This work explores the development and use of patient satisfaction evaluation system in a family practice setting. The goal was to develop a system that would minimally interfere with the delivery of care while simultaneously disclosing sources of patient satisfaction and dissatisfaction. The information would then be used to improve aspects of patient care and service delivery.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. Despite widespread criticism of physician-performed evaluations of medical students’ clinical skills, clinical clerkship evaluations (CCEs) remain the foremost means by which to assess trainees’ clinical prowess. Efforts undertaken to improve the quality of feedback students receive have ostensibly led to higher assessment demands on physician faculty; the consequences of which remain unknown. Accordingly, this study investigated the extent to which physicians’ evaluative responsibilities influenced the quality of CCEs and qualitatively explored physicians’ perceptions of these evaluations. Methods. A questionnaire was delivered to physicians (n = 93) at Indiana University School of Medicine to gauge their perceived evaluative responsibilities. Evaluation records of each participant were obtained and were used to calculate one’s measurable quantity of CCEs, the timeliness of CCE submissions, and the quality of the Likert-scale and written feedback data included in each evaluation. A path analysis estimated the extent to which one’s evaluative responsibilities affected the timeliness of CCE submissions and CCE quality. Semi-structured interviews with a subset of participants (n = 8) gathered perceptions of the evaluations and the evaluative process. Results. One’s measurable quantity of evaluations did not influence one’s perceptions of the evaluative task, but did directly influence the quality of the Likert-scale items. Moreover, one’s perceptions of the evaluative task directly influenced the timeliness of CCE submissions and indirectly influenced the quality of the closed-ended CCE items. Tardiness in the submission of CCEs had a positive effect on the amount of score differentiation among the Likert-scale data. Neither evaluative responsibilities nor the timeliness of CCE submissions influenced the quality of written feedback. Qualitative analysis revealed mixed opinions on the utility of CCEs and highlighted the temporal burden and practical limitations of completing CCEs. Conclusions. These findings suggest physicians’ perceptions of CCEs are independent of their assigned evaluative quantity, yet influence both the timeliness of evaluation submissions and evaluative quality. Further elucidation of the mechanisms underlying the positive influence of evaluation quantity and timely CCE submissions on CCE quality are needed to fully rationalize these findings and improve the evaluative process. Continued research is needed to pinpoint which factors influence the quality of written feedback.

Indiana University-Purdue University Indianapolis (IUPUI) / High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature.

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The COVID-19 pandemic has disrupted all sectors of society including medical education. Medical schools are faced with an ethical dilemma pitting quality of medical education against student safety and delivering quality patient care. This paper identifies the different participants affected by a medical school’s decision on how to educate their students, discusses the current context of the pandemic, and analyzes the different options medical schools have. This paper defines two phases of the pandemic whereby phase two is defined as the time period the scientific community has an adequate understanding of the risks associated with COVID-19 and hospitals have adequate personal protective equipment. Phase one is simply the time before both of those criteria are met, and is the time when medical students should not be allowed on in-person clinical rotations. During phase two, students should be granted agency to make the decision for themselves. Using the analysis of the current pandemic, the paper outlines how medical schools’ decisions should change for future hypothetical pandemics. / Urban Bioethics

The medical ethics curriculum is an important part of medical education as it helps foster students to become virtuous and compassionate caretakers. The format of the curriculum is intended to expose students to ethical and moral issues early in their careers and allow them to apply their knowledge in clinical situations. However, the implementation of the curriculum is incredibly varied and fraught with challenges. This thesis explores the challenges of the current format of the medical ethics curriculum and the repercussions that will extend throughout medical school and moving into residency and beyond. It will additionally delve into potential solutions that, if implemented conscientiously, can encourage more engaged and thoughtful discussions in the classroom and the clinical setting. It is the ultimate hope that such interventions will result in students’ increased moral development and shape these future physicians into better caretakers, colleagues, and leaders. / Urban Bioethics

Medical schools around the country are utilizing service-learning as a method of promoting cultural humility among future physicians and strengthening partnerships between academic institutions and their surrounding communities. Critical service-learning (CSL) is an approach which emphasizes the need to address the power dynamics inherent to service through guided critical self-reflection for student learners, and centers autonomy and self-determination for community stakeholders. STEM Stars is an afterschool STEM enrichment program at a community center in North Philadelphia which was piloted in the 2019-2020 academic year. It was created with a trauma-informed design to address the social and emotional needs of K-6 students at the community center and to introduce trauma-informed practices to staff at the center. STEM Stars also served as a more intensive CSL opportunity for medical student volunteers and a model for future service-learning programs at the medical school. This thesis is a gap analysis of STEM Stars: it will provide a background of the program, review the pilot year, assess its successes and shortcomings, and propose changes to be made in the coming years. / Urban Bioethics

