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Abstracts  |   March 2020
Educating Leaders 2019: Abstracts From AACOM's Annual Conference
Article Information
Abstracts   |   March 2020
Educating Leaders 2019: Abstracts From AACOM's Annual Conference
The Journal of the American Osteopathic Association, March 2020, Vol. 120, e7-e61. doi:https://doi.org/10.7556/jaoa.2020.035
The Journal of the American Osteopathic Association, March 2020, Vol. 120, e7-e61. doi:https://doi.org/10.7556/jaoa.2020.035
Cognitive Task Analysis: Guide to the Development of an Interprofessional Simulation Based Instruction 
Elizabeth Oviawe, PhD, MS 
NSU-COM 
Context: There is a lack of adequate instructional intervention in the core competencies of interprofessionalism and meaningful use of electronic health records (EHRs). Evidence demonstrates that medical schools are graduating students that lack understanding of the importance of the use of EHRs and collaborative skills necessary to practice effectively in a team-based environment. Simulation in medical education has shown promise for addressing these deficiencies. 
Objective: The specific objective of the study included the application and evaluation of the cognitive task analysis (CTA) technique in the design process of a simulation-based instructional module according to guided experiential learning (GEL) theory, and evaluate how CTA could be used to capture the knowledge and skills needed to develop a simulation-based instructional EHR and interprofessionalism module. 
Methods: Guided by GEL design approach, CTA was used to capture the unconscious (tacit) knowledge from the subject matter experts (SMEs) who have been successful in these fields. The participants were trained on the CTA process. Survey instruments from the GEL CTA interview process and IPE in academic settings were adopted and administered to 9 participants in a form of semi-structured interview. Answers to the questionnaire represented the data for this pilot study collected before and after the intervention. The data was analyzed using descriptive and proportional statistics to answer the research question. 
Results: The result of the questionnaire demonstrated that 89% of the participants came into the study with no knowledge (n=5) or some knowledge (n=3) of CTA or its process. After the intervention, all the participants (100%) reported much (n=4) or very much (n=5) value of the skills they learnt from the CTA process. All but 1 participant (89%) had much (n=4) or very much (n=4) confidence in their ability to apply the content of this CTA process in the design of a simulation-based course. Every participant (100%) strongly agreed (n=9) after the intervention that interprofessional learning before qualification will help health professional students to become better team-workers. 
Conclusion: CTA is the first required step in the application of GEL theory to the development of an interprofessional simulation-based module. The SMEs were trained on the process of CTA by doing it which resulted in acquisition of GEL skills. Future research should extend this study to the next step in the application of GEL theory by using it in other types of cases and scenarios, including virtual reality, gamification, and in other settings. 
An Active Learning Method to Achieve Multiple Learning Objectives and Behavioral Outcomes 
Tony A. Slieman, PhD; Troy Camarata, PhD 
NYITCOM A-State 
Context: Knowledge integration is an important aspect of education. In clinical education, there is an emphasis on integration of basic medical science with clinical practice to provide a higher order of comprehension for future physicians. Also of importance in medical education is the promotion and development of professional behaviors (ie, team work, interpersonal professional behavior, and the ability to give proper feedback). 
Objective: We set out to design and implement an active learning activity for 120 first-year medical students to foster knowledge integration and to promote professional development. Our objectives are to identify and integrate basic science and clinical concepts; to develop critical thinking and problem solving skills; to develop and demonstrate teamwork and professional interaction skills; and to assess peer developed concept maps to further content comprehension. 
Methods: We used a small group active-learning approach that was three stages: concept mapping, student peer-review, and student group evaluation. Specific learning objectives and behavioral outcomes were designed to focus the learning activities. Rubrics were also designed to assess students’ group generated concept maps; determine effective student peer review; and appropriate evaluation of group dynamics. In addition to assessment data from the rubrics, survey data from participating students and faculty facilitators was also collected. 
Results: Preliminary analysis of rubric assessments and survey data suggested the concept map-based active-learning approach achieved our designated objectives and outcomes through this weekly, two-hour educational exercise. As a result of instructor feedback and peer reviews, team maps progressed from simplistic and flow chart-like with several dead ends to web-like with no dead ends and complex descriptors. Twenty-2team groups worked well, efficiently, and bonded nicely together as evident from faculty observations and student group evaluations. Two teams required occasional faculty intervention to optimize group dynamics. 
Conclusion: Based on preliminary student surveys, map progression, and faculty observations, the implementation of this exercise was successful and measurable progress was seen regarding all 4 learning objectives. Further analysis of the student survey data will allow us to tease out the difference in progression on the learning outcomes. 
Art in Medicine: The Role of Anatomical Sketching in Medical Education 
Arnavi Varshney, OMS III; Craig Biegel, OMS III; Julia Molnar, PhD 
NYITCOM 
Context: Leonardo da Vinci and Andreas Vesalius pioneered the application of fine art to anatomical science during the early Italian Renaissance. Since this period, illustration has been incorporated in the study and practice of medicine at various institutions throughout the United States and Europe. Recent studies suggest that the analysis, discussion, and appreciation of fine art serve a beneficial role in the education of medical students. 
Objective: This study aims to explore the relationship between art developing and enhancing knowledge of anatomy. We hypothesize that cadaveric drawing from observation improves academic performance on anatomy practical examinations. 
Methods: A 12-week “Art in Medicine” elective, noncredit course was proposed within the framework of a pre-clinical medical curriculum, during which students had an opportunity to discuss artwork, sketch cadaveric anatomy from observation, and ultimately present a portfolio for critique and exhibition. The study was limited to incoming medical students of the Class of 2022 at New York Institute of Technology College of Osteopathic Medicine and excluded those with a pre-existing degree in anatomical science. A control group enrolled in the Lecture-Discussion Based (LDB) and Doctor-Patient Continuum (DPC) curriculum tracks were analyzed against a test group consisting of students in the LDB and DPC tracks as well as the “Art in Medicine” elective. Study endpoints were three summative anatomy practical examinations. We used a paired t test to compare the students’ performance on each of the three tests to judge whether participating in the drawing sessions improved their performance over time. We re-analyzed the data using an ANOVA in order to compare the scores of the study group with those of the rest of the class. In addition, a survey was administered to students in both the test and control groups at the beginning and completion of the course in order to obtain constructive feedback, promote self-reflection, and adjust for certain confounding variables, including a background in illustration, preferred learning style, resources from which to supplement the study of anatomy, and any previous anatomy courses taken. 
Results: The analysis revealed that the participants in the test group performed significantly better than the participants in the control group (P<.05). Although this study proved to be an effective method for solidifying and retaining anatomical knowledge, there are several confounding elements that should be addressed in a larger study: students self-selected to the art in medicine elective, which may reveal a greater motivation to study anatomy. In addition, a majority of the participants in the test group had a background in drawing and illustration. 
Conclusion: This study allowed students to address anatomical concepts from a visual perspective. They learned how to distinguish structures using tone, shape, and perspective. They also became proficient in deciding how to communicate aspects of a given anatomical region to their audience. Further studies can assess whether art can be implemented in the instruction of residents, fellows, and attending physicians at multiple tiers within the hierarchy of continuing medical education. 
Longitudinal Modeling of Interprofessional Collaboration and Conflict Management 
Anita Airee, PharmD1; Melissa Day, MPA1; Sherry Jimenez, EdD1; Byron Turkett, PA1; Jeremy Buchanan1; Rebecca Bowden, PhD2 
1LMU-DCOM; 2KCU-COM Joplin 
Challenge/issue: The Commission on Osteopathic College Accreditation has instituted a standard requiring Interprofessional Education for Collaborative Practice, which states, “a COM must ensure the core curriculum prepares osteopathic medical students to function collaboratively on health care teams.” The challenge is designing educational IPE events appropriate to the level of the learner that can be built upon sequentially for all 4 years of undergraduate medical education. 
Objective: Designing a first and second year IPE curriculum with the aim to learn from and permit interaction with clinical health professionals from social work, nursing, clinical pharmacy, osteopathic medicine, and physician's assistant programs. 
Approach: The OMS I curriculum was designed as an introduction to basic concepts of IPE. A team-based learning (TBL) activity to illustrate roles and responsibilities of different disciplines was designed. A post-operative hip fracture patient scenario was developed to apply ethical principles and clinical relevance to patient care during simulated patient rounds between clinical health professionals from social work, nursing, clinical pharmacy, osteopathic medicine, and physician's assistant programs. Clinical care principles of nutrition, pain management, fluid management, delirium, and prevention of post-operative infection were included. The team dynamic was challenged by an intimidating physician. Therefore, modeling of continued focus on patient care while maintaining collegiality by all team members was an important part of the role play. A postpatient round group debrief was done. The OMS II IPE curriculum was a continuation of the OMS I activity, building upon the previous patient case with the same professionals using a professionally recorded clinical encounter and a debrief panel. The class was again divided into TBL teams for discussion. The case involved the patient returning to a clinic setting years later. Relevant clinical care concepts including fall risks in the elderly, opioid diversion by an addicted caregiver, and elder abuse were highlighted. The roles and responsibilities of each professional within the clinic were illustrated and the consequences of communication breakdown emphasized. 
Results: Two hundred forty-2students participated in this exercise. Questions for TBL-IRAT and GRAT were used to assess learning outcomes for both OMS I and OMS II activities. Student course evaluations were used to assess relevant subjective feedback. The content was appropriate for the OMS I and OMS II learning levels and was well received by the students. These introductory experiences concurrently build into interprofessional collaborative encounters with PA students, pharmacy students, and social work students in the second year. In the first year of the curriculum (OMS I) performance on IRAT/GRAT and examination questions that assessed clinical learning and interprofessional education (IPE) had good statistical performance in all areas. In the second year of the curriculum (OMS II), performance on IRAT/GRAT and examination questions related to IPE and conflict management performed well. Clinical examination questions in the second year had poor statistical performance. The clinical questions in the second year where slightly more complex that what was needed for the focus of the course so they were eliminated. A focus on IPE roles and responsibilities and conflict management remained as the program moved forward. 
Acknowledgment: The authors would like to thank Dr Jonathan King who, with meticulous concern to every aspect of student learning, was the primary developer of this thoughtful and meaningful case. Dr King passed away unexpectedly the week prior to this exercise. 
Student Learning Trajectories: Using Multiple COMSAE Phase 1 Examinations as Progress Tests 
Jana Baker, DO; Sarah Zahl, PhD; Donald Sefcik, DO, MBA 
MU-COM 
Challenge/issue: Progress testing (AMEE Guide 71; 2012) tracks learner performance repeatedly over time to produce a more reliable longitudinal measurement of learner achievement. Scores obtained from repeated, equated, curriculum-independent assessments increase the predictive value of the scores when making decisions regarding likely future performance. While students have relied on the COMSAE as a self-assessment tool since its inception in 2008, COMs have only recently begun to develop institutional policies regarding the use of COMSAE for progress testing and measurement of readiness for the COMLEX. Based on recent threads on AACOM's discussion boards, many COMs have or are currently developing policies regarding the use of the COMSAE Phase 1 as a gateway examinationination for the COMLEX Level 1 (SOME: Required COMSAE Score, October 2017; Academic Support Services: Use of COMSAE, June 2017; Council on Student Affairs: COMSAE Cut Scores and Licensure Exam Preparation, July 2016). The questions and responses in these threads indicate that this practice varies widely across COMs. In 2012, the COMSAE was reported (Sefcik et al, AACOM) to have progress test value after administrations in November 2012 and May 2013 at MSUCOM. Currently, MSUCOM uses a COMSAE Phase 1 cut score of >450 prior to taking COMLEX Level-1 (http://www.com.msu.edu/Students/Boards_and_Prep/COMSAE%20FAQ.pdf). Since use of the COMSAE as a cut score for the COMLEX varies widely, it is a challenge for COMs to identify the best approach. 
Objective: The objectives of our approach at MU-COM were to identify the most appropriate methods of progress testing; determine if the COMSAE Phase 1 would be used as a barrier examination; and develop a phased intervention plan to guide and support students in need of additional academic support prior to taking COMLEX Level 1. 
Approach: After three years of collecting student performance data from various vendor examinations and the COMSAE and comparing those results to COMLEX Level-1 scores, the Marian University College of Osteopathic Medicine (MU-COM) instituted progress testing during the Spring of 2018 (Class of 2020). Three classes of MU-COM students completed COMSAE examinations: Class of 2018=March 2016 (Form D); Class of 2019=March 2017 (Form D); Class of 2020=February 2018 (Form E) and May 2018 (Form D). Student performance on the COMSAE was strongly correlated with performance on the COMLEX Level-1: Class of 2018 (r=0.695), Class of 2019 (r=0.698), and Class of 2020 (r=0.747). Based on clear relationships in the data, MU-COM will add a screening test in March 2019 (rather than a barrier examination or cut score). Results from the screening test will place each student into a specific level of phased intervention designed to maximize student performance on COMLEX Level-1. 
Results: We used the progress scores to design more individualized feedback directed at global behaviors (ie,, study skills) and/or discipline-specific (content-focused) achievement. The COMLEX-Level 1 First-time Pass Rate for MU-COM's Class of 2019 was 92.99%. The first time Pass Rate for the Class of 2020 was 98.08%. Presenters will discuss lessons learned and data-driven plans for the future. 
Supplemental Instruction in Medical School Curriculum: Correlating Participation With Performance 
Debalina Bandyopadhyay, PhD1; Martha A. Faner, PhD1; Raquel P. Ritchie, PhD2; Carol A. Wilkins, PhD3; John L. Wang, PhD3 
1MSUCOM Detroit; 2MSUCOM Clinton Township; 3MSUCOM 
Challenge/issue: Biochemistry courses have been traditionally difficult for medical students. At Michigan State University College of Osteopathic Medicine (MSUCOM), we have found that students typically struggle in biochemistry in their first year of the pre-clinical curriculum, which persisted and was demonstrated by poor performance in the biochemistry section of the COMLEX. 
Objective: MSUCOM introduced Supplemental Instruction (SI), an academic assistance program that uses peer-assisted study sessions, to the biochemistry courses of the MSUCOM curriculum. The SI sessions are regularly scheduled informal review sessions in which students compare their class notes, discuss assigned readings, practice problem solving, develop organizational tools, and predict test items. The participants learn how to integrate course content and study skills while working together. The sessions are facilitated by “SI leaders”, students who have previously taken the courses, performed well in them and are model students. Typically, SI is implemented in historically difficult courses in hopes to improve students performance and their overall learning ability. This project proposes to analyze assessment performance by individual students and to correlate the performance with the student's participation in a SI program. 
Approach: Since 2016, regularly scheduled SI sessions, led by trained SI leaders, were offered to biochemistry courses (BMB 515) for students enrolled in Year 1 at MSUCOM. This was the first-time that an academic-assisted program was incorporated inside the MSUCOM curriculum. The SI program is intertwined with the biochemistry course, and the SI Leaders (year 2 medical students) as well as the course faculty work collaboratively to determine the content and execution of the SI sessions. This program is not only unique from a medical school curriculum perspective, but is also different from traditional SI programs. Moreover, MSUCOM has three sites: East Lansing (EL), Detroit Medical Center (DMC), and Macomb University Center (MUC). The roughly 300 students across the three sites in each class receive an identical instructional program and this facet was maintained during the delivery of the supplemental Instruction program as well. 
Results: We found that SI sessions were popular with the students, with 40 to 50% of students attending a high number of SI sessions in Fall of 2016 and 2017. Attendance yielded the most favorable impact for students just above the Pass-Fail line. Students that had a grade of 70 to 79% in the course and attended SI sessions consistently, showed a marked improvement in performance between examinations 1 and 2, the 2 examinations offered in the course. 
Teaching Case Report Writing as Scholarship During OMS-III Clinical Rotations 
Robert C. Bateman, PhD1; Clifford D. Packer, MD2; Rance McClain, DO3; Makayla L. Merritt, PhD1; 1WCUCOM; 2Case Western Reserve University School of Medicine; 3ARCOM 
Challenge/issue: Many osteopathic medical students perform clinical rotations in community-based settings rather than academic medical centers. These clinical sites are often remote from the home school, focused on providing primary care, and provide limited opportunities for engagement in clinical research. Research and other scholarly activities are an important component of medical education and are becoming necessary for even primary care residencies. The challenge is to engage these students in scholarly activity that can be pursued no matter how remote the clinical setting, inexperienced the preceptor, or limited the resources. 
Objective: The objective of the program was to prepare students to find, write, submit, and present at a medical conference an interesting patient case they encounter on their clinical rotations. The goal, encouraged but not required, is publication of the case report in the primary medical literature. 
Approach: William Carey University College of Osteopathic Medicine (WCUCOM) incorporated a case report writing assignment into the OMS III year. Students were required to complete an evidence-based medicine exercise or to write a case report on a patient they encountered during their rotations. Resource materials including assignment instructions, prior examples of student cases, supporting literature, and an evaluation rubric were available and posted on the Canvas Learning Management System. Students submitted their cases via Canvas and the cases were then evaluated with feedback provided by the WCUCOM research staff and clinical faculty. Students prepared for this exercise through exposure to published case reports as examples during years 1 and 2, and later by the introduction to case reports at OMS III orientation. In the 2018 academic year, Dr Clifford Packer, author of the book Writing Case Reports: A Practical Guide from Conception Through Publication, was invited to provide this introduction. Dr Packer also provided continuing education to the WCUCOM faculty on writing and evaluating case reports as well as their history and intrinsic worth. All clinical faculty were provided a copy of Dr Packer's book as a resource. 
Results: The 2018-2019 academic year was the third year of this project. As a part of our initial efforts 2years ago, three students out of approximately 100 wrote reports. Last year, 10 students wrote reports and at least 2 are in the process of publishing them. This year at the OMS III orientation in May 2018, 27 students (25% of class) said they planned to write a case report during the 2018-2019 academic year. In the first half of 2018, third- and fourth-year students gave 31 conference presentations, of which 24 (77%) were case reports. 
NYCOMEC Blue: Osteopathic Webinars for DOs in Residency Training 
David L. Broder, DO 
New York Colleges of Osteopathic Medicine Educational Consortium 
Challenge/issue: As the transition to a single accreditation system nears, for ACGME internships, residencies and fellowships that have not traditionally been osteopathic, it requires creativity to infuse osteopathic content into those programs that are seeking or have achieved osteopathic recognition. Many programs were hesitant to apply for ACGME osteopathic recognition without external support. 
Another significant challenge is assisting the majority of DOs who are training in programs without osteopathic recognition and want to maintain their distinctive philosophy and skills. An opportunity also presents in explaining osteopathic philosophy and techniques to the MDs who train or train with DOs. 
Objective: NYCOMEC Blue was created to address these challenges by leveraging the power of a GME consortium (previously an OPTI) to deliver, biweekly, high-quality osteopathic webinars to all institutions within the consortium. Our primary objective was to promote and facilitate osteopathic recognition of programs. The webinars could be viewed in a group setting within a program allowing discussion and facilitating additional comments from an onsite faculty member. They could also be viewed by individual residents who might be taking a lunch break or some study time or possibly time off outside the hospital. These webinars could then be viewed by residents who are in either osteopathically recognized or “traditional” programs (eg, programs without osteopathic recognition). Although the lectures are aimed at residents, students at NYCOMEC's 4 COM sites and faculty at all NYCOMEC member institutions are encouraged to register for the webinars when their schedule permits. 
Approach: Utilizing faculty from NYCOMEC's 4 COM sites and multiple hospitals it was relatively easy to provide biweekly live webinars that could be shared by all member institutions. The lectures are also archived and available for later learning as well. The webinars are coordinated centrally from NYCOMEC's offices but allow the presenter to be at any location with sufficient computer resources and internet access. This technology allows us to leverage the resources of our consortium and provide education that would not have otherwise occurred. 
Results: We were successful in encouraging and assisting programs to apply for and achieve ACGME osteopathic recognition. Programs still needed to designate on-site osteopathic faculty to provide clinical oversight but can now rely on a strong osteopathic didactic program with minimal effort on their part. Success has been measured by programs both seeking and obtaining ACGME osteopathic recognition. Additionally, DO residents that are in programs that are not osteopathically recognized, viewed the webinars to enable them to maintain their osteopathic philosophy and skills. MD residents and faculty also occasionally watched the webinars to better understand what their DO colleagues and trainees were evaluating and treating. 
Utilize an Undergraduate Simulation Internship Program to Help Achieve Your Program's Mission! 
Joyce A. Brown, DO; Kelly Kohler, MS; Shriman Balasubramanian, OMS II; Jesse McIlwaine, OMS II; Paige Reinfeld, OMS II 
TouroCOM-NY Middletown 
Challenge/issue: A novel undergraduate Medical Simulation Internship program for master's degree students has been developed to meet these needs: 1. Provide a no-cost, qualified workforce to support a growing simulation program. 2. Support the mission of the osteopathic medical school, particularly in the areas of education and service. 3. Provide students in the master's program with critical educational, networking, mentoring and professional development opportunities. 
Objective: Design and execute an undergraduate Medical Simulation Internship to: support the mission of the school by providing opportunities for medical education, community service and scholarly activity, and develop a rigorous academic program to support the internship described above. 
Approach: The Medical Simulation Internship is designed to achieve the above objectives via a predominantly hands-on experience. In this session, the presenters will discuss the objectives, program framework, and outcomes of their Medical Simulation Internship Program and will work with participants to identify similar opportunities at their own institutions. The internship is comprised of students from the College of Osteopathic Medicine's (COM) Master of Science program. Acceptance is based on academic and nonacademic qualifications. The internship is a noncredit, unpaid, program. The program supports the mission of the COM by providing the interns with opportunities in medical education, community service, and scholarly activity. As part of the program, the interns provide service to the school - yielding no-cost labor to expand the workforce of the simulation program. The program provides the interns with clinical skills training; networking; and mentoring opportunities with faculty, physicians, and medical students; that are not available as part of the COM's Master's program. The Internship Program includes activities to enhance the interns’ interest in osteopathic medicine. The interns utilize that knowledge to serve as Ambassadors to their fellow master's students, thereby serving as a recruitment tool for the COM and the field of osteopathic medicine. The program helps advance the field of simulation education by introducing the interns to concepts, equipment and a myriad of simulation-based careers. 
Results: As demonstrated by intern satisfaction surveys and career choices of the participants, the program has enhanced the student's motivation to go to medical school, and their interest in a career in academic medicine. To date, 100% of the interns earned an offer of admission, and subsequently matriculated into the COM. The simulation workforce was expanded by approximately 0.25-0.32 Full Time Equivalents per semester. Unexpectedly, upon their matriculation to the medical school, the majority of the former interns joined the Medical Simulation Program as Federal Work Study students. This influx of experienced workers provided an enduring workforce benefit to the simulation program. Applications to the internship program increased 600%. Due to its success, an internship program for undergraduate students has been started. 
Wellness Education: An Intervention to Address Burnout in Medical Students 
Stephanie A. Bughi-Capecci, PhD1; Chaya Prasad, MD2; Marcel Fraix, DO2; Stefan Bughi, DO3 
1Rancho Los Amigos; 2Western U/COMP; 3University of Southern California 
Challenge/issue: Distress and burnout are both prevalent in the medical profession, beginning in medical students. Both are known to have negative implications health and academic and professional performance, suggesting a need for early intervention. Effective interventions, such as education and awareness, may need to start as early as in medical school, thereby ensuring the development of long lasting resiliency skills. 
Objective: We evaluated the process of integrating wellness lectures into the medical school curriculum, and its role in the development of effective resiliency skills. We also explored students’ personality preferences with the hopes of identifying those students at risk. Offering students at risk an opportunity to understand the nature of the physician burnout epidemic early in the game may potentially prevent burnout and help them develop enduring resiliency skills. Our pilot study targeted first year osteopathic medical students (OMS I). 
Approach: A prospective study was conducted throughout the academic year, with 327 first-year osteopathic medical students. This comprised 5, interactive wellness lectures that addressed resiliency-building skills such as sleep, exercise, meditation, nutrition and time-management. Pre- and post-assessment information were collected using the General Well-Being Schedule (GWB), Maslach Burnout Inventory-Student Survey (MBI-SS), and Myers-Briggs Type Indicator. To ascertain the prevalence and differences in the variables, descriptive statistics and one-way MANOVAs were performed. 
