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    A Computer-Based Approach to Developing Diagnostic Rules
    (2019-03-05) Papa, Frank; Parikh, Tiraj
    Purpose: In 2015, the National Academy of Medicine published a report revealing that diagnostic error may be America’s third leading cause of death and responsible for the majority of paid medical malpractice claims. Medical education researchers are now looking to the learning sciences for theories that might support improvements in the diagnostic performance of tomorrow’s health care providers. One such theory, called “Dual-Process Theory”, suggests that people utilize two distinct approaches to diagnostic reasoning: pattern recognition and analytical reasoning. To date, researchers have paid little attention to how we reason analytically. Dual-process theorists suggest that analytical reasoning is, in part, predicated upon a clinician’s knowledge of diagnostic rules. These rules encompass knowledge in the form of experientially-based, statistically-framed estimates of the frequency with which a given disease is associated with each of its characteristic findings. The purpose of this project is to produce a computer-based training tool which supports learners in how to analytically reason via the acquisition and application of conditional probability (CP) derived diagnostic rules. Methods: This tool will have four components: 1) a display of CP derived diagnostic rules associated with signs and symptoms most likely to be linked to a given clinical presentation 2) a set of interactive tools enabling learners to identify which of those rules are most robust in ruling in/out the various differentials, 3) a set of practice cases where learners are given multiple opportunities to apply these CP derived rules, and 4) interactive screen prompts designed to guide the students in developing a cognitive strategy to apply high-yield rules to diagnose a multitude of test cases. Results: The exhibitor will demonstrate a tool which: 1) displays disease by sign/symptom CPs, 2) enables their rearrangement (by history & physical, breadth by feature strength, and depth by selected differential) as the basis for formulating diagnostic rules, and 3) functions which support the construction of a diagnostic strategy. Conclusions: After completion of the described educational tool, the authors will execute an IRB approved study involving students in a year 2 systems course, and a treatment/control research design.
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    Senior Medical Student Attitudes Toward Radiology and Confidence in Their Imaging Skills
    (2019-03-05) Smith, Spencer MD; Jafri, Saad
    Purpose: Most medical students do not receive formal radiology training until clinical rotations which is taught in the context of medicine/surgery, or during an elective rotation that is not a part of the core curriculum, leading to young physicians who are sub-optimally prepared to interpret imaging studies. In addition, other physicians’ attitudes towards radiology may be biased by a lack of early exposure to radiologists during medical school. This study is designed to determine senior medical student attitudes toward radiology and their radiology skills confidence levels both prior to and following an elective radiology clerkship in an effort to improve radiology instruction. We hypothesize that a radiology clerkship will positively impact students’ attitudes towards radiology as well as increase their confidence in their own imaging skills. Methods: 4th-year TCOM medical students enrolled in an elective radiology clerkship were sent anonymous online pre and post-clerkship survey via email 2 weeks before the start of their clerkship and 2 weeks after conclusion of the clerkship. The 4-week course covered more than the basics of diagnostic radiology that graduating students should know in preparation for internship. Responses were restricted to 1 per student. Results: 17/25 students enrolled in the February 2019 radiology clerkship responded (68%). At the time of this abstract, only a pre-clerkship survey was conducted. Students were, on average, not confident in their overall image interpretation skills (2.47/5). However, students had higher confidence interpreting plain radiographs (2.94/5) as opposed to computed tomography scans (2.06/5, p = 0.0096). Regarding student attitudes towards radiology, most found radiology to be “interesting in its own right” (58.8%). In addition, students found having a basic working knowledge of radiology important (52.9%) and vitally important (47.1%) in becoming a competent doctor. Finally, students reported that radiology findings often (52.9%) and very often (41.2%) change patient care. Conclusion: The pre-clerkship survey results demonstrate that fourth-year medical students at TCOM lack confidence in their ability to interpret imaging studies. However, they regard radiology as quite important to the contemporary practice of medicine. An identical post-clerkship survey will be offered to the original survey respondents to determine the impact of a didactic radiology clerkship on pre-existing student impressions.
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    Role of Service Learning in Medical Students’ Acquisition of EPAs
    (2019-03-05) Dolan, Kathryn J.
