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  • Curricular Programing (A)
  • Curricular Programing (A)

    PO A1 - A Scoping Review of the Literature Regarding GTA and MUTA Implementation and Utilization

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    The objective of this scoping review is to examine the implementation and utilization of gynecological teaching associates (GTAs) and male urogenital teaching associates (MUTAs) in the education of health professional students. GTAs “teach, assess, and provide feedback to learners about accurate pelvic, rectal and/or breast examination techniques.  They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies as teaching tools in a supportive, non-threatening environment (ASPE)” (Lopreiato et al., 2016). Similarly, MUTAs use the same methodology to educate learners on the urogenital and rectal examination (Lopreiato et al.,2016).  While evidence exists to support the effectiveness of GTAs and MUTAs (eg. Smith, Choudhury, & Clark, 2015), and the degree of utilization (Dugoff et al., 2016), the pedagogical implementation of these methodologies has not been examined on a broad scale.

    Methodology & Methods

    This scoping review will systematically evaluate published and gray literature on GTAs and MUTAs through searches of MEDLINE, CINAHL, ERIC, PsycINFO, Social Sciences Citation Index, and Sociological Abstracts.  The Joanna Briggs Institute (Aromataris, 2017) methodology and the PRISMA recommendations for research and reporting of scoping reviews (Tricco et al., 2018) will be followed.

    Results/Outcome/Discussion

    This scoping review will compare and assess the literature on implementation and utilization of GTAs/MUTAs into curricula for health profession students.  Results will be presented in alignment with PRISMA recommendations (Tricco et al., 2018). This will create a holistic view of the evidence regarding GTA and MUTA implementation and utilization patterns and identify future research questions.

    Conclusion

    While evidence exists regarding the effectiveness of GTAs and MUTAs, it often does not address the underlying structure of the program.  This scoping review will provide a greater understanding of the evidence supporting GTA and MUTA implementation and utilization, which will inform further research.

    PO A2 - The Effect of a Standardized Patient Encounter on Student Self-Perception of Clinical Competence

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    The goal of this study was to examine the effect of a clinical encounter with a standardized patient on a DPT student’s self-perception.  Recently, the use OSCE/SP assessment models have expanded into various Allied Health disciplines.

    Methodology & Methods

    Subjects were recruited from three consecutive cohorts of first-year Doctor of Physical Therapy students at the University of Massachusetts Lowell.  Data: Subjects were asked to complete a 10 item (5-point Likert scale) survey 24 hours prior to their standardized patient (SP) encounter, via an objective structured clinical examination (OSCE), and then again 24 hours following the exposure.  Data Analysis: The sign test with continuity correction was used to compare the difference in student self-perception pre and post OSCE across multiple domains of patient care, educational preparation, and self-assessment.  Overall, students demonstrated a statistically significant positive increase in median self-perception across four survey items (topics).  All statistical analyses were performed using SPSS version 24. This study was approved by the University of Massachusetts Lowell, Institutional Review Board.

    Results/Outcome/Discussion

    67 subjects completed the study. 21 subjects were disqualified for not having completed the second of the two surveys. Data reflect medians unless otherwise stated.  Four survey items suggesting the student’s improved self-perception with regard to their Academic Preparation (z = 2.298, p = .022), Clinical Preparation (z = 2.572, p = .010), Clinical Decision Making ability (z = 2.882, p = .004), and their Cultural Competence (p = .004), each demonstrated a statically significant change.  Descriptive statistics from these items demonstrated student’s indicating positive differences in self-perception post exposure 2.5 -  4 times that of negative differences.

    Conclusion

    Conclusions: The results of this investigation suggest a student’s self-perception of their ability to perform is affected when exposed to a standardized patient encounter early within a DPT curriculum.  Clinical Relevance: Providing pseudo real-world clinical encounters using a well-controlled and structured model, e.g. OSCE, provides DPT students early patient exposure essential to professional growth and confidence.  If positioned properly within a DPT curriculum these standardized patient encounters may help instigate improved acclimation and professional growth on a student’s first clinical education experience (internship) in a genuine real-world clinical setting.