Results: 327 students completed the preassessment survey and 263 students completed the postassessment survey. Prewellness education assessments demonstrated that 22.8% (74/327) of students had severe distress, with high scores on exhaustion in 58.1% (190/327), cynicism in 32.1% (105/327) and low professional efficacy in 67.5% (220/326). Compared with introverts, extroverts noted less depression and greater positive well-being and vitality (P<.01), including high professional efficacy and low exhaustion and cynicism (P<.05). Post-wellness education demonstrated that 21.1% (55/263) reported severe distress, 58.6% (154/263) had high exhaustion, 54.0% (142/263) high cynicism, and 54% (142/263) low professional efficacy. Again, extroverts showed greater positive well-being scores than introverts (P<.01). 
Conclusion: Wellness awareness and education are the first steps in addressing the issue of resiliency building skills. In our study we noted that low professional efficacy had dropped from 67.5% to 54%. Students may have made changes in their study habits, such as using time management skills and taking better care of themselves. Levels of exhaustion and distress generally persisted postassessment. This may be attributed to academic stress. Surprisingly, levels of cynicism escalated in the postassessment surveys. Longitudinal studies assessing students’ distress levels and resilience skills are required to understand the impact of wellness education. Additional efforts, such active student engagement, participation and peer support, are recommended to effectively address wellness in pre-clinical medical education. 
The Practice of Medicine: A Novel Online Course for Clinical Clerks 
Barbara Capozzi, DO 
TouroCOM-NY 
Challenge/issue: Expectations for DO students extend beyond medical knowledge and H&Ps. Clerks must formulate a differential diagnosis, function as accountable team members, implement safety precautions, and contribute to a culture of safety. Students may also be expected to assess the cost benefit of workup and treatment, and understand coding and EMRs. Medical education is limited to basic sciences, systems-based courses, and core clinical disciplines. Most schools do not offer courses that focus on navigating the health care environment, sensitivity to risk/benefit analysis, fiscal awareness, safety challenges, population health, etc. 
Objective: To address these deficiencies, an innovative third year, nonclerkship, 2-week on-line course, (using prerecorded videos), the Practice of Medicine, POM, was developed. The goal was to introduce topics not addressed formally in the curriculum. The objective was to prepare students to integrate optimally into the clinical environment. 
Approach: Students were required to use these videos as a separate, distinct teaching modality during this nonclinical period. This allowed us to deliver content asynchronous with clerkship; accentuate topics; and create a noncompetitive, low-stress environment. Development and implementation were a collaborative effort with an affiliated health system encompassing 6 hospitals. Twenty-five interprofessional education (IPE) leadership members created videos with embedded self-assessment questions, reflective statements, and attestation forms. The course theme is patient safety and quality assurance (QA), highlighting patient care, and underscoring communication and documentation (as required for ICD10, EMR, and risk management). The course recurred every 2 weeks, commencing day 1 of year 3, and included medical presentations (eg, sepsis), supplemented by Aquifer virtual clinical cases. 
Results: A major challenge was to mobilize faculty across 6 hospitals to create a coherent, cohesive curriculum. A subset of faculty were not academicians in the traditional sense. End of course evaluations will provide data-informed guidelines for course revisions. The key factor in success was identifying faculty with expertise to provide a robust curriculum. Faculty feedback was positive, reinforcing our perception that this was a beneficial course integral to clerkship education. Dual feedback will be used to catalyze enhancements. As several of the faculty evaluate these students in clerkships, their feedback will be valuable for course modifications. We will also examine programs at COMs and hospitals. From the student perspective, the course structure (ie, online delivery) permitted flexibility for learning. Depending on the time of year that students are in this course, its impact to influence their clinical experience will vary. Thus, the evaluation will be incremental and sensitive to cohorts. 
Linking Predoctoral EducationWith Osteopathic Recognition and ONMM Residencies. It Is Possible! 
Lisa Chun, DO, MSEd 
Challenge/issue: Maintaining osteopathic distinctiveness remains a challenge. Osteopathic manipulative medicine knowledge and skills are diminish during OMS years 3 and 4 in comparison to OMS years 1 and 2. Therefore meeting the criteria for Osteopathic Recognition can be a realistic concern. However, developing a better understanding Osteopathic Neuromusculoskeletal Medicine Residencies might facilitate addressing this concern. 
Objective: This presentation addresses how what is learned in predoctoral osteopathic medical education can be developed to assist the student to retain integrated OPP knowledge into graduate osteopathic medical education. It also helps to demystify the potential collaboration between NMM specialists and residents in programs with osteopathic recognition. Third, it describes how student and resident clinical rotations with NMM specialists help strengthen osteopathic distinctiveness within the single accreditation system. 
Approach: The approach was to demonstrate and discuss potential models for incorporating the previously identified challenges into a common solution. “Osteopathic distinctiveness” has been a topic of discussion during the transition to the single accreditation system in post-doctoral education. The ACGME recognizes Osteopathic Recognition to offer this distinction. In an AOA poll, more than 70 percent of students indicated that they wanted to continue their osteopathic training during residency. This presentation demonstrated 1 possible adaptation to allowed colleges of osteopathic medicine to not only meet the new COCA standards for teaching osteopathic principles and practices throughout the 4 years of training, but allowed students to train with a residency program, and acquire the skills needed to complete the scholarly activity requirements for an osteopathically focused position. I discuss how the integration of osteopathic recognition and osteopathic neuromusculoskeletal residencies is possible. 
Results: This project introduced ideas on how osteopathic pre-doctoral and osteopathic graduate medical education can collaborate while strengthening opportunities for learning knowledge and skills that can be carried through training in Osteopathic Recognition in graduate medical education. Additionally, collaboration with NMM/OMM specialists was shown to strengthen the pool of qualified applicants for ONMM residency programs as well as address the perceived shortage of NMM/OMM qualified applicants to be eligible as Department Chairs in the discipline of OPP on the predoctoral level. 
The purpose of this presentation was to disseminate information and continue the conversation about achievable relationships among Osteopathic Neuromusculoskeletal Medicine residencies, Osteopathic Recognition, and pre-doctoral osteopathic medical education that will help solidify osteopathic distinction during the period of single accreditation. 
Integration of Experiential Lifestyle Medicine and Wellness Into an Osteopathic Medicine Curriculum 
Tala Dajani, MD, MPH; Aaron Allgood, DO; Shipra Bansal, MD; Noel Carrasco, MD 
ATSU-SOMA 
Challenge/issue: Lifestyle behaviors remain the number one cause of chronic diseases in America and other industrialized countries. A growing body of literature supports lifestyle modification for the prevention and treatment of chronic disease. The osteopathic philosophy emphasizes the observation and evaluation of lifestyle choices that have become a detriment to one's health and ability to heal. Likewise, wellness and self-care are emerging as vital components of the optimal healthy lifestyle. 
Objective: In 2018, A.T. Still University-School of Osteopathic Medicine in Arizona's (ATSU-SOMA) Osteopathic Health and Wellness Lifestyle (OWL) integrated American College of Lifestyle Medicine's (ACLM) learning objectives with an experiential self-care wellness program into the 4-year curriculum. ATSU-SOMA OWL curriculum is an assimilated experiential learning model that provides students the opportunity and resources to grow personally, as well as professionally. Through experiential activities, students are trained to practice self-care as a means to provide quality osteopathic care. 
Approach: OWL is an osteopathic medical education program that infuses lifestyle medicine learning objectives and routine wellness activities into the medical school curriculum in all 4 years. The cognitive education of the principles and evidence of lifestyle medicine are integrated into the existing curriculum map. Using the 5 models of care as our foundation, the ATSU-SOMA OWL program emphasizes 3 major avenues to achieve this goal: the integration of lifestyle medicine didactics into existing curriculum; the experiential learning of culinary medicine and behavior change; and the routine practice of wellness activities and self-care planning. 
Results: Current curriculum design consisted of the integration of lifestyle medicine didactics into existing curriculum, experiential learning of culinary medicine and behavior change and routine practice of wellness activities and self-care planning. Initial student feedback has been overwhelmingly positive with student identifying this curriculum as a need in medical education and relevant to future practice. Optional wellness activities and assessments have had 100% student participation to date. 
Using Illness Scripts to Meaningfully Integrate Basic Sciences Into Clinical Reasoning 
Leslie H. Fall, MD1; Leah Sheridan, PhD2 
1Geisel School of Medicine at Dartmouth / Aquifer; 2OU-HCOM Dublin 
Challenge/issue: The 2015 Institute of Medicine report on “Improving Diagnosis in Healthcare” notes that diagnosis and diagnostic errors have been largely unappreciated in efforts to improve the quality and safety of health care. One of the primary roles of medical training programs is to help learners develop diagnostic decision-making skills, and to do so with graduated levels of independence. Effective cognitive integration of the basic and clinical science concepts plays an essential role in enhancing diagnostic accuracy for novice clinicians. Furthermore, deliberate practice in transferring knowledge obtained in one clinical context to solve a new problem, or the same problem in another context, is critical to the development of clinical expertise. Unfortunately, many students who have demonstrated adequate basic science understanding in the pre-clinical curriculum are often unable to apply this knowledge to clinical problem-solving. Meanwhile, the basic science knowledge of clinical instructors is often encapsulated, challenging their ability to help students integrate basic and clinical science concepts. A process for “unpacking” clinical instructors’ knowledge and reinforcing its connections to clinical decisions would facilitate student activation of their basic science knowledge, improving both diagnostic accuracy and long-term retention. In return, students who are able to use basic science concepts to defend diagnostic decisions may improve their clinician preceptors’ entrustment to allow implementation of students’ provisional decisions. 
Objective: Illness scripts have been shown to be an effective method by which novices learn clinical reasoning skills. Development of ‘integrated’ illness scripts, whereby the key clinical findings of a given condition are clearly combined with the underlying basic science mechanism for each finding, is an effective means for integration of basic science concepts into students’ cognitive representations of core clinical conditions. In this session, participants will learn how to collaboratively develop integrated illness scripts and to apply this cognitive integration method into local curriculum and courses. 
Approach: The workshop directed an interactive group discussion to identify 5 key barriers to integration. Following a brief review of the literature on cognitive integration, illness scripts and their use in clinical reasoning, participants worked in teams of 3-4 to choose a common clinical condition and developed 2 integrated illness scripts to demonstrate the basic science foundation for the presentation of each condition. The session concluded with participants returning to the identified barriers to describe how these integration tools could be implemented at their schools to advance integration. 
Results: At the conclusion of the workshop, participants were provided skills to apply this methodology in the classroom and in clinical settings to facilitate student transfer and articulation of their basic science knowledge directly to their diagnostic decision-making and clinical care. Participants were also provided skills to collaborate effectively with basic science and/or clinical colleagues to develop integrated illness scripts to advance the institution's core curriculum in foundational basic sciences, and transfer to core clinical conditions. 
Incorporation of CASPer Online Situational Judgment Test to Enhance the Holistic Admissions Process 
Stacey L. Fanning, PhD1; Tamie M. Proscia-Lieto, MD, MBA1; Thomas Buskey2; Clayton Karen1; Francis Rose Jr2; Steven Toplan1; Dennis A. Burke, DO2; Nadege Dady, EdD1; Gerald F. Cammarata, PhD2; David Forstein, DO1; Kenneth J. Steier, DO1 
1TouroCOM-NY; 2TouroCOM-NY Middletown 
Challenge/issue: One of the guiding principles of osteopathic medicine is to develop relationships of trust and to deliver patient care with empathy and humanism. Osteopathic medical schools strive to find applicants who will deliver compassionate care with the highest level of ethics and professionalism. However, commonly used medical school admission tools, including personal statements, reference letters, holistic review, and interviews can be unreliable in assessing positive personal characteristics and professionalism. Students with deficiencies in these areas may not embody the osteopathic philosophy. This may result in negative consequences for academic programs, the hospitals and other sites where the students have their clinical rotations, and for the students in question. Programs may incur the burden of addressing behavioral and professionalism issues. 
Objective: The objective of this study was to evaluate the use of the CASPer® online situational judgement test in the COM student admissions process. 
Approach: The CASPer® test is an online situational judgement test that aims to measure personal characteristics such as ethics, empathy, humanism, communication, resilience, teamwork, and professionalism through a series of short video and word-based scenarios with timed open-ended questions. Candidates for the DO program were required to take the CASPer® test as part of the secondary application process. Scores were submitted directly to the TouroCOM Admissions department. Candidates were interviewed by the faculty using the current interview rubric. Interviewers did not have access to the candidates' CASPer® scores. The Admissions Subcommittee incorporated the CASPer® score into the current holistic review process of the candidate to make a final recommendation on acceptance to the Dean. 
Results: The addition of the CASPer® test as an application requirement did not affect the total number of applications received or the demographic breakdown of applicants. CASPer® scores in this cohort were slightly correlated with the Critical Analysis and Reasoning subsection of the MCAT, but not other pre-academic admissions variables such as G.P.A. or total MCAT score. When faculty rubric scores from interviews were assessed, a slight correlation was found between total rubric scores and CASPer® scores—however, faculty admissions recommendations did not always reflect the CASPer® scores. Perceptions of the CASPer® test were assessed via survey administered to test-takers. Overall, most of the survey respondents had neutral to positive experiences with CASPer®. 
Using Technology to Evaluate Student Clerkship Experiences 
Harold R. Garner, PhD; Fred Rawlins, DO; Cameron Sumpter; Dixie Tooke-Rawlins, DO 
VCOM-VC 
Challenge/issue: Accreditation agencies require that Colleges of Osteopathic Medicine demonstrate that their students receive similar clinical education experiences at each distributed site. 
Objective: Our approach to addressing this accreditation requirement was to quantify the clinical experiences for all students during clinical rotations. Our goal was to develop a software “app” that was very fast and easy to use where students could quantify their patient encounters via ICD-10 codes. Those entries were compared with educational expectations (procedure logs, learning objectives) to assess the statistically significantly different variation among students, rotations and rotation sites. 
Approach: VCOM developed and deployed a system to capture information about each student's clinical experience. This web-based system, CREDO, enables students to quickly and easily record diagnoses, procedures and drugs for each clinical encounter using universal WHO ICD codes. 
Results: Over the 2017-2018 third year clinical rotation period, students had over 90,000 patient encounters across 337 hospital and clinic sites. The authors annotated rotation procedure logs, reviewed and questioned ICD codes, and developed a system in real-time to deliver quantitative metrics of learning fulfillment to students, preceptors and administration, and interactive board review information matched to each specific encounter. As the system has learned, CREDO also provides preparatory information in the form of rotation primers based on the most frequent diagnoses, procedures and drugs previously logged in each rotation. The system provides a variety of statistical performance metrics to school administration for each student, site, rotation and review information. To specifically address the recent site uniformity accreditation requirement, the system allows us to monitor the raw number of entries per student for a given rotation and site, a measure of the relative student-patient engagement activity at a given site. Over the 2017-2018 rotation periods, our students rotated into 337 different clinics/hospitals. All sites were within 1 standard deviation of the average activity, except for 9% of sites that were 1 standard deviation above average. Another metric, the breadth of exposure to differing clinical presentations and procedures specific to each rotation specialty, demonstrated that 12% of the sites were 1 standard deviation above average in breadth, while 11% of the sites were 1 standard deviation below average. These numbers indicate, preliminarily, that the student activity at each site is quite uniform, but, for certain sites, the spectrum of patient clinical presentations was narrow. A real-time demonstration of the system was presented and demonstrated a variety of output metrics designed to help optimize student clinical rotation training. 
COMKits: An “In the Box” Approach to Community Outreach and Student Engagement 
Callie A. Gibson, OMS II 
NYITCOM A-State 
Challenge/issue: Patterns, trends, and associations across the nation agree that health education is necessary in secondary and primary schools. Unfortunately, implementing health education is often limited by resources and assets. Additionally, exposure to osteopathic medicine is still limited in many parts of the country. The COMKits program was created as an answer to these challenges by employing the desire for NYITCOM at Arkansas State to invest in the health education of their local community while emphasizing the role of osteopathic physicians in community education. Pioneered by a former-teacher-turned-medical-student, COMKits apply medical student skill, knowledge, creativity, and passion directly to the community. 
Objective: The goal of COMKits is to create an educational health outreach program that can be seamlessly implemented into community schools and organizations by using existing state standards for educational curriculum. Lesson plans for COMKits integrate health and physical education curriculum within “core” subject curriculum such as math and science. Primary and secondary students are also introduced to the ideas of osteopathic medicine. The construction of COMKits provides meaningful roles for medical students to invest in their communities and exemplifies NYITCOM at Arkansas State's desire for community commitment. Lastly, it is important to open an opportunity for direct data collection from the community, and it is necessary for COMKits to be a sustainable product to maximize program effectiveness and longevity. 
Approach: COMKits were created by researching curriculum standards to develop integrated lesson plans for elementary and high schools. The first COMKit integrates sexual health education with biology-targeted virus curriculum for high school students. Another kit combines Second grade data collection with bone identification and the first Osteopathic Tenet. Containers are organized to equip educators with a lesson plan, student workbook materials, and nonconsumable supplies for hands-on activities. The NYITCOM at Arkansas State Library implements the COMKits program by coordinating with community schools and allowing educators to access the kits on a check-out basis directly from the College of Medicine. 
Results: Matching core subject material with health curriculum requires some experience in education and proves to be time-consuming. However, approaching health education in this way could lead to better health outcomes for children and teenagers while familiarizing them with the osteopathic field. COMKits impact primary and secondary school learners by bringing new and innovative resources directly to their classrooms, and it impacts the medical student by providing a meaningful opportunity to use skills. Extension of the COMKits program may include data collection to investigate the ideas and reflections of teachers and students about the effectiveness of health education in the classroom. Most importantly, the COMKits program fosters relationship development between community educators, the College of Medicine, and future physicians. This program can be implemented at any college of medicine where there are staff, faculty, and students willing to engage with their community. 
Creating a CLER Path for Osteopathic Sponsoring Institutions 
Victoria Hanlon, MS 
Jefferson Health-Northeast 
Challenge/issue: As new institutional sponsors of graduate medical education under the ACGME, osteopathic Sponsoring Institutions (SIs) are new to the CLER program. Common structures of osteopathic sponsored GME programs, including consortiums and small community-based single program hospitals, present challenges in Clinical Learning Environment (CLE) oversight. Consortiums are large in size and scope, often spanning an entire state, or even multiple states. Facing different, but just as challenging issues, are small SIs that often lack in diverse resources in many of the CLER areas. 
Objective: To prepare institutional GME leaders to guide their SIs through CLER in order to better align GME and the institution, and to improve the clinical learning and working environment. 
Approach: Multi-program institutions are on their third round of CLER site visits and single-sponsor institutions are on their first round. Taking data and lessons learned from early CLER visits, as well as the new ACGME requirements around the clinical learning environment, new methodologies can be developed to prepare new SIs for CLER before the institution receives the first CLER report back with baseline data. While CLER is not tied to accreditation (other than the fact that each SI must undergo a CLER site visit) it has become increasingly important, as shown by the revisions to the ACGME Requirements, for SIs to have an effective oversight mechanism of the CLER focus areas, and a defined plan to engage key stakeholders. Templates, including CLER data collection tools, will be provided to attendees to use in their own institutions. 
Results: A goal of both the CLER program and of GME leaders and educators is having a well-documented institutional plan for CLER which improves the environment in which trainees learn and work, and better prepares them for providing safe, high quality patient care. After this intervention, GME leaders were better prepared to educate institutional stakeholders and collaborate with them to implement interventions to improve aspects of the clinical learning environment. Key factors to success included communicating with institutional stakeholders consistently and educating them on the CLER program. CLER is a culture and practice change that takes persistence and ongoing effort, so the development of a CLER scorecard to measure and visually communicate data was shown to be an effective tool to engage GMEC, institutional leaders and the C-suite. Obstacles encountered included lack of knowledge and resources, difficulty of data collection, and lack of engagement. 
Osteopathic Clinical Integration: Bringing Osteopathic Principles and Practices to the Clinical Years 
Tami Hendriksz, DO; Nicole Pena, DO; Zachary Anderson, OMS IV; Stacey L. Pierce-Talsma, DO 
TUCOM-CA 
Challenge/issue: Many osteopathic medical schools struggle with the challenge of continuing to expose their students to Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practices (OPP) during the clinical years. Across the colleges of osteopathic medicine, our students note the lack of osteopathic integration and education across their clinical clerkships as is clear from the AACOM 2016-2017 Academic Year Survey of Graduating Seniors. This survey illustrates that 17% of students ‘strongly disagreed’ and 31% ‘disagreed’ that “OPP were well-integrated in each clerkship.” OPP and OMM curriculum in the third and fourth year are opportunities for our students to continue to develop their OMT skills and apply what they have learned in a clinical setting on real patients. Despite this opportunity many of our third and fourth year students report little exposure or integration of OMT or OPP.1 A 2004 study found that only 30% of third and fourth year students perceived there to be enough OMT training in the clinical setting with further drops in residency.2 Additionally, only 34% of students surveyed had opportunity to practice OPP on in-hospital rotations or ambulatory non-primary care rotations.2 
Objective: The Osteopathic Clinical Integration Course at Touro University California College of Osteopathic Medicine is a longitudinal course that takes place during the third year. The primary objective of this course is for learners to review the foundational concepts involved in being an outstanding osteopathic physician including advanced medical knowledge, clinical skills, communication and professionalism in the application of osteopathic principles and practices and the use of OMT. 
Approach: The Osteopathic Clinical Integration Course contained asynchronous and synchronous learning designed to engage learners at their convenience, during any rotation, while transcending the challenges of learners being physically placed at sites distant from the main campus. Online components included OMM logs, OMM e-Conferences, case based COAR modules (Clinical skills, OMM, Anatomy, Radiology), and required and optional readings. In-person, hands on sessions occurred at each clinical site, or, students rotating near campus could attend campus-based COAR sessions. Each of these components was part of the Osteopathic Clinical Integration Course but was also integrated within each core and elective rotation. All students were assessed on their clinical competency during their Spring Callback Session via an osteopathic SOAP Note, diagnosis and treatment session, OMM COMAT, as well as OPP specific content in their OSCEs. One of the key factors to our success in implementing a third year curriculum was the development of the position of Director of Distance Learning & OMM Clinical Integration. This is a dedicated faculty member who provides resources, connection, oversight and delivery of this curriculum. 
Results: We closely monitor our students’ performance on standardized national testing (COMLEX and COMAT), as well as our OSCE, COMLEX L2 PE and OMM Assessments. Of particular significance has been the increase of the TUCOM students’ scores on the OPP COMAT (from an average of 100.6 prior to the start of the Osteopathic Clinical Integration course to >104). This represents an increase of 3.6 points above the national mean. Further outcomes for tracking may include use of OMT during clinical rotations, and future use of OMT or referral habits in clinical practice. 
A Clinical Reasoning Activity to Foster Interprofessional Collaborative Practice in DO and PA Students 
Sherry Jimenez, EdD; R. Christopher Yonts, DO; Stephen Noe, MS; Anya Cope, DO 
LMU-DCOM 
Challenge/issue: Ensuring IPE is present in all 4 years of the DO curriculum. Element 6.8 of the Commission on Osteopathic College Accreditation reads, “Interprofessional Education for Collaborative Practice: (CORE) A COM must ensure that the core curriculum prepares osteopathic medical students to function collaboratively on health care teams by providing opportunities, in each year of the curriculum, to learn in academic and/or clinical environments that permit interaction with students enrolled in other health professions degree programs or other health professionals.” This intervention focused on IPE in the second year. 
Objective: During the activity team members were assessed on their ability to demonstrate competencies in three of the 4 IPEC competency domains: Roles and Responsibilities, Interprofessional Communication, and Teamwork. A rubric was used to determine whether groups met each competency or demonstrated 1 or more deficits. 
Approach: This intervention described an activity where students from the school of osteopathic medicine and physician assistant programs at the Lincoln Memorial University DeBusk College of Osteopathic Medicine (LMU-DCOM) worked in teams to obtain the appropriate information from a patient, communicate findings to all team members, use clinical reasoning to construct a team assessment and plan, and document the results of the process with a SOAP note. 
Results: Three hundred four students participated in this activity. Ninety-four percent, 92%, and 95% agreed/strongly agreed that this exercise was helpful in preparing them for clinical rotations, they learned more about what someone in another professional line was capable of doing in a clinical setting, and recommend this exercise for future students, respectively. Additional information including aggregated/de-identified team performance data and rubric will be shared with attendees as well as recommendations for improvements. 