    PURPOSE Service learning is designed to provide opportunities to engage in experiential learning which is task and problem specific, improves clinical skills, and facilitates experiencing the benefits of altruistic behavior. Students self reported ratings of various service activities shed light on the activities value in learning clinical skills and professionalism, as reflected in EPAs 1, 6, 7, and 9. The model of learning that is applied here has its origin in the work of John Dewey (1938) and more recent elaboration by Kolb and Boyatzis (2000) who addresses issues of emotional intelligence in professional competencies. METHODS Osteopathic medical students perform service during the first two years as one of the required elements of their ‘doctoring’ course. Service learning meets various learning objectives, including exercising clinical skills for EPAs 1, 6, 7, and 9. Students’ self-report data from their service learning activities is captured electronically. Learning objectives for each service activity are rated by student using a Likert scale. Each semester, approximately 1425 service learning reports are available for preliminary analysis and pilot testing. A total of 7 semesters of data will be available for analysis. For significant differences among the various types of services exercising EPAs 1, 6, 7 and 9, two-sided t-tests using z scores and the Bonferroni correction are applied. RESULTS Initial results show students overall agreement that homeless services and school and sports physicals meet the learning objectives associated with EPA1, again homeless services for EPA6, indigent clinics and sporting events for EPA7, health and safety education and health fairs and screening the highest for EPA9, CONCLUSIONS Despite skewedness in the self-reported data, discernable differences exist between types of activities meeting various learning objectives and furthermore ratings ran in expected directions. Students’ comments offer insights into their professional values and empathy.
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    The Pediatric Research Program: A Sustainable Voluntary Experience for Students of the Texas College of Osteopathic Medicine
    (2019-03-05) Hamby, Tyler; Wilson, Don; Bowman, W. Paul; Basha, Riyaz
    Purpose: A knowledge of research is an essential part of medical education. While introducing medical students to the basic concepts of research is vitally important in encouraging trainees to consider academic careers, inclusion in a crowded academic curriculum and the availability of research mentors is challenging. To address this need, in 2013 the Department of Pediatrics and Women’s Health, Texas College of Osteopathic Medicine (TCOM), initiated the Pediatric Research Program (PRP) in collaboration with Cook Children’s Health Care System to provide mentored research experience to enhance research awareness and knowledge among interested TCOM students. Methods: PRP Administrative Team recruited interested academic/community physicians, medical staff and researchers to mentor students. In early spring, interested first year TCOM students complete an application indicating their area of interest. Following a screening interview, those accepted for the PRP are assigned a mentor(s). PRP students conduct research in the summer after the completion of their first year. Participants are provided with a structured on-line curriculum and timeline. Expectations include required training, didactic education covering the topics related to research design, data analysis and preparing research presentations and poster presentations for scientific meetings. A measure of the PRP’s success was determined by surveying participants’ satisfaction and research productivity (number of presentations/publications). Results: PRP trained 180 students between 2013-2018. The number of applicants has more than tripled in 5 years, reaching approximately 40% of the students in TCOM class of 2022. Participation of mentees and mentors was entirely voluntary. PRP assessment through surveys showed a steady improvement in satisfaction and productivity. In 2018, CANVAS platform was exploited for offering the program which was more convenient and became preferred by the participants. Conclusion: PRP demonstrated a successful model for designing a cost-effective, sustainable and productive program for medical students. This program provides research experience with structured training without affecting the regular curriculum. Timely program assessment through surveys and adopting required changes has improved the experience of participants and proven crucial for the success of this program.
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    Student Initiative in Medical Simulation: Review of the UNTHSC Chapter
    (2019-03-05) Nguyen, Thuy
    1. Purpose: Due to the popular demand of more medical simulation, the UNTHSC SIMS organization began as a division of their parent organization, the Emergency Medicine Interest Group. UNTHSC Student Initiative in Medical Simulation(SIMS) offers pre-clinical students an outlet to apply clinical knowledge in a fun, clinically-based setting. Students in SIMS are able to practice mannequin-based cases where teamwork and quick thinking are rewarded. This provides an advantage to the students before their clinical rotations, where urgent situation often arises without warning. The purpose of this review is to explore what UNTHSC SIMS offers student, it's curriculum design, and chronically record all of the events that this organization has contributed to UNTHSC as a whole. 2. Methods: Quantitative data such as event participation were extracted from Orgsync. Further quantitative data for the making of a timeline were received from Dr. Tierney(head of SIMS lab). 3. Results: As this is a review paper, the results section included "growth & engagement" of UNTHSC SIMS. The organization started out with five participants wanting more simulation skills and events, grew to over 200 members, hosting state and national level conferences, and to date have organized several community events in connection with TCOM itself and other organizations. UNTHSC SIMS has grown to be the most active organization on campus due to members participation and sheer numbers of events offered to its members. 4. Conclusions: Despite many successes, UNTHSC SIMS still struggles with challenges such as retaining and involving more physician mentors for meetings and competitions. As member numbers grow, the need for more officers and space is apparent. The UNTHSC SIMS officers also are working on developing more variety in in-house written cases for simulation, a task that takes expert review and hours of design per case.
