Faculty Bibliography

In response to the need for physician leaders, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell developed the Klar Leadership Development and Innovation Management program. This novel program leverages its partnership with a large Northeast health system to longitudinally provide students with leadership fundamentals and mentored experiences.

Medical knowledge examinations employing open-ended (constructed response) items can be useful to assess medical students' factual and conceptual understanding. Modern day curricula that emphasize active learning in small groups and other interactive formats lend themselves to an assessment format that prompts students to share conceptual understanding, explain, and elaborate. The open-ended question examination format can provide faculty with insights into learners' abilities to apply information to clinical or scientific problems, and reveal learners' misunderstandings about essential content. To implement formative or summative assessments with open-ended questions in a rigorous manner, educators must design systems for exam creation and scoring. This includes systems for constructing exam blueprints, items and scoring rubrics, and procedures for scoring and standard setting. Information gained through review of students' responses can guide future educational sessions and curricular changes in a cycle of continuous improvement.

Background/UNASSIGNED:COVID-19 exposed undergraduate medical education curricular gaps in exploring historical pandemics, how to critically consume scientific literature and square it with the lay press, and how to grapple with emerging ethical issues. In addition, as medical students were dismissed from clinical environments, their capacity to build community and promote professional identity formation was compromised. Methods/UNASSIGNED:was developed using a modified guided inquiry approach. Students met daily for 2 weeks in groups of 15 to 18 with a process facilitator. During the first week, students reported on lessons learned from past pandemics; in the second week, students discussed ethical concerns surrounding COVID-19 clinical trials, heard from physicians who provided patient care in the HIV and COVID-19 pandemics, and concluded with an opportunity for reflection. Following the course, students were asked to complete an anonymous, voluntary survey to assess their perceptions of the course. Results/UNASSIGNED:With a response rate of 69%, an overwhelming majority of students agreed or strongly agreed that learning about historical pandemics helped them understand COVID-19 (72, 99%). The course successfully helped students understand current and potential COVID-19 management strategies as 66 (90%) agreed or strongly agreed they developed a better understanding of nonpharmacological interventions and new pharmacological treatments. Students also gained insight into the experiences of healthcare providers who cared for patients with HIV and COVID-19. Qualitative analysis of the open-ended comments yielded 5 main themes: critical appraisal of resources, responsibility of the physician, humanism, knowledge related to pandemics, and learning from history. Conclusions/UNASSIGNED:The onset of the COVID-19 crisis illustrated curricular gaps that could be remedied by introducing the history and biology of pandemics earlier in the curriculum. It was also apparent that learners need more practice in critically reviewing literature and comparing scientific literature with lay press. The flexible format of the course promotes the development of future iterations that could cover evolving topics related to COVID-19. The course could also be repurposed for a graduate or continuing medical education audience.

Curricular revision efforts have resulted in learner-centered programs that value content integration and active learning. Yet, less attention has been placed on assessment methods that are learner-centered and promote assessment for learning. The use of context rich short answer question (CR-SAQ) exams in the preclinical years of medical school was evaluated to determine if this format aligns with the criteria for assessment for learning. Medical students and preclinical faculty members were sent a survey comprised of closed and open-ended questions about their experience using CR-SAQ exams. Data were analyzed using a mixed-method design. Open-ended responses were evaluated using thematic analysis within the framework of criteria for assessment for learning. A total of 274 students (94%) and 24 faculty (75%) completed the survey. Fifty four percent of students reported preferring a CR-SAQ exam format over multiple choice questions (MCQ) format. Quantitative data and qualitative comments by students supported that CR-SAQ exams aligned with criteria for assessment for learning, including acceptability, authenticity, educational effect, and the cueing effect. Student concerns included preparation for USMLE Step 1 exam, as well as the validity and reproducibility of CR-SAQ assessments. Faculty largely agreed with the benefits of the CR-SAQ, but were concerned about feasibility, acceptability and reproducibility. The CR-SAQ exam format assessment strategy supports assessment for learning in an undergraduate medical education setting. Both benefits and drawbacks of this method are presented, however students and faculty describe a broader impact that this assessment method has on their development as a physician.

BACKGROUND:The Medical School Performance Evaluation (MSPE) is an important factor for application to residency programs. Many medical schools are incorporating recent recommendations from the Association of American Medical Colleges MSPE Task Force into their letters. To date, there has been no feedback from the graduate medical education community on the impact of this effort. OBJECTIVE:We surveyed individuals involved in residency candidate selection for internal medicine programs to understand their perceptions on the new MSPE format. METHODS:A survey was distributed in March and April 2018 using the Association of Program Directors in Internal Medicine listserv, which comprises 4220 individuals from 439 residency programs. Responses were analyzed, and themes were extracted from open-ended questions. RESULTS:A total of 140 individuals, predominantly program directors and associate program directors, from across the United States completed the survey. Most were aware of the existence of the MSPE Task Force. Respondents read a median of 200 to 299 letters each recruitment season. The majority reported observing evidence of adoption of the new format in more than one quarter of all medical schools. Among respondents, nearly half reported the new format made the MSPE more important in decision-making about a candidate. Within the MSPE, respondents recognized the following areas as most influential: academic progress, summary paragraph, graphic representation of class performance, academic history, and overall adjective of performance indicator (rank). CONCLUSIONS:The internal medicine graduate medical education community finds value in many components of the new MSPE format, while recognizing there are further opportunities for improvement.