    PO A3 - eQuality: Integrating Gender Minority SPs into Medical Education to Practice Clinical Skills, Increase Comfort And Decrease Bias

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    Significant health disparities exist for gender minority (GM) individuals.1,2 One-third of transgender patients report recent negative experiences with providers,2and such biases contribute to staggering health disparities, including a 40% attempted suicide rate.2Intergroup contact can lessen prejudice toward GM people.3Our educational innovation incorporated GM individuals into SP encounters to increase student comfort, reduce bias, and improve patient-care competency.

    Methodology & Methods

    Eleven GM individuals were recruited to serve as SPs along with four non-minority SPs. All SPs trained to portray a patient establishing primary care and to assess students. Following their last student encounter (n=137), all SPs were invited to participate in an optional focus-group-style debrief to discuss their experiences. Transcripts of the two debriefs with GM SPs or cisgender SPs were analyzed qualitatively using grounded theory.4

    Results/Outcome/Discussion

    All SPs described the encounter as meaningful experience and as “an honor” to represent their perspectives. New SPs felt the experience humanized the process of medical education and made them “better able to advocate for [themselves] in the real world.” SPs emphasized the importance of physicians acknowledging identity before discussing other health issues and described how “it is critical to build a relationship” so GM patients will return to the provider. SPs described methods to avoid assumptions about gender identity in healthcare settings and noted how students desired to manage their case but often lacked sufficient clinical skills to confidently provide gender-affirming care. Comfort with sexual orientation clinical skills, however, suggested to the SPs that similar skills for gender identity could be learned. SPs ultimately “felt very hopeful about the future of trans care” after participating.

    Conclusion

    Our experience demonstrates the importance of recruiting and incorporating GM individuals into medical education. Intergroup contact benefits the transgender community by providing insight into the complexities of healthcare training, and these positive experiences promote additional involvement in medical education from diverse communities. Students benefited through diverse interactions and rich feedback from actual community members.
    Integrating GM community members into medical education is crucial for improving gender-affirming patient care. Medical schools should prioritize the long-term integration of GM SPs to provide students with repeated exposure to practice clinical skills, increase comfort

    PO A4 - Development of a Longitudinal Cross-Clerkship Clinical Skills Exam (C3SE)

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    Assessment of medical students during clerkship rotations is frequently based upon faculty evaluations and written examinations. However, direct observation of each student’s clinical skills is challenging1 and clinical rotation evaluations are frequently unreliable2,3.  We describe the development and implementation of a longitudinal OSCE series we call the Cross-clerkship Clinical Skills Exam (C3SE). We hypothesized that multiple formative clinical skills evaluations throughout the third year would be valuable as preparation for the Step 2CS and early intervention with struggling learners. The C3SE replaced our traditional fourth-year Clinical Skills Exam (CSE).

    Description of Innovation/Discussion Topic

    A working group comprised of multiple clerkship directors, evaluation specialists, clinical skills center directors and standardized patient educators reviewed school of medicine competencies and objectives, and then created milestones for each C3SE period. Balancing the number of competencies to be evaluated and available student/skills center time, the working group developed three exams with four SP encounters each. The group then developed cases through which these competencies could be assessed. Assessment tools for each case were created. SPs were trained for role portrayal and use of the assessment tools. Student surveys were developed and administered after each exam.

    Discussion

    We successfully implemented the C3SE during AY18. Post-C3SE student surveys revealed students felt confident that the activities improved their history-taking, physical examination, clinical reasoning, note-writing, and communication skills (average response C3SE1 3.1, C3SE2 3.0, and C3SE3 3.1 on a 4-point Likert scale). These results did not decline throughout the year despite increasing complexity of the clinical cases. The periodic assessments allowed faculty to identify and intervene on students (n=20 of 219) who were having difficulty.

    Conclusion

    Early intervention may boost student’s development of clinical skills throughout the year and provide focus for their preparation for the Step 2CS. Comparison of scores from cases used in the CSE were surprisingly equivalent no matter when they appeared on the C3SE schedule. The replacement of the CSE with periodic assessments allowed the students to sign up for the Step 2CS earlier than in past years and more effective use of the skills center in June/July. We are monitoring the Step 2CS results for any effect on pass rates.

