Essentials of Procedural Skills: Early Preclinical Introduction to Common Emergency Medicine Procedures Xiao C. Zhang †, MD, MS; Armon Ayandeh ‡, MSc, Jay Diamond †, MD, Sarah Michael †, DO, Steven Rougas †‡, MD, MS † Department of Emergency Medicine, Alpert Medical School, Providence, RI; ‡ Alpert Medical School, Providence, RI BACKGROUND Despite the AAMC's recent emphasis on the assessment of medical students' procedural proficiency through the release of the entrustable professional activities (EPAs), many graduating medical students lack competency in key procedural skills. 1-4 Early introduction and exposure to procedural training can motivate learners to practice skills independently and may lead to improved self-perceived confidence. 5-6 However, current medical school curricula have not kept pace with the need for earlier training, especially in the traditional preclinical years. 7 Given this gap, we proposed a 10-week extracurricular course led by EM faculty for 1 st and 2 nd year medical students to provide a procedural skills foundation prior to the clinical clerkships. CURRICULAR DESIGN EDUCATION OBJECTIVES 1.Define the baseline procedural confidence of medical students at the Alpert Medical School of Brown University (AMS) 2.Develop a 10-week introductory preclinical procedural skills course for first and second year medical students run by EM faculty and residents 3.Assess the perceived change in confidence of students who participated in the elective Medical students and program directors at AMS were surveyed over 3 months to establish baseline procedural confidence level at different stages of training. [Table 1]. The needs-assessment survey allowed investigators to select 10 procedures to be included in the course 14 students completed a 10-week course with 2-hour weekly didactic sessions based on the “flipped classroom model,” where students were required to review course materials before class. Each session included hands-on practice with EM faculty and residents [Image 1]. All students were required to complete a final written and practical exam at the end of the elective [Image 2]. Students showed an increase in perceived confidence in all procedures taught during the elective (p<0.0003). Basic suturing showing the greatest change in confidence [Graphs 1] Gathering informed consent showing the least change [Graphs 1] What did we learn (strengths)? Students noted that the course was a welcome addition to the standard curriculum and allowed for ample hands-on practice time This course leveraged early exposure to common procedures, improved leaner’s confidence, and demonstrated course feasibility for other institutions looking to expose preclinical medical students to key procedural skills early in training. What did we not learn (limitations)? We were unable to assess the correlation between self-perceived confidence and actual procedural competencies in the clinical setting. IMPACT/EFFECTIVENESS Image 2 – Lumbar puncture practical Image 1 – Intubation lecture Graph 1: Self-perceived confidence levels in first (n=4)and second year medical students (n=10) pre- and post- preclinical procedural course. Confidence levels: 1=least, 5=most confident Medical Student (MS) YearClass SizeResponses (%) MS 2 Pre-CSW11845 (38%) Post-CSW11835 (30%) MS (25%) MS (28%) Table 1. Needs Assessment Survey Response Rates. CSW = Clinical Skills Workshop

REFERENCES 1.Dehmer, J. J. et al. Competence and confidence with basic procedural skills: the experience and opinions of fourth-year medical students at a single institution. Acad Med 88, , doi: /ACM.0b013e31828b0007 (2013). 2.Promes, S. B. et al. Gaps in Procedural Experience and Competency in Medical School Graduates. Academic Emergency Medicine 16, S58-S62, doi: /j x (2009). 3.Sanders, C. W., Edwards, J. C. & Burdenski, T. K. A survey of basic technical skills of medical students. Acad Med 79, (2004). 4.Wu, E. H. et al. Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students. Acad Med 83, S63-67, doi: /ACM.0b013e318183c5a7 (2008). 5.Mileder, L., Wegscheider, T. & Dimai, H. P. Teaching first-year medical students in basic clinical and procedural skills--a novel course concept at a medical school in Austria. GMS Z Med Ausbild 31, Doc6, doi: /zma (2014). 6.Pande, S., Pande, S., Parate, V., Pande, S. & Sukhsohale, N. Evaluation of retention of knowledge and skills imparted to first-year medical students through basic life support training. Adv Physiol Educ 38, 42-45, doi: /advan (2014). 7.Anderson, M. B. et al. Learning objectives for medical student education - Guidelines for medical schools: Report I of the Medical School Objectives Project. Acad Med 74, S13-S18 (1999). Essentials of Procedural Skills: Early Preclinical Introduction to Common Emergency Medicine Procedures Xiao C. Zhang †, MD, MS; Armon Ayandeh ‡, MSc, Jay Diamond †, MD, Sarah Michael †, DO, Steven Rougas †‡, MD, MS † Department of Emergency Medicine, Alpert Medical School, Providence, RI; ‡ Alpert Medical School, Providence, RI “Thank You!” – Preclinical procedural course resident and faculty members, 2016 FUTURE DIRECTIONS We would like to establish a long-term follow up with students who participated in the elective to see if increased preclinical procedural training has a long term benefit on procedural skills.