BACKGROUND:Longitudinal standardized patient (LSP) experiences mimic clinical practice by allowing students to interact with standardized patients (SPs) over time. LSP cases facilitate practice, assessment, and feedback in clinical skills and foster an appreciation for the continuum of care. OBJECTIVE:We sought to characterize the nature of relationship-building, feedback, and continuity among all stakeholders participating in a single LSP program. DESIGN/METHODS:We developed and implemented a novel LSP program. Students encountered two LSP characters six times each during the first 2 years of medical school, though continuity pairings of students, SPs, and faculty were frequently not possible. Focus groups were held with second-year medical students (N = 15), core faculty who coached these students in LSP encounters (N = 8), and SPs who had played the role of either LSP character (N = 10) participated. Results were analyzed thematically using a template analysis approach. RESULTS:The longitudinal nature of the experience reinforced the importance of student growth over time, the key role of faculty and SPs in providing feedback, and the tension between feedback and assessment. Students reported that LSP cases encouraged practice and feedback. SPs felt wedded to the longitudinal characters. Continuity pairings were recommended by all stakeholders to increase authenticity and promote relationship-building. CONCLUSION/CONCLUSIONS:Stakeholders observed that the LSP cases brought some sense of continuity missing in other clinical skills encounters which helped prepare students for patient care. Continuity pairings of students, faculty, and SPs were recommended to enhance relationship-building and feedback.

BACKGROUND:Two dominant themes face medical education: developing integrated curricula and improving the undergraduate medical education (UME) to graduate medical education (GME) transition. An innovative solution to both of these challenges at the Zucker School of Medicine has been the application of the cognitive apprenticeship framework in requiring emergency medical technician (EMT) certification during the first course in medical school as the core on which to build an integrated curriculum and provide entrustable clinical skills. METHODS:Beginning with the Class of 2011, student feedback about the short-term impact of the experience was collected annually. In addition, perceptions of near graduates and alumni were surveyed in 2017 to explore the long-term impact of the experience. Theme analysis was conducted via inductive coding. RESULTS:Both first-year and more experienced learners report the value of the EMT curriculum as an integrated component of the first course of medical school. Reported positive long-term impacts included the first-hand observation of social determinants of health and interprofessionalism. Negative comments by early learners focused on course logistics, whereas older learners recalled the variability of clinical experiences during ambulance runs. CONCLUSIONS:The integration of the EMT curriculum as a core component of the first course serves multiple purposes: 1) it provides the foundation of a spiral learning approach; 2) it contextualizes the basic sciences within clinical practice; 3) it provides opportunities for students to engage in authentic clinical activities under the guidance of mentors; 4) it introduces students to the interdisciplinary nature of medicine; and 5) it serves as the first entrustable professional activity (EPA) for our students.

PURPOSE:The Hofstra Northwell School of Medicine (HNSOM) uses an essay-based assessment system. Recognizing the emphasis graduate medical education places on the United States Medical Licensing Examination (USMLE) Step exams, the authors developed a method to predict students at risk for lower performance on USMLE Step 1. METHOD:Beginning with the inaugural class (2015), HNSOM administered National Board of Medical Examiners (NBME) Customized Assessment Service (CAS) examinations as formative assessment at the end of each integrated course in the first two years of medical school. Using preadmission data, the first two courses in the educational program, and NBME score deviation from the national test takers' mean, a statistical model was built to predict students who scored below the Step 1 national mean. RESULTS:A regression equation using the highest Medical College Admission Test (MCAT) score and NBME score deviation predicted student Step 1 scores. The MCAT alone accounted for 21% of the variance. Adding the NBME score deviation from the first and second courses increased the variance to 40% and 50%, respectively. Adding NBME exams from later courses increased the variance to 52% and 64% by the end of years one and two, respectively. Cross-validation demonstrated the model successfully predicted 63% of at-risk students by the end of the fifth month of medical school. CONCLUSIONS:The model identified students at risk for lower performance on Step 1 using the NBME CAS. This model is applicable to schools reforming their curriculum delivery and assessment programs toward an integrated model.

AIM/OBJECTIVE:There has been a call for increased integration of basic and clinical sciences during preclinical years of undergraduate medical education. Despite the recognition that clinical simulation is an effective pedagogical tool, little has been reported on its use to demonstrate the relevance of basic science principles to the practice of clinical medicine. We hypothesized that simulation with an integrated science and clinical debrief used with early learners would illustrate the importance of basic science principles in clinical diagnosis and management of patients. METHODS:Small groups of first- and second-year medical students were engaged in a high-fidelity simulation followed by a comprehensive debrief facilitated by a basic scientist and clinician. Surveys including anchored and open-ended questions were distributed at the conclusion of each experience. RESULTS:The majority of the students agreed that simulation followed by an integrated debrief illustrated the clinical relevance of basic sciences (mean ± standard deviation: 93.8% ± 2.9% of first-year medical students; 96.7% ± 3.5% of second-year medical students) and its importance in patient care (92.8% of first-year medical students; 90.4% of second-year medical students). In a thematic analysis of open-ended responses, students felt that these experiences provided opportunities for direct application of scientific knowledge to diagnosis and treatment, improving student knowledge, simulating real-world experience, and developing clinical reasoning, all of which specifically helped them understand the clinical relevance of basic sciences. CONCLUSION/CONCLUSIONS:Small-group simulation followed by a debrief that integrates basic and clinical sciences is an effective means of demonstrating the relationship between scientific fundamentals and patient care for early learners. As more medical schools embrace integrated curricula and seek opportunities for integration, our model is a novel approach that can be utilized.