OSR Digest | 2013 AAMC Annual Meeting | Philadelphia, PA

Letter from the Chair

Dear OSR, Thank you all for a wonderful, engaging Annual Meeting this year in Philadelphia. I am so proud of our group! The fantastic innovations you have worked to implement at your home institutions over the past year are shining examples of the value that the OSR can contribute. I am particularly impressed with our efforts in coming together around the OSR Joining Forces Initiative this year. Through our involvement in the OSR, we each have an incredibly unique opportunity to give back to the communities we serve. Let's keep up the good work! On behalf of the OSR Administrative Board, I want to thank you for giving us the opportunity to serve you and medical students across the country in our roles. We promise to work hard to earn this privilege over the next year. Please do not hesitate to reach out to me or any other Ad Board member with questions, comments, or suggestions. We are here to serve you.

Best wishes,

Jessica G. Fried AAMC-OSR Chair Dartmouth Geisel School of Medicine

OSR Digest | 2013 AAMC Annual Meeting | Philadelphia, PA

2013 Digest Team

Communications Committee Andrew Doering, University of New Mexico Regina Kwon, University of Colorado Laura Rachal, Louisiana State University Cara Schroeder, Wright State University Peter Wingfield, University of Vermont With special thanks to Ally Anderson, OSR Director OSR, AAMC Shannon Boone, Senior Administrative Associate, AAMC Woody Chang, Stanford University Leland Husband, University of Mississippi Mariya Kalashnikova, University of Southern California Monique Mauge, Administrative Specialist, AAMC Sofia Noori, University of California - San Francisco

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Sessions
Find presentation information and materials here: https://event.crowdcompass.com/aamc2013/ For non-OSR programming, click here: https://www.aamc.org/meetings/annual/am2013/

Practical Finance & Decision Making ............................................................................................................ 4 The Art of Writing and Getting Published ..................................................................................................... 5 Working Within a Team: Navigating Difficult Conversations ....................................................................... 6 AAMC/NBME Updates: Changes to Pivio, USMLE Step Exams ..................................................................... 7 Careers in Medicine/FIRST Update ............................................................................................................... 8 GHLO/VSAS Update ...................................................................................................................................... 9 MCAT/AMCAS Update from the AAMC ...................................................................................................... 10 ERAS & NRMP Update................................................................................................................................. 11 AAMC Advocacy Update ............................................................................................................................. 13 The Case of Dr. M. Smith: Creating a Climate of Civility ............................................................................. 14 Career Fair ................................................................................................................................................... 14 OSR Plenary: AAMC Arnold P. Gold Foundation Humanism in Medicine Award Recognition ................... 14 Conversations About End of Life Care ........................................................................................................ 15 Efficiency, Accountability, and Sustainability: New Models of Medical Education .................................... 16 Joining Forces Initiative & Veterans Health ............................................................................................... 17 To Do No Harm: Patient Safety & Quality ................................................................................................... 18 Change Imperative Plenary: Envisioning Changes in Health Care .............................................................. 19 Transformative Student-Initiated Innovations & Developments in Medical Education............................. 20

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Fri., Nov. 1

Practical Finance & Decision Making

Michael Clancy, CFP, CLU Director of Financial Planning, Division of Medical Education Drexel University College of Medicine

By Leland Husband
How much do student loans cost you? What does it take to buy a house? Can you afford that dream residency? These questions and many more were addressed in the town hall discussion led by Mike Clancy, director of financial planning at Drexel University. Mr. Clancys central theme was to create a budget, even if you merely scratch one out on the back of an envelope. A budget wont solve all your worries, but it will let you know where you stand, he said. And sometimes, just knowing where you stand is all you need. TAKEAWAY: STEPS TO CREATING A BUDGET 1. Track how much you spend for 30 days. Remember to prorate periodic payments, such as car insurance. 2. Split spending into two categories: will literally die without and will figuratively die without. 3. Calculate monthly income. This includes any financial aid disbursement. 4. Subtract the will literally die without costs from monthly income. 5. The remainder can be saved or spent on the will figuratively die without expenses. If the remainder is negative, reassess Step Two. RESOURCES FIRST Medloans Calculator

