitable access to online learning for all students regardless of country or socioeconomic status.

Editor’s Note: This is an amazing study to accomplish across the world. However their recruitment through email and social media did inhibit their ability to track responses and know response rate. (AKP)


Fourth year subinternships--are they all the same?

Garber, A.M., Vu, T.R., Orr, A. et al. Internal Medicine Acting Internship Trends in Rotation Structure and Student Responsibilities: Results from a 2023 National Survey. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08897-2

Reviewed by Amy Creel and Deborah Rana

What was the study question?

What is the current landscape of internal medicine acting internships (AIs) in U.S. allopathic medical schools, and what areas need standardization?

How was the study done?

Researchers conducted a voluntary online survey targeting course directors of internal medicine AIs at U.S. medical schools using the Clerkship Directors in Internal Medicine (CDIM) listserv. The survey included questions on required AI rotations, length, student responsibilities, and curricular components. The response rate was 50.7% (71 of 140 schools). Descriptive statistics summarize data and one-sample two-sided chi-square tests were used to analyze differences from historical rates.

What were the results?

All participating schools require at least one AI rotation for graduation, with 94.4% integrating students into resident teaching teams. The average patient load for AI students was reported as 3-4 patients per day, with significant responsibilities in patient care. However, only 41% of schools utilized at least one portion of the structured curriculum from the AAIM Sub-internship Curriculum 2.0. Only 33.8% of respondents require or offer optional night shifts or night call on the rotation. Further, the study highlighted variability in rotation design, curriculum and a lack of standardized expectations, suggesting opportunities for improved consistency across institutions.

How can I apply this to my work in education?

These findings underscore the lack of a standardized and structured approach to AIs in Internal Medicine despite the existence of curricular resources such as the AAIM Sub-internship Curriculum. Fostering environments where students can manage a higher patient load and participate in night shifts could improve their readiness for the challenges of intern year. Addressing issues discussed in this study may allow UME programs to better prepare students for residency..  This study also offers insight on how the COMSEP survey might be useful in gathering data on pediatric AI practices or how and where the COMSEP curriculum is being used.

Editor’s Note:  I suspect that the landscape for pediatric subinternships is similar.  With all the work that goes into building wonderful resources like the AAIM Sub-Internship Curriculum and the COMSEP and APPD Pediatric SubInternship Curriculum,, it would be useful to identify barriers to using these tools. (JG)


Advising in the age of COVID

Alexandraki I, Ismail N, Lai CJ, Duca NS, Ratcliffe T, Kisielewski M & Pincavage AT. Medical student advising during virtual residency recruitment: results of a national survey of internal medicine clerkship and sub-internship directors.  Medical Education Online 2023; 28(1): 2143926.  https://doi.org/10.1080/10872981.2022.2143926

Reviewed by Erin Pete Devon and Jessica Patrick-Esteve

What was the study question?
What were the advising practices during the 2021 virtual residency application cycle?

How was the study done?

The study used the 2021 national survey of Clerkship Directors in Internal Medicine to gather data. The survey included 11 questions exploring various aspects of student advising related to the residency application process and targeted 186 internal medicine clerkship core and co-/associate/assistant clerkship directors and sub-internship directors across 140 US medical schools. Data analysis included statistical tests (paired t- and z-tests) and thematic analysis for open-ended responses.

What were the results?

The institutional response rate was 67% and individual response rate was 55%. Half (53%) of respondents felt prepared/very prepared for their advising roles.Compared to pre-pandemic cycles, respondents advised typical students to apply to more programs (mean 24 vs 20) and accept more interviews (mean 14 vs 12). Increased advising time was noted, with 63% reporting spending more time advising students and 51% indicating a rise in informal advising requests. Approximately 59% of respondents reported their advisees were able to assess residency programs “somewhat well” and 9% “very well” through virtual interviews and 31% expressed that virtual recruitment should remain permanent.

How can I apply this to my work in education?

This study shows that the shift to virtual interviews resulted in increased workload for clerkship directors and concerns about application inflation, as students were advised to apply to and interview with more programs. A mismatch between advising practices and NRMP data (showing 99% of students would match by ranking 12 or fewer programs) may stem from uncertainty about how virtual interviews affect student candidacy and a lack of awareness of these guidelines. It is important to educate students on NRMP data to help align advising with evidence-based data and decrease application inflation and reduce student stress. Further, it is important to consider the impact on workload from the increase in time spent advising, and subsequent concern about burnout and the need for institutional support and faculty development for their advising roles.

Editor’s Comments: This study shows how a national survey can yield results that provide a sense of what is going on with an issue across many institutions. I was particularly impressed by the response rate: 93/140 institutions and 103/186 individuals responded to the survey. This demonstrates that trends found in advising that are generalizable and may allow for collaborative discussions and solutions to important medical education issues. Perhaps this is also a shameless plug to please fill out the COMSEP annual survey when it comes your way! (KFo) 


Student-centered approaches to family-centered rounds

Trost MJ, Potisek NM, Seltz LB, Rudnick M, Mamey MR, Long M, Quigley PD. Medical Student Participation in Patient- and Family-Centered Rounding: A National Survey of Pediatric Clerkships. Acad Pediatr. 2019 Jul;19(5):549-554.   https://doi.org/10.1016/j.acap.2018.12.010

Reviewed by Erin Pete Devon

What was the study question?
What is  the prevalence of student participation in patient-and-family-centered rounds (PFCR) in pediatric clerkships?   What is the prevalence and type of student orientation to PFCR.

How was the study done?
The study used a national survey of pediatric clerkship educators and administrators to gather data. The authors submitted 5 questions about PFCR to the Council of Medical Student Education in Pediatrics (COMSEP) Survey Committee. The questions were pilot tested, revised and included in the 2017 COMSEP membership survey. Questions were about the prevalence of medical student participation of PFCR, the prevalence and type of student orientation to PFCR, and student challenges with this rounding model from the perspective of clerkship directors and leadership. Responses were analyzed using chi-square and t-tests for quantitative data, and content analysis for qualitative responses.

What were the results?

The overall survey had and individual response rate of 36% (190/521) and a school response rate of 66% (103/156). Questions related to PFCR received a total of 174 responses (33.4%). Responses came from 94 schools and 98 unique training sites/campuses. Students participate in PFCT at 85% of the sites.  While 85% of respondents had an orientation to PFCR, 49% considered it informal. Two programs reported using a published curriculum. Common orientation methods included handouts (26%), videos (10%), and role play (6%), typically delivered at the start of the clerkship (49%) or the first day of the inpatient component (29%). Orientation was done by either clerkship directors (30%) or residents (20%)

Perceived challenges of having students participate in PFCR included communication issues (e.g., translating medical jargon for families), anxiety (e.g., fear of making mistakes in front of families), variable expectations from different attending physicians, and systems (e.g. prioritizing patient care with teaching, ensuring patient safety).

How can I apply this to my work in education?

These findings highlight that while most medical students are participating in PFCR, there is large variance in their orientation. The survey also helps with possible content that can focus on the key areas of concern including reducing variability in expectations and preparing students for commonly encountered emotions and challenging case scenarios. This could include:

  • Developing or adopting formal educational materials tailored to PFCR
  • Using engaging teaching methodologies such as video or role-play exercises
  • Ensuring that all faculty and residents involved in PFCR are trained to deliver consistent messages and expectations to students

Editor’s note: While this is an older study, we wanted to highlight how the COMSEP annual survey can be utilized to understand the current learning environment and get scholarship (AKP).