ABSTRACT Despite changing demographics, policy, technology, and economics; medical education curriculum has changed very little from its inception over 100 years ago. The United States medical system has been under scrutiny for delivery of affordable, quality and accessible care for years. In order to address these challenges, we need to train physicians to consider these criteria when treating patients. A way to do this is through a curriculum that includes Health Systems Science (HSS). The challenge of HSS is that it adds additional topics and competencies to an already full medical education curriculum. In order to move forward in medical school, students are tested on their knowledge of basic science. Because HSS topics are not included in the required testing, students who have not been exposed to an HSS curriculum perceive HSS topics as less valuable than traditional medical school topics. This research sought to understand if students changed their perception of the value of HSS after exposure to an HSS curriculum. First-year medical students from a large, urban medical school were surveyed using a pre-test and post-test survey before and after exposure to an HSS curriculum. This study was conducted with two cohorts over two years to see if there was a change in student perceptions of HSS. An Institutional Cycle design was applied to compare the post-test from the students in cycle 1 to the pre-test of students in cycle 2. This approach was deployed for two reasons. The first because of restrictions placed on the data collection; the pre-test for each person could not be directly linked to the post-test. The second, because there was no way to create a control group. These cohorts could not be randomly assigned to another curriculum. Comparing the post-test of Cohort 1 to the pre-test of Cohort 2 allows for the analysis of change between the two cohorts. Student perceptions did not change significantly between the pre-test in cycle 2 and the post-test in cycle 1. More research is needed to provide guidance for the development of an HSS curriculum that aligns with traditional medical education components. / Educational Administration

When healthcare professionals perceive patients’ symptoms through media or media technologies, how do they respond to them? Many studies have explored the effects of the film, novels, music on empathy and recently a few studies started focusing on the virtual reality (VR) and augmented reality (AR) that visualize patients’ invisible symptoms and their effects on the empathy of medical students as future healthcare professionals; however, their psychological processes are not fully elaborated yet. This dissertation was designed to detail the psychological processes evoked by AR that visually mimics migraine symptoms and uses presence and narrative transportation to increase empathy. A mixed-method study was conducted to untangle the psychological processes of presence, narrative transportation, and empathy by exploring their existence, nature, strength, and meanings. Two treatment conditions were created: a head-mounted display (HMD) as a high immersive condition and a handheld display as a low immersive condition with a focus on media immersiveness as the degree to which AR submerges its users’ perceptual system. The study participants were a small (n=27), but motivated group of medical student learners. In the quantitative results, AR was not visually immersive enough to evoke presence as a perceptual illusion of non-mediation directly since there were systematic effects of media immersiveness of AR on presence, but there were no significant effects of media immersiveness on presence when controlling for medical students’ tendencies and abilities. It was assumed that presence occurred as a constructive perceptual process indirectly mediated through medical students’ tendencies and abilities. In a canonical correlation and stepwise regression, the maximal correlation among immediate sense of presence and narrative transportation and situational empathy revealed an optimal degree of perceptual involvement that leads to sympathy as a positive state of situational empathy. Another canonical correlation and stepwise regression among the traits of immersive tendency and physician empathy and situational empathy showed that there is also an optimal degree of medical students’ sensitivity trait that leads to sympathy as a relatively stable situational empathy. Since, as interview results showed, medical students’ motives were prosocial, it is possible to interpret distress or sadness as another type of situational empathy entailing caring about others. In the qualitative results, there were close relationships between media environment and presence. An immersive virtual environment (IVE) via AR, which affords users the perceptual or embodied feeling of physically being surrounded by its represented environment, was closely related to sensorimotor perceptual processing of presence. A continuous immersive mixed environment (IME) via AR, which affords users the imaginatively situated feeling by mixed reality, extended presence in the actual environment through the process of narrative transportation and affect. The contributions of the findings to the theory and research literature regarding presence are discussed along with recommendations regarding practical contributions to ongoing efforts to enhance healthcare professionals’ empathy and thereby effectiveness in treating patients with migraines and other conditions and illnesses. / Media & Communication