    PO A5 - Changing the Conversation: An Analysis of Interview Content in Longitudinal Encounters

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    Medical students acquire patient interviewing skills by learning the content and structure of this specialized dialog. In addition to the technical aspects of history taking, students must master effective communication skills and recognize the unique perspective with which each patient contextualizes his/her disease. Gaining insight into the person is difficult with a one-time visit. Three years ago, we introduced a pilot project focused on longitudinal patient care to first year medical students. Supported by a small grant from ASPE, we are studying how students at this level incorporate information from prior visits into patient encounters.

    Description of Innovation/Discussion Topic

    Our first-year medical students participate in a year-long course, the Practice of Medicine (POM), which runs concurrently with foundational science curriculum. POM focuses on patient interactions including the medical interview, physical examination, patient presentations, and ethics. Simulated patients are employed for experiential learning. In 2016, we modified four existing SP scenarios to allow a single person to portray these medical presentations over time. (1) Three POM small groups participated in the pilot. Building on lessons learned, we refined the project and continued in 2017 with three small groups. All student-SP encounters are video-recorded. We are currently analyzing the content of the longitudinal medical interviews and comparing this to content of interviews performed when the same primary problems were presented as a first visit. IRB approval for this work was obtained.

    Discussion

    Transcriptions of the longitudinal patient encounters and standard interviews are undergoing final edits. Analysis of the student-SP discussions is underway to determine whether early students adapt their interview when, although presenting with a new medical concern, the patient is known to the student.

    Conclusion

    Early in medical training, students tend to focus on the “disease” rather than the “person with an illness”. (2) Our longitudinal patient experience attempts to bridge this gap by tying together a single person’s story with several presenting problems. Others have described positive outcomes using SP methodology to simulate longitudinal patient interactions. (3,4) We anticipate that this project will demonstrate that even first year students are able to modify the structure of the medical interview to personalize conversations with their patients.

    PO A6 - Translation of Standardized Patient Encounter Performance and Reflection to Clinical Practice

    Sunday, June 09, 2019 5:00 PM - Sunday, June 09, 2019 6:00 PM

    Windermere Foyer

    Introduction/Overview/Purpose

    Standardized patient (SP) encounters have been incorporated into healthcare education programs, yet there is little exploration about the use in post-professional programs for adult learners. The objective of this study was to explore how an SP encounter with debriefing session influences the application of knowledge and skills when returning to clinical practice for athletic trainers enrolled in a post-professional program.

    Methodology & Methods

    We used an action research design with a consensual qualitative research tradition. The study was conducted at one Midwestern University with 15 post-professional athletic training learners (males=3, females=12; age=25 ± 5 years; certified experience=3 ± 3 years) without previous SP experience working clinically. The participants experienced one of the three SP cases that were developed with real patient cases and content validated through review of practicing athletic trainers and educators with expertise in case development. We created a semi-structured interview protocol consisting of 10 open-ended questions. Participants were invited to complete a one-on-one, audio only, online interview with the primary investigator 60 days following their SP encounter. Interviews were audio-recorded, transcribed verbatim, and verified for accuracy by the primary author. A 3-person data analysis team identified domains and categories using a consensus codebook. Credibility was established through external review.

    Results/Outcome/Discussion

    Three main domains emerged from the study: (1) limitations of novice SP experience, (2) practice transformation, (3) promoting self-reflection. Participants reported that the initial SP encounter in their post-professional education was a new experience where they were able to implement new skills learned in their previous courses. Translation of newly learned ideas or ways of thinking to clinical practice varied among clinicians and their job settings. Collaborative thinking and self-reflection were key components for successful. Participants were able to identify with their classmates struggles and triumphs, and take away new learning experiences.

    Conclusion

    SP encounters were found to be a useful learning tool for athletic trainers in a post-professional athletic training degree program to promote self-reflection, translate newly learned skills to their clinical practice, and improving confidence in preparation for a future SP encounter as nerves and anxiety influenced the learners’ ability to suspend reality.