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Fri., Nov. 1

The Art of Writing and Getting Published

Jennifer Campi Senior Staff Editor, Academic Medicine AAMC Mary Beth DeVilbiss Managing Editor, Academic Medicine AAMC

By Laura Rachal
Ms. Campi and Ms. DeVilbiss, editors of the monthly peer-reviewed journal Academic Medicine, provided advice for students and faculty interested in scholarly writing. The main focus was research articles, although some principles can be applied to narrative pieces. Effective titles Most readers come across papers through search engines. Use key search terms, avoid posing questions, avoid acronyms. Be informative and interesting but be sure your tone is appropriate for your audience. Maximize abstracts Read the instructions given by the journal to which you are submitting. Use the entire allotted space and include key search terms. Focus on the main ideas, data, and results rather than background. Clearly define the purpose of the study and include details about the design/methodology. Make conclusions, but do not go beyond the goal of the study. Know the rules Understand how the journal wants articles formattedreferences, abstracts, etc. Follow the instructions they provide for the manuscript and graphics. Ethical considerations If you survey or interview participants, you will need to involve a review board. Authorship Make sure co-authors meet the criteria for authorship. Remember that you must have sign-off from each author. Acknowledge those contributors who are not authors. Avoid the salami mistake Avoid repackaging information in order to get more publications. Learn from others Academic Medicine has published a substantial handbook on scholarly writing, including articles with editors comments. Academic Medicine accepts submissions from students on a variety of topics, including medicine and art, humanism in health care, and personal experiences, both for its print publication and for its new blog, AM Rounds.

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Fri., Nov. 1

Working Within a Team: Navigating Difficult Conversations

Alicia D.H. Monroe, MD Chief Academic Officer & Vice Dean, Educational Affairs USF Health, Morsani College of Medicine

By Woody Chang, Peter Wingfield, and Sofia Noori

USF professor Alicia Monroe and third-year USF medical student Alexandra Printz led a combined presentation and workshop on ways to approach the difficult conversations that can arise during team-based patient care. Difficult conversations can be extremely tough for students in particular because of their low status on the team. Dr. Monroe and Ms. Printz introduced several tools teams can use to improve communication. SBAR (Situation, Background, Assessment, Recommendation) is a standardized approach to patient hand-off and information exchange widely used in nursing. It is now being taught to interns and GME faculty around the country and is being incorporated in some UME courses. Crucial Conversations, a book by organizational performance team VitalSmarts, describes an approach to handling discussions when both stakes and emotions are high and people have opposing opinions. TeamSTEPPS is an evidence-based teamwork skills system developed by the Agency for Healthcare Research and Quality, the Department of Defense, and American Institutes of Research. The presenters then provided different uncomfortable scenarios for attendees to discuss in small groups using these models. TAKEAWAYS To successfully navigate a crucial conversation, find shared goals between you and the person of concern and express them. Environment is the keyif we do not create the right environment, the conversation is very unlikely to take place. Administrators and faculty should take responsibility for this. Team members should bring up sensitive topics in politically acceptable ways so that no one feel they are at fault. Keep the focus on the patients health. RESOURCES SBAR technique from IHI Crucial Conversations TeamSTEPPS

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Fri., Nov. 1

AAMC/NBME Updates: Changes to Pivio, USMLE Step Exams

Joshua Jacobs, MD Director of Pivio AAMC Peter Katsufrakis, MD, MBA Vice President of Assessment National Board of Medical Examiners Agata Butler, PhD VP, Medical Education & Health Profession Services NBME Mary Drescher Medical School Relationship Manager AAMC