Population Health in the Delta: Addressing Poverty as a Social Health Determinant 
Sloane G Kelley, MS; Brookshield Laurent, DO 
NYITCOM A-State 
Challenge/issue: Poverty and health disparities are inherently related. “The nature of the medical profession places physicians in the apex of trust and advocacy for their patients. However, results of a study questioning residents’ perceptions of patients in poverty show that 25% thought poverty was a consequence of laziness, 50% thought the poor were more likely to abuse the health care system, and 50% thought the poor were less attentive to their health than the rest of the population. (Loignon, C., Boudreault-Fournier, A., Truchon, K., Labrousse, Y., & Fortin, B. (2014)Medical residents reflect on their prejudices toward poverty: a photovoice training project. BMC Medical Education, 14, 1050) The Delta is defined by the Delta Regional Authority as 252 counties in 8 states. There are established links between poor health and lower socioeconomic status that result in additional obstacles for physicians to overcome when treating these patients. If health care entities in the Delta do not appreciate or understand the difficulties of the residents in the region, their interventions will not be effective or have a long-term impact. Approximately 12.3% of the United States population lives below the poverty threshold; in the Delta region the poverty rate is 17.4%. Statistics from the CDC indicate that infant mortality rate, cancer, and heart disease are 20% higher than the national rates. 
Objective: The objective of the population health certificate program at NYIT-COM at A-State is to develop and train future osteopathic physicians to identify and address social determinants of health to provide holistic care for their patients and communities. Within the certificate program, we address poverty as a social health determinant and train students on how to apply basic knowledge of poverty and choose appropriate responses to health care issues for patients living in poverty-stricken circumstances. Through these attained skills, student doctors will be better equipped to address the key drivers for prevalent regional health issues. 
Approach: NYIT-COM at Arkansas State University is situated in the heart of the Delta in Jonesboro, Arkansas. In order to adequately prepare students for patient encounters in the region, NYITCOM has established a poverty course within the Population Health Certificate Program, based on the framework “Bridges to Health and Health Care” developed by Ruby Payne and Terie Dreussi-Smith. The certification program bridges this foundational framework into application. Through the learning methods of didactics, group simulation exercises and standardized patient cases students address personal biases against individuals in poverty, gain understanding of the conditions that lead toward poverty and are instructed on how to effectively build mental health plans and impact documents for disease management within an interprofessional team. Furthermore, Cased Based Learning exercises were used to instruct students on how to assess a patient's social barriers during office visits and link them to appropriate services. 
Results: With the knowledge of trends indicating the intricate relationship between health care and poverty, the course on poverty within the population health certificate program was developed to help bridge the gap of communication and understanding between physicians and patients. We are currently in the first year of implementation. We have surveyed our students on attitudes and understanding of people in poverty-stricken circumstances. Qualitatively, students stated that after the course that they had a better understanding of the lives of their patients living in poverty, awareness of their patients’ circumstances impacting their care, and the importance of effective communication across all classes. Through continued surveillance of our students throughout their education and professional continuum, we expect to see demonstrations of their understanding of social health determinants and will engage in advocacy for their patients. As these rising physicians gain a greater understanding of health disparities in their region, they will be empowered to be responsive to achieving the desired health outcomes for their patients and community. 
Developing a Workforce to Address the Growing Needs of Older Adults Through Interprofessional Education 
Janice A. Knebl, DO1; Jennifer Jurado Severance, PhD1; Lynn Wilson, DO2; Nyann Biery, MS2 
1UNTHSC/TCOM; 2Lehigh Valley Health Network, Geriatric Workforce Enhancement Program 
Challenge/issue: Older adults are among the fastest growing age group in the United States, use many health care services, and have complex conditions. Interdisciplinary team-based care holds promise for addressing the complex needs of older adults that are inextricably linked to social and environmental factors. Collaborative community partnerships provide an opportunity for unique interprofessional education experiences for medical students and residents in the care of older adults. 
Objective: The objective of this project was to educate future physicians about issues and strategies related to geriatric care, 2 HRSA-funded Geriatrics Workforce Enhancement Programs (GWEP) at an osteopathic medical center, and a dual-accredited community-based medical center partnered with multiple community providers. Geriatric training also focuses on patient-centered and interdisciplinary collaborative approaches that incorporate nonclinical factors influencing health outcomes for older patients. 
Approach: The University of North Texas Health Science Center (UNTHSC) integrated health literacy strategies and tools into curricula for teams of students (n=623) in multidisciplinary health teams paired with a senior mentor and medical and pharmacy students (n=125) providing health promotion presentations at senior centers. UNTHSC also developed an interprofessional case-based experience as part of a mandatory CORE Geriatrics Clerkship. Lehigh Valley Health Network (LVHN) integrated multidisciplinary care teams consisting of Guided Care Nurses (GC-RN), Community Health Workers (CHW), and Pharmacists into primary care residency practices to care for elderly patients (n=556). The care teams support care coordination, self-management and care transitions for elderly living in the community through home visits. LVHN also implemented these interprofessional teams to shape the experiential learning of students on rotation at the primary care residency practices. 
Results: UNTHSC trainee evaluations show increased awareness of considerations in caring for older adults and increased confidence in caring for geriatric health issues. Innovative, cross-sector approaches to health literacy training may increase students’ and residents’ knowledge, skills, and confidence in communicating with older adults about health issues and can prepare future health professionals for collaborative geriatric care. Findings show that 74% of students paired with senior mentors agreed the training helped them understand how to effectively communicate using health literacy principles and strategies. Ninety percent of students presenting in senior centers reported more confidence when talking with older adults about health care needs and instructions. At LVHN, the evaluation team administered validated measurement scales to assess the attitudes of clinicians, residents, and other staff toward interprofessional teams and geriatric patients at the primary care residency practices. The McMaster-Ottawa Team Scale is an assessment tool for team performance and was used by nursing students (n=20) during their clinical rotations with the interdisciplinary team. The interdisciplinary teams received above average scores from the students, showing above an expected level of collaboration at least 75% of the time in all the measured domains. Evaluations of the residency practices using the Assessment of Inter-professional Team Collaboration Scale (AITCS) demonstrated increasingly positive attitudes toward geriatric patients and interprofessional teams over the course of the GWEP grant at LVHN. This standard scale is used to measure cooperation, coordination, and partnership in interprofessional care. These innovations demonstrate how integrating program evaluation data as part of quality improvement cycles helps faculty make the necessary modifications in curricular content. Developing model sites for geriatric team-based care can support a faculty's teaching of future physicians to meet the needs of older adults in primary care. 
Chicago College of Osteopathic Medicine Professionalism Course 
Patricia K. Krohmer, MS, MBA; Lisa Szymanski; Emily Whitis, MA; Tina Marino, MEd 
CCOM/MWU 
Challenge/issue: A Professionalism Task Force was created within the Chicago College of Osteopathic Medicine (CCOM) to address medical student professionalism issues not consistent with a course failure. 
Objective: remediation tool was designed for students who previously appeared before the Promotions Committee, to address professionalism issues that could potentially derail the students' medical career. 
Approach: An online course was created with modules based on the previous professionalism issues noted by the committee. The following modules were created: Communication, Email Etiquette, Time Management, Civility and Compassion, Team Building, and Ethical Decision-Making. 
Results: Students now appear before the Professionalism Task Force for direction. Pre and Post assessment are completed by each student enrolled. 
Data-Driven Approaches to Student Success at a College of Osteopathic Medicine 
Timothy Leonard, MD, PhD; Matt Pelletier, PhD 
LUCOM 
Challenge/issue: The development of a new medical school is a challenging task requiring several important policy decisions. A COM must address needs and concerns from both potential and current students, COCA, and possibly a parent or affiliated institution. 
Objective: We aim to make evidence-guided decisions regarding admission standards, student progress in both the preclinical and clinical years, policies related to releasing students to take COMLEX, tracking student performance across the curriculum, and helping students navigate the match processes 
Approach: We have used novel tools and approaches to collect and analyze large data sets for continuous quality improvement related to admission practices, curricular strengths and weaknesses, communication with advisors when students are at-risk academically, determining when students are eligible for COMLEX Level 1, and helping students make informed decisions when applying to residencies. We have also developed Excel-based tools for analyzing the learning objectives and the assessment of those objectives across the curriculum. We can easily search for keywords in learning objectives across the entire curriculum to get a snapshot of where topics are covered across the first 2 years. These searches allow the user to use several logical operators (and, or, not), and ultimately are helping us identify areas of redundancy as well as curricular gaps. We can also easily generate and e-mail custom reports to students regarding how they are doing in specific disciplines, communicate outcomes to academic advisors, and help students understand their competitiveness for matching in given specialties. 
Results: As an example of the utility of these approaches, a predictive model (PM) to assess COMLEX Level 1 readiness was developed using multivariable regression analysis. We have found among the variables analyzed, the best predictors at LUCOM of Level 1 performance are the biomedical examination average in the second pre-clinical year, along with student performance on COMSAE. We have used this model to promote student success. With the development and implementation of this PM, COMLEX Level 1 failure rates have decreased to one-half to two-thirds of the failure rate for the inaugural class, even though there has not been a large change in the academic qualifications of students who matriculate. Ongoing statistical analysis is being used to determine the best pre-matriculation predictors of success at LUCOM. We strive to apply evidence-based tools to pair student success with our core mission and vision from matriculation to graduation and practice. Some of these tools will be demonstrated during the presentation. 
Health Systems Science: Community Clinic-Based Collaborative Care Practice 
Lise McCoy, EdD1; Christine Morgan, EdD1; Felipe Perez, DO2; Ray Wagner, MD1 
1ATSU-SOMA; 2The Wright Center for Graduate Medical Education 
Challenge/issue: Preparing osteopathic medical school graduates and residents to employ Health Systems Science (HSS) competencies is essential. Described as the third pillar of medical education, HSS provides “new physicians a broad view of the societal influences and administrative challenges that sometimes complicate patient care.” (Skochelak et al, 2017.) 
To integrate the collaborative practice attributes of HSS into the curriculum, we sought to design a collaborative practice experience for medical students and family medicine residents during clinic hours; to connect and sequence HSS competencies from undergraduate to residency-level clinical training, and involve residents in leading the Interprofessional Education (IPE) clinic; to challenge preceptors to integrate a siloed system and synchronize interprofessional training time; to design an evaluation plan that measures the impact of interprofessional teamwork on patients; and to design a cost-effective collaborative environment. 
Objective: To teach these principles, a project was developed to design and pilot a new “IPE Clinic” hosted by a community health center, managed by osteopathic family medicine residents. The aim of this pilot study was to explore the potential of the clinic in 5 aspects: 1) clinic design, 2) medical student perception of value of learning, 3) patient satisfaction, 4) patient outcomes as measured by the completion of diabetic care guidelines, or screenings, as documented in the EHR, and 5) themes involving clinic cost effectiveness. 
Approach: From March 2018-August 2018, a team of ATSU-SOMA faculty conducted a study at El Rio Health Center in Tucson, Arizona. Over the course of 4 months, we observed the clinic and collected data from 10 medical students via electronic survey and 35 patients via electronic health records and patient satisfaction surveys. This study was exempted by the ATSU Institutional Review Board and received approval from the El Rio Clinic. A team comprised of family medicine, dental and pharmacy residency directors worked cooperatively to design and implement a new IPE clinic. Osteopathic family medicine residents managed the clinic and coordinated care for a panel of vulnerable patients. Medical students, family medicine residents, dental students/residents, and pharmacy students/residents. 
Results In terms of clinic design, the study resulted in a description of the clinic, a stepwise sequence for setting up an IPE clinic, and a ‘problems and solutions’ chart for solving design challenges through PDSA. Seven of 10 OMS II rotating through this clinic volunteered to respond to the ‘IPE experience /value of learning’ survey. Of these, the average number of experiences in the clinic was 2.5, and 86% were willing to participate in the clinic again. This group of OMS II provided suggestions for improving the clinic, such as requesting more time to debrief, and refining approaches to reduce patient no-shows and downtime in the schedule. With respect to patient satisfaction, 35 patients responded to a patient satisfaction survey distributed by the clinic. In response to the prompt, “How well did the staff work together as a team to take care of you?”, patients responded excellent (51.43%), good (45.71%), and fair (2.86%). Patient outcomes were measured by diabetes screenings completed, and a comparison of the IPE clinic with the control clinic generated no statistically significant differences in completion rate for eye examinations, foot examinations, Hb1AC, and micro albumin. There was a higher rate of completion of the lipid profile screen in the control clinic (100%) vs the IPE clinic (68.2%), P=.001. In terms of clinic cost factors, 4 themes emerged from researcher field notes: patient encounters, physical examination space, resident and attending time and cost, and interdisciplinary billing/coding. In designing the clinic to optimize costs, it is essential to maximize the number of patient encounters. To support a large number of patients, the clinic needs enough examination rooms to allow for many concurrent patient encounters. It is also important that the dental suite is located near the primary care clinic. Prior to IPE clinic launch, the clinic should estimate the minimum number of patients each resident should see, and factor in teaching time, such as facilitating the morning huddle with the trainees. The clinic should streamline the system for billing and coding across primary care, dental and any other providers involved in patient care. 
Promoting Resiliency and Preventing Burnout in Future Physicians 
Józia McGowan, DO; Robert Jason Walker, PhD 
KCU-COM 
Challenge/issue: The onset of burnout is often referred to as a psychological disruption that is characterized by individualized feeling of emotional exhaustion, depersonalization, and a lack of self-achievement. Recent findings have identified higher rates of stress, burnout, and self-harm among physicians than in nonphysician groups 
Objective: Does implementation of small group interactive sessions with inclusion of various elements of mindfulness alter perceived burnout in second year medical students? 
Approach: A pilot study was conducted with a set of bi-weekly small group interactive sessions to a cohort of OMS II students that include information related to mindfulness, reflection, shared experience, and small group learning. Faculty and staff facilitators guided these sessions designed to reduce emotional exhaustion and depersonalization, and to promote a sense of personal accomplishment among this group of osteopathic medical students at KCU-COM. Specific time points were scheduled to administer the Maslach Burnout Inventory (MBI) to all osteopathic medical students in the Fall Semester as a baseline for the study. Students who participated in these sessions repeated the MBI after completion of the series of small group sessions. 
Results: After completion of the series of small group interactions, students expressed improvement in feelings associated with burnout, as well as an improved confidence in being mindful as it relates to academics as well as personal wellbeing. Further results indicated that students would prefer more and earlier implementation of these small groups so that the small groups become more preventative than treatment oriented. 
Finding the Best Fit: Integrating Library Instruction Into Medical Education Curriculum 
Molly Montgomery, MLS1; Lori Fitterling, MLS2; Erin Palazzolo, MLS3; Norice Lee, MLS3 
1ICOM; 2KCU-COM; 3BCOM 
Challenge/issue: As osteopathic universities develop, define, and revise medical education curricula, librarians have faced challenges in finding the best fit for integrating library instruction within the core curriculum. Specific issues addressed in this presentation include: How does the library optimally support teaching and learning research and evidence-based practice in a systems-based curriculum?; How does the library address potential redundancies with other course sessions as it integrates instruction on evidence-based medicine, medical informatics, and data management?; and How does the library incorporate core competencies within library course instruction? 
Objective: Our objective was to demonstrate how three osteopathic libraries have integrated, or plan to integrate, library instruction into the curriculum of each respective institution. 
Approach: The first osteopathic library adapted their fully integrated course by eliminating the previous grand rounds case presentations and focusing on library instruction with an emphasis on using current resources for each section. This provided opportunities to underscore evidence-based medicine and literature searching skills. All learning objectives are linked to systems topics, informatics tools and databases, AOA Core Competencies and the EPAs when appropriate. The curricula at the second osteopathic library qA evolving while being integrated into a primary care course that is undergoing refinement. The library curriculum focuses on evidence-based practice (EBP), literature searching skills, health literacy, and the ethical use of information. Further, the library is working with course directors to incorporate EBP skills into active learning activities within the systems. The librarian at the third and newest of these osteopathic schools is approaching library involvement at the ground level by serving on the Curriculum Committee. In this capacity, the librarian has the ability to advise on how to best support the objectives of each course and ensure that the library is a part of instruction related to research and/or EBM. 
Results: By team-teaching evidence-based classes with biomedical and/or clinical faculty, creating and delivering medical informatics and information literacy courses, serving on curriculum committees, mapping course objectives to core competencies, and adapting to changes in course offerings, librarians at three osteopathic schools have developed multiple strategies to deliver quality library instruction within the curriculum. 
Revitalizing Shared Governance at Ohio University Heritage College of Osteopathic Medicine 
Erin R. Murphy, PhD1; Susan H. Williams, PhD1; Jody Gerome, DO2; Kenneth Johnson, DO1 
1OU-HCOM; 2AACOM 
Challenge/issue: The Ohio University Heritage College of Osteopathic Medicine was founded in Athens, Ohio in 1975 with an entering class size of 24. HCOM has since grown to a total of 814 students on 3 academic campuses and 12 clinical campuses across the state. Much of this growth is due to the recent addition of 2new preclinical academic campuses, 1 in Dublin, Ohio with support from the Osteopathic Heritage Foundation and 1 in Cleveland, Ohio in collaboration with the Cleveland Clinic. Because these campuses have faculty and administrative support nested under the historically Athens-based academic department and leadership structure, we have had to revisit our governance policies and procedures. Moreover, college by-laws specifying the faculty's role in governance had not been formally or thoroughly reviewed to accommodate increased numbers of faculty distributed across the 3 campuses, and governance had largely been based around oral tradition. The increased organizational complexity in a time of transformational growth coupled with a lack of clarity in decision-making processes necessitated a review of both structure and function within HCOM, particularly with respect to shared governance and faculty responsibilities therein. 
Objective: Given these dramatic changes in the college, in 2016 a group of elected faculty were tasked by the Executive Dean with leading an initiative to develop a structure for shared governance that was inclusive, sustainable and that enhanced organizational effectiveness for all stakeholders. 
Approach: In collaboration with the Association of American Medical Colleges and the Executive Dean, elected faculty leaders facilitated a variety of activities to open dialog on a shared vision for roles, responsibilities, and governance. At the same time, confidential individual interviews were conducted with faculty, staff and leadership at all three campuses to better understand organizational culture. 
Results: With broad input from faculty, staff, and leadership, principles for shared governance were developed that emphasize collaborative decision-making, transparency in roles and responsibilities, and open communication. Additionally, these principles stressed solution-focused dialogue based on the assumption that all individuals are working in the best interest of the college. In parallel with the development of shared governance principles, a new organizational structure is being implemented that leads to more transparent decision-making and implementation responsibilities within the college. Finally, an Ad Hoc Committee on Shared Governance consisting of faculty, staff and leadership was ultimately created, with a primary charge to implement the principles within the college. The adoption of principles as well as improved organization structure is expected to lead to greater transparency in decision-making and a collective sense of shared responsibility among all stakeholders. 
Applying the New NBOME COMLEX Blueprint to Preclinical Exam Tagging 
Michael W. Oglesby, PhD1; Leslie Wimsatt, PhD2; David Mason, DO, MBA1 
1UNTHSC/TCOM; 2DMU-COM 
Challenge/issue: In preclinical examinations, what do we test, how do we know if it is the right material to test, and how well does it align with previous teaching and testing? The NBOME has recently released its COMLEX Blueprint 2018-2019 that can be used to explore these test construction issues, but most medical educators have not yet had the opportunity to explore its application. Examination items have primarily been used to assess competencies in the Medical Knowledge and Patient Care domains. It has arguably taken the emergence of Entrustable Professional Activities to highlight the importance of reliable and valid assessments of physician task performance that provide clinically-relevant evidence of student competency attainment. This workshop will provide participants with an opportunity to explore how tagging examination items by physician task can positively inform both curricular design and student learning assessment. Practice opportunities will allow participants to tag examination items and discuss implications of this approach. 
Objective: A primary objective of this workshop was for participants to gain facility with tagging examination items using the NBOME COMLEX Blueprint 2018-2019 as a guide for selecting appropriate patient presentations. To this end, item tagging was explored in detail at the origin or cause of the patient presentation as related to the tagging of physician tasks. Participants practiced this approach to gain facility in making systematic tagging decisions. 
Approach: Workshop facilitators and participants explored various aspects of the Blueprint, including: 1) the power of patient presentations in defining what should be taught and assessed during medical school; 2) the necessity for expanding patient presentations to explicitly address common and important causes of the presentation; 3) how guidance concerning use of the differentials affiliated with each patient presentation is required to ensure consistency in item tagging. Organizers then shared approaches to tagging that specified patient presentation, differential, and physician diagnostic task(s), describing symptomatology and/or treatment/management. Participants had the opportunity to categorize several examination items to demonstrate facility with the process. Organizers and participants addressed limitations to this approach, including the problem of factual recall Items that are not set within the context of patient presentation. Case-based discussions were used to emphasize how tagging shapes the content and format of test items and improves their quality, resulting in more consistent examinations. Participants engaged in item tagging using an approach that focused on physician tasks: 1) diagnosis; 2) application of basic science information; 3) treatment/management. The workshop also addressed important issues related to faculty training, data input/integrity, and the obligation to provide numerous practice items if examinations are designed as summative. 
Results: Participants were to develop facility with tagging examination items within the context of physician tasks as those tasks relate to specific medical problems. Participants were to recognize that a systematic approach to item tagging provides a foundation for realistic assessment of the alignment between curriculum content coverage and student competency attainment. 
Measuring the Impact of the ‘DREAM’ Program on ‘URM’ Participants Considering a Career in Medicine 
Mirabelle E Fernandes Paul, EdD; Jan Garo, BA; Omar Rachdi, BS; Jordan Bilbrew, BS; Giulia DiBella, BS 
Western U/COMP-Northwest 
Challenge/Issue: According to the American Medical Student Association (AMSA), diversity among the student body facilitates cultural competence in medical education. A study conducted at UCLA found that medical students who attend racially and ethnically diverse medical schools feel that they are better equipped to serve a diverse patient population. Physicians from under-represented racial/ethnic groups are likely to be able to better identify and empathize with racially/ethnically marginalized patients. AMSA also discusses that under-represented minorities (URM) physicians are more likely to practice in underserved communities. Hence having a diverse medical student body is important on many fronts. However, current levels of diversity among current medical student does not reflect the diversity of the US population. Even though we believe that the tenets of osteopathic medicine would align with students of all backgrounds, osteopathic colleges struggle even more than allopathic colleges in URM student recruitment. Our college, being one of them. 
Objective: Create a workshop for URMs to learn more about how to become an osteopathic physician. 
Approach: The workshops and talks given during the program were carefully chosen to counter dis-empowering messages and the lack of role models while equipping aspiring DREAMers with skills and understanding of the medical school application process. Participants were surveyed before and after the program to 1) measure the impact our program had on their interest and in pursuing medical school 2) gain insight into URM's perspective on their own health care experiences in the US. 
Results: We created the DREAM (Diversity Recognition Emphasized and Assimilated into Medicine) program, a two-and-a-half-day summer program that was carefully designed to equip URM students who have a desire to be physicians but are denied the same messages and resources of empowerment that their non-URM counterparts have received early on. 87.5% of participants feel that a physician of the same race/ethnicity could understand them and empathize with them better than a physician of a race/ethnicity different from their own. Lack of exposure was also found to be the largest obstacle for our participants (over 80%) in their journey for pursuing medical education. Based on a Likert Scale, 1 being no understanding and 5 being complete understanding, the P values of .004, <.001, and .008 were gathered from the following questions: “How comfortable are you with the medical school application process?”; “What is your current level of understanding of what being a medical student entails?”; and “What is your current level of understanding of the difference between allopathic physicians and osteopathic physicians?”, respectively. These P values show statistically significant increases on a Likert Scale for the above statements. After the program was over, 5 students sought further premedical counseling/resources directly from COMP-Northwest outside of the DREAM program including meetings with the office of professional development, conducting mock interviews, and post-application follow-ups. Five DREAM students applied for the COMP-Northwest DO Class of 2023, three have interviewed, and 2accepted seats. The DREAM Program had its second cohort of 22 participants finish early August of 2019. This data is being complied and will be released in 2020. 
“Roots to Wings”: A Partnership Response to the Shortage of Native Americans in Osteopathic Medicine 
Mirna I. Ramos-Diaz, MD 
PNWU-COM 
Challenge/issue: By 2030, current estimates predict over a 100,000-physician shortfall in the US workforce. There appear to be 4 independent predictors regarding who will most likely serve in the areas of greatest need. These factors are: “(1) being a member of an underserved ethnic/minority group, (2) having participated in the National Health Service Corps, (3) having a strong interest in practicing in an underserved area prior to attending medical school, and (4) growing up in an underserved area.”1 Yet the percent of physicians having these 4 attributes is dismal. 
