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    (2013-04-12) Cummings, David
    Purpose: To identify factors that influence the medical education of rural undergraduates and increase the number of graduates that practice in rural communities. Objectives 1.Develop a valid survey tool to evaluate and measure the barriers of rural students that affect their decision to apply and gain admission to medical school. 2.To examine the barrier and support factors associated with the medical school application process that affects premed undergraduate rural students. 3.To examine the barrier and support factors associated with the medical school admissions process and outcome that affects applicants to TCOM. Methods: The research design for this study is primarily observational. Descriptive statistics were generated using SPSS© version 19 and crosstabs were used for comparisons. Hypothesis testing was performed on relevant comparisons. Non-Parametric analysis methods including Chi Squared and the Mann-Whitney Rank Sum Test were performed to test for significance among comparisons. A significant alpha level of .05 will be used for all significance tests. Results: For rural students, the level of positive influence from "other relatives" was statistically significant (p value= .018). Rural status may also be associated with the perceived level of helpful advice given to the students by selected persons. Rural students did show more helpful feedback was provided to them by their premedical/prehealth advisor than non-rural counterparts.The association was not significant at the .05 level (p value=.089). For rural students, the top three obstacles include prerequisite courses, MCAT preparation, and MCAT score. Non rural students share the same three top choices, except healthcare experience and prerequisite classes tied for third largest obstacle. MCAT score accounted for the largest difference between the groups but was not statistically significant (p value=.75). Conclusions: Factors exist that can impair or assist undergraduates in achieving their goals of applying to medical school or being accepted into a medical program. Rural students may experience these factors differently than their non-rural counterparts. Determining which persons and which programs are most helpful is a necessity. A small sample size and a lack of diversity within our pre-test sample make it difficult to generalize our findings to the target population. A pilot study with a sufficient number of diverse respondents must be conducted to evaluate the contributing factors accurately.
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    (2013-04-12) Pitts, Yolanda
    Purpose: All health professions schools are facing the challenge to integrate both recommended geriatric and IPE competencies into their curriculums. Creating meaningful activities that fit current curriculum offerings and allow students to move beyond declarative knowledge to procedural knowledge are often difficult to create early in any health profession school. Varying schedules, curricular timing, and a history of training as independent professions can create challenges to the process. Innovative and dynamic learning experiences that meet both geriatrics and interprofessional competencies in a meaningful way must be established. IPE SAGE was piloted to provide a unique learning environment to increase student opportunity for early exposure to older adults and issues of geriatrics through IPE team based learning. Methods: The IPE SAGE program piloted in the fall 2012, created teams which include a 1st year medical student with a 1st year PA & PT student, & teams which include a 1st year medical student with a PA student. Teams made 8 home visits over a two year period. Visits consisted of an assignment integrating geriatric & IPE competencies associated with attitudes, knowledge, & skills. IPE SAGE assignments allow students the opportunity to practice and demonstrate competency in basic clinical skills, client interviewing, physical exam skills, home safety, cognitive assessments, & advanced care planning. Students completed assignments within the context of a health care team practicing team development, leadership, & communication. Students submit their assignments to faculty mentors who grade their assignments & give feedback to the students. Senior mentors also evaluate the student teams. Results: 31 geriatrics competency areas related to knowledge, attitudes, & skills are addressed along with IPE competencies in four domains: values/ethics, roles/responsibilities, interprofessional communication, and teams/teamwork are addressed through the IPE SAGE program. Students who fail to demonstrate competency are identified for remediation of the assignment. Student survey data & senior mentor evaluation data are reported. Conclusions: 1st year medical students, PA & PT students are experiencing increased competency based geriatrics & IPE training through health care teams participation in the SAGE senior mentor program. 78 1st year medical, 78 PA, & 41 PT students were impacted by the IPE SAGE Program.
