The COVID-19 pandemic uncovered instructional changes within higher education. Accommodations for continued instruction included a transition to remote learning. However, little research exists regarding the experiences of medical residents during this transition in their education while combating the COVID-19 pandemic. This qualitative study, phenomenological in nature, aimed to explore the lived experiences of internal medicine medical residents at one medical college in Central Florida regarding the transition from face-to-face instruction to remote learning due to the COVID-19 pandemic. Eleven participating medical residents underwent semi-structured interviews via Zoom. Garrison's Community of Inquiry conceptual model and Hall and Hord's Concerns-Based Adoption Model theoretical framework were used. The researcher utilized Colaizzi's phenomenological analysis method to analyze the interview transcripts and Saldaña's coding method to code the data. Dedoose software was used in the analysis process. Participants were found to have shared and non-shared experiences and encountered both benefits and challenges from remote learning. Shared experiences included travel difficulties due to border closures and family challenges. Benefits included the presence of national guest speakers in lectures, attending lectures from the convenience and comfort of home, and the addition of interactive learning methods such as Kahoot and Jeopardy. Challenges experienced during the transition included curricular disorganization, distractions such as watching movies, a lack of interest in attending lectures, and a lack of interaction, with colleagues and by the instructor. Further research recommendations are discussed regarding emergency preparedness in higher education and graduate medical education, in addition to instructor perspectives.

Assessing Virtual Versus In-Person Experiential Learning in Medical Student Pediatric Clerkship Training Andrew Berry, Andrew Wigger, Karilynn Craig, Dr. Brock Blankenship, Dr. Jennifer Gibson, Center for Experiential Learning, Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Simulation and experiential training have been incorporated into medical school training for decades. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience. As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, our research team was interested in understanding students’ perceptions of virtual and in-person experiential learning activities. The primary goal of this study is to compare medical students’ perceptions of the quality and value of in-person versus virtual experiential learning during their pediatric clerkship. Secondary measures of this study examine the differences regarding the retention of case information presented, the clinical relevance of the pediatric cases discussed, and the likelihood that students will attend similar future sessions. Our team hypothesized that students would perceive in-person sessions as more valuable and meaningful to their medical education. One academic year of medical students who participated in two experiential learning encounters during their pediatric clerkship was assessed. Each encounter involved a series of approximately ten patient cases over two hours; one encounter was done in person, and the other was done virtually. Each case was then discussed using a Socratic format; faculty would ask questions and engage students individually, assessing their decision-making capability (including differential diagnosis, treatment plans, and dispositions). Data was collected by a survey administered after both encounters, each with the same questions. Students generally felt the virtual format for this type of training was as well received as the in-person format (56% vs. 52.2% for excellent value ratings, respectively). Similarly, 43.5% of students reported that the in-person cases greatly improved their retention, while 40% said the virtual cases improved their retention of educational material to the same degree. The in-person experiences were reported as being extremely clinically relevant by 56.5% of students, while the virtual cases were perceived as extremely relevant by 48% of respondents. Lastly, survey data showed that 47.8% of respondents said they would very likely attend similar future in-person sessions (compared to 44% for similar virtual events). Our team feels that the results of this study demonstrate that utilizing a Socratic Model of teaching in experiential learning has excellent value, and high-quality training can be accomplished virtually, even during times of potential virtual fatigue. These findings are important as our results show that experiential learning can be adapted, yet still beneficial, when in-person activities cannot take place, such as what we encountered during the COVID-19 pandemic.

