Exploring the breadth of medicine: 8-year outcomes of a brief clinical summer immersion for premedical students | BMC Medical Education

Setting

Stanford-CSI was developed within an academic health system with 4 affiliated hospitals (Stanford Hospital, Stanford Lucile Packard Children’s Hospital, Palo Alto Veterans Hospital and Stanford Healthcare TriValley Hospital), utilizing existing unique centers (e.g. Goodman Surgical Simulation Center, the Center for Advanced Pediatric and Perinatal Education, Stanford Cardiovascular Research Building Skills Lab, Stanford University Human Performance Lab), and the innovative teaching tools within Stanford’s Anatomy Lab and Stanford School of Medicine.

Participant selection

Participants were selected from undergraduates and high-school juniors and seniors, using holistic review. Holistic review included academic standing, standardized test scores, two essays, extracurricular activities, and a professor or guidance counselor recommendation. Standardized test scores (SAT and ACT) were excluded from consideration during the pandemic and are optional for students to submit as of 2023. Classes were composed with attention to participant diversity (i.e. gender, geographic, learner level, ethnicity). Each class enrolled around 10% international students. Program fees vary yearly based on cost structure (virtual vs. in-person, facilities, faculty and staff time, lunches, and supplies). Need-based financial scholarships were initially awarded to 10% of non-international students, expanding to 14% in 2021 with the help of a matching division grant and donor support. By 2023, 20% of students received full program and/or residential aid. The availability and distribution of scholarships varied based on institutional and philanthropic funding. Once funding became available, need-based application waivers and scholarships were also granted to students requesting them who fell under the $80,000 poverty line and who contributed to creating a well-rounded and diverse class.

Current CSI program information and fees can be found at: and https://med.stanford.edu/medcsi/about/cost.html.

Program framework

Using the Association of American Medical Colleges (AAMC) core competency framework, we developed our core themes around critical thinking, teamwork, cultural competency, empathy, oral communication, scientific inquiry, and skills acquisition/exposure (Fig. 1). Within the two-week framework, our goal was to create structured, contextualized skills/roles exposure, stimulate learner curiosity and engagement, and help learners acquire appropriate and important first aid/prehospital skills.

Stanford Clinical Summer Immersion (CSI) curricular map and schedule, based on American Academy Medical Colleges clinical competencies: Stanford-CSI Curricular map

Program objectives

By the end of program participation, we hoped that learners would:

1. 1.

   Understand multiple career options in medicine, including in primary care, specialty care, and healthcare research.

2. 2.

   Develop a roadmap to successfully apply to medical or nurse practitioner/physician assistant school.

3. 3.

   Establish relationships with Stanford faculty, medical and PA students, and program peers.

4. 4.

   Be able to provide basic first aid and prehospital stabilization.

5. 5.

   Gain experience in distilling and presenting complex medical information.

6. 6.

   Be inspired to pursue a pathway in healthcare.

Program overview

From 2015–2018, the Stanford-CSI was conducted in-person. A single session was offered in 2015, expanding to two the following years. Class size was kept small at 30 learners, to create an intimate learner-centered environment. Responding to participant feedback, a Stanford Campus residential component was added in 2017. In 2020, as a result of the pandemic, we pivoted to video-based Zoom format, expanding each of the two class sizes to 40, and then to 50 in 2021. Both in-person and remote students received a Stanford-CSI backpack containing a blood pressure cuff, stethoscope, tourniquet, and Stanford-CSI ware; Remote students also received preserved dissection specimens (animal heart, kidney, brain), suture/dissection kits, and a shopping list of optional material (ie. glucometer, oximeter). International students, unable to receive biological material, were sent a purchase list to enable full participation.

Curricular structure

We integrated core themes into all seminars, simulations, hands-on and skills-building workshops (Figs. 2 and 3). Clinical skills workshops were modeled after educational activities undertaken during medical school. In keeping with our clinical focus, participants practiced basic history and physical exam skills (with medical and physician assistant students, and faculty oversight). For dissections we provided pig hearts and kidneys, and sheep brains. For suturing we provided pigs feet and suture kits. We utilized existing resources including injection and venipuncture models, suturing kits, glucometers, bedside ultrasounds, obstetrics and neonatology simulations, prehospital emergency care supplies, virtual colonoscopy and minimally invasive surgical techniques in our surgical simulation lab. We often included current medical and physician assistant students to allow for mentorship opportunities, role-modeling and to decrease the learner to teacher ratio. In the Anatomy Lab, our students interacted with the Anatomage Table [10] and virtual reality headsets and were led through skeletal surveys and prosections by anatomy scholars. Since 2021 anatomy exposure has been restricted to virtual, but we plan to be allowed back in the lab in 2024. Participants practiced hands-on activities (e.g. vitals, physical exam skills and ultrasound) on each other, and during virtual sessions, were encouraged to do so with a friend, or family member.