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    Physical Therapist Student Perceptions of Creating and Consuming Peer-Generated Flipped Content to Augment Psychomotor Learning
    (2019-03-05) Hamilton, Caren SPT; Shelack, Farrah SPT; Richardson, Mike PT, DPT, GCS, COMT; Schwarz, Brandy PT, EdD, DPT, OT, MBA; Papa, Evan PT, DPT, PhD; Henderson, Elizabeth SPT
    Background: The flipped classroom showed increased mastery and employment of content (McLaughlin et al., 2014). Reciprocal peer teaching (RPT) has also proven valid in enhancing students’ learning (Lydon, 2017; Irvine 2017). Using these two learning styles creates an innovative strategy of peer-generated flipped content (FC). The purpose of this study was to explore student perceptions of creating and consuming peer-generated FC to augment psychomotor learning. We hypothesize students will view this design favorably. Case Information: As part of RPT, first year Doctor of Physical Therapy (DPT) students created manual muscle test videos to augment psychomotor learning. Students viewed the videos via an online learning management platform. Upon course completion, students completed a Likert survey on their perceptions of teaching and learning from peers. Participants completed an electronic informed consent. This study was approved by the IRB at a public university in Texas. Conclusions: This study shows an overall positive experience creating and consuming peer-generated FC as part of RPT. Students valued the RPT experiences as useful for content mastery. The sample was limited to 1st year DPT students at UNTHSC in Fort Worth, TX and involved one course. Data may not be generalizable beyond these conditions.
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    Sports Team Participation: Suicidal Ideation Assessment of Adolescents in the U.S.
    (2019-03-05) Adams, Ann; Thompson, Erika; Dharni, Luvleen
    Sports Team Participation: Suicidal Ideation Assessment of Adolescents in the U.S. Luvleen K. Dharni, MPH(c)1, Ann Adams, MS(c)2, Erika Thompson, Ph.D3 1. Department of Health Behavior and Systems, School of Public Health, UNTHSC 2. Department of Biostatistics and Epidemiology, School of Public Health, UNTHSC 3. Department of Health Behavior and Systems, School of Public Health, UNTHSC Purpose Increasing rates of depression and death by suicide among adolescent populations remains a key public health issue. As such, national health promotion programs have recommended an increase in physical activity as a potential approach to suicide prevention. It is important to explore whether participation or non-participation in sports activity impacts suicide ideation among adolescents. The objective of this study was to assess the association between participation in sports teams and suicidal ideation among US adolescents. Methods The Youth Risk Behavior Surveillance System (YRBSS) 2017 was examined among 9th– 12thgrade students in the United States. The initial inclusion sample size was a total of 14,765 usable observations and after a complete domain analysis, 3,466 participants are excluded for missing values with the final sample size of N=11,299. The outcome variable was suicidal ideation in the last 12 months. The predictor variable was participation in a sports team (yes/no). An adjusted survey-weighted logistic regression analysis in SAS 9.4 was used to assess the participation in sports teams and suicidal ideation adjusting for age, gender, grade level, and race/ethnicity. Results 17.1% of adolescents were found to consider suicidal ideation and 47.8% of those students participated in at least one or more sports team. Those who participated in 0 teams were significantly less likely to consider seriously attempting suicide than those who participated in one or more teams (OR=0.77, 95%CI 0.61,0.96). Females were less likely (OR=0.48, 95%CI 0.40, 0.57) to consider suicide ideation than males. Multiple non-Hispanic were less likely to have suicidal ideations than their white counterparts (OR=0.70, 95%CI 0.50,0.89). Conclusions The findings indicate participation in 0 sports teams may be a protective factor against suicidal ideation when controlling for age, gender, grade level, and race/ethnicity. This may be indicative of student participation in one team or more may be a burden or stressor contributing to adolescents’ mental health status. Next steps could consider assessing the dose of the sports activity and its influence on adolescent’s mental health status.