Medical simulations provide hands-on training at various levels of medical expertise. Yet these simulators fail to accurately mimic the look, feel and behavior of human tissue. Applying measured mechanical properties from human cadaver tissues promises to improve the fidelity of simulated tissue behaviors when subjected to medical procedures. Samples of human parietal pleura were tested under uniaxial tension to failure and measured characteristics were replicated in synthetic pleura. Context specific parameters were then collected and compared between human pleura and the new synthetics. These comparisons tested the hypothesis; H1 Gaps exist between synthetic and human pleura performance, H2: Human tissue fracture mechanics define desired performance of synthetic tissues, H3: Synthetic and human tissues with similar stress/strain parameters will behave similarly when blunt punctured. The results promote the future development of high fidelity tissue simulants for medical training. The studied tissue is parietal pleura which contributes the critical haptic "pop" indicating access to the proper anatomic space during the tube thoracostomy procedure. Once accessed through blunt puncture, tube is then inserted to drain air and fluid from around the lungs. Stress/strain based hyper-elastic and fracture properties calibrated from fresh human cadaver pleura were used to define performance requirements. Synthetic pleura were then prototyped and their mechanical properties were characterized. Commercial pleura simulants were puncture tested and compared to compliant custom and off-the-shelf formulations. A non-compliant but commonly used pleura substitute was also tested. Blunt puncture force and displacement were compared for each of the materials to test the stated hypotheses.

In regions of the world that experience a deficit of surgical care, educational initiatives can foster the development of a skilled surgical workforce. Implicit in training these health workers is the mandate to retain them in the country in order build capacity. Eyal’s framework presents ways in which locally relevant training can improve retention and outlines the ethical and pragmatic concerns of such initiatives. In 2006, Guyana established it’s first surgical training program, an example of locally relevant training. The University of Guyana Diploma of Surgery (UGDS) program was selected for this case study research. Consistent data collection, supported by a systemic procedure to analyze that data, is paramount to increase the effectiveness of the UGDS program. The purposes of this dissertation research were two-fold. Firstly, it sought to understand how the UGDS program influences retention and the ways in which the UGDS members contribute to capacity building and the program’s sustainability. Secondly, this program evaluation provides a useful context to inform Eyal’s framework. 8 graduates, 2 trainees, 4 faculty members and 2 persons identified as policy makers were interviewed. Interviews were conducted face to face, and then transcribed. Surveys were administered to graduates and trainees and reflective reports and presentations were coded and analyzed. Overall, the data mapped fairly well onto Eyal’s framework. The results of the study suggest that the benefits and concerns Eyal outlines would be better represented along a continuum rather than being classified as either advantageous or disadvantageous with respect to retention. While Eyal’s claims generalize across settings, he should acknowledge this limitation and consider the important role that context plays. Overall, the results suggest that the UGDS program has positively influenced retention and capacity building. Key recommendations were made to the UGDS program that aim to improve retention and capacity building. As regions continue to face challenges associated with providing adequate surgical care, fostering retention and capacity building is recommended so that a sustainable surgical workforce can meet surgical needs. / Thesis / Candidate in Philosophy

In light of Accessibility for Ontarians with Disabilities Act, 2005, medical schools witnessed increased number of students with disabilities matriculating in their program. However, the administrators face challenges because ensuring accessibility in dynamic clinical settings may not always be feasible or ideal while considering the resource implication and patient safety. There is little consensus and established guidance on how to provide responsible accommodations for otherwise-qualified medical students with disabilities. To understand the development of resilience in medical students with disabilities as they confront potential institutional barriers and social or self-imposed stigma, we asked: how do medical students with disabilities identify and communicate their learning needs to negotiate necessary accommodations with the Student Accessibility Services and/or the MD program? The Constructivist Grounded Theory approach by Charmaz (2006) served as the methodological guide. In-depth individual interviews were conducted capturing the students’ perspective on accommodations arranged by the program, inclusion challenges in medical education and their recommendations on how to enhance program accessibility. Three major themes emerged: 1) creating a dialogue to devise learner-centered accommodation strategies, 2) recognizing available extrinsic and intrinsic resources, and 3) optimizing available extrinsic and intrinsic resources. Self-reflection was the key underlying ingredient driving students’ resilience development in partnership with inclusive learning environment and supportive faculty. Student diversity present in the medical schools merits further research. Diminishing stigma towards health professionals with disabilities is imperative. Endorsement of cross-departmental and institutional collaboration that enables dissemination of cost-effective and comprehensive accommodation strategies is recommended. / Thesis / Master of Science (MSc)