Stanford Clinical Summer Immersion (CSI) curricular map and schedule, based on American Academy Medical Colleges clinical competencies: Stanford-CSI curricular schedule week 1

Stanford Clinical Summer Immersion (CSI) curricular map and schedule, based on American Academy Medical Colleges clinical competencies: Stanford-CSI curricular schedule week 2

We collaborated with experienced educators to showcase diverse healthcare career options and flexibility, in interactive medical lectures and “Day in the Life” seminars. We highlighted a broad array of healthcare specialties, including primary care, specialty medical and surgical care, psychology, psychiatry, nurse educators, dieticians, and pharmacists. Thought leaders in global health discussed social determinants of health and the intersection between health and climate.

When in person, student-teams had the opportunity to demonstrate the skills, knowledge and behaviors they had acquired in small team-based SOAP evaluations of a Standardized Patient (SP) with faculty oversight and SP feedback.

Students’ capstone projects were clinically focused. They worked individually to research specific medical diseases, including the S.O.A.P approach, distilling information down to how they might present during morning rounds, and sharing this summary prior to their system-based challenging case which was then navigated in small groups of 5–6, with a faculty facilitator, all in front of their peers.

Stanford faculty and staff available to students in-person for shadowing opportunities included: generalist & specialty physicians and primary care physician assistants and nurse practitioners. Physician specialties include physicians with expertise in family medicine, outpatient internal medicine, hospitalists, neurology, surgery (cardiac/plastics), urgent/express care, and critical care.

In lieu of the shadowing experiences for the virtual CSI program, Stanford faculty from multiple departments were invited to talk to the students about their professional life & experiences. We also had “office hours” with faculty, and PA/Medical students to share interesting cases.

Program assessment

Post-course, at the end of each two-week session, we surveyed learners about course content, specific speaker feedback, learning climate, and their CSI experience, which was solely used for iterative course quality improvement. In 2022 & 2023, we re-surveyed all past participants about longer term program impact. The results from this alumni survey were analyzed for this program evaluation. Alumni were surveying anonymously through Qualtrics XM Survey Tool [11], with an 16 item survey that included multiple choice, Likert-like (five-point scale, strongly agree to strongly disagree), and open-ended questions (Supplemental Table 1). Students shared their reasons for program participation (two survey items), program contribution to perspectives regarding career opportunities and aspirations in health care (four survey items), use of their time and resources (three survey items), and program impact on educational and career path insights (four survey items). We also assessed the ability for virtual participants to engage with program material (two survey items). Participants were sent two follow up personalized email reminders.

Likert questions were collapsed to Agree (strongly agree, agree) vs Not Agree (neutral, disagree, strongly disagree), and presented as percent agreement. Responses are presented by level of education at time of matriculation as either high school or college/post-high school (gap year, college/university, post-graduate, working). Responses of in-person (2016–2019) and virtual participants (2020–2021) were compared in order to understand the impact of the mode of participation. To compare the response groups, Likert scale questions were coded on a scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). An unpaired T-test was then conducted to statistically analyze the significance of differences in responses between the two comparison groups, and the p-value was determined. Open-ended comments were analyzed using a rapid qualitative analysis [12, 13], using the lens of the Consolidated Framework for Implementation Research adapted for medical education, considering the inner and outer program settings, plus individual and intervention characteristics to understand program effects, strengths and areas for improvement [14, 15]. Two investigators (EW, LS) reviewed learner comments, distilled themes based on this construct, and resolved discrepancies through iterative discussion with the full investigator team.

This study was considered a program evaluation by the Stanford Institutional Review Board (IRB-76189). The program evaluation was conducted anonymously and completed voluntarily by prior program participants, and did not require specific consent to participate.