By Woody Chang and Regina Kwon

Pivio enters pilot phase The AAMC and the National Board of Medical Examiners (NBME) are developing a new software tool that will connect data needed by medical students, residents, and physicians across their academic and professional careers, assisting them with lifelong career growth and improvement.. Examples of storable data include transcripts, standardized test scores, biographical data, and licenses and certifications. Pivio is working on features to pull in data from external sources, such as PubMed and E*Value, and to export to various systems, such as ERAS. The service is currently being piloted and is expected to launch in 2014. Annual fees will vary by stage of career, from $100 for medical students and $150 for residents to more for attendings. No significant changes expected to Step 1 until 2016 The 2014 and 2015 administrations will include questions covering quality improvement and safety science concepts. The 2016 exam will have a significant increase in clinically focused questions. Step 2 CK continues current path, CS still scrutinized for being too easy Step 2 CK questions will continue the trend of including more questions on biostatistics, critically evaluating drug advertisements, and working up diagnoses/making treatment plans. NBME will test different question formats but did not offer specifics. NBME is still concerned that Step 2 CS is too easy. These concerns led to the note component; future changes may include adding difficult encounters. These changes are under review, as they pose timing and synchronization issues. Students to have greater flexibility in scheduling Step 3 In November 2014, students will be able to schedule Step 3 on two nonconsecutive days, with up to two weeks between days. Although the two days are scored separately, they are together considered a single test (i.e., students taking Step 3 more than once may not combine days from different test administrations). NBME states that the restructured exam will take significantly longer to score. Step 3 will also increase content tied to specific competencies and to biostats and the names of the two parts of the exam will change as well, to Step 3 Foundations of Independent Practice and Step 3 Advanced Clinical Methods. RESOURCES Pivio USMLE changes

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Fri., Nov. 1

Careers in Medicine/FIRST Update

Julie Fresne Director, Student Financial Services AAMC Jeanette Calli, MS Manager, Careers in Medicine AAMC

By Laura Rachal
Student Financial Services Director Julie Fresne and Careers in Medicine (CiM) Manager Jeanette Calli reviewed updates to their respective Web sites. Ms. Fresne also discussed current data on medical education debt, new methods of repayment for federal loans, and how to be an informed borrower. Careers in Medicine (CiM) relaunched in July 2013 new, four-phase structure: browsing, understanding oneself, choosing a specialty, landing a residency site tracks your year in medical school and offers targeted recommendations CiM timeline provides a step-by-step guide to specialties users can favorite articles and resources throughout site specialty pages have been expanded, with comparisons and lifestyles information, and now link to Docphin, a medical research and specialty news provider landing a residency feature provides a database of residency programs CiM is working on expanding information on the competitiveness of particular programs users can rank and favorite residency programs Financial Information, Resources, Services, and Tools (FIRST) Ms. Fresne discussed the Debt Fact Card 2013 as well as all the resources available on the Web site, including advice on tax deductions and weighing financial decisions (e.g., buying vs. renting); 15-minute snapshot videos; publications on student debt and residency selection; and the perennial favorites, the Medloans organizer and calculator. Ms. Fresne also reviewed legislative federal loan changes and new, income-driven (pay-as-you-earn) repayment plans. TAKEAWAYS median student loan debt is increasing with medical tuition; however, debt does not appear to be impacting students specialty choices use the Medloans organizer and calculator to track all your educational loans and estimate payments subsidy was lost on federal loans last year; loans now have a variable interest rate income-driven repayment plans are based on income, not debt these plans can be paired with Public Service Loan Forgiveness programs RESOURCES Careers in Medicine (CiM) Financial Information, Resources, Services, and Tools (FIRST) Debt Fact Card 2013 State debt report Can Medical Students Choose To Afford Primary Care?

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Fri., Nov. 1

GHLO/VSAS Update
Melissa Donner Director, VSAS AAMC Jenny Samaan Director, GHLO AAMC

By Peter Wingfield and Woody Chang

Visiting Student Application Service (VSAS) VSAS is an application service for medical students applying for domestic clinical rotations away from their home institution. Although the statistics indicate that some applications are not successful, the numbers do not take into account the fact that students apply to multiple away rotations. VSAS goal for the coming year is to make the application process easier. This group will be focusing on: standardizing immunization forms reducing redundancy in the system standardizing affiliation agreements improving clarity decreasing the time spent applying