Background: Current literature promotes a student-centred approach with an active learning design, as such curricula have demonstrated improvements in outcomes such as critical thinking and clinical competence. Current literature demonstrates success in North America and Europe. However, research in low-resource countries have highlighted resource- and satisfaction-related issues due to such shifts. This study implements a case-based learning (CBL) intervention at Kasturba Medical College Mangalore Campus (KMCMG), India. Faculty and undergraduate medical student perceptions are explored in order to understand the contextual factors that will lead to an effective, acceptable and feasible medical curriculum. Methods: This cross-sectional, mixed-methods study employed a Likert scale questionnaire and semi-structured focus groups to 3rd year medical students (n=248), as well as semi-structured interviews with faculty (n=10) in the Department of Community Medicine. Cases were created through a co-development process with KMCMG faculty. Questionnaire data was analyzed by descriptive statistics and qualitative data was analyzed primarily by an inductive-iterative approach. Results: Both faculty and students find CBL to be more valuable than the traditional lecture-based method, and find CBL meaningful for students as future physicians. Comments highlighted the importance of student preparedness and of trained facilitators in order to enhance the learning experience. A significantly larger proportion of Indian schooled students, versus those who studied abroad, felt that CBL helped acquire new information (p=0.016), enhanced their clinical approach (p=0.008), and believed the role of the facilitator was important (p=0.001). Conclusion: Feedback towards CBL was found to be satisfactory in all aspects, and both students and faculty would like to see more CBL sessions in the future. Limitations such as faculty shortage and the inability to use informational technology at this time should be taken into consideration when moving forward. It is recommended that a resource-light version of CBL be considered, to provide robust orientations to faculty and students, and to further engage with faculty and students in order to enhance the CBL experience. / Thesis / Master of Science (MSc)

BACKGROUND: Many patients face chronic pain, which can be debilitating and dramatically impair patient's quality of life. These patients often seek treatment from their primary care physicians, who may utilize a wide range of options to manage their chronic pain, including opioids. Opioids provide analgesia while potentially leading to other adverse effects, including misuse, addiction and overdose. Therefore there is a need for clinicians to develop safe opioid prescribing practices. This has been recognized by the development of national guidelines and recommendations to improve the training and education of physicians in this domain. However, a gap in medical education and training for safe opioid prescribing skill exists, creating physicians who may feel ill prepared to treat this patient population. To remedy this problem, an educational intervention was designed that utilized a didactic session with or without an immediate or delayed observed structured clinical exam (OSCE) to improve safe opioid prescribing skills among internal medicine residents at an academic medical center. The specific aims of this thesis are to understand both quantitative and qualitative impacts of this educational intervention, specifically to describe participant characteristics, quantitatively evaluate within and between group changes at 8-months in safe opioid prescribing knowledge, confidence and self-reported practices and qualitatively describe participants' experience of the OSCE as a learning tool. METHODS: Using a quasi-experimental design, 39 internal medicine residents were assigned to either a control or intervention groups. The intervention groups received a didactic session alone, a didactic session and immediate OSCE or a didactic session and a delayed OSCE. Participants were surveyed at baseline, 4- and 8-month follow-up to assess their safe opioid prescribing knowledge, confidence, and self-reported practices. RESULTS: Participants in the didactic followed by immediate OSCE group significantly improved both within group confidence and practices at 8-month follow-up. Additionally, participants in this group improved their confidence at 8-month follow-up significantly compared to the control group. Participants from the other educational intervention groups (didactic followed by delayed OSCE and didactic only) also saw improvements in confidence and practice, but the effect was not as robust. OSCE participants found the OSCE to be a useful learning tool and both participants in the immediate and delayed OSCE groups highlighted the need to receive the didactic session immediately prior to the OSCE session. DISCUSSION: Despite many barriers in safe opioid prescribing facing internal medicine residents including limited faculty mentorship and difficult inherited patients, this educational intervention still improved their safe opioid prescribing knowledge, confidence and practice. The use of OSCEs as an education tool is an innovative approach to develop clinical skills and can be adapted in a variety of ways to accommodate institutional and learners' needs. / 2017-05-01T00:00:00Z

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