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    (2013-04-12) Collins, Vanneise
    Purpose: The importance of promoting students' Higher Order Thinking (HOT) is widely recognized at all levels of education. Engaging faculty in professional development that cultivates students' HOT is essential. Professional development efforts are limited by lack of information of faculty's current knowledge about and confidence in promoting students' HOT. The purpose of this study was to identify faculty development needs that will cultivate students' higher order thinking skills across the health sciences curricula. A valid and reliable assessment was used to gather data for effective faculty development efforts. Methods: Development of two assessment tools to identify: 1) faculty's knowledge about and confidence in using instructional strategies, technologies and assessment methods to promote students' HOT, and 2) instructional strategies, technologies and assessment methods faculty are currently using in their teaching practice. The first assessment tool is an annual faculty survey. The survey was developed by a panel of faculty from all schools at UNTHSC. The survey consists of five multifaceted, self-report, Likert type questions. The survey was administered in 2010 to collect baseline data, and was subsequently deployed online each year to the teaching faculty at UNTHSC. The second assessment tool is a survey deployed after each faculty development event. The survey contains specific items targeting faculty's HOT teaching practice. Together, the two assessment tools establish a two-tiered mechanism that provides both longitudinal and ongoing monitoring and feedback to guide faculty development. Results: The faculty survey results in the past three years demonstrated how faculty's use of instructional strategy, assessment and technology evolved over time. For example, in the 2nd year, there was a drop in faculty's confidence in integrating technology with instructional strategies to promote HOT, which suggested the need to provide more faculty development to address the challenge. The findings from the faculty development event evaluation indicated faculty needs and interests for future faculty development topics. Conclusions: The two-tiered assessment framework provides both longitudinal and ongoing monitoring and feedback regarding faculty's teaching practice that promotes students' HOT. It gauges the evidence of impact of the faculty development program, identifies best practices, topics for further development and supports campus initiatives to promote students'HOT.
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    (2013-04-12) Tshuma, Lisa
    Purpose: Diagnostic errors are more likely to result in patient harm than other types of medical errors and are frequently preventable. The primary causes of diagnostic error are breakdowns in our health care systems, clinical reasoning or both. Although significant effort has been placed in developing health care system solutions, relatively little has been done to mitigate the common causes of breakdown in clinical reasoning such as failed perception, implicit bias and failed heuristics. Our project employed a set of active and reflective learning activities in the MPAS 5242 course designed to provide physician assistant (PA) students with tools to reduce cognitive diagnostic errors in clinical practice. Methods: An integrated teaching approach centered on five strategies to decrease diagnostic cognitive error was employed. These strategies include Cognitive Dispositions to Respond (CDR) awareness, consideration of alternatives, metacognition, simulation and decreased reliance on memory. Students were introduced to CDRs through lectures and assigned readings including the book How Doctors Think. Students completed pre-class online quizzes to prepare them for interactive lectures and small group activities, including small group skits. Students completed weekly online Implicit Associations Tests to help them identify subconscious biases that may contribute to cognitive diagnostic errors. Finally, students wrote a reflection paper to synthesize their learning experience. Fifteen reflection papers were randomly selected and evaluated by 2 raters using a rubric measuring students' ability identify potential cognitive errors, analyze the reason(s) they were likely to commit the errors, and apply strategies to avoid future similar errors. To achieve inter-rater reliability, the two raters independently rated the 15 samples, and then met to resolve any discrepancies. Results: Overall, the results showed that students achieved a satisfactory outcome, which was shown by their mean scores in the three parts of the rubric: 2.8 out of 3.0 in the ability to identify cognitive errors, 3.5 out of 5.0 in the ability to analyze potential errors, and 3.0 out of 5.0 in their ability to formulate strategies to prevent the errors. Conclusions: The integrated teaching strategy was effective promoting higher order thinking by providing PA students with tools to reduce cognitive diagnostic errors in their clinical practicums and future clinical practice.