FACTS & FIGURES: VSAS 160 medical schools (131 U.S. LCME schools plus 29 COCA (DO) schools) use VSAS 96 U.S. LCME schools are host institutions as well (the other 29 are members of the Council of Teaching Hospitals and Health Systems) VSAS received 97,000 elective requests last year. 75% of applicants were MD students and 25% DO most students apply to two or more institutions and three or more electives 84% of students first-choice electives received at least a single offer Global Health Learning Opportunities (GHLO) GHLO is an application service for medical students applying for international global health experiences, such as clinical, research, or public health electives, outside of their home country. It is a relatively new program with a limited number of institutions able to enroll students. GHLO plans to expand its roster of schools as well as address logistical issues, such as funding for expenses (including travel and housing) not included in the cost of the application. current membership: 24 schools in the United States, 10 in Europe, 7 in Africa, 8 in Asia, 6 in Australia/New Zealand, and 4 in Latin America currently, students may only participate in GHLO if their institution is a member RESOURCES Visiting Student Application Service (VSAS) Global Health Learning Opportunities (GHLO)

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Fri., Nov. 1

MCAT/AMCAS Update from the AAMC

Jen Page, MEd Director, MCAT Preparation Products Kelly Begatto Director, AMCAS Judith Byrne, MA Director, MCAT Administration and Reporting Scott Oppler, PhD Director, MCAT Development and Psychometrics Rebecca Rice, MSB Manager, MCAT 2015 Outreach and Communications

By Peter Wingfield and Woody Chang

Notes on the MCAT Requests for accommodations have been increasing. Questions in biochemistry, sociology, and psychology were offered as an optional trial. These subjects will officially become part of the exam in the spring of 2015. Applicants can take the test up to three times in one year. A "no-show" is counted as an attempt. The cost of changing your exam date increases as you get closer to the date. AAMC continues to consider whether the MCAT is fair across different backgrounds and whether it is a good predictor of acceptance into medical school. AAMC offers free and paid resources for test preparation, including webinars, its official guide, sample exams, online content, practice texts, and a collaborative on MedEdPortal (of which Khan Academy is part). FACTS & FIGURES: 2013 MCAT ADMINISTRATION 94,000 exams given on 25 days 83,000 unique examinees 16,500 from underrepresented groups mean score 25.3 (25.2 in 2012) Notes on AMCAS Applications are both increasing and being submitted earlier. AMCAS has the goal of ensuring that schools can identify the students who are the best fit for them. New tools being planned for the AMCAS application service include integration of secondary applications; iPad compatibility; and integration of interview scheduling. There is no discussion at this time about changing the current tools and software. FACTS & FIGURES: 2013 MEDICAL SCHOOL APPLICATIONS 48,000 applicants first-year matriculants exceeded 20,000 for the first time ever 47.2% female, 52.8% male on average, students apply to 15.4 schools RESOURCES See the May 2013 issue of Academic Medicine for more about the MCAT and AMCAS.

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Fri., Nov. 1

ERAS & NRMP Update

Amy Mathis Manager, Applicant and Medical Schools Relations AAMC Mona Signer, MPH Executive Director NRMP

