Band 120, Heft 4

Context Medication nonadherence is an important barrier to achieving optimal clinical outcomes. Currently, there are limited data on methods used to train medical students about medication adherence. Objective To evaluate the knowledge, confidence, and attitudes of first-year osteopathic medical students before and after a 30-minute peer-to-peer medication adherence education program led by a third-year pharmacy student. Methods All first-year medical students from Touro University California College of Osteopathic Medicine were invited to participate in 1 of 3 medication adherence educational sessions held in May 2019. A third-year pharmacy student who received training from Touro University California College of Pharmacy faculty served as the peer educator. Each session took approximately 1 hour to complete. The session included a preprogram survey, a 30-minute program, and a postprogram survey. Survey items included demographics; medication adherence knowledge, confidence, and attitudes; and attitudes toward the peer-to-peer educational format. Statistical comparisons of preprogram and postprogram knowledge, confidence, and attitudes were made using a paired t test, the McNemar test, and the Wilcoxon signed-rank test. P <.05 was considered statistically significant. A sample size calculation was performed using mean knowledge scores to determine whether the study achieved 80% power. Results Twenty-three students participated in the study. Medication adherence knowledge scores improved after the program (17.4 [77.4%] vs 9.98 [92.2%]; P <.001). Confidence scores also improved for all 7 survey items ( P <.001). Medical students had more positive attitudes toward medication adherence after the program, with 8 of 10 survey items in this domain showing improvement. Most students had a positive attitude toward the peer-to-peer educational format. All participants reported that they would implement the medication adherence skills learned at the program with future patients. Conclusion A 30-minute peer-to-peer program led by a pharmacy student improved first-year medical students’ knowledge, confidence, and attitudes with regard to medication adherence and provided an effective format to enhance interprofessional learning and collaboration.

Theoretical approaches provide a foundation for helping students in academic settings. The application of learning theories in medical education is also well documented. However, very few studies have applied a theoretical framework to academic advising for struggling students in the preclinical years of their medical education. This article summarizes key learning theories and their application to commonly found problems among first- and second-year medical students. The authors review current advising processes based on widely used theories in medical education and cite examples from their practices about how these theories can be used in effective academic advising. They also discuss the importance of using a holistic approach while helping students overcome academic barriers during their time in medical school.

Context There are limited data regarding the experiences of and attitudes toward research participation among osteopathic medical students despite rapidly increasing enrollment and expansion of the number of osteopathic medical schools. Objective To assess first-year osteopathic medical students’ experience with research, their interest in it, their perceptions of its value, and barriers to participation. Methods An anonymous, online survey was sent to 868 medical students in the class of 2021 at 4 colleges of osteopathic medicine. The survey consisted of 14 multiple-choice items (7 of which offered the option of a written response) and 1 open-ended item that asked them to report their age. The survey remained open for 2 weeks, with 1 reminder email sent on the last day of the survey. Incomplete responses were excluded from the analysis. Results A total of 328 participants were included, for a response rate of 38%. A majority of respondents reported previous research experience (261 [79.6%]), consistent with a strong perception that research participation is important (315 [96.0%]). Fewer students (177 [54.0%]) were either currently participating in research or affirmed interest in performing research during medical school, with the highest level of interest in clinical research (259 [79.0%]) followed by basic science (166 [50.6%]). Regarding incentives that might encourage participation in research, students preferred monetary compensation (213 [64.9%]) or extra credit in courses (195 [59.5%]). A commonly reported barrier to performing research during medical school was the possibility of a negative impact on performance in coursework (289 [88.1%]). Conclusion First-year osteopathic medical students are interested in research, view research experience as valuable, and consider research experience as beneficial to future career development. This study's findings highlight opportunities for increasing student participation in research through incentives or removal of perceived barriers.

Context Osteopathic medical students are required to pass the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1- and 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation (PE) to graduate. Predictors of COMLEX-USA cognitive exam performance are well established, but relatively few studies have explored factors associated with performance on the Level 2-PE. Objective To evaluate the relationship between school-based clinical competency assessments (written, simulation, and workplace evaluations) and Level 2-PE performance to ensure that these assessment efforts are effective and grounded in evidence to support student readiness. Methods School-based performance measures for 451 first-time takers of COMLEX-USA Level 2-PE were analyzed. A series of Mann-Whitney analyses were applied to compare 3 types of clinical performance assessments against COMLEX-USA Level 2-PE pass-fail performance: (1) internal objective structured clinical examinations (OSCE; average discipline-specific OSCE score and a comprehensive OSCE); (2) national examination performance (average clinical subject Comprehensive Osteopathic Medical Achievement Test, or COMAT, scores and Comprehensive Osteopathic Medical Self-Assessment Examination, or COMSAE, Phase 2 scores); and (3) a workplace-based clinical evaluation by preceptors. Results Students who passed the Level 2-PE had a significantly higher average discipline-specific OSCE score, COMSAE Phase 2 performance score, average COMAT score, and individual subject COMAT scores in all subjects except Psychiatry. Students who passed the Level 2-PE humanistic domain also had significantly higher scores in the communication skill component of the school's comprehensive OSCE. Similarly, students who passed the Level 2-PE biomedical domain had significantly higher scores in the data gathering and subjective, objective, assessment, and plan documentation scores on the internal OSCE. The size of these differences (η 2 ) was relatively small. Student performance on the competency-based preceptor evaluation showed no significant relationship with pass-fail performance on the Level 2-PE. Conclusion High-stakes OSCEs aligned with the level 2-PE blueprint are effective predictors of performance and are an important way to support student readiness for the Level 2-PE. Other assessments, such as subject-based COMATs and COMSAE Phase 2, add value to school-based assessments over workplace-based assessments.

