Approaches to ensure an equitable and fair admissions process for medical training.

There has been considerable discussion of how best to address racial and ethnic disparities in health outcomes, both globally and specifically in the United States. Increasing diversity among future clinicians and physician-scientists has been identified as a key strategy for addressing and correcting health disparities among underrepresented populations. Increasingly, medical schools, the institutions that train clinicians, have embraced the practice of holistic review for evaluating applicants and virtually all medical schools have reported contributing to a diverse physician workforce as an important aspect of their educational mission.

Evaluating Clinical Reasoning in Undergraduate Medical Education: The Value of a Virtual Oral Assessment.

Background: Oral assessments are essential components of board certification in numerous fields, as they provide insight into problem-solving capacity and clinical reasoning. The development of clinical reasoning often begins in undergraduate medical education and remains a challenge to assess.

Objective: We developed a pilot oral assessment to evaluate medical student oral presentations and systematically assess clinical reasoning.

Designing a Situational Judgment Test for Use in Medical School Admissions.

It has long been acknowledged that professional competencies are required for success in medical school, residency training, and medical practice. Over the last decade, medical schools have begun to introduce standardized assessments of professional competencies, but many still rely on interviews to assess these competencies, which occur after about half of the applicant pool has already been screened out. In this article, the authors discuss the development, evaluation, and launch of the Association of American Medical Colleges (AAMC) situational judgment test (SJT) for use in medical school admissions.

Critical Care Teamwork in the Future: The Role of TeamSTEPPS in the COVID-19 Pandemic and Implications for the Future.

At our institution, we observed inconsistency in the application of structural facilitators for interprofessional teamwork such as handoffs and communication of contingency planning, complete formation and engagement of teams on interprofessional rounds, regular situation monitoring, interprofessional huddles, use of "check back" during code situations, and standard debriefings after codes and procedures (TeamSTEPPS). To enhance team performance, we piloted TeamSTEPPS training and reinforcement for all healthcare team members in the medical intensive care unit (MICU), inclusive of trainees, advanced practice providers (APPs), nurses, and respiratory therapists rotating through the unit. Seven months after the training launch, the initial COVID-19 surge interrupted the reinforcement stage of the pilot providing an opportunity to study the retention of TeamSTEPPS principles and its potential role in response to a crisis.

Comparison of self and simulated patient assessments of first-year medical students' Interpersonal and Communication Skills (ICS) during Objective Structured Clinical Examinations (OSCE).

Background: Interpersonal and communication skills (ICS) are important core competencies in medical education and certification. In this study, we identified self- and simulated patient (SP)-reported ratings of US first-year medical students' ICS and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE).

Methods: OSCE participants, including 172 first-year medical students and 15 SPs were asked to evaluate the students' ICS using the American Board of Internal Medicine-Patient-Satisfaction Questionnaire (ABIM-PSQ), electronically and via paper, respectively.

Development of an empathy and clarity rating scale to measure the effect of medical improv on end-of-first-year OCSE performance: a pilot study.

Patients want empathetic physicians who listen and understand. How do you teach and measure empathy? Medical educators, including those inspired by Alan Alda, have turned to theater to teach skills in empathetic communication. Improvisation-informedcurriculum (medical improv) draws upon foundational actors training: deep listening, emotional understanding, connections, authenticity.

The Diversity and Success of Medical School Applicants With Scores in the Middle Third of the MCAT Score Scale.

Admissions officers assemble classes of medical students with different backgrounds and experiences who can contribute to their institutions' service, leadership, and research goals. While schools' local interests vary, they share a common goal: meeting the health needs of an increasingly diverse population. Despite the well-known benefits of diversity, the physician workforce does not yet reflect the nation's diversity by socioeconomic status, race/ethnicity, or other background characteristics.

Machine Learning-Augmented Propensity Score-Adjusted Multilevel Mixed Effects Panel Analysis of Hands-On Cooking and Nutrition Education versus Traditional Curriculum for Medical Students as Preventive Cardiology: Multisite Cohort Study of 3,248 Trainees over 5 Years.

Background: Cardiovascular disease (CVD) annually claims more lives and costs more dollars than any other disease globally amid widening health disparities, despite the known significant reductions in this burden by low cost dietary changes. The world's first medical school-based teaching kitchen therefore launched CHOP-Medical Students as the largest known multisite cohort study of hands-on cooking and nutrition education versus traditional curriculum for medical students.

Methods: This analysis provides a novel integration of artificial intelligence-based machine learning (ML) with causal inference statistics.

How good are we at selecting students that meet our mission? Outcomes of the 2011 and 2012 entering classes selected by a locally developed multiple mini interview.

