Medical students as human subjects in educational research

Introduction: Special concerns often arise when medical students are themselves the subjects of education research. A recently completed large, multi-center randomized controlled trial of computer-assisted learning modules for surgical clerks provided the opportunity to explore the perceived level of risk of studies where medical students serve as human subjects by reporting on: 1) the response of Institutional Review Boards (IRBs) at seven institutions to the same study protocol; and 2) the thoughts and feelings of students across study sites about being research subjects. Methods: From July 2009 to August 2010, all third-year medical students at seven collaborating institutions were eligible to participate. Patterns of IRB review of the same protocol were compared. Participation burden was calculated in terms of the time spent interacting with the modules. Focus groups were conducted with medical students at each site. Transcripts were coded by three independent reviewers and analyzed using Atlas.ti. Results: The IRBs at the seven participating institutions granted full (n=1), expedited (n=4), or exempt (n=2) review of the WISE Trial protocol. 995 (73% of those eligible) consented to participate, and 207 (20%) of these students completed all outcome measures. The average time to complete the computer modules and associated measures was 175 min. Common themes in focus groups with participant students included the desire to contribute to medical education research, the absence of coercion to consent, and the low-risk nature of the research. Discussion: Our findings demonstrate that risk assessment and the extent of review utilized for medical education research vary among IRBs. Despite variability in the perception of risk implied by differing IRB requirements, students themselves felt education research was low risk and did not consider themselves to be vulnerable. The vast majority of eligible medical students were willing to participate as research subjects. Participants acknowledged the time demands of their participation and were readily able to withdraw when those burdens became unsustainable

A simulated “Night-onCall” to assess and address the readiness-for-internship of transitioning medical students

Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic “night on call” experience for near graduating students and build measurements of students’ readiness for this transition framed by the Association of American Medical College’s Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education

Stress, fatigue, and medical students' study resource selection: Implications for the design of educational multimedia

BACKGROUND AND METHOD: Medical students are generally considered to be a unique group of experienced learners, functioning under high levels of stress and fatigue. The use of multimedia in digital environments has become a standard feature in most medical schools, but it has met with limited success. A study was designed to investigate the impact of stress and fatigue on general study resource selection, with particular interest in multimedia, and its limited uptake by medical students. A series of 58 focus groups with 107 third and fourth year medical students at the NYU School of Medicine was conducted in the spring of 2015. A survey instrument was also administered. Quantitative data analysis was conducted in SPSS-23; the qualitative data analysis was conducted through open coding and grounded theory procedures in ATLAS.ti. FINDINGS: Results produced a model of stress and fatigue for third-year medical students, and showed a statistically significant increase in multimedia usage under fatigue but not under stress alone, and a statistically significant decline in textbook preference under conditions of stress and/or fatigue. Practice questions (i.e., “question banks”) and text-based websites (evidence-based, clinical decision resources related to diagnosis and case management) were the preferred study resources under all conditions. Further analysis of the qualitative data regarding multimedia’s strengths and weaknesses under stress and fatigue produced a series of 12 multimedia design and implementation factors. DISCUSSION While these findings are based on the specific medical student population, there may be significant implications for the general learner population, which is also confronting increased stress and fatigue. As on-line learners and other populations of learners start to look more like medical students – trying to study when they are tired, stressed, and under severe time pressure – it’s worth considering that many of the suggestions for making multimedia resources more appealing to medical students might also have the same effects with other populations

Choosing effective multimedia simulations for learning

Molecules & Minds is in its 8th year of researching how to improve the effectiveness of simulations based on kinetic molecular theory. Our immediate goal is to help learners explore and understand observable, symbolic, and explanatory levels of representation through interactive multimedia resources that allow learners to control variables and pacing. Our key findings: big ideas need a simple design; icons work better than symbols; freedom to explore supports learning and engagement; problematizing narratives that bring science from the classroom into the everyday world lead to better learning outcomes; and that topic order may be important for learning, are presented