Faculty Bibliography

OBJECTIVE/UNASSIGNED:We expect medical students to be able to apply evidence-based medicine (EBM) skills in the context of the clinical care of patients. Previous assessments of this domain have primarily utilized decontextualized knowledge tests, which provide limited insights into students' understanding of EBM skills in the context of patient care. New performance-based EBM competence assessments using Objective Structured Clinical Examinations (OSCEs) are being developed and tested. Understanding how students experience and interact with a simulation-based assessment of EBM competence would enable us to improve the modality. METHODS/UNASSIGNED:We recruited 13 graduating medical students from one medical school who had recently completed an immersive multi station readiness-for-residency OSCE (Night onCall) which included a case-based EBM assessment. We conducted individual interviews to explore their perceptions of participating in this OSCE as a method of EBM assessment. The interviews were transcribed, coded, and analyzed using Dedoose by three health science librarians. RESULTS/UNASSIGNED:Students discussed their experience and perceptions in six main areas: connection to clinical practice, curricular timing and content coverage, feedback, station instructions, awareness of their own limitations, and an OSCE as a format for assessing EBM. CONCLUSION/UNASSIGNED:Medical students appreciated the EBM OSCE because it enhanced their learning about how to integrate EBM into clinical practice. They proposed implementing multiple such opportunities throughout medical school because it would improve their competence and provide highly impactful opportunities to build toward EBM mastery. They endorsed that this would be well-accepted by medical students.

INTRODUCTION/UNASSIGNED:Medical students may arrive at medical school with some research background but not necessarily evidence-based medicine (EBM) skills. First-year preclinical medical students require foundational skills for EBM (formulating background and foreground questions, navigating information sources, and conducting database searches) before critically appraising evidence and applying it to clinical scenarios. METHODS/UNASSIGNED:We developed a flipped classroom EBM workshop for preclinical students combining prework modules and a 60-minute in-person session. After completing the online modules on foundational EBM skills, students participated in an in-person activity based on patient cases. In small groups, students formulated background and foreground questions based on a case and looked for evidence in resources assigned to each group. Small groups reported back to the whole group how they searched for information for their patient cases. A total of 105 first-year medical students were required to complete this workshop after concluding their basic sciences courses. RESULTS/UNASSIGNED:= .002). DISCUSSION/UNASSIGNED:This flipped classroom approach to teaching foundational EBM skills may be adapted for different contexts, but educators should consider time limitations, group size, and tools for interactivity.

BACKGROUND:Teaching clinical pharmacology is often a challenge for medical schools. The benefits and popularity of active recall and spaced repetition through Anki flashcards are well-established and can offer a solution for teaching complex topics, but educators are often unfamiliar with this resource. APPROACH/METHODS:We implemented 501 faculty-generated pharmacology flashcards in five modules across the medical preclinical curriculum, available to 104 first-year students. At the end of each module, students were surveyed on the usefulness of this novel resource. The data from the cohort who had access to flashcards was compared with the previous cohort, without access, to analyse whether student use of Anki flashcards changed students' perceptions of the pharmacology curriculum and whether there were changes in pharmacology exam performance. EVALUATION/RESULTS:Seventy-five percent of the respondents rated the Anki pharmacology flashcards as 'very useful' or 'somewhat useful'. Eight hundred and seventy-five responses were analysed with a natural language processing algorithm, showing that fewer students mentioned pharmacology as a difficult topic in the cardiovascular and renal modules, compared with the cohort who did not use Anki flashcards. There was not a statistically significant difference in test scores between the cohorts. IMPLICATIONS/CONCLUSIONS:Anki flashcards were well-received by medical students, which might have impacted their perception of the curriculum, as evidenced by the decrease in mentions of pharmacology being a difficult topic, maintaining consistency in academic performance. Educators should consider providing flashcards to offer spaced repetition opportunities in the curriculum; an additional benefit could be increasing information equality in medical schools.

CONTEXT/BACKGROUND:Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE:To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES/METHODS:PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION/METHODS:Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION/METHODS:Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS:Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS/CONCLUSIONS:No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS:Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.

OBJECTIVE/UNASSIGNED:Many health sciences librarians enter the profession without specific health sciences training. Some LIS programs have health sciences courses or tracks, but health sciences training within an LIS program is only one path to entering health sciences librarianship. To develop a map of pathways into health sciences librarianship, an immersion session at the Medical Library Association conference in 2022 asked health sciences librarians to share how they entered the profession. METHODS/UNASSIGNED:The immersion session was structured in three parts: facilitator introductions, small group discussions, and a whole group summary discussion. Guided by questions from the facilitators, small groups discussed what pathways currently exist, how to promote existing pathways, what new pathways should be created, and how to develop and promote pathways that make the profession more equitable, diverse, and inclusive. RESULTS/UNASSIGNED:Through in-the-moment thematic analysis of the small group discussions, the following emerged as key pathways: library school education; internships and practica; the Library and Information Science (LIS) pipeline; on-thejob training; mentoring; self-teaching/hands-on learning; and continuing education. Themes of equity, diversity, and inclusion arose throughout the session, especially in the concluding whole group discussion. CONCLUSION/UNASSIGNED:Small group discussions in a conference immersion session showed the value of community building in a profession that has multiple pathways for entrance, highlighting the importance of unearthing hidden knowledge about avenues for exploring and enhancing career pathways. The article seeks to address barriers to entry into the profession and adds to the literature on strengthening the field of health sciences librarianship.

BACKGROUND:Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS:A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS/RESULTS:Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION/CONCLUSIONS:Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.