Objective: To create a pathway for students living on the Yakama Nation Lands to enter the medical profession and to foster cultural humility and the ability and desire among medical students to work successfully with under-represented groups. 
Approach: The Pacific Northwest University of Health Sciences - College of Osteopathic Medicine (PNWU-COM) formed a partnership with Heritage University (HU), Mount Adams School District (MASD), and Yakama Nation Tribal School (YNTS) in Washington State. The goal of the partnership was to address the issue of addressing the health care needs of the underserved. The result was the development of: “Roots to Wings” (RTW), a transformative co-mentoring (TCM) Program. The goal is to provide opportunities for students, grades 6-12 to increase their interest in the sciences and to enhance their opportunities in osteopathic medicine while, at the same time, preparing osteopathic medical students to embody cultural humility and increase their desire to practice in underserved communities. The program's design responds to the needs of the 2school districts and incorporates the elders’ knowledge into the development of every aspect of the program. 
Results: Preliminary data suggested that the program has been associated with increased student achievement among Yakama Nation student; increased entry of Yakama Nation students into science programs; increased cultural humility among medical students; partnership with the NINDS; funding from NIH to implement 5-week summer program for high school students; and recognition by The Harvard Project on American Indian Economic Development. The main factor for the program's success is the matrix of TCM: egalitarian, collaborative, humility and openness to learning. Challenges that were overcome included: (1) Respect for different cultures, laws, values and traditions; (2) Maintaining trust between the Tribe and the Universities; (3) Funding for transportation and other student needs. RTW is changing the way medical students and professors view medical education and the communities and people of the Tribe. It is also changing the relationships between the students and faculty of the Universities and the Tribal Nation. As hearts, minds and relationships change, the goal of assuring that members of the Yakama Nation and caring people from other cultures will be working side by side in serving the medical needs of the Yakama, coupling their medical knowledge and skills with a deep understanding and respect for the culture and people they serve. 
The Lessons of Improv in Health Care Education: From “Learning From” to “Creating With” 
Brian D. Schwartz, PhD; Nicole Michels, PhD; Darcy Solanyk, MS 
RVUCOM 
Challenge/issue: Osteopathic medical education teaches and strengthens patient-centered communication and interactions. As medical educators, finding novel ways to improve communication techniques and confidence in our students can enhance the eventual practice of patient-centered care. Clinician focus, commitment, and specificity in the examination room ensures patient understanding, comfort, and clinician-patient connection; however, as medical educators, how do we teach communication in a way that does not rely on protocols and checklists? Faculty-designed improvisation workshops that broaden the development of student's communication skills and encompass unscripted scenarios can promote students’ aptitude to build relationships with patients. 
Objective: To create an opportunity for students in a Master of Science in Biomedical Sciences (MSBS) program and students in a physician's assistant program to develop the skills and attitudes to foster teamwork and enhance communication, and construct meaningful interactions that promote patient-centered communication. 
Approach: Improvisational acting or comedy teaches people to communicate effectively and work together to achieve a mutually agreed upon end, 2facets on which productive teamwork and clinician-patient communication rest. At RVU, we use the techniques of improv to teach communication skills in a class combining students from our MSBS and PA programs. Improv is about coming together with someone else and focusing your goals. It is the process of learning to relate, to listen actively, and to form a bond with another person—to come to a place of understanding in which individuals may commit fully to work together: not to “learn from,” but to “create with.” Improv rests on several rules: yes, and; listen and focus; be specific; change and grow; get it moving. Deviation from these can either destroy a scene or keep it from materializing. Using improv games and workshops, small-group activities designed to enhance communication and embrace teamwork, and some grounding discussion of rhetorical theory, the students develop teamwork and communication skills in a very real, practical way. 
Results: In this pilot study, we used Shen's State Empathy Scale, a validated instrument which differentiates state (one's current feelings in relation to others) from trait (the disposition of a person to be empathic in general) empathy. The instrument was given to the study group (n=58 comprised of relatively equal numbers of MSBS and PA students) three times - at the beginning of the class session before the improv lessons, at the end of the same session, and at the end of the semester, 5 weeks after the improv lessons. We saw an effect size difference of 0.67 between the first and second iterations of the instrument, constituting crucial practical importance. Between the second and third iterations, we calculated an effect size of 0.26, which indicates moderate practical importance. Individual effect sizes between first and second iteration range from 0.3 - 0.57. Many students forgot their unique identifier between the second and third iteration, which we hypothesize accounts for the smaller effect size. P-values between first-and-second, and second-and-third iterations indicate statistical significance. The study will be repeated in December of 2019 in order to increase participation. 
Learning 360: Preparing Primary Care Associates (PCAs) to be Effective Junior Faculty Members 
Olivia T. Ojano Sheehan, PhD; Briju Thankachan, PhD; Richard Latham, BS; Jane Balbo, DO, MHA 
OU-HCOM 
Challenge/issue: Faculty and professional development is key to preparing future medical educators in their role. 
Objective: In this session, the presenters highlighted experiences from 1 college of osteopathic medicine in implementing a faculty and professional development program for Primary Care Associates (PCAs) called Learning 360. At the end of the session, participants could: 1) describe the PCA program and 2) discuss lessons learned from the program design, implementation, and evaluation. 
Approach: A multidisciplinary and multifaceted approach was undertaken in the program design, implementation, and evaluation of the PCA program. 1) Problem identification found a faculty and professional development program for PCAs was important and needed. 2) A needs assessment was provided. PCAs completed the self-assessment survey to determine their current and desired levels of expertise in different teaching and learning topics, results of which guide program content. 3) The goals and objectives of the program addressed the following topics: Curriculum, Instruction & Assessment; Technology Integrated Teaching & Learning; Experiential Learning/Simulation; Administration, Management and Leadership; Professional Academic Skills; Research & Scholarly Activity Strategies. The educational strategies used included flipped classroom pedagogy, experiential sessions, small group discussions, online learning, independent readings, assignments, and team-based learning. 4) During implementation, 10 PCAs began Learning 360 in July 2018, coordinated by an HCOM faculty member and facilitated by members of HCOM Office of Faculty Learning, Development, and Scholarship. A Learning Management System (BlackBoard) was used to facilitate Learning 360. 5) Evaluation and Feedback was gathered during the program and evaluation survey was planned at the end of the Learning 360. 
Results: Learning 360 is focused on preparing the PCAs to be effective junior faculty members and was a key faculty and professional development program at HCOM. PCAs have shared positive comments about the program. Ongoing feedback from the PCAs also indicate a need for more practice time to write measurable learning objectives, and the challenges of working with team members on three different campuses. 
An Innovative Approach to Medical Education That Blends Best Practices in Active Learning 
Leah Sheridan, PhD1; Jody M. Gerome, DO2; Andrea Barresi, PhD3; Fabian Benencia, PhD2; Nancy J. Stevens, PhD2; Chun Cheng Andy Chen, PhD3; Jodie Strauss, DO3; Sheila Chelimo, PhD4; Peter Coschigano, PhD2; Amdrea Barresi 
1OU-HCOM Dublin; 2OU-HCOM; 3OU-HCOM Cleveland; 4Ohio University, Office of Institutional Research 
Challenge/issue: Health care is changing rapidly, driving transformations in medical education across the continuum. To ensure osteopathic medical students continue to be well prepared for success in this new environment, the Heritage College of Osteopathic Medicine assessed the effectiveness of its curriculum to meet the challenges and demands of graduates today. The college has a rich history of adhering to best practices in medical education through its distinct curricular tracks that employed problem-based and case-based learning, respectively, and its graduates have benefited from this exceptional training exemplified by board scores and match rates. However, based on pedagogical practices, resource limitations and time constraints, major elements (over 50%) of each curriculum began to be delivered in a unified fashion. This co-evolution of the 2curricula illustrated the need and value of a single curricular track that would maintain the college's ability to graduate master learners with the knowledge and skills to practice high quality contemporary patient care. 
Objective: The Heritage College embarked on a curriculum assessment and transformation, in which it considered options of developing a unified curriculum structure or maintaining multiple curricular pathways. Factors considered included but were not limited to: modern adult learning theory, the evolving role of the physician, contemporary health care delivery, interprofessional and team-based care, and leadership. Based on its discovery, the Heritage College agreed to design a single curriculum that draws from both internal and external evidence-based best practices in medical education. 
Approach: The innovative Pathways to Health and Wellness Curriculum blends best practices in active learning models, such as problem-based, team-based, and case-based learning. The iterative problem-based learning cycle forms the overarching curricular framework for learning activities, in which sequential patient encounters are carefully designed and revealed over a pre-determined unit of time to support learner identification of knowledge gaps and self-directed learning. Overlaid are principles of team-based learning in which each a learner's degree of preparation and readiness for classroom activities is assessed and classroom activities emphasize application of knowledge and skill via collaborative teamwork. Case-based learning supplements each patient encounter to support learner acquisition of the language of medicine as well as integration and application of pre-class study to clinical reasoning. The learning cycle associated with each patient encounter is sustained through weekly meetings between each learner group and their assigned coach. In these meetings, small groups reflect and report on learning, and complement each other's knowledge. 
Results: The Heritage College of Osteopathic Medicine launched the Pathways to Health and Wellness Curriculum in Fall 2018. With any innovation, assessment is key to understanding its effectiveness. The College has a process in place for observation, assessment and feedback that will allow real-time refinement of the evolved curricular model, and plans for formal review at the 1-, 2- and 3-year anniversaries to gauge its success in graduating master learners with the knowledge and skills to practice high quality contemporary patient care. Preliminary results indicate an increased level of engagement and significant improvement in students' performance on assessments. 
Building a Pipeline for College of Osteopathic Medicine Access and Success for American Indians 
Kent S. Smith, PhD; Kayse Shrum, DO; William Pettit, DO 
OSU-COM 
Challenge/issue: Oklahoma ranks in the bottom quarter of the nation for the number of primary care physicians practicing per 100,000 residents, and its rural and underserved communities are struggling with a paucity of physicians. Addressing the physician shortage in rural and underserved areas of Oklahoma is an objective for Oklahoma's medical schools. The College of Osteopathic Medicine (COM) at Oklahoma State University Center for Health Science (OSU-CHS) is taking a novel approach in addressing the physician shortage by recruiting American Indian students from rural and underserved areas in the state and in partnering with tribal nations with sustainable training sites located in rural and underserved areas. 
Objective: Increasing the number of primary care physicians practicing in rural and underserved areas in Oklahoma. 
Approach: Although the OSU-COM has trained American Indians (AIs) in osteopathic medicine for decades, it historically has not focused its recruiting efforts on AIs. In 2003, OSU-COM hired tenure track biomedical and clinical faculty who are enrolled in federally recognized tribes (Cherokee, Chickasaw, and Comanche). The AI faculty have been instrumental in developing unique programs that weave medicine and science with culture. These medical and science programs are aimed at AIs in grades preK-12 (STEM/medical camps and summer internships), undergraduate and graduate students (Native Explorers Program), medical students (clerkships in tribal hospitals and clinics), and COM graduates (residency training at tribal hospitals and clinics) while working directly with AI faculty and students (graduate and medical): Native-to-Native mentorship. Concurrent to the numerous outreach and research activities aimed at AI youth from Oklahoma and beyond, several partnerships between the COM and tribal nations based in Oklahoma have been formed, which includes the first institutional partnership between a medical school and a federally recognized tribe (Cherokee Nation). With the successes of the AI programs and partnerships between the COM and key AI stakeholders (Cherokee, Chickasaw, Choctaw, and Creek Nations), in 2014, the Office for American Indians in Medicine and Science (AIMS) was established as the flagship to increase the number of AIs pursuing careers as physicians, scientists, and educator, to address AI retention and graduation rates, and to strengthen partnerships with Oklahoma tribes to address tribal health and wellness needs. 
Results: The least represented minority in medicine is the American Indian. Therefore, 1 of the greatest challenges in recruiting AIs to medicine is having mentors and peers they can identify with. The AI faculty and students at OSU-COM continue to provide Native mentorship while recruiting and training the next generation of AI physicians, scientists, and educators, as well as developing a culturally relevant curriculum. Nationally, the percentage of AI COM graduates is at about 0.5%; whereas, the percentage of AI graduates at the COM in Oklahoma is nearly 10%. In 2018, OSU-COM had a banner year with nearly 18% of its COM graduates identifying as AI. The AI recruiting and training programs and strategies in medicine and science at OSU-COM should serve as a template in recruiting and training other underrepresented groups in Oklahoma and beyond. 
Training Healthy Healers: A Multi-Modal Approach to Resident Wellness 
Mary Elizabeth Vitucci, DO1; Peter Bidey, DO, MSEd2; Margaret Wilkins, DO2; Guy Hamilton, DO1; Tanya Ray, MS1 
1Suburban Community Hospital; 2PCOM 
Challenge/issue: Historically, residents have been required to work long hours in a high stakes environment where their personal wellbeing takes a backseat to the responsibilities of their training. This can lead to developing bad habits in self-care and the de-prioritization of their emotional, physical, and psychological health as an attending physician. Burnout and depression are exceedingly prevalent in the medical world with more than 1 third of physicians across all specialties having experienced burnout. Physician burnout can lead to poor outcomes for both patients and physicians. The rate of death by suicide in physicians is more than double that of the general population. A change in the attitude toward physician wellbeing is imperative to ensure positive outcomes for both physicians and patients. 
Objective: Our goal was to develop a curriculum that included multiple aspects of wellness so that we can train residents to be healthy physicians who can provide their personal best to their patients. By creating an expectation for promoting physician wellness in residency, we hope to influence a change in attitude toward physician wellbeing for attending physicians as well. A positive emphasis on physician wellbeing may lead to decreased rates of burnout and improved outcomes for physicians and patients alike. 
Approach: Our institution developed an approach that employs multiple modalities to promote and monitor resident wellness. Every month, a physician faculty member runs an hour-long session promoting resident wellness activities. The residents are also given protected time for wellness activities that have included yoga sessions, coloring, therapy pets, and a resident led painting session. Two wellness grants provided funding for resources to our residents, including yoga mats, ukuleles, and funding to build a garden. Our Administrative Director/DIO in Graduate Medical Education and our Director of Medical Education holds monthly meetings with the resident to provide transparency for the residents with a question and answer session. There is a resident-led wellness committee that guides projects important to trainee wellbeing. These projects include a newsletter; weekly emails to all residents that include inspirational videos, blogposts, and podcasts recommended by committee members; an act of gratitude for residents to carry out during the week; and a 5-minute lesson on meditation. The committee also schedules a social activity at the end of every rotation. Because the committee is resident-led, new projects can continue to evolve as the needs of the residents change. This approach not only promotes resident wellness through activities but also through monitoring the residents’ wellbeing using a resident wellness index to assess and gage resident wellness throughout the academic year. 
Results: Our multimodal approach meets the resident wellness requirements for ACGME while improving resident satisfaction, morale, and survey results. We continue to build upon the processes developed to promote physician wellness throughout our institution. 
Enhancing Neuroanatomy Virtual and Hands-on Learning Tools for Future Osteopathic Students 
Christian Yacuk, OMS II; Teena Alex, OMS II; Craig A. Biegel, OMS III; Samantha Gottlieb, OMS III; Joerg R. Leheste, PhD; Randy F. Stout, PhD 
NYITCOM 
Challenge/issue: For many medical students, neuroanatomy poses a daunting challenge as it requires a combination of spatial thinking and a deep understanding of the clinical relevance, in conjunction with the highly complex anatomy of the central nervous system. Developing a mental model of gross brain anatomy is crucial to allow recognition of important anatomical features in arbitrary sections across the various image modalities that students may encounter in clinical settings. 
Objective: The aim of our present work is to develop 2-D and 3-D digital neuroanatomy learning materials using various staining methods, including photography/illustration software, 3D digital scanning technology (photogrammetry), and virtual reality training environments to increase the effectiveness of neuroanatomy learning tools. The question that is posed is whether this can be achieved using only materials that are readily available at any medical institution. We believe that using interactive 3D models will equip students to more effectively build mental spatial maps of various brain structures, thereby greatly improving this area of study in osteopathic medical training. 
Approach: We combined digital imaging and processing tools to develop a novel workflow to produce digital materials sourced directly from the same materials that students encounter in their anatomy dissections. Brains obtained from the NYITCOM anatomy laboratory were sliced into coronal, horizontal, and sagittal sections. These slices were then either stained with 1 of three stains or left unstained. Photographs were taken using a consumer-grade digital camera on a tripod. These photos were enhanced using Adobe Photoshop, masked from the background, and imported into Illustrator where structures were annotated. Prior to slicing the brains, photogrammetry 3D scanning was performed using a custom-built LED stage. These photos were used to reconstruct a 3D model using Agisoft Photoscan software. The generated mesh was exported into the 3D modeling program Blender where they were further processed. Once complete, they were brought into the video game development platform, Unity 3D. Using pre-configured packages and custom written scripts, user-interface rules were assigned. The 3D anatomical training environment was tested in Oculus Rift Virtual Reality system. 
Results: We hypothesized that this workflow will enable us to successfully bring the neuroanatomy laboratory into a virtual reality video-gaming environment, such that this workflow can be easily replicated at other institutions and that our learning materials can be customized and easily disseminated between instructors, courses, and even campuses. Using the specimens that were readily available from the anatomy laboratory we achieved the necessary level of resolution to recognize otherwise hard-to-identify structures in the brain, providing the basis for 3D reconstruction. We were able to join these prepared materials with open-source and easily accessed software/acquisition tools to reconstruct 3D digital models of the same brains that students observed during their first year of neuroanatomical studies. The successful development of this virtual reality learning laboratory allows for future educational research where we can record and analyze student behavior and retention with the goal of improving learning efficiency. 
The DO-ABLE Program: A New Way To Educate And Recruit Medical School Applicants 
Taiwo T. Ajumobi, OMS IV1; Hina Mujadad, MS2; Karon Millar, MS3; Yessica Manzo, MS4; Tashawni Channer, OMS III1; Cassandra Ramirez, OMS II1; Nkechiyere Eboka, OMS III1; Paula Watkins, MA1; Linda Boyd, DO1 
1RowanSOM; 2Ross University Medical School; 3Weil Cornell Medical Center; 4Columbia University 
Context: A 2014 study showed that despite more than 100 years of history of osteopathic medical schools in America, 29% of people did not know that osteopathic physicians practice medicine, 33% did not know that osteopathic physicians could prescribe pharmaceutical drugs, and 66% did not know that osteopathic physicians could perform surgeries. This is a significant gap in public awareness that the admissions department has worked tirelessly to close. Traditionally, admissions departments at osteopathic medical schools use a variety of recruitment strategies to attract potential applicants; these methods however tend to rely on passive learning. This may be a disadvantage to the osteopathic profession because studies show that students retain more knowledge when they are actively learning and engaged in the process, improving both their information retention and their perspective of the experience. These factors are important for successful applicant recruitment. A successful example of an active learning model is the flipped-learning model. This model is designed to encourage active learning by allowing students to use online content, engage in discussions with an online community, as well as discuss concepts in the classroom with the guidance of a mentor. Thus there is a need for a new recruitment program that encourages participants to actively learn about osteopathic medicine. In addition, despite an increase in the overall applicants applying to Osteopathic medical schools, there is still a stagnant enrollment of underrepresented minority (URM) matriculants as reported by the American Association of Colleges of Osteopathic Medicine (AACOM). This statistic reinforces the need for further optimization of recruitment strategies in order to better recruit and educate potential candidates which a flipped-learning model based admissions recruitment program may be able to successfully address. 
Objective: The goal of this 2-year pilot study is to quantitatively assess how a flipped-learning based admissions recruitment program, changes post-baccalaureate pre-medical students' knowledge and interest in Osteopathic medicine profession and osteopathic medical schools. 
Methods: Students from the Rowan University Graduate Students of Biomedical Sciences (RowanGSBS) Minority Association Premedical Students (MAPS) chapter participated in the one-day admissions program. In this program, they were educated on the osteopathic medical field through an online course, one-on-one peer mentoring with a medical student and active participation in the clinical medicine and osteopathic manipulative medicine course. At the beginning of the program, participants were given pre-assessments that gauged their baseline knowledge of osteopathic medicine as a health care field, osteopathic manipulative medicine, and their interest in applying to an osteopathic medical school. Within 24 hours after completing the program, participants were given a post-assessment. The data was then analyzed using a paired t test. 
Results: Comparison of pre- and post-assessment after each program session showed that participants improved their scores by an average of 6.25%. This indicates that the D.O.A.B.L.E. program positively contributed to participants' increased understanding of osteopathic medicine field. The results of the paired t test showed that this improvement was statistically significant at P value<0.01. The assessments also showed that participants' interest in applying to osteopathic medical schools in the future increased. 
Conclusion: This pilot study on the D.O. A.B.L.E. program shows that creating an admissions recruitment program using the flipped-learning model may help admissions programs optimize their recruitment of prospective students. This strategy would be especially advantageous to admissions programs at osteopathic medical schools due to concepts of osteopathic medicine and osteopathic manipulative therapy being not well known by prospective students. A program that allows participants to actively engage in learning has a strong likelihood of increasing participants’ interest and knowledge about the osteopathic medical field and their enthusiasm in applying to osteopathic medical schools in the future. 
A Retrospective Evaluation of Compliance to Clostridium Difficile Treatment Guidelines 
Rida Aslam, DO1; Hazem Tabbaa, DO2; Alex Yarbrough, DO2; Paul Kozak, DO2 
1Franciscan St James Olympia Fields; 2Midwestern University 
Context: Nearly half a million Americans suffered from Clostridium difficile infections in a single year according to a study released in 2015, by the Centers for Disease Control and Prevention (CDC). Approximately 29,000 patients died within 30 days of the initial diagnosis of a C difficile infection. Of these 29,000, approximately 15,000 deaths were estimated to be directly related to a C difficile infection. 
Objective: The purpose of this study is to investigate via a comprehensive medical record review to find out how often guideline adherent treatment was administered for patients being admitted with a diagnosis of C difficile. 
Methods: This research study was a retrospective medical record review on patients admitted between Feb 2018- Feb 2019 at St. James Hospital. Participants were randomly selected with ICD-10 code for C diff. infection (CDI). Participants were divided into non-severe disease, severe disease and fulminant disease. The compliance to guidelines assessed at initial treatment and as participants further stratified into the categories described above. Clinical outcomes such as 90-day mortality, therapy escalation and clinical cure were also evaluated. 
Results: The overall compliance to guidelines in C diff. management is 50% at St. James Hospital. In addition, compliance was lower in participants with severe and fulminant disease. Overall mortality at SJOF related to C diff. was about 23% and it was higher in patients with fulminant disease. Overall, therapy was escalated in only 13% of cases. The specialty most adherent to guidelines at SJOF was the Internal Medicine service, and least adherent was the Emergency Department team. 
Conclusion: CDI is a highly morbid condition and places a heavy burden on the health care system. Failing to adhere to the guidelines for treatment of C difficile is detrimental to patients and results in worse clinical outcomes. This study identified that compliance to treatment guidelines is poor and barriers to compliance still exist despite education and guideline availability. To improve compliance to treatment guidelines in our hospital, we are currently developing an electronic order set through EPIC based on IDSA guidelines to allow for accurate treatment delivery and provide better outcomes. We propose that the order set will remind physicians to pick the appropriate antibiotic based on patient's clinical presentation. As a result, the next step in this study is to incorporate an order set in our EHR to evaluate if that improves compliance with treatment guidelines leading to better clinical outcomes. 
Loans and Income Potential on the Choice of Residency for Osteopathic Medical Students 
Mirette Atnas, OMS II; William R. Blazey, DO; Sharon Koehler, DO; Maria A. Pino, PhD 
NYITCOM 
Context: A 2017 report by AAMC estimated that physician demand will continue to grow faster than supply, leading to a projected total physician shortfall of between 40,800 and 104,900 physicians by 2030. On average, primary care physicians overall earn $195,000 annually, compared with $284,000 for physicians in other specialties. The amount of debt owed by an osteopathic medical student and the expected financial reward may factor into an osteopathic medical student's choice of a primary care residency. 
Objective: To determine if the selection of a residency depends on income potential of the specialty and the amount of loans which need to be paid by the student following medical school graduation. 
