UNASSIGNED: Global ophthalmology opportunities are becoming increasingly popular, and international partnerships are becoming more common among academic training institutions in the United States. There is need for training in the complex relational, motivational, ethical, and logistical issues that may arise in these partnerships.
UNASSIGNED: We developed a 3-hour case-based session featuring four characters in a fictitious international ophthalmology partnership scenario. Facilitators used structured questions for each of the four parts to foster interaction and discussion among learners. After the activity, participants completed an evaluation/questionnaire consisting of Likert-scale and open-ended questions.
UNASSIGNED: A total of 23 ophthalmology residents and seven medical students underwent the activity over four iterations. The activity was well received, with 100% of learners either strongly agreeing (90%) or agreeing (10%) when asked if the session was worthwhile and 100% of learners either strongly agreeing (87%) or agreeing (13%) when asked if the format was conducive to achieving the learning objectives. Answers to questions on how learners would change how they practice ophthalmology in their residency and in their future careers revolved around the following topics: consideration of other perspectives, humility, self- and situational awareness, complexities of partnerships, reciprocity and exchange, importance of communication, and connection of principles between international and domestic medical practice.
UNASSIGNED: While this case study explores an international ophthalmology partnership scenario, the principles and themes presented can be applicable to other fields of medicine, and can be applicable to the practice of medicine both internationally and domestically.

Ethical and professional dilemmas are part of the day-to-day practice of medicine, including within dermatopathology (e.g., ethical implications of self-referring skin biopsies for pathology interpretation). There is a need for teaching aids that dermatology educators can easily access to help provide ethics education.
We held an hour-long, faculty-facilitated, interactive, virtual discussion about ethical issues in dermatopathology. The session followed a structured, case-based format. We administered anonymous online feedback surveys after the session and used the Wilcoxon signed rank test to compare participants\' before and after responses.
Seventy-two individuals from two academic institutions participated in the session. We collected 35 total responses (49%) from dermatology residents (n = 15), dermatology faculty (n = 14), medical students (n = 2), and other providers and learners (n = 4). Feedback was largely positive, with 21 attendees (60%) indicating they learned a few things and 11 (31%) indicating they learned a great deal. Additionally, 32 participants (91%) indicated they would recommend the session to a colleague. Our analysis showed that attendees had a greater self-perceived level of achievement for each of our three objectives after the session.
This dermatoethics session is structured so as to be easily shared, deployed, and built on by other institutions. We hope that other institutions will use our materials and results to improve upon the foundation presented here and that this framework will be used by other medical specialties seeking to foster ethics education in their training programs.

To assess which potential future outcomes are most important to parents of children with bronchopulmonary dysplasia, a disease that affects future respiratory, medical, and developmental outcomes for children born preterm.
We recruited parents from 2 children\'s hospitals\' neonatal follow-up clinics and elicited their importance rating for 20 different potential future outcomes associated with bronchopulmonary dysplasia. These outcomes were identified and selected through a literature review and discussions with panels of parents and clinician stakeholders, via a discrete choice experiment.
One hundred and 5 parents participated. Overall, parents ranked \"Will my child be more vulnerable to other problems because of having lung disease?\" as the most important outcome, with other respiratory health related outcomes also highly ranked. Outcomes related to child development and effects on the family were among the lowest ranked. Individually, parents rated outcomes differently, resulting in a broad distribution of importance scores for many of the outcomes.
The overall rankings suggest that parents prioritize future outcomes related to physical health and safety. Notably, for guiding research, some top-rated outcomes are not traditionally measured in outcome studies. For guiding individual counseling, the broad distribution of importance scores for many outcomes highlights the extent to which parents differ in their prioritization of outcomes.