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    (2013-04-12) Board, Amy
    Purpose: To identify gaps in knowledge and access to pregnancy-related care for Karen Burmese refugee women in Fort Worth, to identify a natural leader within this population, and to design a culturally appropriate educational intervention to enhance healthy pregnancy behavior. Methods: Through collaboration with local refugee resettlement agencies, the Karen were identified as a particularly vulnerable refugee population with regard to accessing proper prenatal care. Focus groups were designed to identify the baseline level of pregnancy knowledge and access to care. The March of Dimes curriculum was selected to translate into Karen and to adapt according to the specific cultural and educational needs of this group. Through discussion with key players in the Karen community, a natural leader within the population was identified to facilitate future education classes. Picture-based pre- and post-test materials were developed to accommodate the low-literacy rates of the population. The lay health worker model is used as a guide for focus group and intervention implementation. Results: A natural community leader within this population was identified to conduct focus groups and the education-based intervention. Discussions with leadership in the Karen community were integrated into an existing knowledge base about the population from a refugee resettlement agency perspective as well as from prior research experience with this group. It was concluded that conducting outreach for the focus groups and intervention should occur within the context of the Karen church to maximize acceptance of the project within the community. Focus groups will be initiated in March. The results will be used to tailor March of Dimes curriculum to meet the needs of a unique population at risk of poor prenatal outcomes and maternal health. Conclusions: Utilization of a natural community leader within the context of the lay health worker model is an ideal approach for properly identifying and tailoring interventions among the Karen Burmese due to its unique ability to overcome cultural and linguistic barriers.
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    (2013-04-12) Chiapa, Ana Luz
    Purpose: : It is widely acknowledged that the U.S. is experiencing a shortage of physicians, especially in primary care. Currently, the shortage of PCPs is of 7,400 nationwide; by 2025 that number will have ballooned to 65,800. A more significant problem, however, is the maldistribution of primary care providers in rural areas and areas of greater need. In response to this problem, the Texas College of Osteopathic Medicine (TCOM) established the Rural Family Medicine Track. This rural track was a longitudinal program designed to prepare medical students for family practice in a rural community. The purpose of this project was to assess the relationship between rural track participation and rural practice. Methods: : Information about Rural Track graduates was collected and entered into a comprehensive database. Graduate information was obtained from academic records and medical board websites. Information regarding graduates' demographic characteristics and current practice location was examined using descriptive statistics. A logistic regression was used to assess the relationship between rural track participation and rural practice. Results: Of the 218 students that participated in a rural track or clerkship, 67% completed the rural track, and 60% (n=132) were female. In terms of ethnicity, the majority were white (73%, n=150), with 10% (n=23) Hispanic, 14% (n= 30) Asian, and 1% (n=2) Black. Once in practice, 20% (n=39) of graduates practiced in a rural county, 40% (n=76) practiced in a Medically Underserved Area (MUA), and 16% practiced in a Health Profession Shortage Area (HPSA). A logistic regression was performed to assess the association between rural track participation and rural practice; no statistically significant relationship was found. Conclusions: Results show that there was no statistical significant relationship between rural track participation and rural practice. However, the rural track has produced graduates that practice in rural and underserved areas. The current ROME curriculum will continue the success of the Rural Track and plans to place a greater number of students in rural practice.
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    (2013-04-12) Chen, Hsueh-fen
    Purpose: The purpose was to explore the feasibility of using student construction of multiple choice questions (MCQs) to foster active learning and improve higher order thinking skills in a graduate course in public health. Student performance statistics, a written survey, and focus groups determined success in engaging students and developing higher order thinking skills. Methods: Students participated in a hands-on lab where PeerWise software was introduced and students participated in exercises to create MCQs, answer questions created by other students, and rate questions according to a rubric that evaluated each question on a 5 point scale awarding points based upon question clarity, completeness of explanation, and extent to which questions addressed HOT skills. Statistics collected within the PeerWise software system assessed level of student engagement and quality of student contributions. These were number of questions created, average question rating, number of questions answered, volume of comments received, volume of comments provided, and overall participation score. A survey administered halfway through the implementation gauged students' satisfaction with PeerWise, the extent to which they were actively engaged, and the extent to which they thought creating, answering, rating, and commenting contributed to development of HOT skills and course mastery. Results: Preliminary results show a high level of student engagement and successful student creation of MCQs that measure HOT skills. After five weeks more than half of the students have answered more than 100 questions and all but one have answered more than 30 questions. Halfway through the study the 20 enrolled students enrolled have created 117 questions of which 89% were rated as clear, appropriately related to class topic, and including an explanation of both correct and incorrect answers. A subset of ten higher order thinking questions have been included on the midterm exam. Conclusions: This study provides evidence that student creation of MCQs is feasible and effective for a graduate class, that the exercise is engaging for students, and that the exercise succeeds in developing students' HOT skills.