Methods: A survey was adapted from previous validated questionnaires. This was then administered to the OMS I and OMS IV at NYITCOM classes via email, following IRB approval. The factors analyzed were the amount of loans that need to be paid after graduation and income potential of the residency. Students in their first or last year of osteopathic medical school were asked if these factors had a positive influence, negative influence or no influence on their residency choices. This was followed by statistical analysis. 
Results: One hundred seventy-five OMS I and 72 OMS IV students responded to the questions regarding the influence of student loans/debt and income potential on their choice of residency. A χ2analysis was performed producing statistically significant results. The P value for the first- and fourth-year medical students was 0.0001 for both factors. 
Conclusion: The amount of loans that need to be paid and income potential significantly affect the choice of residency. Therefore, methods to reduce medical school debt may need to be considered in order to encourage more students to pursue a primary care residency. In addition, there was no difference found between the significance of the influence between OMS I and OMS IV respondents, which makes these 2 factors a major influence on residency choice among students even after exploring different specialties during third- and fourth-year hospital rotations. 
Factors That Residency Program Directors Value In The Match 
Christopher Cappellini, DO, MS; Jessica Barton, DO, MS; Jason Cohn, DO; Arthur Sesso, DO; Robert DiTomasso, PhD 
PCOM 
Context: For postgraduate medical education applicants, the process of being selected for an internship is a high stakes game fraught with anticipation and distress. Historically, applicants have had minimal resources to guide them in understanding what characteristics are valued by residency program directors. Knowing what factors residency program directors value most highly may be useful in informing applicants about how to enhance their chances of being a viable candidate for a postgraduate position. 
Objective: The objective of this study was to assess what factors are most important to residency program directors in the match. This study is part of a larger investigation that examined what both applicants and program directors defined as important and not important in matching potential residents with available positions. The present study aimed to identify similarities that residency program directors’ value as important in the match process. 
Methods: This study examined the relative importance of 34 variables that osteopathic program directors consider when selecting an applicant. These individual variables were created by consulting previous published articles on the topic as well as obtaining expert opinions from a small sample of physicians, medical students, interns, and residents. A total of 108 out of 512 (21.10%) osteopathic residency program directors representing 32 osteopathic medical schools and 3 specialties (general surgery, family medicine, internal medicine) volunteered to participate in the questionnaire. The program directors were instructed to rank which aspects and characteristics of applicants they consider when selecting an applicant. Items were rated on a 5-point Likert scale, ranging from 1 Not Important to 5 Very Important. As a data reduction strategy, a principal components analysis was conducted. Demographic analysis, descriptive statistics, factor analysis, Cronbach alpha reliability analysis of the factors, intercorrelations among the factors, and multivariate analyses were also performed. 
Results: Based on the ratings of the individual items, a rank ordering of the items revealed that the top 3 highly rated items related to the interpersonal skills of the applicants, including ability to interact well with attending physicians, residents, nurses, and ancillary staff. The items rated as least important were involving students being required to rotate at the residency site as an audition rotation for which they are applying, student's experiences with medical mission trips, and other degrees obtained by students. Analysis revealed 9 factors that accounted for 61.64% of the variance. Coefficient alphas ranged from a low of 0.54 to a high of 0.95. A number of multivariate analyses comparing primary care vs non-primary care program directors across the 7 reliable factors revealed no differences between broad specialty groups. 
Conclusion: Regardless of specialty, program directors appear to weigh factors related to decision-making in a comparable manner. The top 3 most highly rated items related to the interpersonal skills of the applicants regarding the ability to work and interact well with attending physicians, residents, nurses, and ancillary staff. This finding underscores the importance of the applicant's potential for serving as an integral and successful member of the medical team. 
Use of Physician Mentored Patient Rounds to Observe EPA 4 in Second-Year Medical Students 
Neal R. Chamberlain, PhD; Matthew R. Hardee, DO; Trish S. Sexton, DHEd; Robert W. Baer, PhD 
ATSU-KCOM 
Context: A.T. Still University/KCOM has a program called physician mentored patient rounds (PMPR), which allowed us to assess various Entrustable Professional Activities (EPAs) in preclinical medical students. 
Objective: To assess the readiness of our pre-clinical second year medical students to diagnose a patient with chronic obstructive pulmonary disease (COPD GOLD 2A; EPA2) and develop an appropriate treatment plan for this patient (EPA4). 
Methods: The PMPR sessions occur over several weeks (30 minutes per week), during which students gather a patient's history (weeks 1 and 2), observe a physical examination by the physician mentor (week 2), analyze diagnostic test results (week 3), and formulate a treatment plan (week 4). The PMPR followed a patient with chronic cough, shortness of breath, and sputum production, 30 pack/year smoking history (currently smoking 1 pack/day), FEV1/FVC ratio of 60% post bronchodilator (GOLD 2A), and no history of exacerbations. Between weeks 3 and 4, students completed an assignment to demonstrate they could diagnose the patient's current condition (EPA 2- prioritize a differential diagnosis following a clinical encounter) and could suggest an appropriate treatment plan (EPA 4). Students’ diagnostic accuracy was measured at the conclusion of week 3. Students were also asked to provide treatment plans for the patient based on their diagnosis. 
Results: Four hundred and seventy students from 3 class cohorts were included in the study. After a patient history and physical examination was performed and analysis of diagnostic test results was completed, 466 students included COPD as the patients’ most likely diagnosis. Albuterol was suggested by 78% of the students for short-term treatment followed by ipratropium (7.7%), no treatment (4.1%), levalbuterol or albuterol/levalbuterol (1.9%), and inhaled corticosteroids (1.3%). Tiotropium was suggested by 37% of the students for long-term treatment followed by salmeterol (29%), indacaterol (6.4%), fomoterol (5.3%), long acting muscarinic antagonist (LAMA) or long acting beta agonist (LABA)(4.9%), fluticasone (3.4%), budesonide (2.1%), ipratropium /tiotropium (1.7%), none (1.3%), albuterol (1.3%), roflumilast (0.85%), and inhaled corticosteroid (ICS) and a LABA or LAMA (0.85%). Students were also asked to provide non-pharmacologic treatments. Smoking cessation was the most common treatment mentioned (45%), followed by pulmonary rehabilitation (28%), supplemental oxygen (20%), lifestyle changes (diet, exercise; 15%), none (15%), avoidance of irritants/allergens (11%), vaccinations (9.4%), bilevel positive airway pressure or continuous positive airway pressure device (3.6%), and OMM (2.8%). 
Conclusion: Nearly all students determined the patient had COPD (99%). However, a significant number of students did not appear to follow guidelines when developing their treatment plans. Many did not include a plan to encourage the patient to quit smoking (55%) or to get vaccinated (91%). Some suggested treatments that should not be used alone for long-term treatment (eg,, inhaled corticosteroids; 6.8%). While others suggested treatments that should be reserved for use later when the patient's condition became more severe (eg,, oxygen supplementation; 20%). 
Academic Medicine Fellowship: Pilot Study at the Arkansas College of Osteopathic Medicine 
Daniel Chilcote, OMS II; Michael Page, OMS II 
ARCOM 
Context: The nationwide shortage of physicians and growth in the number of medical schools has created a shortage of clinical faculty. Most physicians working in academia note stimulation from students and academic colleagues, research, and mentorship during their undergraduate medical education as motivating factors to enter a career in academics. However, interest in academic positions, teaching, research, and mentorship continues to decline. 
Objective: This study focused on identifying the prevalence and curriculum structure of undergraduate Academic Medicine Fellowship (AMF) programs at Allopathic and Osteopathic institutions in the United States. Additionally, factors that influence or hinder medical students to pursue a career in academics were examined. 
Methods: An electronic survey was sent to associate deans or directors of clinical medicine at 39 Osteopathic and 29 Allopathic medical schools with similar geographic locations or class size, as the Arkansas College of Osteopathic Medicine (ARCOM). Schools responding to the survey were then sent a secondary survey asking for more details about their programs. All 68 schools were phoned to increase response rate. Objectives of the surveys were to identify the presence and structure of undergraduate AMF programs. Institution websites from schools indicating they had a program were searched for additional information. 
Results: Sixty-eight schools were surveyed; 46 (67.7%) schools responded. Of the 46 respondents, 11 (23.9%) schools indicated the presence of a program and 35 (76.1%) indicated they did not have an AMF. Four schools provided additional information about fellowship structure. Information provided was qualitative in nature and is not reported here. Literature review results showed that lack of early mentorship and research is a hindrance to students considering academic careers. Practicing physicians noted a lack of support for their research, absence of autonomy, and less leisure time as factors deterring them from teaching. 
Conclusion: Early introduction into academic medicine increases the likelihood students will enter a career in academic medicine. Although allopathic and osteopathic medical schools need clinical faculty, few have early AMF programs to interest students in academic careers. The scope and structure of AMF programs is varied. Further study is needed to delineate the best program design. 
Developing a Medical Student Auditory Screening Program: Listening to the Community 
Justin Chin, OMS III; Patrick J. O'Toole, OMS III; Jun H. Lin, OMS III; Julie M. Lavalliere, OMS III; Narcisse Amine, OMS III; Amanda Milam, OMS III; Grace Huang, OMS III; Mahnoor Asghar, OMS III; Sonu Sahni, MD; Mark Terrell, EdD; Christine Lomiguen, MD; Tipsuda Junsanto-Bahri, MD 
TouroCOM-NY 
Context: One in 6 Americans has or will have a sensory or communication disorder in their lifetime. In New York, approximately 12.6% of the population is affected by some degree of hearing loss or vestibular dysfunction. Osteopathic medical student auditory screenings can positively impact communities in screening for auditory disorders. In health fair surveys, participants indicated a desire for auditory screening, with concerns of unaddressed hearing pathologies. 
Objective: The objective of this research was to describe osteopathic medical student efforts in developing an auditory screening program and to highlight its application to the needs of the local community. A secondary objective was to begin a discussion on how more communication needs to occur with the local community to better determine medical school health efforts. 
Methods: Participants were recruited from Touro College of Osteopathic Medicine's fall and spring health fairs and were predominantly African American, with an average age of 56. Osteopathic medical students developed an appropriate auditory screening protocol and trained other student volunteers. 
Results: During the inaugural health fairs, 22 participants were screened for auditory pathologies. 4 participants (18%) were referred for additional testing due to abnormal or inconclusive results. No statistical significance was observed in comparing auditory pathology to age, gender, or race. Average age of participants was 56 with 13 females and 9 males. Participants primarily identified as African American/Black (68%), with Hispanic (24%), Caucasian (4%), and Asian (4%) comprising the remainder. 
Conclusion: Auditory dysfunction was found to occur in 14% of our population. These findings are consistent with previously published data, mirroring the overall incidence in New York. Auditory screenings allow for this early detection and helps to inform patients of their care options. This study was limited by a very small sample size, so without more research, the generalization of these findings is limited. The Touro auditory screenings will use these ideas to better serve the Harlem community. 
Neisseria MeningitidIs Carriage Rate Among Students at Ohio University Following a Serogroup B Outbreak 
Megan L. Lytle, OMS II1; Sarah Klim, DO2; Jane Balbo, DO1; Nathan J. Weyand, PhD2; Erin R. Murphy, PhD1 
1OU-HCOM; 2Ohio University, Biomedical Sciences 
Context: Meningitis, inflammation of the meninges, is caused by a variety of organisms including bacteria, viruses, fungi, and parasites. Bacterial meningitis caused by Neisseria meningitidis is a serious infection, fatal in up to 50% of cases when left untreated. Those who do recover are often left with permanent disabilities such as brain damage, kidney failure, and limb amputation. N meningitidis is categorized into 13 serogroups based on the organism's capsular polysaccharides. Six serogroups, A, B, C, W, X, and Y are associated with invasive disease and epidemics. There are currently 2 types of vaccines approved for use to prevent meningococcal meningitis, that which is protective against serogroups A, C, W and Y, and that which is protective against serogroup B. Routine meningococcal conjugate vaccination against serogroups A, C, W, and Y is recommended by the CDC for all youth 11 to 12 years old with a booster dose at 16. Vaccination with the serogroup B vaccine is currently not recommended in the routine vaccination schedule. 
Objective: Meningococcal disease is of great concern at colleges and universities due to many factors that make the student population susceptible. In recent years, serogroup B N. meningitidis has caused many outbreaks, including one at Ohio University between January 2008 and November 2010 that resulted in 13 reported cases, including one fatality. In 10 of these cases, the causative strain was isolated and determined to be serogroup B. The objective of this study is to assess carriage of N meningitidis in students and determine the serogroup distribution among these carriers following the university serogroup B outbreak. 
Methods: Pharyngeal swabs were collected from 262 undergraduate students across Ohio University and cultured on Neisseria selective growth medium. DNA from purified isolates was amplified using primers for the rplf gene and sequenced in order to determine the species. Samples, which were confirmed to be N meningitidis based on PCR and sequencing were tested using multiplex PCR and gel electrophoresis with serogroup-specific primers (A, B, C, W/Y, 29E). Serogroups were determined based on expected band size. Samples were also tested using slide agglutination with antisera against serogroups A/B/C/D, A, B, C, W135, X/Y/Z, and 29E. 
Results: From 77 samples confirmed to be Neisseria, 54 were N meningitidis, nine were Neisseria lactamica, and 14 were not characterized. Multiplex PCR of samples confirmed to be N meningitidis showed 6 serogroup B, 32 serogroup 29E, and 8 non-groupable samples (n=43). Slide agglutination showed 4 serogroup B, 1 serogroup C, 4 serogroup X/Y/Z, 25 serogroup 29E, 4 serogroup W135, 1 A/B/C/D, and 10 non-groupable samples (n=40). 
Conclusion: While data between PCR and slide agglutination had only moderate correlation, results from both methods of analysis indicated carriage of serogroup 29E was much higher than for carriage of serogroups A, B, C, W, and Y. Future research on current serogroup carriage of N. meningitidis years after the serogroup B outbreak as well as correlate behavioral and social data taken at the time of sampling with results from this study. 
Prevalence, Attitudes, and Effects of Sexual Assault and Harassment in Osteopathic Medical Schools 
Jordan A. Johnstone, OMS II; Kali Chiriboga, OMS II; Matthew A. Zeller, OMS II; Matthew LaPlante, OMS II; Cameron Hadley, OMS II; Chaya Prasad, MD 
Western U/COMP-Northwest 
Context: The #MeToo movement has brought discussions surrounding sexual misconduct (sexual assault and harassment) to the forefront of attention across the US. Considerable research has been conducted in sexual misconduct involving graduate students, practicing physicians and residents showing a shockingly high prevalence of sexual harassment. However, little research has been done to discover the prevalence of sexual misconduct in osteopathic medical school. 
Objective: This study aims to determine the following issues: a) the prevalence of sexual harassment and sexual assault in osteopathic medical schools, b) differentiate types of sexual harassment and sexual assault based on gender, level and setting of medical education, and c) determine osteopathic medical students’ experience with how sexual assault or harassment claims were dealt with at their respective accredited osteopathic medical schools. 
Methods: An electronic survey was distributed to 11,118 current osteopathic medical students within 14 osteopathic medical schools with 1619 responses. The survey contained a maximum of 23 questions and was administered via Qualtrics after WesternU IRB approval. All Deans of each contacted school provided a letter of support regarding their osteopathic medical students’ study participation. Survey link was sent to class presidents and forwarded to students. All responses were anonymous with no identifying information being collected. Three reminder emails were sent. Submission of survey constituted informed consent. 
Results: Survey responses were received from 14.56% of original recipients. 54% were female, 44% male. 59.5% were in didactic education and 40.59% were in clinical education. Overall, 1 in 6 respondents experienced sexual assault and/or harassment in osteopathic medical school. Fellow students were the perpetrators of 52% of reported events. Preceptors were the perpetrators in 19% of the events. Prevalence of sexual assault and sexual harassment were 4.9% and 12.6%, respectively, with female students constituting 67.5% of those sexually assaulted and 83.2% of those sexually harassed. 80.5% of victims did not report sexual misconduct to their institution citing reasons such as; (causing a) negative influence on career, being accused of overreacting, gaining a negative reputation, and fear that no action would be taken. 78.8% of those respondents who experienced sexual assault and 67.2% of respondents that experienced sexual harassment said it interfered with their education. Students were the main perpetrators of sexual assault and harassment throughout didactic education. Students were also the main perpetrators of sexual assault in clinical education. Preceptors were the main perpetrator of sexual harassment in clinical education 
Conclusion: There has been little information about sexual misconduct in the medical community, with even less in medical school. This is the first pilot study surveying the prevalence of sexual assault and sexual harassment, reporting rates, perpetrator status, and reporting barriers in osteopathic medical school. Our results show that osteopathic medical students are negatively impacted by sexual assault and harassment. Osteopathic medical schools should offer more support to students that are victims in the educational setting. Underreporting of sexual misconduct is an essential problem. Osteopathic medical schools should investigate creative ways of reporting and tracking sexual misconduct to identify repeat offenders and offer support to affected students. 
What Works? A Big Data AnalysIs of the Effectiveness of COMLEX-USA Level 1 Study Tools 
Colt Kennington, DO1; Mitchell Gleed, DO1; Ryan Dyches, DO1; Mark R. Speicher, PhD2 
1AZCOM/MWU; 2AACOM 
Context: Performance on COMLEX-USA Level 1 is one of the most important factors residency selection committees use to evaluate prospective osteopathic residents. Students are keenly aware of this and seek out resources and strategies to help prepare them most effectively. Multiple studies have shown that factors such as MCAT performance, undergraduate GPA, and medical school GPA have a strong impact on COMLEX performance; however, research demonstrating the impact of specific exam-preparation resources on examination outcomes are limited in number and in scope. Knowing which tools and strategies produce the strongest impact on examination outcomes will be of great benefit to thousands of medical students. 
Objective: The study sought to determine which study resources and methods employed by osteopathic medical students in the second year of undergraduate medical education were effective predictors for COMLEX Level 1 performance. 
Methods: An online survey of was designed by the authors to evaluate the use and utility of popular board preparation resources in COMLEX Level 1 preparation. Survey invitations were distributed via email to medical students in the graduating class of 2019 from the Arizona College of Osteopathic Medicine after completion of the COMLEX Level 1 examination. The opening page of the survey detailed the intent of the study, and respondents were given the opportunity to opt-out; those who agreed to participate consented to the use of their examination scores and survey responses by the researchers. Survey responses were connected to each student's medical school records and examination scores, and then each student's data were de-identified by random number assignment. 
Results: Of 252 students invited, 129 (51%) completed the survey. A 2-step regression model was developed using pre-matriculation variables and pre-clinical course performance (including individual course grades), adding survey questions on study strategies and tools for the second step. The model itself was significant (F=9.923; P<.001) with an adjusted r2 of 0.791 (eg, the analysis using pre-matriculation and pre-clinical performance variables, but not study variables explained 79% of the variance in COMLEX Level 1 score); adding the survey responses added 0.041 (4.1%) to the entire model's explanatory power. Survey variables that were significant in predicting COMLEX-USA Level 1 score were beginning studying in April (-54.362; t=−2.666, P=.011) or May (-62.391; t=2.422, P=.20), and doing targeted questions (compared with doing random questions) (-21.440, t=−2.475, P=.048). 
Conclusion: This study shows the impact of some standard board studying techniques. For example, waiting until after classes end to begin studying has a strong negative impact (54 to 62 points lower average score than starting earlier); doing targeted questions rather than random questions results in a score more than 21 points lower, on average, other factors held constant. Surveys of study tools provide students valuable information on what their classmates are doing, but perhaps more importantly, taking a data analytics approach to the results provides students and advisors with solid evidence that has meaningful impacts on COMLEX scores and can potentially provide students with better match results. 
Osteopathic Medical Students' Emotional Intelligence Before Starting Clinical Rotations 
Anna M. Kerr, PhD1; Charee M. Thompson, PhD2; Valerie Rubinsky, MA3; Taylor Walker, MA3 
1OU-HCOM; 2University of Illinois Urbana-Champaign, College of Liberal Arts & Sciences; 3Ohio University, Scripps College of Communication 
Context: Emotional intelligence (EI) involves the ability to identify emotions in oneself and others. EI can help physicians increase patient trust and is associated with increased empathy in medical students. Previous research has found that empathy declines during medical education. In fact, third-year medical students often suppress emotional responses. Therefore, increasing students’ EI may help minimize decreases in empathy. Previous research has explored EI at multiple points throughout medical school including the first year, the final year, and after third-year clinical rotations. However, little is known about students’ EI immediately before the first day of their clinical rotations. Moreover, most EI research has been conducted with allopathic students;more research is needed to understand the EI of osteopathic students. 
Objective: The present study investigates third-year osteopathic medical students self-reported emotional intelligence before beginning clinical rotations. 
Methods: An anonymous online survey was sent to third-year osteopathic medical students. Emotional Intelligence (EI) was measured using the Petrides Trait Emotional Intelligence Questionnaire - Short Form (TEIQue-SF) composed of a 30-items assessing emotionality, sociability, self-control, and well-being with a response scale ranging from 1 (strongly disagree) to 7 (strongly agree). Descriptive and inferential statistics were used to evaluate students’ EI and the relationship between EI and specialty intention, gender, age, and race/ethnicity. 
Results: 173 students completed the survey. On average, participants were 25.7 years old (SD=2.91), and respondents were primarily white (74.6%) male (53.1%) students. The average global emotional intelligence score was M=5.00 (SD=.71). Among the EI dimensions, students' wellbeing scores were the highest (M=5.40; SD=.99), followed by emotionality (M=5.00; SD=.90), sociability (M=4.74; SD=.83), and self-control (M=4.70; SD=.80). Female students reported higher scores on global emotional intelligence (t=2.49, P<.05), wellbeing (t=2.29, P<.05), and emotionality (t=3.47, P=.001) than male students. Significant differences in emotionality scores were also found between specialties (F=2.253; P<.05). Students interested in pediatrics reported higher emotionality than student who were interested in internal medicine (P<.05), emergency medicine (P<.05), or undecided (P<.05). Students interested in emergency medicine reported higher emotionality than students interested in obstetrics and gynecology (P<.05) and surgery (P<.05). No relationship emerged between EI and age or race/ethnicity. 
Conclusion: The results suggest that when entering their clinical rotations, osteopathic students report moderate levels of global and domain-specific EI. The highest levels of EI were reported for wellbeing, which is consistent with the osteopathic philosophy. In addition to wellness, osteopathic medical schools should consider ways to increase students’ emotionality, sociability, and self-control. The current study also suggests that female students and students interested in pediatrics have higher levels of emotionality. This study is one of the first to explore EI, specifically the TEIQue-SF, in osteopathic medical students and offers insight into opportunities for EI training and future directions for research. 
Is Ultrasound First the Correct Approach for Pediatric AppendicitIs a Community Hospital? 
Roland Haj, DO; Kyle Leneweaver, DO 
Flushing Hospital Medical Center 
Context: Increasing concern for pediatric radiation exposure from use of CT scanning has led to a concerted effort to decrease exposure for common pediatric conditions. Centers have reported up to 50% of patients obtaining a CT prior proceeding to the OR.5 An estimated 1,730 neoplasms in the US are attributable to pediatric radiation exposure. Evaluation for appendicitis accounts for approximately 5% to 10% of all pediatric ED visits. With a renewed focus on reducing radiation exposure in the pediatric population this has led to the development of an “ultrasound first” approach. However, in the community hospital setting nondiagnostic ultrasound rates are reported as high as 74%. 
Objective: 1) Understand the use rate of ultrasound and its diagnostic rate in our community hospital setting. 2) Determine whether using the Pediatric Appendicitis Scoring system will increase diagnostic yield with acceptable increase false negative or positive rates (<5%). 
Methods: A retrospective cohort conducted at a community hospital in NYC. Patients were identified from December 1, 2012 to December 31, 2017. Pediatric patients (those under 18 years old) who underwent abdominal ultrasound for abdominal pain were included. Patients were excluded if US was performed as an outpatient or for other intra-abdominal pathology. In total, 169 patients were identified, 38 were excluded, and 131 patients were evaluated. All U/S performed were based on standard department protocol with classic graded compression technique. U/S were reviewed by board certified radiologist and imaging was finalized as acute appendicitis, negative appendicitis, or appendix not visualized. A patient PAS score was determined based on the patient's initial surgical consult note, ER physician documentation, and H&P. Fever was determined based on documented fever (>38C) on day of admission and WBC count determination (>10,000) and Absolute Neutrophil Count (ANC; >7,500) were based on CBC results on day of admission. Computed Tomography results were recorded as positive for appendicitis, negative for appendicitis, or not performed. Patient outcome was documented based on intervention whether surgical, drainage by Interventional Radiology, or no surgical intervention. 