By Cara Schroeder
ERAS Enhancements optional Deans Office Workstation (DWS) for quality assurance (QA) streamlined exam tab to expedite retransmissions USMLE Tracking Report usability updates to MyERAS Careers in Medicine (CiM) provides information about programs but is limited to information programs choose to share CiMs new site offers characteristics of entering residents for participating specialties ERAS answers student questions over Twitter (#ERAS2014); launched Sept. 15 and had 435 tweets and 152 participants SOAP students able to submit 35 applications Monday through Wednesday and 10 applications Wednesday through Thursday of match week SOAP to conclude on Thursday of match week moving forward ERAS to collaborate with NRMP to provide applications with tracked data in ERAS medical schools will still have reports to help guide students Enhancements planned for ERAS 2015 and beyond mid-April opening will give more time to work on applications and to seek peer help from fourth years Applicant Interview Scheduler: application intended to ease traffic and reduce phone-tag between applicants and programs in scheduling residency interviews Letter of Recommendation watermark: transparency for source of letter DWS reports for problem files; ERAS will provide report for office to work through two-way messaging for Program Directors WorkStation (PDWS) Pilot participants using Web-based software DWS will eventually have Web-based software for medical schools, though not for the 2015 season Pivio beta-testing concluding soon and is planned for launch in 2014 ERAS can import/export with Pivio NRMP The NRMP is an independent organization and maintains a separate board. Students and residents on the board bring the student perspective. Match trends 2013 was the largest-ever Match, with more than 40,000 registrants 29,171 total spots available; 28,130 were filled in the main Match 17,487 applicants were allopathic seniors) match rates increased for all applicants except U.S. seniors 93.7% US seniors matched in 2013 (leaving 1,097 unmatched), compared to a match rate of 95.1% in 2012 2013 applicant survey results: How do students choose/rank programs? top considerations: geographic location, reputation of program, quality of residents, quality of program salary was at the bottom

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SOAP average of seven graduates per school unmatched 939 unfilled positions placed in SOAP; only 61 unfilled at the conclusion of SOAP more than half were PGY1-only preliminary/transition years competitive specialties tended to have more unmatched seniors 878 positions filled during SOAP this past year, with most positions filled the first day U.S. seniors accepted majority (595) of positions offered during SOAP Characteristics of unmatched U.S. seniors less likely to rank a mix of programs as well as a safety-net programs on average, these students submit more applications, are offered fewer interviews, and rank fewer programs on average, unmatched US seniors submitted 51 applications, were offered seven interviews, and ranked seven programs Program Rating and Interview Scheduling Manager (PRISM) A free, confidential application that allows the student to: track interviews export data to e-mail to create a rank list track the timeline of the main residency Match (next summer will include fellowships) search programs (i.e., access all information in the NRMP system) create a list of favorite programs record whether theyve applied, received an interview sync calendar to phone enter notes about a program rate programs based on criteria from survey and custom data TAKEAWAYS FROM THE ERAS/NRMP Q&A NRMP is working on producing an independent publication similar to the historic Charting Outcomes in the Match, which was previously a joint effort between NRMP and AAMC. this has resulted in additional required questions when registering for NRMP (e.g., board scores) exploring options to allow verified board scores to be acquired rather than self-reported in the future SOAP students must wait for programs to contact them; deans cannot contact programs on students behalf. Programs cannot coerce a student to commit during the SOAP process. All-in policy was very successful and match rates increased overall. 2,399 more positions included in the match in 2013 (1,000 in internal medicine) A program director survey in the upcoming cycle will help to determine how program directors are reacting to the evolving Match climate. RESOURCES ERAS NRMP

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Fri., Nov. 1

AAMC Advocacy Update

Atul Grover, MD, PhD Chief Public Policy Officer AAMC

By Woody Chang and Laura Rachal

Dr. Grover, chief public policy officer for the AAMC, provided updates regarding AAMCs advocacy efforts and news from Capitol Hill as well as answered many students questions concerning health care policy and funding. The goals of his presentation were to outline AAMCs priority goals for 2013-2014, discuss GME and medical research funding deficits, and encourage students to become more involved in these efforts. AAMC priorities for 2013-2014 sustain funding for medical research and GME minimize the impact of sequestration fix the Medicare Sustainable Growth Rate (SGR) preserve the ability to provide high quality care to all populations implement the Affordable Care Act and expand coverage A deficit in GME positions greater number of applicants (non-MD and international students) but no increase in positions a bill currently before the House is attempting to increase spots over the next five years schools must provide better Match counseling for students; an increasingly competitive Match predicted NIH funding sequestration medical students and the public must advocate for reasons to fund science: clinical trials, basic science research, etc. student letters sent to politicians to reverse NIH funding cuts have met with some success Goals for student involvement use AAMCAction app to keep updated on lobbying efforts contact local legislative reps advocating for NIH funding educate current patients, family members, and friends join with other medical organizations to get these messages out RESOURCES AAMCAction About the Medicare Sustainable Growth Rate (SGR)