Values clarification is a structured, reflective process individuals engage in to better understand their own beliefs and priorities. We designed a workshop on values clarification to help preclerkship medical students anticipate and manage potential conflicts between their personal values and professional expectations.
We assigned participating students a values clarification exercise as prework. The 2-hour workshop included introductory remarks, a presentation by two physicians on personal ethical challenges they had faced, and faculty-facilitated small groups. In the small groups, students discussed moral discomfort in the context of various health care scenarios. Students were invited to complete an optional postworkshop survey with Likert-scale and short-answer questions. We analyzed the qualitative data and formulated 10 emerging themes.
Thirty-eight of 180 participating students (21%) returned the survey. Of these, 30 (79%) agreed the workshop helped them appreciate that their values might come into conflict with professional obligations, 26 (68%) agreed they would be able to apply what they learned to future scenarios, and 30 (79%) agreed the workshop helped them understand their colleagues\' values. The most prominent themes identified were that students found the physician panel especially meaningful and that the workshop helped students examine their own values and prepared them to better understand their future patients\' values.
Our workshop is unique in that it does not focus on a single area in health care but addresses moral discomfort broadly. To the best of our knowledge, it is the first values clarification curricular initiative developed for preclerkship medical students.

The opioid epidemic impacts all ages, yet few published medical education curricula exist to train physicians on how to care for opioid use disorder (OUD) in adolescents, a developmental stage where confidentiality protection is appropriate and contributes to quality health care. We developed a simulation-based educational intervention to increase addiction medicine and addiction psychiatry trainees\' confidence in managing adolescents with OUD.
Trainees completed a confidence survey and viewed an educational video covering state-specific confidentiality laws pertinent to treating adolescents with OUD. One week later, trainees participated in a simulated encounter where they described the scope of confidentiality to a trained actor, used the Clinical Opiate Withdrawal Scale to assess symptoms of opioid withdrawal, and explained adolescent-specific OUD medication treatment options. Immediately afterward, trainees completed a self-reflection and satisfaction survey and participated in a debriefing session with a faculty member where they identified learning goals. One month later, they completed the confidence survey to quantify changes in confidence.
Thirty-five fellows (21 male, 14 female) completed the simulation-based educational intervention between 2016 and 2019. When asked to answer yes or no, 96% of participants described the exercise as effective and 100% (n = 26) would recommend it to peers. In addition, learners identified future learning goals, including researching specific topics and seeking out additional opportunities to evaluate adolescents with OUD.
Based on our participants\' report, this simulation-based educational intervention is an effective teaching method for increasing trainee confidence in managing adolescents with OUD.

Understanding population health in the context of infectious disease outbreaks is an important physician competency. However, identifying effective ways to engage early medical students in this content remains a challenge. We designed an innovative pandemic simulation for first-year medical students utilizing the pop culture theme of zombies.
This 2.5-hour simulation was conducted in 2018 and 2020 during students\' virology course. Student teams collected and analyzed data to formulate hypotheses for the source pathogen. The teams completed reports explaining their diagnostic hypotheses, infection containment recommendations, and resource allocation recommendations. Learners completed an evaluation of the simulation through an online survey. Responses were analyzed using descriptive statistics; narrative responses were analyzed qualitatively for themes. A content analysis was performed on students\' reports.
Two hundred eighty-four medical students participated in this activity. Nearly all respondents agreed that the small-group format (98%, 2018 and 2020) and pace and duration (92%, 2018; 94%, 2020) were appropriate and that the activity was intellectually stimulating (97%, 2018; 96%, 2020). Learner engagement measures were high (90%-97%, 2018; 83%-96%, 2020). Analysis of students\' reports revealed evidence of cognitive integration of virology, population health, and bioethics concepts, including integration of new learning content.
Collaborative problem-solving during a simulated zombie-themed pandemic provided preclinical medical students with an engaging opportunity to integrate virology, population health, and bioethics concepts. Implementing this event required advanced planning, use of multiple spaces, learning materials preparation, and recruitment of several faculty, staff, and actors.

Medical students have limited opportunities to learn about current genetic testing. This session provided exposure to different types of testing and the complex issues that physicians may encounter when counseling patients on proper testing and interpreting results.
We designed a 1-hour interactive lecture for second-year medical students. We presented an overview of the topic, then applied the concepts to specific disorders and cases. Students were asked to answer questions regarding cases using an audience response system, and we used their responses as the basis for our in-class discussion. This session has been held twice, with 25 students attending in 2018 and 31 students in 2019. The session was also recorded so that additional students not in attendance could watch, and was available to 151 students in 2018 and 333 students in 2019.
Students answered questions via audience response system. There was a range of 47%-100% of students giving the correct answers in 2018, and 55%-93% in 2019. Exam questions covering genetic counseling issues were answered correctly by 66% and 77% of students in 2018, and 70% and 68% of students in 2019.
This session provided an opportunity for medical students to be exposed to some of the complex ethical and psychosocial issues that may arise with genetic testing for liver disease and to consider how to navigate them. Using an audience response system during the lecture made the session more interactive and allowed the teacher to correct errors and teach based on the responses.