Results: One hundred thirty-one patients who underwent ultrasound evaluation for possible appendicitis were reviewed. Seventy-five were male and 56 female, with an average age of 10 years old. At presentation, the average PAS score was 4. Seventy-seven (58.8%) of the patients had a PAS of 4 or greater, an indication for further imaging. The PAS score was less than 4 for 6 (4.62%) patients who were determined to have appendicitis based on further imaging and pathology. Of the 131 ultrasounds, 44 (33.5%) demonstrated acute appendicitis, 7 (5.34%) no appendicitis, and 80 (61.1%) were nondiagnostic. Follow up CT scan was obtained for 47 (35.8%) patients. Twenty-six (19.8%) patients with nondiagnostic ultrasound findings had appendicitis diagnosed by CT while 11 (8.4%) had appendicitis ruled out by CT. 
Conclusion: Use of a scoring system would decrease unnecessary ultrasound use, increase diagnostic yield by excluding low probability patients, and potentially avoid excessive CT scans through a standardized approach. Implementation of such an algorithm would have limited increase in cost with modest cost savings. 
HPV: Understanding Perceived Barriers to Vaccination by Healthcare Providers 
Nikki A. Medina, OMS II1; Taylor M. Bates, OMS II2; Elizabeth K. McClain, PhD3 
1ARCOM; 2WCUCOM; 3Arkansas Colleges of Health Education 
Context: Human papillomavirus (HPV) vaccine is a cost-effective way to provide evidenced based protection against genital warts and several types of cancer, and yet it remains one of the most underused vaccines in the United States. Mississippi, according to CDC reports, falls in the highest risk category for rates of all groups of HPV related cancer. Mississippi ranked in the lowest category by state reported less than 55% of both females and males reporting more than 1 dose of the HPV vaccine. Health care providers’ recommendations have been found to be a strong predictor of HPV vaccination behaviors. Osteopathic medical schools have a higher proportion of graduates who chose to enter primary care, this research is important to identify opportunities for change. Therefore, understanding the perceived barriers of providers regarding HPV vaccination, creates a first step learning how to overcome those barriers. 
Objective: This research explores provider-perceived barriers to HPV vaccination including 1) financial 2) beliefs regarding the vaccine, 3) communication and educational resources and 4) provider self-confidence regarding HPV vaccination. The study also proposes to identify gaps and areas for interventions to support provider HPV vaccination. 
Methods: This IRB-approved pilot used a 20-item electronic survey with 6 demographic and 14 questions regarding practice, patient population, barriers, beliefs and self-efficacy were assessed through multiple choice and Likert-type scale rating was deployed electronically to physician associations in Mississippi with an anonymous link that could be shared. 182 emails with the link were sent. All participation was voluntary, and no compensation was provided. 
Results: Of the 182, 123 responded with 120 (65.9%) completing the survey. Most respondents were physicians (MD: 55.9% and DO: 31.4%). Nearly 68% of respondents (72) offered one or more vaccinations with 62 offering HPV vaccines (Gardasil or Cervarix). Top barriers reported were lack of interest by patients and cost. All barriers included 1) financial: upfront cost, insurance reimbursement and concerns of vaccine expiration; 2) parent communication: time needed to convince parents, belief that child was not sexually active, belief that child was low risk, concerns over vaccine. Most physicians agreed that vaccinating both male (81.82%) and female (90.91%) patients was important and agreed patients were at risk (86.36%) of HPV. Most providers felt confident regarding their knowledge and ability to communicate HPV related information, and agreed with the importance of discussing HPV and HPV related diseases (62%). 
Conclusion: This pilot survey identified that though Mississippi providers agreed that both male and female patients were at risk and should receive the HPV vaccine, there were barriers in communication focused on lack of time to address parent beliefs regarding lack of HPV risk for children. Though HPV is now covered by most medical insurance, providers still believe there are complex financial barriers to patients obtaining the vaccine. Though physicians were confident in their ability to address HPV and HPV vaccination, educational materials were lacking. Future research can address strategies to reduce provider financial barriers and assess educational materials present in providers’ offices as well as the cultural diversity of HPV educational information. 
Barriers to Seeking Regular Vision Exams in New York City's Harlem Community 
Khaled Moumneh, OMS II; Jenifer Centeno Gavica, OMS II; Mishelle Centeno, OMS II; Julia Kang, OMS II; Sagar Patel, OMS II; Christine Lomiguen, MD 
TouroCOM-NY 
Context: According to the American Optometric Association (AOA), it is recommended that adults between the ages of 18 to 60 should have a visual examination every 2 years, while older individuals or those who utilize vision correction equipment should have one every year. Through previous free vision screenings provided to New York City's Harlem community, results showed 60% of those screened warranted referral to an ophthalmologist. 
Objective: As delayed vision screening could potentially leave a time-sensitive condition undiagnosed for many years, the objective of this study was to assess fear and lack of knowledge regarding ophthalmologists as barriers to seeking regular vision examinations. 
Methods: An assisted voluntary anonymous survey was administered at free student-run vision screenings in multiple Harlem community health fairs. Data gathered included demographics, comfort with, and knowledge associated with an ophthalmologist vision examination. Participants were then educated about gaps in their knowledge and assured about uncertainties. Lastly, comfort levels were re-measured after education. 
Results: 100 survey responses fit inclusion criteria. Of the participants with suboptimal knowledge of a vision examination (n=41), 32% were more comfortable after education and assurance vs 3% of the optimal knowledge participants (n=59). Of the participants with past due eye examinations (n=39), 54% had suboptimal knowledge and 23% were more comfortable after education vs 33% (n=20) and 10% of the non-past due participants (n=61), respectively. 
Conclusion: Participants with suboptimal knowledge were more likely to leave an ophthalmologist appointment past due and become more comfortable after education and assurance than those with optimal knowledge. This evaluation of opinion on ophthalmology in New York City's Harlem community identified lack of understanding of ophthalmological examinations as a clear barrier against proper vision care. Our preliminary data indicates that by empowering people with knowledge barriers to timely eye examinations can be reduced in this population. 
Assessing Knowledge of the Osteopathic Profession in New York City's Asian Communities 
Sarah Li, OMS II; Gregory Yim, OMS II; Peter J. Wan, OMS II; YaQun Zhou, OMS II; Anisha Rajavel, OMS II; Nathan Kang, OMS II; Vincent Dong, OMS II; Jeremy Shugar, DO; Justin Chin, OMS III; Sonu Sahni, MD; Christine Lomiguen, MD 
TouroCOM-NY 
Context: Despite having practice privileges in over 50 countries, many immigrant minority communities in the United States are unexposed to osteopathic physicians (DO) prior to re-establishing health care in the United States and thus may be reticent to seek out osteopathic manipulative medicine (OMM). 
Objective: To assess osteopathic awareness in New York City's Chinese community. Secondary objectives include characterization of potential barriers in hindering access to osteopathic medicine. 
Methods: An anonymous survey prepared in Chinese and English was used to gather information on respondent demographic, education level, health care habits, and knowledge of the osteopathic profession. To provide a clinical scenario, a health habit question regarding low back pain (LBP), one of the most common reasons for doctor visits and one for which OMM has been shown to effectively treat, was provided to participants. Participants over the age of 18 were randomly selected to complete a paper survey, with the option to decline. 
Results: 96 surveys fit inclusion criteria, with participants questioned on familiarity with DOs and OMM. 54 males and 42 females were included in the survey, with an age range of 18-80 and an average age of 40. Overall, only 18% of respondents (n=17) indicated knowledge about OMM while only 16% (n=15) seemed to recognize the DO profession. Gender, age, highest level of education, country of birth, and English proficiency did not reveal any differences in knowledge of DOs or OMM (p-values >0.05 for all). In regards to LBP, no participants indicated that they would see a DO, with 60% going to their family doctor/primary care physician (n=60), 15% seeing a chiropractor (n=15), and 10% using traditional Chinese medicine (n=10). 
Conclusion: There exists a general lack of awareness of OMM and DOs within the Chinese community in New York City. While this difference can be ascribed to numerous factors, further research and osteopathic outreach is needed in this community. 
Development of Pre-Clinical, Undergraduate Ultrasound Curriculum: A Preceptor Perspective 
Jay Olson, OMS II; Charles “Chip” Finch Jr, DO; Randall Nydam, PhD 
AZCOM/MWU 
Context: As the number of medical schools integrating ultrasound into their pre-clinical curriculum increases, it is important to ensure these changes align with what preceptors utilize in practice. Because the purpose of the pre-clinical coursework is to prepare students for rotations, curricular changes must support that purpose. 
Objective: By performing this needs-based assessment, the investigators were able to understand the perspective of clinical preceptors toward the integration of ultrasound early into the curriculum. By gaining this understanding, the faculty responsible for this curricular paradigm will be able to further develop the program to nurture the relationship between basic and clinical sciences and best prepare medical students as future clinicians. 
Methods: A 4-point, Likert-style survey was developed and distributed via SurveyMonkey. The survey was distributed to clinical preceptors marked available for the 2018-2019 academic year for the Arizona College of Osteopathic Medicine. The participants were asked demographic questions to allow for multiple comparisons to be made. The participants were then asked their perception of the integration of ultrasound into the basic sciences curriculum. Then, participants were asked if they believed students should know about the technological capabilities, image interpretation, or if they believed any education would be useful. Lastly, the participants were asked which ultrasound examinations they utilized in their practice and which examinations they felt students should use to enhance their educational experience. 
Results: After receiving the responses from the preceptors (597 preceptors contacted, 107 responded; 17.9% response rate), the Likert-style questions and responses were assigned numerical values with 1 being strongly agreed and 4 being strongly disagreed. The means of those values calculated based upon demographic identifier or response were analyzed Mann Whitney U or Kruskal-Wallis to measure for statistical significance. Those respondents that do not utilize ultrasound nor thought it had a place in didactic course work disagreed more that ultrasound should be used in didactic coursework than those that use ultrasound every day, infrequently, or not at all but thought it would be useful (P<.005). Additionally, those that use ultrasound, either every day or infrequently, more strongly agreed that ultrasound's technology and potential use should be integrated into the didactic coursework than those that do not use ultrasound nor believe it has a during didactic medical education (P<.005). No other significant differences were found between any of the other identifiers. The majority of respondents (59%) believed that any ultrasound education would be beneficial for a medical student's education. Lastly, preceptors were asked which ultrasound examinations they utilized in practice and which they believe students should learn to enhance their didactic curriculum. It was found that there were some examinations that preceptors found valuable for a student's education even though they did not utilize them it in practice. 
Conclusion: The results of this study reinforce the current momentum to integrate ultrasound into the pre-clinical coursework of medical school curriculums. The participants from a wide range of specialties who reported benign practice for different lengths of time, all strongly agreed that ultrasound can enhance a student's educational experience in the basic science concepts as well as clinical education preparation. As other medical schools begin to develop their own ultrasound curriculums, these results can facilitate justification for ultrasound curricular integration and guidance of key components for integration. 
Homelessness and Its Impact on Health Outcomes: A Survey Based Investigation in Middletown, NY 
Maisie Orsillo, OMS III1; Andrea Attenasio, OMS IV1; Ian Hopper, OMS IV1; Lauren Fleig, OMS III1; Angela Cavanna, DO2 
1TouroCOM-NY Middletown; 2TouroCOM-NY 
Context: A recent HONOR (Helping Others Needing Our Resources) “Point in Time” survey of those living in shelters, warming stations, and outdoor locations in Orange County, NY, found 350 people to be homeless. The Mid-Hudson Valley, Middletown, NY has some of the highest rates of poverty with 13% of the population meeting the poverty definition. Homeless populations face additional health challenges, increased morbidity and mortality, and high stress levels compared with the general population. Since 2014, Touro College of Osteopathic Medicine (TouroCOM-NY) has partnered with HONOR to offer a student run clinic that uses an osteopathic approach to health care, providing health screenings, health counseling and osteopathic manipulative therapy (OMT). These screenings allow students to work with a high need population. The interactions help to break down barriers that exist between homeless individuals and health care providers, and assess the needs of the homeless population. 
Objective: To identify and address health conditions that are most common among the homeless of Middletown, NY and to find ways to address these health conditions through a student run clinic with local community agency support. 
Methods: Residents at HONOR's homeless shelter were invited to participate in this project by completing a 43-question survey following a clinic encounter. All participation was voluntary. Questions covered demographics, medical history, education, current housing, and employment status. Surveys were collected and coded electronically via Google Forms to analyze trends using descriptive statistics. 
Results: 56 residents chose to participate. Of those who participated, 55.6% of residents were male and 44.4% were female. 50% identified as Caucasian, 25.9% as African American, and 22.2% as Latino. The unemployment rate was 78.2% with 34.5% receiving disability benefits. Hypertension (44.9%) and musculoskeletal problems (34.7%) were some of the most common health concerns. 41.1% have had or currently have a mental health disorder. 57.1% currently smoke tobacco products, 16.1% currently consume alcohol, and 32.1% of participants have been treated for substance abuse in the past. 55.4% stated that they experienced moderate to severe stress daily. 23.1% reported they were never able to control stress in their life, while 48% reported that they felt they were sometimes or were almost never able to control their stress. 
Conclusion: Currently, medical students at the clinic provide multiple services focusing on an osteopathic wholistic approach to patient care. These services include 1) measuring and recording blood pressure;2) conducting a basic health examination; 3) nutrition and smoking cessation resources; 4) (OMT), and; 5) connecting clients with follow-up medical care. The survey identified that in a sample of the homeless population in Middletown, NY, hypertension, musculoskeletal pain, and high stress are a significant concern. Our results suggest the need to educate and counsel residents regarding hypertension management, specifically smoking cessation and nutrition. Additionally, the survey highlighted the ongoing benefit of continuing to provide OMT to patients to address stress and musculoskeletal concerns. Finally, this survey identified the need to address stress management with residents. Although a complex issue, we believe our health screenings can help alleviate stress by providing an outlet for residents to speak about their concerns. We hope to further develop stress relieving activities like exercise classes or art therapy to help reduce stress. Although these results only represent the health conditions afflicting a portion of the homeless population, sharing this information with HONOR administration and local organizations can help to promote a “team-based” approach when caring for our neighbors in need. 
Cultural Factors in Childhood Lead Poisoning: An Osteopathic Approach to Prevention 
Bahadar Singh Srichawla, OMS II 
TouroCOM-NY Middletown 
Context: The Lead Contamination Control Act of 1988 allowed the Centers for Disease Control (CDC) to initiate Childhood Lead Poisoning Prevention Programs (CLPPPs) throughout the United States. Studies have shown that lead poisoning is harmful in adolescent populations causing significant neurological dysfunctions. Although we have seen a decrease in lead poisoning, specific immigrant communities still face elevated incidence of toxic blood lead levels (BLL). Thus, further interventions are needed in osteopathic community based medical education to determine risk factors and provide resources for physicians in providing support for high-risk immigrant communities. 
Objective: In this observational study, we evaluated the incidence of childhood lead poisoning (CLP) in various ethnic immigrant populations. To assess the incidence of CLP, data for elevated BLL were obtained from immigrant and non-immigrant populations. We further investigated the agent of elevated BLL to develop further insights into cultural factors, which lead to CLP, which can be used to improve future public health outcomes via osteopathic community based medical education. 
Methods: Declassified county department of health data was obtained on parameters related to childhood (under 18 years of age) lead poisoning from 2013-2016. Data were classified based on research parameters ie, elevated BLL, country of origin, and causative agent. Immigrant classification was designated via parental country of birth. Elevated BLL was defined by CDC threshold of> 10 μg/dL, indicating immediate public health intervention. Comparative data analysis was conducted to determine the incidence of elevated BLL in immigrant population compared with non-immigrant populations. Further correlative insights were generated based on “non-traditional” causative agents of elevated BLL ie, imported candy, cultural cosmetic products, imported toys, pottery, etc. to propose an osteopathic preventative medical model to tackle this public health threat. 
Results: 106 children were newly identified with blood levels > 10.0 μg/dL between 2013-2016. The average BLL of these children was 17.6 μg/dL as compared with an average BLL of 16.1 μg/dL from 2006-2012. More males were found to be affected than females (58% vs 42%). Approximately, 40% of the children had BLL between 10-14.9, 33% between 15.0-19.9 about 26% between 20-44.0 and 1% over 45. About 45% of cases were classified as exposure to “non-traditional” agents. We found that over 78% of products (ie, kohl, kajol, surma) were traced to the South Asian community, and approximately 18% were of Mexican origin (ie, candy, pottery, toys). The South Asian community makes up over 37% of children with EBLL, yet account for only 3% of the county population. The Hispanic community made up approximately 28% of children with EBLL but only 13% of the county population. 
Conclusion: Our analysis shows that CLP is of significant concern among South Asian and Mexican ethnic communities. In order to mitigate the incidence of CLP, new preventative interventions are proposed to improve osteopathic community based medical education via identification of cultural risk factors mentioned. Further research on public health outreach mechanisms is also warranted to prevent lead poisoning in these communities. 
A Pilot Study of the NAMI Provider Education Program at a College of Osteopathic Medicine 
Jeritt Tucker, PhD1; Lisa Streyffeler, PhD1; Andrew Seidman2; Teri Brister, PhD3; Alexis Hanson, OMS II1; Sydney Westfield, OMS II1 
1DMU-COM; 2Iowa State University; 3National Alliance on Mental Illness 
Context: The disparity in life expectancy between those with severe mental illness and the general population ranges from 13 to 30 years (Holt & Peveler, 2010; Rössler et al., 2005). This disparity is due primarily to the effects of comorbid physical illness rather than the sequela of mental illness itself (eg, suicide; Hert et al., 2011). Although substance use, unhealthy lifestyles, and the side effects of medications increase the risk of physical illness in people with SMI, unequal health care provision by primary care providers plays a major role (Lawrence & Kisely, 2010). Unfortunately, negative feelings, attitudes, and self-efficacy surrounding care of patients with mental illness appears to be exacerbated, rather than improved, by medical education due a myriad of factors (Byrne, 1999; Caceres & Penas-Lledo, 2002). Recent research has called for more contact-based education, which emphasizes counter-stereotypes while providing clinical skills (Sadow & Ryder, 2008), to better address disparities in care. 
Objective: The purpose of the present study was to evaluate the effects of the NAMI Provider Education Program—a 15-hour curriculum utilizing contact-based education—on the attitudes, feelings, and skills of students in their third year of medical education at a college of osteopathic medicine. 
Methods: Two-hundred thirty-one OMS III students, having just completed clinical rotations in psychiatry and other disciplines, were invited to either participate in the optional 15-hour NAMI curriculum, or complete waitlist surveys. Students thus self-selected, leading to non-random assignment to the two conditions. Participants in both conditions completed questionnaires assessing attitudes, comfort, and skill (including clinical vignettes) at pre-test, one-week post-curriculum, and at three-month follow-up. 
Results: In total, 124 students participated for a response rate of 53%. Eighty-two completed the control surveys and 42 participated in the curriculum during the same period. Initial results indicate that, after accounting for differences between the two conditions owing to non-random assignment, there was a significant time by condition interaction (F=3.24, P<.0001, ηp2=.42). In other words, there was a significant difference between the 2 conditions, across the various outcomes, between the pre-test and one-week follow-up. These effects were all in favor of the treatment condition, with greatest increases in competent caring in response to a clinical vignette (F=28.19, P<.0001, ηp2 =.23), intentions to attend to psychosocial aspects in routine care (F=14.9, P<.0001, ηp2 =.14, and reduced stigma (F=7.67, P=.007, ηp2=.07). Three-month follow-up data will be collected in late August 2018. 
Conclusion: While medical students typically receive core training in evaluation, diagnosis, and somatic treatments of patients with psychiatric illness—the specific emphasis of this training and its position in the pre-clinical years may not adequately address the many barriers to treatment in primary care settings. The present study suggests that a contact-based education program in the third year of training can greatly augment the training students typically receive. 
Relationship of Preceptor Entrustment Decisions With Students’ Clinical Performance 
Shiyuan Wang, PhD; Pam M. Basehore, EdD 
RowanSOM 
Context: This study is supported by 2018-2019 AACOM medical education research grant to advance Entrustable Professional Activities (EPAs) in undergraduate medical education. EPAs as observable tasks core to professional practice were recently established to operationalize the assessment of competencies. To better assess EPAs and provide more effective feedback to students on their skill development, we need to understand physician entrustment decisions. Examining the relationship between preceptor entrustment ratings and students’ clinical performance can shed light on our understanding of their entrustment decisions. The Rowan University School of Osteopathic Medicine created a new workplace-based preceptor evaluation instrument linked to core osteopathic EPA skills. Preceptors rate students’ performance on fundamental clinical skills and subsequently select their level of entrustability for each of the core thirteen EPAs. 
Objective: The researchers hypothesize that a preceptor's level of entrustment is grounded in their ratings of EPA-based skills that are directly observed on rotation. Since EPA performance reflects a students’ ability across competency domains, it is also expected that entrustment decisions will correlate with other measures of students’ overall performance, eg, scores on OSCEs, and COMAT. The overall hypothesis of the study is that a preceptors’ identified level of entrustment will directly relate to their ratings of observed clinical skills and correlate with other objective measures of a student's clerkship performance. 
Methods: Data from 188 third-year medical students on nine clerkships were collected for this project. Fifteen clinical skills across six competency domains were rated on a 6-point scale with behavioral anchor at each level. Then, preceptors select a level of their entrustment for the 13 EPAs. The instrument also requires preceptors to provide qualitative comments on student performance and feedback on skill development. 
Results: Preliminary results showed that preceptor's entrustment correlated with their evaluation of student clinical skills, although the magnitude and correlations varies by clerkships (eg, lower in Neuromuscular Medicine and Pain Management clerkship). And the correlation between certain professional activities (eg, EPA1) and clinical skill ratings were more consistent across clerkships. Preceptor's entrustment within clerkships in general also correlated with student performance on clerkship-specific OSCEs, as well as corresponding COMATs. In some clerkships, preceptor's entrustment correlated with aspects of the comprehensive OSCE (taken at end of third year), eg, in Internal Medicine clerkship, entrustment on EPA5 correlated with SOAP note (documentation) scores. Entrustment also correlated with student performance on standardized assessment such as COMATs. In all clerkships that have COMATs, student performance on their COMAT correlated with preceptor's entrustment on some professional activities, except Psychiatry and Surgery. 
Conclusion: The results confirmed the hypothesis that preceptor's decisions of entrusting students on core EPAs were based on their views of student's clinical skills and related to students’ actual clinical performance. More analyses will be conducted to explore relationship of preceptor's entrustment and COMLEX PE performance, and detailed entrustment decision making by delving into preceptors’ comments. 
Developing a Skills Roadmap for the Training and Evaluation of Entrustable Professional Activities 
William R. Blazey, DO1; Paula Ryo, DO1; Brookshield Laurent, DO2 
1NYITCOM; 2NYITCOM A-State 
Challenge/issue: Ensuring that Entrustable Professional Activities (EPAs) are incorporated into the training and assessment of our students through the diverse learning environments that occur during the four years of their training requires clear expectations to avoid confusion of objectives for both students and faculty. 
Objective: Incorporating EPAs throughout all 4 years of training into our integrated systems based course work during the pre-clerkship years followed by the students’ training during clinical rotations is being planned for both training purposes and evaluation of the student and for quality improvement in our courses. It is our expectation that this will decrease both learner and trainer apprehension regarding implementation. 
Approach: A milestones based concept was used to develop rubrics outlining the range of observable behaviors from pre-entrustable to entrustable learners to evaluate student outcomes and ensure consistency between multiple a diverse environments, assessments and faculty. Observable behaviors for each element of a particular EPA were graphically presented along a continuum of actions and are determined by cross-referencing AACOM competencies and panel review by clinical educators. These rubrics then can be used as formative devices to permit students to see explicit behaviors and expectations. Additionally, they can be used to standardize assessments of faculty and staff at our two campus locations and multiple clinical sites. 
Results: An initial road map of expected clinical skills and the anticipated elements of each EPA throughout each year of training was completed. Next steps are to develop the rubrics for each element with our clinical faculty and pilot test each rubric for planned implementation in the fall of 2019 as part of our competency based clinical skills assessments. 
