This study was undertaken at a public university medical school in the United States with 400 to 500 students across four years. The medical school curriculum at this institution is line with other programs in the United States in that it is a four-year program. The first two years are spent with pre-clinical studies. At the end of the second year, the first United States Licensing Examination is taken. The third and fourth year are clinical years, where students spend time on physician led teams and participate in direct patient care. The interventions noted in this study involved students from all levels of study in the school of medicine. We employed 4 major components of change including: expanding the leadership, early engagement of students, scheduling around school requirements, and offering a variety of activities.
Changes in SIGN executive committee:
The SIGN executive committee was re-organized as an open-board style executive committee with greater engagement of first and second year students. The board consisted of primary positions of president, vice president, treasurer, secretary, and medical student committee representative. It was expanded with the addition of preclinical years class representative, community outreach chair, and secondary positions for any of the previously listed positions. Positions exclusively for first and second year students allowed for early involvement of pre-clinical students. Events were delegated among the positions to keep members involved and allowed for a variety of events covering a variety of interests.
Early engagement of students with continued involvement:
Students were engaged early with events involving faculty and events that overlapped multiple areas of interests. Continued involvement was encouraged through research opportunities, a student run free neurology clinic for the community, and community service events.
For research, a concise summary of research opportunities with faculty within our institution and research programs at outside institutions was provided. This list was sent to the SIGN chapter email group. Another major initiative was a free neurology clinic for uninsured patients which collaborated with the preexisting student run clinic at our institution. The neurology clinic was held once per month and consisted of teams of one pre-clinical student paired with a clinical student who see patients. The students then present to attending and resident neurologists. We placed a special emphasis on allowing the first and second year students to lead the patient encounter as much as they felt comfortable.
Activities to Pique Student Interest:
A variety of events were held throughout the year to engage students. This first event of the year was an informal event a local restaurant with neurologist representing various sub-specialties. Through the year, interactive labs were held in partnership with local biotechnology companies to provide simulated cases and experiences for students. These included simulations with botulinum toxin injections, lumbar punctures, and interventional neurology simulations. We also had an on-site skills lab to help students learn and participate in an electromyography and nerve conduction studies.
Patient experience panels were also held featuring patients with neurologic disorders who shared their outlook and answered questions about their experience. This was possible by working with the faculty at our institution or neurology clinics in the surrounding areas. The neurologists were able to assess which patients would be interested in speaking with students.
Community service events were held including raising money and awareness for the Amyotrophic Lateral Sclerosis (ALS) foundation by participating in the annual ALS walk. We subsequently helped organized a Myasthenia Gravis (MG) walk. A community outreach event involved interacting with elementary to middle school age children at a local community center with events revolving around the brain.
To aid in preparation for school exams and United States Medical Licensing exams, small group sessions were held involving localization cases and a video review session covering commonly tested principles. We also carried out various journal club discussions pertaining to issues in neurology.
Scheduling around School Activities:
A major barrier of student participation is conflict with other school requirements. As a result, events were scheduled during lunch hours and in the evenings. Our medical school employs an 8-week block system with exams at the end. As a result, the activities were scheduled in the first four weeks to avoid the latter weeks when students focused on exams.
Data Collection and Analysis:
Planned activities were carried out during the 2015-2018 calendar years. The following parameters were compared: student enrollment, activities planned and successfully carried out, Students interested in neurology residency, number of neurology-related research projects with student involvement.
Student enrollment in the SIGN chapter was determined by the students on the email list at the end of the academic year. Students would enroll in the list at the opening meeting or at events through the year. The number of students interested in neurology residency and number of neurology-related research projects were determined by informal polling during the various SIGN events throughout the year. The number of students entering the field of neurology was obtained from official match list released by the medical school. The data was analyzed using linear regression with P value of 0.05 considered significant. We assessed whether or not there was a positive linear relationship between the data over time.