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    Retrospective Analysis of Pharmacy Students' Perceived Readiness from Pharmacy Residency Preparation Elective with their Match Rates
    (2019-03-05) Elrod, Shara; Nguyen, Hoang
    PURPOSE: Pharmacy residency is becoming a standard requirement for pharmacists who work in the clinical field and is a competitive process. Giving a presentation is a part of the interview process to obtain a residency. There are courses available that helps students to better prepare for residency by having them give a presentation. The purpose of this study is to compare students’ and preceptors’ evaluations of how well each student gave their presentations with relation to their match rates to ASHP certified residency programs. Secondary factors that could affect match rates include GPA, gender, and age. METHODS: Students taking the residency preparation course during the Spring of 2016 and 2017 were asked to choose and present a disease state presentation from a list of topics. Their presentations were assessed by their peers, as well as, by pharmacists who have had residency experience. A Likert scale was utilized to assess 15 different areas of the presentation ranging from nonverbal cues to depth of knowledge. Scores ranges from 1 to 5, with 5 being favorable. Mann Whitney U was used to assess the 15 areas with relation to residency match rate via SPSS. De-identified information concerning residency match rates, age, gender and overall GPA, from both groups were analyzed and compared to one another to see how the seminar is impacting student match rates. The de-identified information was obtained from UNTHSC's senior data manager. RESULTS: A total of 26 students were assessed who took the residency preparation course in 2016 or 2017 and applied for residency. Of these students, 18 were female (69.2%) and 8 were male (30.8%). The median age was 24.5 years (IRQ 23 - 27.5) and the average GPA was 3.28 ± 0.3. Of the students that took the course in 2016, 12 were assessed; 9 were females, 3 were males. The median age for 2016 was 24 (IQR 23 -25) and the mean GPA was 3.32 ± 0.30. Of the students that took the course in 2017, a total of 14 students were assessed, with 9 females and 5 males. The median age for 2017 was 25.5 (IQR 23 – 30) with a mean GPA of 3.18 ± 0.3. Most of the median scores for the 15 questions had a value of 5. CONCLUSION: Students tended to rate their peers highly in formative assessments. A possible limitation to this study could include having a small study population. Also, we noticed that students and pharmacists tended to prefer to rate each presentation highly so our results may have been skewed to the right.
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    Branchial Cleft Cyst: A Case Study in a Thirteen Year Old Girl
    (2019-03-05) Marcincuk, Michelle; Bowman, W.; Shakibai, Nasim
    Abstract Background: Second branchial cleft cysts are the most common branchial cleft lesions, found near the anterior upper one-third aspect of the sternocleidomastoid muscle. Branchial sinuses or fistulae are often found after birth, but internal sinus tracts and branchial cleft cysts may be found later in life. Although branchial clefts are resectable, the surgeries become more complicated following an infection. We report a case of a patient with a second branchial cleft cyst with a previous infection, leading to a difficult resection. Case information: A 13-year-old female patient presented to her pediatrician with tender mass on the left side of her neck for two days. She denied fever, fatigue, weight loss, or cat scratches. Her boyfriend had Infectious Mononucleosis a few weeks prior. Her labs revealed a normal Epstein-Barr Virus panel and a negative mononucleosis spot test, rapid strep A test, and Bartonella Henselae Antibodies. Her erythrocyte sedimentation rate and C-reactive protein were elevated. She completed a course of clindamycin and azithromycin, but the mass remained. A chest x-ray revealed clear lungs. Her MRI with contrast showed a mass which her otolaryngologist identified as a branchial cleft cyst. The resection was complicated due to her previous infection; the cyst was adherent to the great vessels, the accessory nerve and the sternocleidomastoid. The patient recovered uneventfully. Conclusions: Branchial cleft cysts account for approximately 20-30% of all pediatric neck masses. If a patient presents with a neck mass, health care providers should consider branchial cleft anomalies in the differential diagnosis. Knowledge about branchial cleft cysts and their presentation will help health care providers ensure these patients receive appropriate management more rapidly, thus avoiding some of the challenges and risks of surgical excision once infection has occurred.
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    Making the Patient Safety Connection Between Rx and OTC: Assessment of an Active Learning Activity
    (2019-03-05) Taei, Nasrin; Fix, Jennifer
    Purpose: This active learning activity exercise allows the student to: Use available resources to learn information about prescription (Rx) and over-the-counter (OTC) medications Connect OTC product concerns with prescription medications Connect OTC products that support or complement the use of prescription medications Consider self-care options for patients when they are unable to afford going to the doctor Consider the dangers of OTC medication use Consider patient safety concerns Method: Using Qualtrix, a survey will be completed before beginning the session which included the activity. One week later, the same survey will be administered. Results will be tabulated to compare before and after entries with the anticipation that the activity developed their confidence in the material. Description of the Active Learning Exercise: Each student randomly selected an empty prescription stock bottle before being seated for class. Once class began, the before survey was administered. All students logged into to Qualtrix to complete the before survey. A questionnaire was provided that the allowed the student to use available drug databases and answer questions related to the prescription product they selected. A follow up survey will be administered one week later to observe any changes in student perception after having completed the exercise. Results: The data and results are available through Qualtrix. 113 students participated in the activity and the before and after surveys. Conclusions: The expected outcome is that students will have improved impressions regarding lessons learned. Results will be published and will potentially motivate faculty in other schools of pharmacy to adopt such an activity.