Resident-Lead Case Conferences Model Critical Thinking Skills for Psychiatry Residents 
Andrea DeSimone, DO 
Thomas Jefferson University Hospital 
Challenge/issue: The existing didactic curriculum for PGY 1 and 2 psychiatry residents at Thomas Jefferson University Hospital offers no dedicated time for resident-driven, faculty-moderated case discussion on the inpatient services. Current case presentations are held with third year medical students in attendance and, therefore, attending moderators tend to tailor their talk to the medical student level. Resident participation in the discussion greatly increased when medical students were absent, suggesting an opportunity exists to engage residents in continued learning with the implementation of dedicated time for resident-driven case conferences. 
Objective: Residents will learn how to think critically, ask pertinent questions, and prepare for independent practice using recent consultation-liaison cases as a springboard for discussion. The idea is not to come up with the right answer, but to learn how to think, incorporate new information, and address uncertainty. 
Approach: A monthly, hour-long case series served as a platform to discuss our most difficult and thought-provoking cases, modeling the unique consultation-liaison thought process to trainees and increasing collaboration between house staff and attending physicians. In the first 20 minutes, a resident presented the relevant background information, followed by 20 minutes of attending-moderated discussion, and concluded with a 10-minute trainee-lead wrap-up. 
Results: Case conferences have occurred monthly since March 2018 except for two months, with about 2 to 3 attendings and 7 to 8 residents at each meeting. Limitations include accommodating both attending and resident schedules, while strengths of the program include resident presence at attending-level patient care discussions while requiring little prior preparation for both groups. This model of clinically oriented discussion between several junior residents and attending physicians allows residents to make connections between clinical cases and academic learning while preparing them for the intricacies of independent practice. 
Increased COMLEX-USA Level 1 Anatomy Performance Scores With Implementation of Flipped Classroom 
Natalie Haugen, OMS II; Sushama Rich, MD; Arthur Prancan, PhD; Christine Lomiguen, MD 
TouroCOM-NY 
Challenge/issue: TouroCOM-NY (Harlem) COMLEX-USA Level 1 discipline mean scores in anatomy were below the national mean from 2008 to 2013. Additionally, the first pass rate was also below the national mean. 
Objective: The purpose of the intervention was to increase COMLEX-USA Level 1 Anatomy performance scores, resulting in an increased overall first pass rate. 
Approach: Clinical Anatomy, in the first year at Touro College of Osteopathic Medicine—New York (Harlem Campus), or TouroCOM-NY (Harlem), was offered as didactic lectures and laboratory sessions with both written and practical examinations, and guidelines provided for students in the syllabus covering course expectations, topics, class schedule, and learning objectives beginning in fall 2008. Content was delivered in class via PowerPoint presentations for 50-minute sessions. Attendance varied between 20% and 60%. As reported by NBOME, TouroCOM-NY (Harlem) COMLEX-USA Level 1 discipline mean scores in anatomy ranged from 450.73 in 2010 (in correlation with the timing of when the fall 2008 student cohort took the COMLEX) to 507.33 in 2013. The national mean during this period ranged from 484.48 in 2010 to 521.35 in 2013. The first pass rate during this time period averaged 82.82% against the national first pass rate average of 89.69%. In fall 2012, the Clinical Anatomy course content delivery and access was changed to pre-recorded video lectures by the faculty. Students were able to access course content via a server housing a video library of course topics in accordance with the syllabus. No classroom lectures were offered; however, students were invited to participate in an iClicker quiz and discussion sessions in the classroom, 50 minutes per week per course. Classroom time was decreased to one-third. Students can watch lecture videos without the requirement of being present in class, with the additional benefit of standard video options, such as pause, rewind, and increased or decreased speed. Discussing topics in the classroom setting is encouraged and is often animated and dynamic. Students are better able to manage their time and come to class prepared for quizzes and discussion. Students receive minor credit for the quiz and leave sessions aligned in their understanding of topics. 
Results: Class attendance is typically 85% and may reach 100%. TouroCOM-NY (Harlem) COMLEX-USA Level 1 mean discipline scores in anatomy have improved from 522.26 in 2014 to 575.68 in 2017 compared with the national mean of 531.13 in 2014 and 557.25 in 2017. The first pass rate has increased from 87.29% in 2013 to 97.74% in 2018. The mean national first pass rate for this period is 92.91%. The faculty at TouroCOM-NY (Harlem) can provide consistent and regularly improved content presentations via video lectures while freeing time for scholarly activities. Students manage their study efficiently during time that is free of scheduled lectures. 
Curriculum Mapping Using an Artificial Intelligence Approach 
Randall K. Harris, PhD1; Elizabeth K. McClain, PhD2; Dolph Ellefson, PhD3; Ian S. Haworth, PhD4; Brian T. Sutch, PhD3; Timothy K. Gallaher, PhD3 
1WCUCOM; 2Arkansas Colleges of Health Education; 3Sarcix, Inc.; 4University of Southern California 
Challenge/issue: Curriculum maps provide medical schools with a clear overview to guide curriculum evaluation and management. Mapping fosters accountability, quality, and transparency of the educational process, which is a requirement for accreditation. There are many challenges to curriculum mapping when addressing accreditation, such as the recent updates to the standards of the AOA Commission on Osteopathic College Accreditation (COCA). Mapping must be an ongoing process with new maps being generated whenever there are changes in the curriculum, resulting in a potentially time-consuming and costly process. To reduce these negative aspects, as well as to increase the quality and utility of these maps, some undergraduate medical schools are examining construction of computer-based curriculum maps using artificial intelligence to interpret, evaluate, and manage the large data sets associated with medical curricula. 
Objective: 1) Leverage technological algorithms in the evolution of a standard curriculum map; 2) Engage faculty at all levels in quality improvement activities surrounding curriculum mapping using disruptive innovation to identify perceived utility and value of the map; 3) Enhance curriculum mapping by linking to multiple nationally recognized competency outcome standards including COMLEX Level 1-2, USMLE Step 1, AACOM Student Core Competencies, AACOM EPAs and MeSH terms; 4) Identify the accuracy and completeness of the map in representing curricular content associated with different learning activities; 5) Explore the application of the map as a blueprint for quality improvement of curricular integration and content. 
Approach: All curricular materials and learning events from the current map were identified and systematically organized into a coded directory structure. Nationally recognized competency outcome standards were selected for inclusion in the mapping process. A computerized mapping program, MapRadish (Sarcix Inc.), was used to correlate curricular events to competency outcome standards. 
Results: The mapping process demonstrated the feasibility of creating multiple maps of curricular events linked to COMLEX and USMLE, Core Competencies, EPAs, and MeSH terms. Initial meetings with faculty identified potential innovators and early adopters (those willing to be first to try) as well as faculty falling into the late majority or laggard group (those skeptical of change). Subsequent meetings resulted in increased interest and positive feedback, with course directors finding the maps intriguing and useful. The following areas for quality improvement have been identified. 1) Image- or video-oriented learning events with limited text-based narrative were not appropriately represented on the map. 2) Meetings with faculty to investigate gaps in content and verify the accuracy of gaps were initiated. 3) Opportunities for faculty development and collaborative engagement to address content (coverage, timing, depth, and duplication) with the goal of increasing meaningful engagement in learning. 4) Discussions of accurate and meaningful monitoring as well as evaluation of content alignment with key metrics (COMLEX, USMLE, MeSH Terms, AACOM Student Core Competencies and EPAs) have been initiated. 5) Discussions of expanding the mapping process to the third and fourth years of the curriculum have begun. 
Predicting Performance on National Board Examinations 
Frank Jackson, OMS IV; Ethan Duane, OMS IV; Robert Harmon, OMS IV; Ryan Kollar, OMS III; Nicole Rainville, OMS IV; Ryan Smith, DO, MSEd 
UNECOM 
Challenge/issue: Residency programs accredited by the ACGME report the United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Licensing Examination USA (COMLEX-USA) Level 1 as the most important criteria utilized in selecting medical students for a residency program interview. Osteopathic medical schools are additionally required to report pass rates on COMLEX-USA for use in the accreditation process. One survey demonstrated the importance of doing practice questions and how this positively related to students’ performance on the USMLE, but none are available regarding the COMLEX-USA. 
Objective: Purpose: Examine factors related to student performance on national medical licensing board examinations. Hypotheses: 1. Certain resources are superior to others in preparing for national medical licensing board examinations. 2. Certain practice tests will be superior to others in assessing preparedness on these examinations. 3. Performance on the allopathic examination (USMLE) will be correlated with the osteopathic examination (COMLEX-USA). 
Approach: A convenience sample of 101 second-year osteopathic medical student at the University of New England College of Osteopathic Medicine answered a survey asking them: (1) which resources they used to prepare for the examinations; (2) how many different resources did they use; (3) what scores they received on practice examinations; and (4) what scores they received on the national medical licensing board examinations. Data analysis was performed using the R Statistical Programing Package to perform linear regressions, t tests, and both parametric and non-parametric correlations. 
Results: Resources for national board medical licensing board examinations: USMLE-specific question banks were positively correlated with performance on the COMLEX-USA (r=0.42) while there was no correlation between COMLEX-USA-specific question banks and the COMLEX-USA (r=−0.03). Students who used COMBANK (t=2.04, df=34.67 P=.049) and UWorld (t=2.17 f=38.24, P=.036) in timed mode performed better on the COMLEX-USA than those who used the resources in Tutor Mode. Of the video resources, Sketchy Micro was the only resource that was related to higher performance on the COMLEX-USA (t=−2.17, P=.04). Practice Examinations: NBME CBSSA practice tests were consistently positively correlated with performance on the USMLE (r 0.53-0.80) and the COMLEX-USA (r 0.55-0.73). Students’ highest performing NBME CBSSA was correlated with both the USMLE (r=0.82) and the COMLEX-USA (r=0.74). Students’ COMSAE taken closest to their USMLE and COMLEX-USA was correlated with the USMLE (r=0.41) and the COMLEX-USA (r=0.61). Relationship of allopathic and osteopathic examinations: The USMLE and the COMLEX-USA were highly correlated (r=0.78). Students reporting taking the USMLE performed better on the COMLEX-USA than those who did not (P<0.001). 
Conclusion: Resources for national board examination studying are not equivalent and COMLEX-USA specific resources do not appear to adequately prepare students for the COMLEX-USA. Students studying for the COMLEX-USA may benefit by preparing for the USMLE even though the test is designed for the licensing of allopathic physicians. Future studies should prospectively evaluate the use of various resources and their relationships with performance on these medical licensing board examinations. 
Integrating Pain Management Competencies Into the Osteopathic Medical School Curriculum 
James Kribs, DO; Linda S. Mintle, PhD; Ashley R. Toler, DO; Alisa Dyson, EdD 
LUCOM 
Challenge/issue: With the growing awareness of the opioid epidemic, clinicians and patients are seeking to decrease pharmaceutical use, turning to alternative therapies. The Integrative Pain Management course offers an in-depth look at the current state of pain management; including challenges, latest evidence-based integrative therapies, and clinical applications. 
Objective: OMM integrates osteopathic philosophy with the principles of evaluating somatic dysfunction and treating it using OMT along with understanding the psychosocial aspects of pain that help modulate pain. The goal of OMT is not necessarily to remove pain but to restore function to the dysfunctional structures and allow the body's own self-healing mechanisms to resolve pain. Students are taught the unique role of osteopathic physicians in the United States as providers of both conventional medical treatment and OMM for pain. Enhancing awareness of the osteopathic approach to patient care provides an opportunity to optimize collaboration between osteopathic physicians and other health care providers to maximize healing for patients. 
Approach: Liberty University College of Osteopathic Medicine has developed an innovative approach to pain education during an OMS IV Clerkship Pain Course to address not only the traditional primary approaches to pain management, but also incorporates osteopathic principles and treatment methods, including behavioral and manipulative approaches. 
Results: According to student self-report data, there was an overwhelmingly positive response to the course in terms of gaining confidence, developing more positive attitudes toward managing pain patients, and learning more pain management tools eg, injection laboratories, psychology and pharmacology of pain, and OMT. Based on evaluations, this course appears to an effective way to integrate pain management into the fourth year curriculum using an interdisciplinary approach. Post course evaluations indicated that student doctors felt better prepared to manage complex pain and addiction patients prior to the start of their residencies. Data from course evaluations will be used to refine elements of the course for future classes. 
The Lost Art of the Physical Examination: Communication and Bedside Teaching in Osteopathic Medical Education 
Janet Lieto, DO 
UNTHSC/TCOM 
Challenge/issue: When medical students, residents and faculty are asked if bedside teaching occurs, most will say yes. When details are explored it is found that very few patient encounters occur with an attending physician examining the patient and then each of the students and residents following with their own examination. When asked why attendings do not perform in this traditional way, most will admit that time is a factor. This Honors Course was limited to 6 students, divided into 2 groups of 3 students. Even with this small medical student Honors Course, it was difficult to get all the participants together at the same time. The course filled in 40 seconds, leaving students distressed as they wanted to participate. 
Objective: The objectives for students in this course were to increase student confidence in identifying the physical examination findings found with End-of-Life (EOL) patients compared with healthy patients; build skills for becoming confident and improving compassionate communication with both patients and their families; and provide opportunities for students to demonstrate the skills learned in their small groups at TCOM in a real life clinical experience. 
Approach: The experience included the following learning activities: participation in bedside physical examination and teaching sessions; identification of physical examination findings consistent with End-of-Life; identification of physical examination findings consistent with disease pathology and contrast them with normal patients physical examination findings; observation and at time participation in communication with patients and families at End-of-Life; working as part of an interprofessional team; selecting and researching a medical topic observed during the experience; and presenting the chosen medical topic to the class and fielding questions. 
Results: Students were surveyed before and after the learning experience in the following areas: 
their frequency of participation in different types of bedside rounds; their level of confidence; and specifically their confidence in their ability to perform a physical examination that identified diagnostic signs including cardiac disease, COPD, cancer, stroke, end stage liver disease, adult failure to thrive, opioid toxicity, and an actively dying patient. Students were also surveyed on their level of confidence in their ability to discuss, communicate, or provide information to patients and families about End-of-Life topics including DNR orders, goals of care, plan of care, grief, prognostication of time to death, the dying process, and working with an interprofessional team. While results showed their perceived confidence level increased in both physical examination skills and their ability to discuss and communicate with patients and families, specifics were dependent on each student's encounters. Richer results were found in the student's reflective narratives about their experience. Students wrote a reflective essay that identified a problem they faced or how they felt (ie, their comfort level) regarding end-of-life, and how they processed and resolved the problem. The personal aspect of each of the essays showed how the experience brought insight into students’ personal thoughts and experiences with each student extrapolating how the experience would influence their future medical practice. 
Impact of Learning Theory and Learning Style Awareness for Students in a Medical School Curriculum 
Sarah Li, OMS II; Gregory Yim, OMS II; Tipsuda Junsanto-Bahri, MD; Christine Lomiguen, MD 
TouroCOM-NY 
Challenge/issue: Many students may not be aware of their individual learning methods at the start of medical school and thus may not study as effectively until much later, possibly after examination failures or course remediation. Struggling during the first year of basic science curriculum establishes a poor foundation for second year curriculum, which can ultimately lead to difficulty preparing for licensure examinations and developing robust, long-term medical knowledge for future practice as a physician. 
Objective: To determine whether it is of value for students in a medical school-based curriculum program to be aware of various learning theories and identify effective learning strategies before coursework begins. This study aims to educate students about learning theory and styles and how awareness can create individualized approaches to the medical school curriculum. 
Approach: Participants were given a presentation outlining the basic characteristics of different learning styles and corresponding study/learning habits that are most effective. Participants were administered the modality (learning channel preference) questionnaire by O'Brien (1985), which helped participants determine their personal learning style. Participants consisted of students at the Touro College of Osteopathic Medicine in Harlem. A pre-presentation and a post-presentation survey gathered information on the different types of learning styles, and awareness of personal learning styles. 
Results: 272 people were surveyed. Participants were surveyed on which of three learning styles (visual, auditory, and kinesthetic) most applied to them. Results were grouped to track trends among students, including basic demographic information, awareness of learning styles, knowledge of personal learning styles, and interest in a personalized study approach for medical school. After the presentation on learning styles, participants were asked if the presentation made them more aware about learning styles, if it was beneficial to determine learning styles for future studying, and if they would attempt to tailor studying towards their learning style. Overall, 94.12% (n=256) were interested in learning study skills for medical school. 72.06% (n=196) were aware of their learning style whereas 27.57% (n=75) were unaware of their learning style. 82.62% (n=222) indicated that it would be beneficial to future studying to determine learning styles. 83.82% (n=228) indicated they would attempt to tailor studying towards their learning style. Ultimately, an overwhelming majority at 92.65% (n=252) were interested in a personalized study approach catered to their learning style. Students who are aware of the theories of cognition can create an approach that aligns with their perceived learning preferences starting in their first semester of undergraduate medical education, which may allow them to build a stronger foundation, develop a more rehearsed working memory, and eventually incorporate more information and knowledge into their long-term memory. Future studies can analyze success in the DO program when students utilize the correct learning style from the start. 
A Novel Approach to Medical Education: Integration of Social Medicine to Meet Needs in Global Health 
Renán E. Orellana, OMS II, BCOM1; Randdie-Joyce Rameau, OMS II1; Tiguiran Kane, OMS II2; Anna Tran, OMS II3; Jonas Attilus, MD4 
1VCOM-VC; 2TouroCOM-NY; 3TouroCOM-NY Middletown; 4Rutgers University School of Public Health 
Challenge/issue: Medical school curricula, both nationally and internationally, tend to lack an integration of Social Medicine in the training of future physicians. Contemporary issues in global health and medical care indicate that Social Medicine should become an essential pillar of medical education, alongside biological and physiological sciences, and clinical skills training. Whether it be in Lower Ninth Ward “Post-Hurricane Katrina New Orleans, or post-earthquake Port-Au-Prince, Haiti, many American medical students and volunteers flock to areas of extreme need with a disregard for the profound concerns of impoverished communities, abroad or domestically. They often lack an adequate understanding of local culture, history, customs, and language, or if anything, simply do not express a respect for the community and its needs. The modern practice of health care requires better understanding of interactions between the biology of disease and the social, cultural, economic, political, and historical factors that influence illness presentation and social experience. 
Objective: Our objective was to present the novel and replicative pedagogical approach of EqualHealth to teaching Social Medicine in the context of the continuously changing and diverse medical school curriculums in the United States. 
Approach: Our team participated in the 2018 cohort of the EqualHealth Social Medicine Course, Beyond the Biological Basis of Disease. The innovative curriculum of this Haiti-based course linked tropical medicine with the principles of Social Medicine. The immersive three-week intellectual and cultural exchange brought together students from Haiti, the Ivory Coast, Rwanda, Mexico and the United States, studying medicine, nursing, midwifery, public health, and other health care disciplines. Tackling the issue of socially-neutral biomedicine curriculums requires transformative pedagogical approaches. The field of Social Medicine establishes an essential bridge between the study of medicine and public health, social work, public policy, law, history, and other disciplines in the humanities and social sciences. It draws from principles of community, political action, the organization of services, prevention of disease, and a comprehensive understanding of the causes and distribution of disease. Social Medicine challenges preconceived notions of global health and encourages physicians and other health care professionals to work alongside patients to address social determinants of health, instead of simply providing services based on biomedical needs. 
Results: Obstacles: It was found that cultural differences enriched classroom discussions and cohort dynamics, but if inconsistencies and divergence were not handled carefully by faculty, they could derail collaborative learning. Another obstacle encountered by our 2018 EqualHealth SocMed cohort stemmed from the idea that each discipline would espouse its particular methodologies, lexicons and approaches to health care (eg,, when medical students are taught alongside social work students). Mediating such differences in perspective, culture and learning experiences is a virtue of the Social Medicine ideology. Impact: It was identified that integration of Social Medicine in American medical school curriculums can increase compassion in medical practice, promote collaboration between disciplines and international medical student counterparts, and increase awareness of issues pertinent to a given community, as identified by the community and the community's key stakeholders. 
The Rule of Fours: A Systematic Approach to Teaching Musculoskeletal Examination of the Knee 
Shawn Lerew, DO; Steven Stocker, DO; Shivangee Nallamtha, DO 
MSUCOM 
Challenge/issue: New medical school graduates fail to demonstrate basic competency in musculoskeletal examination as defined by both internal medicine and orthopedic program directors [Freedman, 2002]. 
Objective: Create a systematic approach to musculoskeletal examination that could be easily taught and applied by both orthopedic and non-orthopedic physicians alike. 
Approach: The “Rules of Four” was developed as a technique that emphasized a systematic approach to musculoskeletal examination. With this approach the area to be examined is divided into columns each with four corresponding examination points. The points correspond to palpable landmarks that aid in the diagnosis of common musculoskeletal complaints. After some experience, the examination can be a more directed examination where the diagnosis can be obtained very quickly and accurately. After a complete history of the injury is taken a thorough examination of the knee includes inspection and palpation. These 2 very important aspects along with the history may already direct the examiner towards a diagnosis. 
Results: The “Rules of Four” provided a technique that was both teachable and reproducible. Its application could improve the number of medical students and new doctors that are equipped with the tools necessary to confidently and efficiently evaluate patients with musculoskeletal complaints. 
Capturing, Analyzing, and Reporting EPA Assessment Data on Third-Year Core Clerkships Using a Mobile App 
Machelle Linsenmeyer, EdD 
WVSOM 
Challenge/issue: True assessment of entrustable professional activities can produce a huge amount of data because of the necessity for multiple observations in different contexts over an extended period. Dr Robert Englander reported at the recent AAMC Virtual Medical Education event that in the EPAC program students logged around 300-350 EPA assessments in a single year. This is a huge amount of data to collect, analyze, and report in a meaningful way on 200+ students. Therefore, ten Cate and others have recommended mobile technologies and portfolios to capture this big data. Most mobile technologies are still under development. 
Objective: We describe the development of an app to collect data related to EPAs in third year required clerkship rotations, to discuss the key features of the product to make the assessment most efficient, identify pros/cons of the implementation of the app, and to discuss results of the implementation thus far. 
Approach: The West Virginia School of Osteopathic Medicine has developed an app to allow faculty/preceptors to assess students on EPAs using their mobile devices. This allows the assessment to be done on the fly rather than requiring the faculty/preceptor to be at a computer (in turn potentially requiring them to do the assessment asynchronously from the observation). This data is captured and stored in the institution's academic management system. 
Results: WVSOM took great care to ensure that the development of the app and the efficiency of using the app was well-defined. The app was integrated with the school's academic management system to allow for live data analysis and reporting in conjunction with other data or assessment variables. This collection of all data in one location will impact not only administrators but also learners as they will have all evidence of success or deficiencies in multiple realms (competencies, disciplines, EPAs, etc.) in one location. Having data at their fingertips, will help them make informed decisions about their educational path. This information as well as a demonstration of the app and display of the reports can help other schools in their collection of big data from EPAs and beyond. 
Secrets to Successful Residency Placements: A Faculty's Experience 
Chaya Prasad, MD 
Western U/COMP 
Challenge/issue: The combination of decreasing residency spots and single accreditation has osteopathic students competing with allopathic medical students for highly competitive ACGME residency spots. Medical students are realizing that residency placements are competitive and that they have to start early on to determine their top choices for residency and then proceed to strengthen their resumes to reflect their interest. Students need help and guidance from faculty, advisors and mentors. This can be daunting to academically overwhelmed faculty. 
Objective: Our goal was to provide students with early exposure to clinical specialties. We hoped to spark interest in clinical specialties as possible residency options. Our hypotheses were that when students had early exposure to different specialties, they would have an early start on strengthening their resumes and would therefore be more competitive. 
Approach: In Pathology, an average 1-2 students per medical school enter the specialty annually. Students rarely undertake pathology rotations and have no exposure to laboratory medicine, an area that is critical to all specialties. To change these deficiencies, we attempted the following: 1) Gave presentations to OMS I and II students about the pros and cons of pathology as a career option. 2) Offered shadowing opportunity in preclinical years 3) Started a pathology interest group that offered leadership positions 4) Offered research projects to OMS I and II students 5) Offered the opportunity to write up case reports 6) Offered clinical laboratory rotation to OMS III and 4 students 7) Mandatory, graded, laboratory research proposal needed to be completed. 