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Fri., Nov. 1

The Case of Dr. M. Smith: Creating a Climate of Civility

Charles Samenow, MD, MPH Program Director Jeffrey Steiger Artistic Director Cast, The Center for the Application of Scholarship of Theater in Medicine George Washington University School of Medicine

By Regina Kwon
The Center for the Application of Scholarship of Theater in Medicine (CAST) at the George Washington University School of Medicine produces plays and workshops to promote dialogue about the culture of medicine and patient safety. Milestones: The Case of Dr. M. Smith is a two-act play that follows the life of a woman from her start as an awkward, intense medical student to her punishment for vicious behavior as a resident. RESOURCES The Center for the Application and Scholarship of Theater (CAST) in Medicine

Sat., Nov. 2

Career Fair
By Andrew Doering
The Community & Diversity Committee participated in a career fair for premedical students, parents, and advisors from the local Philadelphia area. The session connected OSR reps with attendees to talk about the path to medical school, including applying and financial aid. Widely regarded by OSR reps as one of the most rewarding reasons to attend the Annual Meeting, the career fair allows current medical students to play a role in enriching the pipeline of physicians of the future.

Sat., Nov. 2

OSR Plenary: AAMC Arnold P. Gold Foundation Humanism in Medicine Award Recognition & Luncheon
Lee Todd Miller, MD Co-Director, Global Health Education Program Vice Chair for Education, Department of Pediatrics David Geffen School of Medicine at UCLA

By Cara Schroeder
The AAMC honored educator and pediatrician Lee Todd Miller, MD, with the Arnold P. Gold Foundation Humanism in Medicine Award. Dr. Miller gave an inspirational talk, using his work combatting pediatric diarrheal diseases to illustrate advice for medical students. Every person should strive to be compassionate and respectful and to acknowledge the dignity of others, he said. Dr. Miller also emphasized the ripple effect of our actions: We should never forget the impact we can have on our patients lives. We may never see those ripples, but they exist. RESOURCES About Dr. Miller

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Sat., Nov. 2

Conversations About End of Life Care

Deborah L. Dokken, MPA Family Leader/Consultant, Institute for Patient-andFamily Centered Care Jessica McCannon, MD Instructor in Medicine, Harvard Medical School Physician, Pulmonary and Critical Care Unit, Massachusetts General Hospital Medical Advisor, The Conversation Project Jennifer Reidy, MS, MD, FAAHPM Co-Chief, Division of Palliative Care UMass Memorial Medical Center Assistant Professor University of Massachusetts Medical School Jonathan Giftos, MD PGY2, Primary Care and Social Medicine, Montefiore Medical Center

By Andrew Doering
This session addressed ways to improve the communication skills of residents in the context of end-of-life care. Dr. Jessica McCannon introduced The Conversation Project, a national campaign begun by writer Ellen Goodman and professor Len Fishman in 2010. Supported by the Institute for Healthcare Improvement, The Conversation Project hopes to create cultural change by promoting open discussions about death (see Resources below). Although medical students receive some training in end-of-life conversations, said Dr. Jennifer Reidy, the educational opportunities lag in residency. She encouraged family meetings, but likened them to medical procedures in that they require expertise. TAKEAWAYS Do your homework. Have a firm prognosis and make sure you know the facts and the risks and benefits of different options. Be able to discuss these without jargon. Gather the right people in the roomthe case worker, for exampleand make sure the group will have adequate privacy and time to meet. Let family set the agenda: Be a listener first and assess what the family understands about the prognosis and their options. Balance hope with honesty: Dont give false hope, but paint a positive light if one exists. Summarize and follow-up with all those present at the meeting. RESOURCES Conversation Starter Kit VitalTalk oncotalk

