Rachel Gordon

Problem: Due to generational exposure to the Black Lives Matter movement, other antibias social movements, and diverse peer advocacy groups, health professions students are often more knowledgeable than their teachers about ways in which systemic racism and bias have led to scientific inaccuracies that contribute to health inequities. However, traditional hierarchies and concerns about retaliation may limit educational communities from benefiting maximally from students’ contributions. Approach: In spring 2021, faculty and students at the Vagelos College of Physicians and Surgeons, Columbia University, designed a structural innovation to engage faculty and students in partnership toward decreasing bias in medical education. This article discusses development and implementation of a Statement of Partnership and Humility (SPH) disclosure slide on which faculty members acknowledge consideration of potential teaching biases and invite student feedback. Outcomes: The initial primary goal of the SPH slide was to increase faculty awareness and engagement in antibias topics; however, the unexpected dividends of decreasing faculty anxiety about receiving student feedback and promoting student engagement have proven equally powerful in promoting a healthy, inclusive learning environment. Next Steps: Next steps include gathering qualitative and quantitative data to elicit both faculty and student perspectives on the use of the SPH slide, particularly with regard to psychological safety and openness to feedback.

Background: The number of new HIV diagnoses in the United States continues to slowly decline; yet, transgender women and men who have sex with men remain disproportionately affected. Key to improving the quality of prevention services are providers who are comfortable broaching the subjects of sexual health and HIV prevention with people across the spectrum of gender identities and sexual orientations. Preservice training is a critical point to establish HIV prevention and sexual health education practices before providers’ practice habits are established. Objective: The study aimed to develop participative web-based educational modules and test their impact on HIV prevention knowledge and awareness in future providers. Methods: Sexual health providers at an academic hospital, research clinicians, community engagement professionals, and New York City community members were consulted to develop 7 web-based educational modules, which were then piloted among medical students. We assessed knowledge of HIV and sexually transmitted infection prevention and comfort assessing the prevention needs of various patients via web-based questionnaires administered before and after our educational intervention. We conducted exploratory factor analysis of the items in the questionnaire. Results: Pre- and postmodule surveys were completed by 125 students and 89 students, respectively, from all 4 years of training. Before the intervention, the majority of students had heard of HIV pre-exposure prophylaxis (122/123, 99.2%) and postexposure prophylaxis (114/123, 92.7%). Before the training, 30.9% (38/123) of the students agreed that they could confidently identify a patient who is a candidate for pre-exposure prophylaxis or postexposure prophylaxis; this increased to 91% (81/89) after the intervention. Conclusions: Our findings highlight a need for increased HIV and sexually transmitted infection prevention training in medical school curricula to enable future providers to identify and care for diverse at-risk populations. Participative web-based modules offer an effective way to teach these concepts.

Public Broadcasters and the Specialty TV Ecosystem explains the technical and professional environments that program documentary films for television. Public broadcasting is a key market for documentaries. Public broadcasters get involved at several stages of production, from commissioning a series, to acquiring a completed product. This chapter explains two paths for getting content to air: Co-productions established before shooting begins, and acquisitions of finished projects. Filmmaker examples are provided for both scenarios and from different countries. A breakdown of deliverables needed is included, as well as licensing terms to be aware of. Practical money matters are also discussed, such as creating a business for a film project to harness the power of tax credits. There is also a listing of some public broadcasters who accept content directly from producers, and distributors that are known for working in this field.

The Hard Work of Crowdfunding uses the examples of four filmmakers who utilized crowdfunding to fund production and increase their audiences. This chapter explores the type of work needed to successfully harness crowdfunding’s potential, locally and internationally. It also breaks down the economic models, and the resulting benefits, of five popular platforms currently in use: Kickstarter, Indiegogo, Seed & Spark, GoFundMe and Patreon. To help financially prepare filmmakers considering crowdfunding, the chapter also discusses planning for tax implications, and the importance of maintaining receipts and audience lists for future distribution.