Students are taught the basics of medical ethics during their pre-clinical education, but need additional instruction on how to apply these principles to patient situations they may encounter during their clinical rotations. The ethical principles of autonomy and justice become especially pertinent to patient care in the setting of discharge decision-making. Third-year medical students would therefore benefit from an interactive educational activity that allows them to practice applying these principles within the context of discharge decision-making.
This session was designed for third-year medical students completing their required rotation in neurology. Students participated in a 1-hour, facilitator-led, interactive, small-group, ethics-based activity meant to simulate the typical 4-day post-stroke hospital stay. Learning objectives for the activity were to enhance students\' understanding of the principles of autonomy, justice, competence, and capacity. Students were given pretest to gauge prior knowledge of activity learning objectives; their knowledge was again assessed afterwards, and they were surveyed on the usefulness and value of the activity.
Twenty-three third-year medical students completed the activity over three sessions. The average improvement between pre- and posttest score was 40%. Lastly, on the qualitative feedback form, a majority of students strongly agreed that the activity was useful and presented new information, with 18 of 23 students giving the activity the highest possible rating of excellent.
A large majority of the students found the activity to be valuable, and the activity was shown to be effective at improving students\' knowledge of a key aspect of successful medical practice.

Although increasing numbers of states are legalizing cannabis for both medical and recreational purposes, health care providers and students report low comfort levels and limited knowledge regarding cannabis, highlighting current deficits in medical training.
We developed a structured cannabis curriculum for a general psychiatry residency program at the University of Colorado. In constructing our curriculum, we initially surveyed advanced psychiatry residents and attending psychiatrists in the university outpatient clinic regarding attitudes and approaches to psychiatric patients using cannabis. Prior to implementation in the following year\'s core curriculum for first-year postgraduates (PGY 1s), pretest assessments evaluated PGY 1s\' attitudes towards cannabis use and identified learning expectations, challenges, and confidence levels. After the seminars were completed, residents provided posttest assessments and general course evaluations. Utilizing initial survey information, we constructed a Marijuana and Medicine introduction curriculum for psychiatry PGY 1s. Topics included strains and formulations, pharmacokinetics, the endocannabinoid system, local Colorado laws, monitoring, evidence regarding use in psychiatric disorders, use in pregnancy, and ethical issues. These topics were covered via case-based discussion, interactive quizzes, direct instruction, and facilitated discussion.
Posttest assessments indicated improvement in trainees\' confidence and knowledge base and requests for additional instruction on topics such as adolescent use.
The positive posttest assessments support the value of incorporating a cannabis curriculum into psychiatric training. Now in its second year, the course has been expanded to 4 hours. As cannabis is medicalized, it is increasingly important that psychiatrists be able to knowledgably counsel their patients.

Pediatric residents are faced with ethical dilemmas in beginning- and end-of-life situations throughout their training. These situations are innately challenging, yet despite recommendations that residents receive training in ethics and end-of-life domains, they continue to report the need for additional training. To address these concerns, we developed an interactive and reflective palliative care and medical ethics curriculum including sessions focusing on ethical dilemmas at the beginning and end of life.
This module includes a trio of case-based, small-group discussions on artificial nutrition and hydration, futility, and ethical considerations in neonatology. Content was developed based on a needs assessment, input from local experts, and previously published material. Trainees completed assessments of comfort and understanding before and after each session.
The module was attended and assessed by an average of 27 trainees per session, including residents and medical students. Knowledge of ethical considerations improved after individual sessions, with 86% of trainees reporting understanding ethical considerations involved in the decision to withdraw or withhold medically provided nutrition and hydration and 67% of trainees reporting understanding the use of the term futility. Trainee comfort in providing counseling or recommendations regarding specific ethical issues demonstrated a trend toward improvement but did not reach statistical significance.
We successfully implemented this innovative module, which increased trainees\' comfort with end-of-life care and ethical conflicts. Future studies should focus on the trainees\' ability to implement these skills in clinical practice.