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Sat., Nov. 2

Efficiency, Accountability, and Sustainability: New Models of Medical Education

Marc J. Kahn, MD, MBA Peterman-Prosser Professor and Senior Associate Dean for Admissions & Student Affairs Tulane University School of Medicine Alan K. David, MD Chair & Professor Department of Family Medicine Medical College of Wisconsin Louise M. Arnold, PhD Professor, Associate Dean for Medical Education University of Missouri-Kansas City School of Medicine Barbara Beckman, PhD Associate Dean of Admissions and Professor of Pharmacology Tulane University School of Medicine

By Regina Kwon
At an average cost of $62,000 per student per year, the U.S. model of medical education is expensive compared with that of other countries. Student debt is high as well, averaging $180,000 on graduation. The presenters described different models of medical education designed to address these unfortunate economics. Accelerated residency to promote interest in primary care students meet intern-year requirements in fourth year pilot revealed high performance by students but some problems with acceptance by staff and residents currently in place at six schools (five MD, one DO) in the United States and Canada decreased need with increased interest in primary care HEAL-X: accelerated MD for students with PhDs to increase numbers of clinician scientists/educators reduce time in medical school by six months emphasized small-group learning sessions in pilot phase at Tulane University University of Missouri-Kansas city: combined baccalaureate-MD program students enter after high school graduation 11-month curriculum allows for completion in six years program begun in 1971; 3,150 graduates to date board scores and march rate comparable to other schools graduates students rated highly as residents

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Sat., Nov. 2

Joining Forces Initiative & Veterans Health

Jeffrey L. Brown, MD Clinical Professor of Pediatrics, New York Medical College Associate Clinical Professor in Psychiatry, Weill Cornell Medical College

By Leland Husband
Joining Forces was started in 2011 by First Lady Michelle Obama and Dr. Jill Biden as a national initiative to promote societal support of military personnel and their families. In 2012, more than 100 medical school Deans joined the AAMC in a pledge to prioritize veterans health in medical education. In 2013, the OSR asked reps to create and implement projects at their home institutions speaking to the Joining Forces mission. In this session, Nora Zeidan (MS2, OSR) and the Medical College of Georgia were recognized for their outstanding projecta week of coordinated sessions and activities during Veterans Wellness Week. The keynote speaker, Dr. Jeffrey Brown, discussed his time as a physician in Vietnam and provided perspective on the important impact military service can have on the health of a veteran and his or her family. Although he had been exposed to Agent Orange during his time of service, it was not until his own physician questioned him many years later that it occurred to Dr. Brown that his military history may have a bearing on his health. That one physicians interest sparked a revolution in him. Dr. Brown published an article in JAMA (see Resources below) in which he recounted his own journey, advocating for attention to military service in medical history taking; today, he is a vocal advocate for veterans health care. Civilian physicians rarely take a moment to identify those patients who are veterans, said Dr. Brown, a serious oversight when only 40% of veterans receive any portion of their care from the Veterans Health Administration and roughly 10% of the U.S. population has served in the military. TAKEAWAYS: QUESTIONS TO ASK VETERANS Dr. Brown recommends asking not only about your patient but also about their loved ones. 1. When and where were you stationed? 2. What was your job description? 3. Were you physically injured? 4. Did you ever receive a blood transfusion before routine screening for hepatitis C? 5. Were you ever exposed to Agent Orange? 6. Were you ever treated for parasitic or tropical diseases? 7. Have you ever been treated for a service-related condition? 8. Were you affected psychologically by your military experiences? RESOURCES The Unasked Question by Jeffrey Brown Facts about veterans and their health

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Sat., Nov. 2

To Do No Harm: Patient Safety & Quality

David B. Nash, MD, MBA Dean and Founder, Jefferson School of Population Health Thomas Jefferson University