Background: Can a locally developed multiple mini interview (MMI) process lead to outcomes reflective of local values and mission?

Methods: In 2017, the authors performed a retrospective analysis of the relationship of MMI with multiple-choice-based outcomes and non-multiple-choice-based outcomes, including clerkship competencies, OSCE, scholarship/service/leadership, academic honor society induction, peer and faculty humanism nominations, and overall performance at graduation for two entering classes with acceptance decisions based exclusively on a locally developed MMI.

Results: There was no association between MMI and performance on multiple-choice-based examinations. For other outcomes, the effect size of MMI for OSCE was small and leadership/service and scholarship did not correlate with MMI score.

Implementation of a Mini-CEX Requirement Across All Third-Year Clerkships.

Problem: Direct observation of medical students performing clinical tasks, such as eliciting a patient history or examining a patient, and the provision of feedback, are foundational to student improvement but have been reported to occur infrequently. The mini clinical evaluation exercise (mini-CEX) is a tool that can facilitate direct observation and feedback. This study assessed the impact of a mini-CEX requirement across all 3rd-year clerkships on student report of direct observation by faculty and objectively measured clinical skills.

The Effect of Differential Weighting of Academics, Experiences, and Competencies Measured by Multiple Mini Interview (MMI) on Race and Ethnicity of Cohorts Accepted to One Medical School.

Purpose: To examine whether academic scores, experience scores, and Multiple Mini Interview (MMI) core personal competencies scores vary across applicants' self-reported ethnicities, and whether changes in weighting of scores would alter the proportion of ethnicities underrepresented in medicine (URIM) in the entering class composition.

Method: This study analyzed retrospective data from 1,339 applicants to the Rutgers Robert Wood Johnson Medical School interviewed for entering classes 2011-2013. Data analyzed included two academic scores-grade point average (GPA) and Medical College Admission Test (MCAT)-service/clinical/research (SCR) scores, and MMI scores.

Core personal competencies important to entering students' success in medical school: what are they and how could they be assessed early in the admission process?

Assessing applicants' personal competencies in the admission process has proven difficult because there is not an agreed-on set of personal competencies for entering medical students. In addition, there are questions about the measurement properties and costs of currently available assessment tools. The Association of American Medical College's Innovation Lab Working Group (ILWG) and Admissions Initiative therefore engaged in a multistep, multiyear process to identify personal competencies important to entering students' success in medical school as well as ways to measure them early in the admission process.

Creative group performances to assess core competencies in a first-year patient-centered medicine course.

Introduction: A novel assessment of systems-based practice and practice-based learning and improvement learning objectives, implemented in a first-year patient-centered medicine course, is qualitatively described.

Methods: Student learning communities were asked to creatively demonstrate a problem and solution for health care delivery. Skits, filmed performances, plays, and documentaries were chosen by the students.

Comparison of linear-stochastic and nonlinear-deterministic algorithms in the analysis of 15-minute clinical ECGs to predict risk of arrhythmic death.

Objective: Comparative algorithmic evaluation of heartbeat series in low-to-high risk cardiac patients for the prospective prediction of risk of arrhythmic death (AD).

Background: Heartbeat variation reflects cardiac autonomic function and risk of AD. Indices based on linear stochastic models are independent risk factors for AD in post-myocardial infarction (post-MI) cohorts.

Risk stratification for arrhythmic death in an emergency department cohort: a new method of nonlinear PD2i analysis of the ECG.

Heart rate variability (HRV) reflects both cardiac autonomic function and risk of sudden arrhythmic death (AD). Indices of HRV based on linear stochastic models are independent risk factors for AD in postmyocardial infarction (MI) cohorts. Indices based on nonlinear deterministic models have a higher sensitivity and specificity for predicting AD in retrospective data.

Inflammatory cytokines provide limited early prognostic information in emergency department patients with suspected myocardial ischemia.

Study Objective: The aim of this study was to assess the early prognostic value of the inflammatory cytokines interleukin 6, interleukin 8, and tumor necrosis factor alpha in a cohort of emergency department (ED) patients with chest pain who have suspected myocardial ischemia.

Methods: One hundred eighteen patients with chest pain presenting to 2 urban EDs were studied. Interleukin 6, interleukin 8, and tumor necrosis factor alpha levels were assayed at presentation.

Elevated soluble P-selectin levels are associated with an increased risk of early adverse events in patients with presumed myocardial ischemia.

Background: Cell adhesion molecules (CAMs) play a pivotal role in the interactions between leukocytes, platelets, and vascular endothelium. Soluble CAMs (sCAMs) are shed from cell surfaces and reflect cellular activation. Elevated levels of sCAMs have been reported in the acute coronary syndromes.