Creating Community: Partnerships With Purpose describes the developing practice of impact producing, or using media to make societal change. If you are making a documentary with the intention of creating social impact, this chapter provides examples and strategies for embarking on community involvement with such relevant organizations as nonprofits and government agencies. Using the experiences of filmmakers who have worked with the United Nations, to filmmakers who have lobbied their local government to focus on specific causes, we will explore the type of relationship building needed to produce the results you are shooting for. The more you participate in the communities you are working to help, the better your impact will be.

Educational Facilities and Academic Professional Development creates a roadmap for filmmakers to reach out to educational facilities. Documentaries are often used in classrooms to illustrate the human side of a particular subject. Using feedback received from professors and librarians, as well as success stories of filmmakers whose films have been programmed in this environment, this chapter will provide an overview of what a filmmaker needs to get their content into the educational marketplace. It provides technical and strategic information on how films get added to teaching, mostly focused on university and college campuses. The examples included are based in North America, but it may be possible to perform similar activities with educational institutions in other countries. A listing of existing educational distribution companies and the topics they focus on is also included for those interested in finding partners.

Sex Positive!^[+] is a two-arm, video-based web intervention aimed at reducing condomless anal sex (CAS) with partners of known and unknown serostatus that was delivered online to a racially and ethnically diverse sample of 830 gay, bisexual, and other men who have sex with men living with HIV. Men in each arm received 6 weekly videos after completing a baseline assessment and 4 weekly booster videos following a 6-month assessment. Follow-up assessments were conducted every 3 months for 1 year. At 3-month follow-up, men in the intervention arm reported significantly reduced risk of having unknown serodiscordant CAS partners than men in the control arm (RR 0.60, 95% CI 0.39–0.92), partially supporting study hypotheses. Aside from this finding, similar reductions in sexual risk behaviors were observed in both arms over the study period. There is much to be learned about video-based web interventions in terms of methodological development and intervention delivery, including frequency and duration of intervention components.

Program directors have expressed concern that some medical school graduates are unprepared for residency. Trainees should be able to perform the AAMC’s Entrustable Professional Activities (EPAs) without supervision on day 1. We describe an innovative approach for evaluating performance in EPA 4 (orders and prescriptions) within a flipped, blended “Ready 4 Residency” (R4R) course. We assessed fourth year medical students’ recognition and management of sepsis in an online case. Students took R4R in March or April of 2017. R4R included two sepsis workshops and a simulation involving a septic patient. In the online component a patient presented with sepsis from soft-tissue infection. After receiving history and exam findings, 141 students submitted order sets. In March, 35% of students engaged in the training before the order set due date, while all April students engaged in these activities beforehand. Orders were assessed for entrustment using a rubric guided by the AAMC’s description of EPA 4. Each criterion (4.1–4.4) was scored as “not entrustable”, “developing entrustment”, or “entrustable”, and given an overall rating. We recorded which components of the sepsis bundle were included. Two reviewers independently assessed the de-identified data. Data analysis included the t-test, significant at α=0.05. Overall, 50% of students recognized sepsis (42% in March vs. 57% in April), 74% ordered blood cultures (74% vs. 75%), 62% ordered a lactate (58% vs. 66%), 60% ordered appropriate antibiotics (63% vs. 57%), and 40% ordered adequate fluid resuscitation (30% vs. 50%, P = 0.02). Entrustment was different by month (March vs. April) but was not significant: 70% vs. 54% were not entrustable, 18% vs. 28% were developing entrustment, 12% vs. 18% were entrustable. A flipped, blended residency preparedness course is an innovative approach to assessing entrustment prior to residency. Virtual online patients can help educators identify knowledge gaps in recognizing and managing emergent conditions (i.e., sepsis). Students had difficulties with sepsis recognition and management, particularly with fluid resuscitation and antibiotic choice. We will bolster the curriculum to develop students’ abilities to detect and manage sepsis to improve patient safety and outcomes. All authors: No reported disclosures.