By Cara Schroeder
The medical profession has poured great energy into quality and safety initiatives since the 1999 publication of To Do No Harm by the Institute of Medicine. In this session, Dr. Nash highlighted accomplishments, described the current state of affairs, and identified specific ways students can get involved. The quality & safety movement is national, and it is growing AAMC sponsors Integrating Quality Initiative four schools with masters programs in quality & safety (Northwestern, University of Illinois, Thomas Jefferson University, George Washington University) more than 100,000 students worldwide engaged in IHI Open School curricula 12 global peer-reviewed journals about quality & safety new fellowships in quality & safety But training is still lacking medical errors and hospital-acquired infections are the third-leading cause of death in the United States more than 80 wrong-site surgeries per month in 2012 surgery overutilized few doctors have the skills to lead projects to improve care and improve patient safety TAKEAWAYS: HOW TO GET INVOLVED For every patient you see, write a note about how you could have improved your work. Identify how feedback loops are closed for mistakes made. Start an IHI Open School chapter. Join the American College of Physician Executives. Start a House Staff Quality Council during residency. Build awareness by screening a movie, such as Escape Fire, Chasing Zero, or The Waiting Room. Implement an improvement project. Contribute to the American Journal of Medical Quality. Find a mentor! RESOURCES Integrating Quality Initiative Health Care Quality: The Clinician's Primer (ed. David Nash) Why Hospitals Should Fly (by John N. Nance) start an IHI Open School chapter Call for abstracts for the AJMQ Q-TIP column

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Sun., Nov. 3

Change Imperative Plenary: Envisioning Changes in Health Care The Future of the Health Care Marketplace
Marsha Rappley, MD Dean, Michigan State University College of Human Medicine Ian Morrison, PhD Health Care Futurist and Author

By Cara Schroeder
Dr. Ian Morrison is an internationally known author, consultant, lecturer, and media commentator specializing in long-term forecasting and planning, with an emphasis on health care and market trends. He has written several books and articles and consulted and lectured on a wide variety of health care topics for organizations on three continents. With his expertise, he has helped more than 100 Fortune 500 companies navigate market changes and plan for the future. In 2011, he published Leading Change in Health Care: Building a Viable System for Today and Tomorrow. This session was recorded. Please log in to view it.

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Sun., Nov. 3

Transformative Student-Initiated Innovations & Developments in Medical Education

By Leland Husband
Operation Mend Gil Weintraub Kristofer Roberts David Geffen School of Medicine at UCLA Through the Operation Mend Medical Student Organization (OMMSO), medical students use a multidisciplinary approach to help veterans recovering from complicated war wounds. Veterans are paired with buddy families who provide social support and continuity of care. Medical student buddy families accompany service members to clinic visits and surgeries while helping them experience life outside the hospital through meals and activities. Mental Health Clinic at the East Harlem Health Outreach Partnership Jessica Fields Icahn School of Medicine at Mount Sinai In East Harlem, over a quarter of the population is uninsured, and the mental health hospitalization rate is twice as high as for the rest of Manhattan. East Harlem residents receive longitudinal mental health care through a student-run clinic.

SELECT Superutilizer Project Alexandra Printz USF Morsani College of Medicine, SELECT Program Patients with high hospital re-admittance rates overwhelm the health-care system, increasing costs for all parties. SELECT is a longitudinal third-year primary care clerkship curriculum through which students identify superutilizers and enroll them in the Camden Coalition. Success of the program has had a ripple effect, leading to greater engagement by community providers.

Simulated Chaos: Adding Interactive Education to UCF COMs Annual Global Health Conference Erin Kane University of Central Florida College of Medicine The second annual Global Health Conference sponsored by MedPACT (Medical Students Providing Across Continents) focused on disaster preparedness and emergency medicine, highlighted by a half-day of interactive simulations. Participants engaged in six different simulations designed to further the participants knowledge of various maladies and situational decision-making skills. Individual simulations included a short briefing by student and physician instructors, a 15- to 20-minute experience, and a debriefing with instructor feedback and participant Q&A.

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OSR Digest | 2013 AAMC Annual Meeting | Philadelphia, PA

Homerun Project Kevin Batte University of Mississippi Medical Center The Homerun Project partners medical students and other health professionals work with classroom teachers to improve elementary and middle school students understanding of science and to discuss healthful nutrition, exercise, and tobacco- and drug-avoidance. Science teachers identify topics to be taught by participating medical students. Classes were simple and included time for discussions about healthful choices, exercise, and tobacco- and drug-avoidance. RESOURCES Project summaries

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