Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection

What have we learned about constructed response short-answer questions from students and faculty? A multi-institutional study

PURPOSE

The purpose of this study was to enrich understanding about the perceived benefits and drawbacks of constructed response short-answer questions (CR-SAQs) in preclerkship assessment using Norcini's criteria for good assessment as a framework.

METHODS

This multi-institutional study surveyed students and faculty at three institutions. A survey using Likert scale and open-ended questions was developed to evaluate faculty and student perceptions of CR-SAQs using the criteria of good assessment to determine the benefits and drawbacks. Descriptive statistics and Chi-square analyses are presented, and open responses were analyzed using directed content analysis to describe benefits and drawbacks of CR-SAQs.

RESULTS

A total of 260 students (19%) and 57 faculty (48%) completed the survey. Students and faculty report that the benefits of CR-SAQs are authenticity, deeper learning (educational effect), and receiving feedback (catalytic effect). Drawbacks included feasibility, construct validity, and scoring reproducibility. Students and faculty found CR-SAQs to be both acceptable (can show your reasoning, partial credit) and unacceptable (stressful, not USMLE format).

CONCLUSIONS

CR-SAQs are a method of aligning innovative curricula with assessment and could enrich the assessment toolkit for medical educators.

Perspectives from two recent medical school graduates on exposure to pathology during undergraduate medical education: A narrative inquiry

The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students' face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.

Examination Scores but not Clinical Performance Correlate With Duration of Preclinical Didactic Time: A Synchronous Comparison of Second- Versus Third-Year Medical Students on the Surgery Clerkship

OBJECTIVE

Numerous institutions have reduced preclinical didactic time to facilitate earlier clinical exposure during the second year of medical education. However, the effects that shortened preclinical education may have on performance in the surgery clerkship are unclear. This study aims to compare the clinical and examination performance of second- (MS2) and third-year (MS3) students synchronously completing an identical surgery clerkship.

DESIGN

All students completing the surgery clerkship (identical didactics, examinations, clinical rotations, etc.) were included. MS3s received 24 months of preclinical education, whereas MS2s received 14 months. Performance outcomes included weekly quizzes based on lectures, NBME Surgery Shelf Exam, numeric clinical evaluations, objective structured clinical examination (OSCE) scores, and overall clerkship grades.

SETTING

University of Miami Miller School of Medicine.

PARTICIPANTS

All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over 1 year (n = 395).

RESULTS

There were 199 MS3 (50%) and 196 MS2 (50%) students. MS3s demonstrated higher median shelf exams (77% vs 72% MS2s), weekly quiz score averages (87% vs 80% MS2s), clinical evaluations (96% vs 95% MS2s), and overall clerkship grades (89% vs 87% MS2s), all p < 0.020. There was no difference in median OSCE performance (both 92%; p = 0.499). A greater proportion of MS3 students performed in the highest 50% of weekly quiz scores (57% vs 43% MS2), NBME shelf exams (59% vs 39% MS2), and overall clerkship grades (45% vs 37% MS2), all p < 0.010. No significant difference in the proportion of students placing in the top 50% of clinical parameters including the OSCE (48% MS3 vs 46% MS2; p = 0.106) and clinical evaluations (45% MS3 vs 38%; p = 0.185) was observed.

CONCLUSIONS

Although the duration of preclerkship education may correspond to examination scores, MS2s and MS3s perform similarly on clinical metrics. Future strategies to enhance available preclinical didactic time and preparation for examinations are needed.

Virtual Microscopy Goes Global: The Images Are Virtual and the Problems Are Real

For the last two centuries, the scholarly education of histology and pathology has been based on technology, initially on the availability of low-cost, high-quality light microscopes, and more recently on the introduction of computers and e-learning approaches to biomedical education. Consequently, virtual microscopy (VM) is replacing glass slides and the traditional light microscope as the main instruments of instruction in histology and pathology laboratories. However, as with most educational changes, there are advantages and disadvantages associated with a new technology. The use of VM for the teaching of histology and pathology requires an extensive infrastructure and the availability of computing devices to all learners, both posing a considerable financial strain on schools and students. Furthermore, there may be valid reasons for practicing healthcare professionals to maintain competency in using light microscopes. In addition, some educators may be reluctant to embrace new technologies. These are some of the reasons why the introduction of VM as an integral part of histology and pathology instruction has been globally uneven. This paper compares the teaching of histology and pathology using traditional or VM in five different countries and their adjacent regions, representing developed, as well as developing areas of the globe. We identify general and local roadblocks to the introduction of this still-emerging didactic technology and outline solutions for overcoming these barriers.

Histology education in an integrated, time-restricted medical curriculum: Academic outcomes and students' study adaptations

In an ever-changing medical curricular environment, time dedicated for anatomical education has been progressively reduced. This happened at the University of Michigan Medical School starting in 2016-2017 when preclinical medical education was condensed to one year. Histology instruction remained integrated in organ system courses but reduced to a lecture-only format without scheduling time for laboratory exercises, requiring students to study virtual histology slides on their own time. In accordance with the shortened instructional time, the number of histology examination questions was reduced more than twofold. This study analyzed students' histology examination results and assessed their motivation to learn histology and use of educational opportunities before and after these curricular changes were implemented. Students' motivation to learn histology and their evaluation of histology lectures increased in the new curriculum. However, students devoted less study time to studying histology. Students' cumulative histology examination scores were significantly lower in the new curriculum and the number of students with overall scores <75%, defined as a substandard performance, increased more than 15-fold. Academically weaker students' histology scores were disproportionately more affected. As medical educational strategies, priorities, and curricular frameworks continue to evolve, traditional didactic topics like histology will need to adapt to continue providing educational value to future health care providers.