Results: At our school zero students matched into pathology in 2016, 3 in 2017 and 7 in 2018 and a potential 10 students in 2019. Our goal was to 1) Engage students early 2) Educate them about pathology and laboratory medicine 3) Increase awareness of pathology as a viable career option 4) Help students, regardless of their specialty interests, strengthen their resumes 5) Provide leadership opportunities. Students line up for the laboratory rotation. All students complete a research proposal at the end of the rotation, which they take with them on interviews. The program currently has over 40 students enrolled in the PIG group, 16 students involved in research projects, and at least 7 students have given presentations and workshops with at national conferences with members of the Pathology faculty. This strategy is easily applicable to all specialties. It does involve active faculty participation, but the outcome outweighs the efforts. 
The Oral Microbiome and Early Childhood Caries: Applications to the Education of Primary Care Physicians 
Boone Rhinehart, OMS II; Wyatt Hayden, OMS II; Aarzu Isa, OMS II; Kimberly J. Taylor, PhD 
PNWU-COM 
Challenge/issue: The past decade has seen numerous changes in basic science research based on the underpinnings of advancing molecular methods utilized in biomedical research. The human oral microbiome is one such area that has experienced a meteoric rise in our understanding of the numbers and types of bacteria that colonize our oral cavities, as well as in their role in the most common chronic disease of childhood—Early Childhood Caries (ECC). The genomic sequences of the oral microbiome members are being elucidated on a daily basis with a current taxa count of approximately 770. The advancing knowledge is allowing for an understanding of the specific taxa playing a role in the development of ECC, an understanding of the interprofessionally-based preventive measures that can be taken to control dysbiosis and pathology development, and an updated knowledge on taxonomy changes of known microorganisms that were previously classified differently in medical literature. The oral microbiome is the only microbiome (according to current our knowledge) that causes disease in most people, indicating its imbalance or dysbiosis as a constant. Knowing and changing members of the oral microbiome, their role in developing disease, and an understanding of prevention of this dysbiosis is important to educating patients in assuming an attitude of preventive care. Understanding of the existence, integration, and application of the large amounts of oral microbiome information being produced is challenging to a primary care setting and to its meaningful use in patient care. 
Objective: The main objective of this work was to evaluate how physicians and physicians-in-training could apply to patient care the basic science knowledge of the oral microbiome and its role in developing ECC, while simultaneously advancing knowledge of prevention of this pathology. 
Approach: Application of the knowledge of the oral microbiome and its dysbiosis in developing ECC can be approached in two sequential steps. The first step is to summarize important advances in the discovery of the taxa of the oral microbiome and how the synergy of the oral microbiome members relates to the dysbiosis and pathology in children up to six years of age (ie,, via a diagnosis of Early Childhood Caries). The second step is to relate this knowledge in a meaningful and applicable way to primary care. This was accomplished via inclusion of oral health principles (utilizing basic science advances) in medical education curriculums, CME events (inclusive of “Grand Rounds”), and key journal publications that discussed preventive measures and patient education that can be utilized by family physicians, pediatricians, and obstetricians. 
Results: The integration of basic science oral microbiome knowledge into the practice and training of primary care physicians posits a valid application of advancing biomedical science in a translational manner. It also allows for physician and physician-in-training education and application of microbiome taxonomy studies that can result in an interprofessional approach to prevention of the most common chronic disease of childhood: Early Childhood Caries. 
A Process Learning Approach Bootcamp for Boards (B4B) 
Mangala Sadasivan, PhD; Andrew Goldynia, MA; Furqan Irfan, MD, PhD 
MSUCOM 
Challenge/issue: The osteopathic medical profession is transitioning to a single accreditation system for graduate medical training. By 2020, all residency programs will be accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the U.S. This has encouraged more osteopathic medical students to consider taking both the USMLE and COMLEX-USA board examinations. Our earlier research demonstrated the efficacy of a process approach when preparing for the COMLEX-USA board examination. Although both board examinations focus on the same content, students are aware that studying for each test requires strategic planning specific to the test. 
Objective: The authors were interested in evaluating osteopathic medical students’ resource preference for question banks when using a process learning approach “Bootcamp for Boards (B4B)” to prepare for Board (COMLEX-USA Level I and USMLE Step I) Examinations. In addition, since the B4B design (self-study pre-test, post-test card format) has intrinsic value that promotes a sense of self-satisfaction and autonomy of learning, we looked at the students’ endorsement of the program and continued interest in B4B to study for COMLEX-USA Level II and USMLE Step II. 
Approach: The authors distributed a survey to 90 students registered in the process learning approach B4B, after they had completed the program and taken their examinations between July 15 and August 15, 2018 at a single institution. Qualtrics survey software, an online platform was used to create a 21 item questionnaire (Yes/No, fill in, multiple choice and rank order) and students were assured anonymity unless they chose to self-identify in the comment section of the survey. 
Results: Of the 43 students who took the survey at the time of this analysis, 17 (39.5%) completed the USMLE examination while almost all the students took the COMLEX-USA examination. Approximately half (n=19, 44.2%) of the students initiated the B4B program before 2018, while 7 (16.3%) students started in the first quarter of 2018, and 16 (37.2%) students in the second quarter of 2018. The students who utilized the Uworld Q-bank to complete their pre-test and post-test cards in the B4B program were more likely to take the USMLE examination. The association between these variables, USMLE and pre-test cards (P=.003) and the USMLE and post-test cards (P<.001) was compelling. In addition, when students were surveyed to see if they wanted to participate in a STEP II/ Level II B4B program, the data showed a favorable interest (76%) in continuing this process approach (B4B) program (P<.001). 
Conclusion: Students find value in using this process approach, B4B, to prepare for board examinations. Students’ who prefer the UWorld q-bank when preparing for the USMLE are more likely to complete the test. Finally, students reported a positive experience going through the program and a significant number have asked to continue with B4B moving to COMLEX-USA Level II and/or USMLE Step II. 
Learning to Thrive: Learning Strategies for Medical School and Beyond 
Scott Severance, PhD, MS 
LUCOM 
Challenge/issue: Due to the numerous differences between the expectations and goals of medical school and students’ previous educational experiences, academic success before medical school does not necessarily translate into academic success in medical school. To earn the grades necessary for advancement and to learn the material competently in a manner that ensures understanding and long-term retention, students must learn how to learn. Learning to handle the volume and pace of medical school instruction is essential. For many students, the primary goal in academic programs prior to entering medical school was earning high grades. Thus, the majority of students are often inadequately equipped to understand course material and utilize effective learning methods. 
Objective: Our goal was to develop an initiative, in which students would voluntarily participate, that would explain major differences between medical school and their previous work at the undergraduate/master's level, highlight pitfalls that can delay a student's transition to effective medical school learning, and provide methods for adapting to medical education. A secondary goal was to explain to students, who expected that medical school would be difficult and different from their previous educational experiences, why it would be more challenging, and to guide them in developing goals that are more realistic and appropriate for medical school. 
Approach: We developed a series of seven 20 to 30-minute sessions that covered topics related to medical school learning. Although the topics varied, the structure of each session followed the same pattern: the topic was introduced, the case was made as to why the topic was important, a second- or third-year student talked about the lessons they had to learn in this area to succeed in medical school, and, lastly, practical steps the students could start using that day to improve their learning were given and explained. Each session was intended to provide real-life examples of students, including some who had struggled academically, who had to change their learning methods to succeed in medical school and to provide concrete steps the students could take to overcome the difficulties students face as they transition to medical school. 
Results: LUCOM has 168 students in its class of 2022. Sixty-seven of those students have attended all the “Learning to Thrive” sessions, although other students did attend various sessions. The sessions have led to several productive conversations about learning how to learn, about thinking like a medical school student, and about actively utilizing, instead of simply memorizing, information. The academic performance of these students in the curriculum and on standardized board examinations will be tracked as the students proceed in the program over the next two years. 
Institute of Health Careers: A Jackson Public School JROTC Summer Camp at William Carey University 
Melissa R. Stephens, MD1; LaDonna Davidson1; Paul Willis, DO2 
1WCUCOM; 2Jackson Public Schools 
Challenge/issue: Mississippi is plagued by some of the highest rates of diabetes, hypertension, obesity, and other poor health outcomes in the country. Much of the state is also faced with significant health disparities, restricted access to medical care, and a shortage of health professionals. Innovative programs are needed to expand the health care workforce to meet the growing needs of the state, as well as promote positive change for a healthier Mississippi. 
Objective: The STEM-inspired camp, which debuted in 2015, was created to introduce high school students to the world of health care and its associated career opportunities. The program encourages: 1) self-discovery of personal strengths as well as areas for growth; 2) creation of personal and professional life goals; 3) development of interpersonal communication skills (verbal and non-verbal); 4) enhancement of team collaboration skills; 5) cultivation of leadership abilities; 6) recognition of the benefits of good citizenship; 7) better comprehension of private, state, and federal scholarship and other funding opportunities for higher education; 8) strengthened understanding of the college admission process; 9) increased awareness of the diversity of professions within the world of health care and the steps required to attain a degree or certification in those professions; and 10) enhanced knowledge of osteopathic medicine and its philosophy. 
Approach: Prior to each camp, cadre pre-enrolled 60 cadets from the seven high schools in the Jackson Public School District. The cadets were then brought to the campus of William Carey University for a 5-day residential summer camp, which was designed and directed by a faculty member at the College of Osteopathic Medicine. The camp itinerary included interactive lectures with health professionals, including but not limited to: nursing; pharmacy; osteopathic medicine; music therapy; laboratory technology; athletic training and physical therapy; social work; dentistry; nutrition and food services; public health; emergency medical services; health information management and information technology; palliative care; and clinical psychology. Demonstrations and hands-on activities included: cadaver dissection; medical imaging; simulation technology; emergency first aid skills; microscopy; osteopathic manipulative therapy; physical therapy; and music therapy. Faculty from the College of Osteopathic Medicine and College of Health Sciences along with health care professionals from the community delivered the camp's educational content. 
Results: In 2018, 44 cadets completed the camp. Approximately 25 hours of health care-related activities were delivered. Other scheduled activities included: physical training, hospital tour, and social events. Cadets were inspired and equipped by the camp to pursue diverse health care careers to meet the growing workforce needs of Mississippi. Cadets were also challenged to become leaders in their communities, where they were encouraged to serve as forces of change for a healthier Mississippi. 
Community Health Center Track: An Innovative Third-Year Clerkship Experience 
Anne VanGarsse, MD 
CHSU-COM 
Challenge/issue: The practice of medicine is changing rapidly. Physicians are being called upon to lead their profession—and the entirety of the US health delivery system—through this change, often without adequate education or training in economics, health policy, or social science. Community Health Centers (CHCs) are at the forefront of value-based care, quality improvement, team science, population health, social determinants of health, health informatics, and health policy. Collectively referred to as Health Systems Science, these non-medical components of health care are increasingly critical to physician leadership. 
Objective: By exposing medical students to health care delivery in a Community Health Center, we aimed to train and inspire passion in Health Systems Science and care of the underserved. Via the creation of a Community Health Center track, we piloted an innovative approach to third-year training. Students were embedded in three FQHCs as a member of the care team. 
Approach: Our project consisted of embedding third year osteopathic medical students in3 different Federally Qualified Health Centers for the majority of their required third year core clinical clerkships. Students completed Internal Medicine, Family Medicine, Women's Health, psychiatry and pediatrics clerkships among the three FQHCs. Surgery clerkships were scheduled in rural practice sites. Students additionally were able to choose electives from among three specially designed for the track: oral health, addiction medicine, and 2 different population health and quality improvement options. Once a month, students were presented with didactic and small group discussion content covering the topics of the community health center movement and health systems science topics. Further, students spent 1 half day per week embedded as functional members of the health care team, where they cared for and interacted with a small panel of health center patients, helping those patients navigate the complexities of the health care system. 
Results: All of the students described how the experience enabled them to better understand Health System Science concepts. One student took part in a month-long Spanish immersion women's health elective. Student comments included, “The importance of providing care to the underserved population and how much health care is missing in their life…”; “Watching how the clinic works in following up with patients and providing them with regular care has inspired me to accomplish similar goals in the future”; “This experience taught me most about the side of health care not commonly witnessed at clinics that have insured patients.”; “I learned a lot about different cultures and their approach to health. I also thought it was important learning about the psychosocial impact on health of the underserved.”; “This experience was life changing for me and definitely impacted my future career choices. My passion grew for working with the Hispanic community and made me want to specifically seek out residencies that have a medical Spanish need and opportunities to serve the underserved. I now plan to look for a job in an FQHC or similar clinic setting. I feel like I have a much better understanding of community health.” 
An Institutional Coordinated Plan to Achieve Health Equity and Workforce Diversity 
Jamboor K Vishwanatha, PhD; Riyaz M. Basha, PhD; Maya Nair, PhD; Harlan P. Jones, PhD 
UNTHSC/TCOM 
Challenge/issue: The rapid growth and accumulation of specialized knowledge in today's biomedical fields combined with entrenched and emerging health issues that persist among certain groups within the U.S. population emphasize the significant need to diversify the nation's biomedical science workforce. The underrepresentation of minorities in science results in inadequate scientific input from divergent social or cultural perspectives and detracts from our nation's ability to resolve health disparities. 
Objective: To develop an integrated and coordinated institutional plan that promotes health professional education across career stages from K-12 to faculty level. 
Approach: The University of North Texas Health Science Center at Fort Worth has developed coordinated approach with local, regional and national partnership to increase participation of underrepresented students along the career pathway from K-12 to faculty level. Career stage specific activities that include research, mentoring, networking, career development, grantsmanship and health disparities curriculum are provided for participants. Successful outcomes from our coordinated plan includes increase in participant self-efficacy, research presentation awards, increase in grant awards and publications, and career advancement. 
Results: Through partnerships within our institution, local school districts and minority serving institutions nationwide, our coordinated plan provides mutually beneficial co-learning experiences to increase the number of under-represented individuals entering translational research focused on increase in biomedical research workforce diversity and achieving health equity. 
Cultural Sensitivity and Global Health Experiences in Osteopathic Medical Education 
Peter J Wan, OMS II; YaQun Zhou, OMS II; Ka Yuk Wong, OMS II; Tipsuda Junsanto-Bahri, MD; Christine Lomiguen, MD 
TouroCOM-NY 
Challenge/issue: Limited awareness of osteopathic medicine abroad, lack of student exposure to different cultures, and emphasis on the importance of cultural sensitivity in undergraduate osteopathic medical education. 
Objective: 1) To allow osteopathic medical students to satisfy the7 AOA Core Competencies through global health experiences; 2) to encourage osteopathic medical schools to support international health student organizations and elective rotations with experiences abroad; 3) to train future osteopathic physicians in counseling for health promotion and disease prevention, cultural competencies, public health systems, and global health. 
Approach: This is a descriptive summary involving experiences from first year osteopathic medical students who traveled with faculty members to three international medical missions. 1) Nepal: Student experiences included medical campaigns comprised of baseline primary care assessments through patient history taking and physical examinations. Patients were educated on and introduced to osteopathic manipulative medicine in a rural setting. Osteopathic manipulative therapy (OMT) was administered in the treatment of musculoskeletal, gastrointestinal, and neuropathic disorders. In addition, patients were educated on home osteopathic self-exercises to supplement their recent OMT treatment, as well as public health practices and proper hygiene. 2) China: First-hand student experiences in cultural traditional medicine, such as acupuncture and herbal medicine. Focus on treatments in women's wellness, reproductive health, musculoskeletal disorders, and acute inflammation. Highlighting the similarities and differences in traditional medicine and osteopathic medicine to introduce OMT. Students’ reflections from personal experience and patient perspectives would supplement their education in osteopathic principles and practices. 3) Philippines: Student educational exposure to infectious diseases not prevalent in the United States, such as tuberculosis, diphtheria, dengue hemorrhagic fever, tetanus, and rabies. Focus on preventive health care (education, vaccinations) and outreach to rural areas. In addition, students were exposed to primary care campaigns with focus on nutrition, exercise, and wellness. 
Results: Key factors towards establishing a successful global health experience includes student orientation to expectations, cultural appropriateness and overcoming language barriers while working with local staff to establish trust and participation. In addition, efforts to develop a key organization to help maintain regular trips, recruit students, as well as foster connections with the host medical facility are critical to establishing sustainability of such a program. Students should keep an open mind about other therapies and modalities, and how patients of other cultures will perceive OMT. They should also be mindful about the type of traditional medicine these patients may be receiving; particularly, any contradictive or supportive effects these traditional modalities may have with OMT. Additionally, we highlight the value of a supportive COM administration in these endeavors. 
Smallpox Vaccination in the Setting of Autoimmune Disease: A Case Report 
James Wilson, DO1; Chris Snitchler, DO2; Adam Ladzinski, OMS IV3; Madyson Riddell, OMS IV3; Hardik Dand, OMS II3 
1Franciscan Health Olympia Fields, Internal Medicine; 2United States Naval Hospital Okinawa; 3CCOM/MWU 
Challenge/issue: Patients with psoriasis, an autoimmune disorder involving the skin, joints, and eyes are cautioned from participating in various medical interventions, including vaccinations for smallpox. Current limited data regarding the association with the smallpox vaccine and psoriasis revolves around the deep Koebner phenomenon and eczema vaccinatum. While the vaccination has been discontinued for use in the general population since 1972 in the United States, certain populations such as travelers to foreign countries, laboratory workers at risk of exposure, and military personnel being deployed to or around nation states of concern with suspected stockpiles of smallpox still receive the vaccine. A case of a 23-year-old military service member whose previously mild psoriasis progressed rapidly after smallpox vaccination was presented. Usually, questionnaires and medical screening should separate those patients in whom the vaccine may be contraindicated. On average, progression from skin limited psoriasis to psoriatic arthritis is approximately 10 years. In the case of this Marine, these protocols failed; he had scalp psoriasis formally diagnosed two months prior to the vaccination, in addition to strong family history of psoriasis. Two months later he presented with a severe and precipitous progression to psoriatic arthritis. 
Objective: In an effort to drive inquiring minds early in medical training, first and second year osteopathic medical students were asked to transform together clinical cases into case reports to challenge their clinical understanding and better understand how case reports can drive larger research topics. 
Approach: The broader concern is in the event of a need to vaccinate a large population, would all seeking vaccination be truthful in medical history in light of concern for exposure; and would the risk of vaccination vs the risk of exposure justify an adverse reaction to the vaccine. Considering these concerns, the need to understand the pathology to better mitigate those at risk, or at the very least have an understanding, of these types of events warrants further investigation. 
Results: Historically, the adverse effects caused by the smallpox vaccination range from skin manifestations to at worst, post vaccination encephalopathy. However, based on this case, it should be explored if the smallpox vaccine has the potential to significantly progress psoriasis as one of its adverse effects and why this could happen. Smallpox vaccine induces heightened CD4+ and CD8+ T cell responses that peak two to four weeks post immunization. The cytokines released from the CD8+ cells induce activation and proliferation of synovial fibroblasts. These fibroblasts can secrete increased amounts of TNFa, IL-1B, IL-6, and IL-8, all which may point to the patient's cause of his psoriatic arthritis. Therefore, we hypothesize that the administered smallpox vaccine incited several immunological reactions that hastened the process of developing psoriatic arthritis in a patient with preexisting psoriasis. 
Perceived Impact of Novel Board Resources on COMLEX-USA Level 1 Pathology Performance 
Gregory Yim, OMS II; Sarah Li, OMS II; Tipsuda Junsanto-Bahri, MD; Christine Lomiguen, MD 
TouroCOM-NY 
Challenge/issue: Pathology remains one of the major components of the undergraduate medical foundational biomedical science curriculum. Due to advances in educational technology, there has been a recent surge of resources available to medical students both to supplement what is taught in the classroom and to provide high-yield review for licensure examinations. 
Objective: The aim of this study is to assess the perceived impact of novel board preparatory resources on COMLEX-USA Level 1 pathology performance. 
Approach: An anonymous questionnaire was distributed to Touro College of Osteopathic Medicine—New York (Harlem) students who recently took COMLEX-USA Level 1 to gather information on demographics and responses regarding different pathology board preparatory resources. All participants were given access to the survey via email. The survey was distributed and completed by participants electronically using the online service SurveyMonkey. Participants were provided with a brief explanation prior to the survey, via SurveyMonkey, with the option to decline. Participant responses were recorded on a Likert scale ranging from 1 to 5, with 1 corresponding to “strongly disagree” and 5 corresponding to “strongly agree.” 
Results: 44 surveys were included in this preliminary study; the response rate was 30%. Participants were surveyed on which resource was crucial in preparation for COMLEX-USA Level 1 Pathology, their most preferred preparatory resource for the examination, if the school's curriculum was sufficient for the examination, and were provided an open comment section about additional insight regarding their preferred pathology resources. Results were grouped based on class year and age at time of COMLEX-USA level 1 preparation (ranged: 20-29, 30-39, 40-49, 50+ years old). 63.64% of participants surveyed indicated that Pathoma: Fundamentals of Pathology was their preferred resource while preparing for the COMLEX-USA Level 1 Pathology Subsection (n=28). More than 90% of all participants indicated that question banks (COMbank, UWorld, etc.) were crucial for COMLEX-USA Level 1 pathology preparation, followed by Pathoma: Fundamentals of Pathology (roughly 80%) and then First Aid Pathology subsections (roughly 50%). Conversely, most participants “strongly disagreed” that BRS-Pathology and Robbins and Cotran Review of Pathology (Textbook) were crucial for COMLEX-USA Level 1 pathology preparation, which also correlated with the resources that the fewest students used. These trends showed no significant differences when comparing class years and age at time of COMLEX-USA level 1 preparation. The landscape of board preparatory resources has been constantly changing, with novel resources across various media made available every year to supplement the current medical curriculum. Our preliminary findings showed that students generally preferred digital resources over traditional paper resources, like textbooks, rating the former more ‘crucial’ than the latter. Identifying characteristics of recently released resources that appeal to current of medical students can help medical educators improve their curriculum and become more effective in preparing their students for COMLEX-USA Level 1. 
Impact of Non-Credit Summer Anatomy Course on Performance-Based Entry Into Medical School 
Gregory Yim, OMS II; Sarah Li, OMS II; Ivan Radujko, not listed; Sushama Rich, MD; Christine Lomiguen, MD 
TouroCOM-NY 
Challenge/issue: Despite rigorous medical school prerequisites, encountering medical school curriculum for the first time can be overwhelming, with anatomy often acknowledged as one of the most challenging courses. Touro College of Osteopathic Medicine in Harlem (TouroCOM) offers a 1-year, 43-credit, Master of Science (MS) program featuring classes taught by medical college faculty. Success in this program guarantees students direct admission into the DO program at TouroCOM. Master's students who struggle during their first semester of basic science curriculum often establish a poor foundation for success in subsequent courses, and may ultimately fail to promote into the DO program. 
Objective: TouroCOM offers a non-credit, 4-week, intensive summer anatomy course, which aims to ease the transition into a medical school-level curriculum for both incoming MS and DO candidates. This study aims to evaluate the effectiveness of TouroCOM's four-week summer anatomy course in preparing its MS candidates for successful promotion into the DO program. 
Approach: Participants consisted of all MS candidates from the class of 2016 and class of 2017 at TouroCOM in Harlem. Quantitative data was collected on written and practical examination performance throughout the first semester anatomy course as well as final course grade. Qualitative information was also gathered on participation in the four-week summer anatomy program and successful promotion into the DO program. Statistical significance was measured by comparing percentages of grouped study participants with one sample t testing and the resulting p-values. Results with a P<.05 were reported as statistically significant. 
Results: Summer anatomy course anatomy participation was ultimately correlated with successful promotion into the DO program and final course grade for first semester anatomy. Of the 138 total participants included in this study, 26 students from the class of 2016 and 16 students from the class of 2017 participated in the summer anatomy program. Of the 2016 and 2017 MS candidates who were promoted into the following DO class, 69% (n=38) received a final course grade of A- or above in first semester anatomy. Only 3.6% (n=2) of 2016 and 2017 MS candidates who received a final first semester anatomy course grade of B- or below went on to promote into the DO class. Anatomy remains one of the major foundational components of the medical school biomedical science curriculum. Early exposure to course content and the rigors of a medical school curriculum allow students the time they need, in a non-competitive environment, to establish effective study habits, cater their studies to increase long-term information retention, and prepare for success in other courses. It may be of value for medical schools to offer a similar, non-weighted introductory course to students entering their first year of medical school to ease the transition into a rigorous medical school curriculum. Struggling during the first year establishes a poor foundation for future coursework and difficulty in retaining long-term medical knowledge for future practice as a physician. Future studies can analyze previous graduates of the masters degree program and their success in the DO program.