Physician burnout rates are on the rise due to increasing clerical workload, reduced sense of efficacy, and moral injury. Untreated, burnout can lead to medical errors, a decline in empathy, and, in extreme cases, suicide. Medical students experience burnout associated with maladaptive coping strategies, and lack of exercise. Physicians and medical students who practice regular self-care have higher well-being scores and better patient outcomes. To mitigate burnout, undergraduate medical institutions have adopted student wellness programs. However, medical students may perceive mandatory wellness activities as ineffective, promoting unhealthy competition and cultivating toxic positivity. At A.T. Still University's School of Osteopathic Medicine in Arizona, we have worked to reduce the unintended consequences of wellness programs. Strategies to reduce these consequences include providing optional activities at meetings, detailing related scientific evidence and encouraging faculty and staff participation. The current article delineates these mitigation strategies.

Background: Preventable medical errors represent a leading cause of death in the United States. Effective undergraduate medical education (UME) strategies are needed to train medical students in error prevention, early identification of potential errors, and proactive communication. To address this need, a team of faculty from A.T. Still University’s School of Osteopathic Medicine in Arizona developed four digital patient safety case scenarios for second-year medical students. These scenarios were designed to integrate interprofessional collaboration and patient safety principles, increase student ability to identify potential errors, and promote proactive communication skills. Methods: Faculty used Qualtrics to create four digital case scenarios on patient safety covering the following domains: communicating about potential drug-to-drug interactions; effective handoffs; human factors errors, such as fatigue, illness, and stress; and conflicts with supervising resident. In fall 2018, 97 second-year medical students completed the entire safety module in dyad or triad teams. As they worked through each case study, student teams completed 11 assessment questions with instant feedback, and participated in short case debrief discussions. Next, each individual student took a 12-question post-test to assess learning. Descriptive statistics were reviewed for the assessment questions, and case critical thinking discussion answers were reviewed to evaluate student comprehension. Results: The mean score for the module was 95.5% (SD= 6.36%, range = 75%-100%). Seventy-eight students completed the post-test, which had a mean score of 96.5% (SD = 6.51%, range = 66.7%-100%). Student written responses to the four case critical thinking discussion prompts indicated a high level of comprehension. Conclusion: Our results demonstrated that digital case studies can provide an innovative mechanism to introduce key patient safety concepts and experiential practice of interprofessional communication in early UME. Our design and implementation of these engaging interprofessional patient safety training modules provided an opportunity for students to learn key communication and safety concepts in small teams. This training method was cost-effective and could be replicated in other online learning or blended learning environments for a wide range of health professions.

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

Context Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. With the graduating class of 2017, A.T. Still University’s School of Osteopathic Medicine in Arizona (ATSU-SOMA) began requiring additional online curricula for all clerkship courses. Objectives To determine whether third year and fourth year students receiving ATSU-SOMA’s online curricula during core clerkships performed better overall on national standardized examinations than students from previous years who had not received the curricula, and whether scores from online coursework correlated with outcomes on standardized examinations as possible early predictors of success. Methods This retrospective cohort study analyzed existing data (demographics and assessments) from ATSU-SOMA classes of 2017–2020 (curriculum group) and 2014–2016 (precurriculum group). The effect of the curriculum on national standardized examinations (Comprehensive Osteopathic Medical Achievement Test [COMAT] and Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) was estimated using augmented inverse probability weighting (AIPW). Correlations between assignment scores and national standardized examinations were estimated using linear regression models. Results The curriculum group had 405 students with a mean (standard deviation [SD]) age of 25.7 (±3.1) years. Two hundred and fifteen (53.1%) students in the curriculum group were female and 190 (46.9%) were male. The precurriculum group had 308 students (mean ± SD age, 26.4 ± 4.2 years; 157 [51.0%] male; 151 [49.0%] female). The online curriculum group had higher COMAT clinical subject exam scores in obstetrics and gynecology, osteopathic principles and practice (OPP), psychiatry, and surgery (all p≤0.04), as well as higher COMLEX-USA Level 2-Cognitive Evaluation (CE) family medicine and OPP subscores (both p≤0.03). The curriculum group had a 9.4 point increase in mean total COMLEX-USA Level 2-CE score (p=0.08). No effect was found for the curriculum overall on COMAT mean or COMLEX-USA Level 2-Performance Evaluation scores (all p≥0.11). Total coursework scores in each core clerkship, excluding pediatrics, were correlated with COMAT mean score (all adjusted p≤0.03). Mean scores for five of the seven assignment types in core clerkships, excluding evidence based medicine types, were positively correlated with COMAT mean scores (all adjusted p≤0.049). All assignment types correlated with COMLEX-USA Level 2-CE total score (all adjusted p≤0.04), except interprofessional education (IPE). Conclusions Results from this study of 713 students from ATSU-SOMA suggested that our online curriculum supplemented clinic based learning during clerkship courses and improved student outcomes on national standardized examinations.