We developed an innovative, online, interactive learning tool called Macrophage (www.macrophage.co) to replace virology lectures for 165 first-year medical students in the microbiology/infectious diseases course at Columbia University. Macrophage Virology (MV) teaches using video lessons followed by questions. Students are asked to review questions they have the most trouble with according to machine learning algorithms. We evaluated this novel blended-learning curriculum. MV consists of 54 videos (~4 minutes) and 354 questions (multiple choice; select all; fill in the blank) reviewed by content experts. MV replaced 7 lecture hours. Topics include introductory virology as well as pathogenesis, clinical features, and treatment/prevention of respiratory viruses, enteric viruses, herpesviruses, and viral encephalitis. Online learning was complemented with team-based learning. MV and lecture were evaluated using a 5-point Likert scale for efficiency of learning, perceived long-term retention, preparedness for exam, and enjoyment. Responses were analyzed with a binomial test comparing MV to lecture. Student comments were analyzed for common themes. Finally, we analyzed the improvement in the mean performance of students on 28 questions repeated from last year’s exam, using the Mann–Whitney U test. Students rated MV as superior to lecture in terms of efficiency (61% found it “more” or “a lot more” efficient vs. 16% “less” or “a lot less”, N = 163, P = 2e-7), retention (67% vs. 9%, P = 4e-12), exam preparedness (57% vs. 11%, P = 1e-8), and enjoyment (59% vs. 14%, P = 1e-7). Written feedback indicated that MV was “fun” and “engaging,” and that the short videos and numerous questions made it more effective than lecture. Performance on repeated exam questions improved from 86.1% to 90.1% with MV (P = 4e-5). Students preferred Macrophage Virology, an interactive online platform that reduces passive listening time and utilizes machine learning to adapt to each individual user. Pre-clinical medical school curricula remain predominantly lecture-based, but this study suggests that digital tools, which have the advantage of being both permanent and scalable, have the potential to be more effective. All authors: No reported disclosures.

Gay, bisexual, and other men who have sex with men (GBMSM) accounted for 67% of new US human immunodeficiency virus (HIV) infections in 2012; however, less than 40% of HIV-positive GBMSM are virally suppressed. Preventing transmission from virally unsuppressed men who have condomless anal sex (CAS) with serodiscordant partners is a public health imperative. New HIV infections in GBMSM are attributed in part to online access to sex partners; therefore, low-cost eHealth interventions are a unique opportunity to reach men where they meet partners. To describe the protocol of a randomized controlled trial evaluating whether video-based messaging delivered online may lead to reductions in serodiscordant CAS and increased HIV disclosure. Sex Positive!([+]) is a two-arm, phase III, video-based randomized controlled trial delivered online to GBMSM living with HIV. Participants in the intervention arm receive 10 video vignettes grounded in social learning and social cognitive theories that are designed to elicit critical thinking around issues of HIV transmission and disclosure. Participants in the attention control arm receive 10 video vignettes that focus on healthy living. All videos are optimized for mobile viewing. The study protocol includes five online assessments conducted over a 1-year period among 1500 US white, black, or Hispanic/Latino GBMSM living with HIV who report suboptimal antiretroviral therapy (ART) adherence or a detectable viral load in the past 12 months and recent CAS (past 6 months) with HIV-negative or unknown status male partners. Compared to the control arm, we hypothesize that men who watch the intervention videos will report at 12-month follow-up significantly fewer serodiscordant CAS partners, increased HIV disclosure, and improved social cognition (eg, condom use self-efficacy, perceived responsibility). Participant recruitment began in June 2015 and ended in December 2015. This protocol describes the underlying theoretical framework and measures, study design, recruitment challenges, and antifraud measures for an online, video-based randomized controlled trial that has the potential to decrease HIV transmission risk behaviors among HIV-positive GBMSM who struggle with ART adherence. The Sex Positive!([+]) intervention allows for participation through multiple Internet-based mediums and has the potential to reach and engage a broader population of HIV-positive GBMSM who are virally unsuppressed. ClinicalTrials.gov NCT02023580; https://clinicaltrials.gov/ct2/show/NCT02023580 (Archived by WebCite at http://www.webcitation.org/6iHzA8wRG).