Hello COMSEP!
We call it the summer edition–but truth be told it would be more accurate to call it the end-of-summer edition. Whether you are busy with new white coats, back-to-school shopping or just grieving the shortening days and cooler nights, the fall season is nigh.
On the plus side, it’s a great time to begin a new project. (Hint, hint ).
Enjoy!
Jon, Karen and Amit
How Do Medical Students Use Trauma-Informed Policies?
Perez-Urbano I, Jowhar ZM, et al.Student, Staff and Faculty Experience with a Medical School Racial and Sociopolitical Trauma Protocol: A Mixed Methods Study Teaching and Learning in Medicine. June 2024. https://dx.doi.org/10.1080/10401334.2024.2361912
Reviewed by Kelly Blanchet and Molly Rideout
What was the study question?
How did medical students utilize an institutional racial and sociopolitical trauma protocol and what was the student, staff, and faculty experience with the protocol?
How was the study done?
A diverse public medical school instituted a protocol to be activated following community racial and sociopolitical traumas to allow students to respond and heal. The protocol allowed for optional time-limited absence from didactics, and delayed assignments and assessments. This mixed methods study consisted of (1) quantitative analysis of student utilization of the protocol from June 2020 to November 2021 and (2) qualitative thematic analysis of focus groups of students, staff, and faculty.
What were the results?
Almost 60% of all students enrolled utilized the protocol during at least 1 of 8 protocol activations during the study period. 46% of protocol users self-identified as Underrepresented in Medicine (UIM). 88% of delayed/excused activities occurred in pre-clerkship. The protocol was most commonly used for delayed assignments (70.6%), followed by attendance (55.5%) and, least commonly, assessments (14.3%). Themes that emerged from the focus group were (1) considerations for utilizing the protocol, (2) impact of the protocol, and (3) implementation issues. Some students felt utilizing the protocol allowed them to engage in restorative activities after traumas while others preferred to operate as normal in the face of trauma. They weighed their academic and patient-care responsibilities against the restoration they may achieve by utilizing the protocol. Faculty and staff felt that the additional draw on resources was justified by the mission-based purpose of the protocol and value it provided the students. Some students felt undervalued when the protocol was not activated after a trauma that impacted them and a few felt the protocol did not provide enough support.
How can I apply this to my work in education?
Medical schools should consider the implementation of a racial and sociopolitical trauma protocol for individualized academic flexibility following a community trauma. Such a protocol employs critical race theory and trauma-informed medical education practices to support students’ identities, autonomy, and well-being by providing time for restoration.
Editor’s Comments: This paper reflects an important curricular innovation, embracing trauma-informed medical education that acknowledges the burden of repeated and the associated stress endured by medical learners, particularly those from marginalized groups. We should all be asking ourselves, what are our schools doing to support students with regards to racial and sociopolitical trauma? (KFo)
Pace Yourself
Holland JE, Rohwer JK, O’Connor JM, Wahlberg KJ, DeSarno M, Hopkins WE, Flyer JN. Development, Feasibility, and Initial Evaluation of an Active Learning Module for Teaching Pediatric ECG Interpretation and Entrustable Professional Activities to Clinical Medical Students. Acad Pediatr. 2023 Sep-Oct;23(7):1465-1468. https://dx.doi.org/10.1016/j.acap.2022.12.014
Reviewed by Ataya Spears and Stephanie Berger
What was the study question?
Could an asynchronous remote active learning module called Pediatric Active Learning Electrocardiography (PACE) be satisfactorily implemented and increase pediatric ECG interpretation competency in 4th year medical students?
How was the study done?
4th year medical students enrolled in a pediatric cardiology elective or pre-pediatric residency bootcamp were eligible to participate. Participation was voluntary. Pediatric residents on cardiology elective served as controls. Historical in-rotation exam data showed these 2 groups to be comparable. Participants completed an ECG assessment and survey at the start (baseline), 2 weeks (post-curriculum), and 10 weeks. Between the baseline and 2-week assessments, the study group completed the 2-week PACE curriculum described as an interactive PowerPoint design with 31 ECGs/cases linked to EPAs. A 5-point Likert scale assessed the primary outcomes, user satisfaction and feasibility. ANOVA analyzed the secondary outcome of changes in scores on ECG assessments.
What were the results?
Seventeen medical students were in the study group; 6 residents in the control group. Mean time to complete the PACE module was 3.3 hrs. Students rated the module highly, with an average of 4.5 for both satisfaction and feasibility. Mean ECG assessment scores at baseline, 2 weeks and 10 weeks for the student/study group were 56%, 75%, and 69% respectively (p < 0.01). Resident/control group showed no change over the 3 time points with scores of 69%, 75% and 77% respectively (p = 0.23).
How can I apply this to my work in education?
Medical student end-of- rotation feedback drove this curricular innovation. Students were part of the interprofessional team that developed and assessed the curriculum. Early involvement of students in curriculum development is an opportunity to shape the next generation of MedEd leaders. The need for PACE may be unique to this specific institution,but it serves to remind us that the implementation of curriculum resources should be done in a thoughtful manner, with the students’ needs and satisfaction at the forefront.
Editor’s Note: Involving medical students in curriculum development is a win-win in so many ways–getting end-user input, developing young scholars, helping students distinguish themselves in residency applications. Involving medical students in COMSEP Journal Club is good, too (JG)
It doesn’t get better
Kristoffersson E, Boman J, Bitar A. Impostor phenomenon and its association with resilience in medical education – a questionnaire study among Swedish medical students
BMC Med Educ. 2024;24(1):782. https://dx.doi.org/10.1186/s12909-024-05788-2
Reviewed by Emily Deboy
What was the study question?
What is the prevalence of impostor phenomenon (IP) among Swedish medical students? Is IP associated with lack of resilience and therefore psychological distress?
How was the study done?
A cross-sectional survey was distributed to medical students attending 5.5/6 year undergraduate medical education programs at Umeå University in Sweden in February and March of 2023. To assess IP and resilience, the study utilized the Clance Imposter Phenomenon Scale (CIPS) and Brief Resilience Scale (BRS) which are both validated to measure the respective areas. Cutoffs were used for degree of imposter feeling and level of resilience. ANOVA analysis was used for comparison within each scale, and Pearson was performed for correlation between scales.
What were the results?
Response rate was 48% (N = 457). Among respondents, 58.4% met the threshold for IP with only 10.9% having low IP. Over a quarter (27.9%) had low resilience. Feelings of IP did not change significantly throughout the curriculum and were already present on matriculation. Women had significantly higher levels of IP and lower levels of resilience than men. The study also demonstrated a moderately significant negative association between IP and resilience (R = -0.412, p<0.001).
How can I apply this to my work in education?
To reduce the effect of IP in the learning environment educators can employ strategies including addressing the existence of IP, sharing their own experiences as applicable, and holding open discussions. The authors also note that although IP, particularly in women, is often attributed to personal characteristics (e.g. perfectionism), there is a significant contribution of systemic factors such as discrimination. In addition to considering the individual, educators should consider systemic causes of IP feelings in the learning environment and how these can be addressed.
Editor’s Note: This study shows that impostor phenomenon is mostly present before medical school starts. Even though the prevalence does not change over time it still needs to be addressed in undergraduate medical education as it may help with resilience. (AP)