Context Medical education institutions often use community-based sites and preceptors during students' third and fourth years for clinical training. However, differences in the sites, preceptors, assessment methods, and students may result in variations in clinical training, potentially affecting educational outcomes. During clerkships at A.T. Still University School of Osteopathic Medicine in Arizona, all students are evaluated by several methods for each required clerkship course. Required assessments include the clinical preceptor's evaluation, online coursework specific to each clerkship, patient log documentation, and the Comprehensive Osteopathic Medical Achievement Test (COMAT) relevant to that clerkship. Objective To evaluate which methods of student assessment in a family medicine clerkship course were most predictive of the future success of students on national standardized examinations. Methods Third-year osteopathic medical students from a single class who had completed the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)-USA Level 2-Cognitive Evaluation (CE) and 2-Performance Evaluation (PE) and the COMAT were included in the study. Scores on the examinations were used as success benchmarks. Analysis of 4 categories of predictor variables—clerkship site, previous student performance, preceptor evaluation, and clerkship coursework assessment (ie, assignment scores and log numbers)—was used to predict success on the national standardized examinations. Results Ninety-nine of 105 students were eligible for inclusion. No associations were found between examination scores and clerkship site or log numbers (all P ≥.10). Correlations were found for previous student performance (ie, grade point average for first-year and second-year coursework) and all examinations except COMLEX-USA Level 2-PE ( r =0.56-0.74, all P <.001), and between total score in family medicine clerkship coursework and COMLEX-USA Level 2-CE and COMAT scores ( r =0.28-0.39, all P ≤.006). Correlations were also found between preceptor evaluation (total score and subscore on medical knowledge) and all assessed national standardized examinations ( r =0.20-0.34, all P <.049). Conclusion Our results suggest that analysis of predictor variables in clerkship courses can reasonably predict success on national standardized examinations and may be useful for early identification of struggling students who may need additional support to perform well on the examinations.

Context The role of professional identity development has been established as a significant element of the “hidden curriculum” in medical education. While most programs do not contain explicit instruction on that topic, service learning initiatives are a popular trend in medical education that offer medical students early clinical experience and an opportunity to develop professional identity. Through intentional reflective practices, service learning can also promote empathy development, a critical component missing from current models. Objective To determine the role of service learning participation on the development of empathy and professional identity among osteopathic medical students. Methods Using a grounded theory method, the authors analyzed reflective essays from students who voluntarily participated in a service learning project that provided medical care to patients who are homeless. Essays were completed within 1 week of volunteer experience. Results The authors collected and analyzed 64 reflective essays from 55 students in this study. A review of the 64 texts yielded 5 coding domains and several subdomains. The codes revealed 4 major themes: (1) incoming attitudes, (2) transformative experiences, (3) empathy development, and (4) professional identity formation. Conclusions Structured service learning experiences provide students with an opportunity to develop an empathetic professional identity in the preclinical stage of medical education. This form of volunteer service is a transformative experience that challenges students’ incoming perceptions and leads to the development of both empathy and professional identity.

Context Various forms of simulation-based training, including training models, increase training opportunities and help assess performance of a task. However, commercial training models for lumbar puncture and epidural procedures are costly. Objective To assess medical students’ and residents’ perception of 3-dimensional (3D)-printed lumbar, cervical, and pelvic models for mastering joint injection techniques and to determine the utility of ultrasonography-guided needle procedure training. Methods Osteopathic medical students and residents used in-house 3D-printed gel joint models during an injection ultrasonography laboratory for mastering lumbar epidural, caudal epidural, sacroiliac, and facet joint injection techniques. After the laboratory, they answered a 17-item survey about their perception of the importance of the models in medical education and future practice. The survey also evaluated comfort levels with performing joint injections after using the models, overall satisfaction with the models, and likelihood of using models in the future. Results Thirty-six medical students and residents participated. Both students and residents agreed that 3D-printed models were easy to use, aided understanding of corresponding procedures, and increased comfort with performing joint injections (all P <.001). Most participants (35 [97.2%]) believed that the models were reasonable alternatives to commercial models. Over half felt capable of successfully performing cervical or pelvic (22 [61.1%]) and lumbar epidural (23 [63.9%]) injections. The majority of participants (34 [94.4%]) would like to use the models in the future for personal training purposes. Overall, 100% believed that the 3D-printed models were a useful tool for injection training. Conclusions Results suggest that 3D-printed models provided realistic training experience for injection procedures and seemed to allow participants to quickly master new injection techniques. These models offer a visual representation of human anatomy and could be a cost-saving alternative to commercial trainers.

Heterotopic ossification (HO) is excess bone growth in soft tissues, typically juxta-articular and interfascicular, with varying incidence. This excess bone growth has been well-documented in cases of traumatic amputation but less frequently observed in cases of nontraumatic amputation. Symptomatic heterotopic ossification usually includes pain during prosthetic use with management involving prosthetic adjustments for comfort. This atypical case highlights a patient with a nontraumatic amputation and a proximal-oriented large spur formation that was not painful with ambulation but with doffing his prosthesis.