Supplemental Digital Appendix 1 - download.lww.com · A subset of students participates in running two free clinics (one-half day per week) in Rhode Island. Duties include rooming

Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med.

Supplemental Digital Appendix 1

Examples of Early (Years 1 and 2) Authentic Clinical and Systems Experiences in the Required Curricula of Nine Participating U.S. Medical Schools, 2015–2016 and 2016–2017 Academic Years, From a Survey of Attitudes Toward Value-Added Education at 9 U.S. Medical Schools, 2017

Participating Medical School

Timing in Curriculum

Examples of Early Authentic Clinical and Systems Experiencesa

Clinical - traditional physician activities

Clinical – activities typically performed by other members

of the healthcare team

Systems operations and/or improvement

Warren Alpert Medical School of Brown University

Years 1 and 2

A subset of students (24 per class) in the Primary Care-Population Medicine program participates in a patient navigation program, in which they partner with patients from vulnerable backgrounds and navigate them through both medical and social service systems. A subset of students not in this program also participates in a patient navigation program as an elective, performing the aforementioned role with homeless individuals.

Copyright © the Association of American Medical Colleges. Unauthorized reproduction is prohibited. 1


A subset of students participates in running two free clinics (one-half day per week) in Rhode Island. Duties include rooming patients, translating for patients, taking patient histories, and performing physical examinations.

All students participate in preclinical elective courses (which include activities in clinical or community settings) on topics such as health disparities, health systems, sex and gender-based medicine, food and nutrition, and working in interprofessional teams (1-2 hours per week).

Brody School of Medicine at East Carolina University

Year 1

Students observe healthcare teams in a clinical setting for 1 day and report out their findings related to professional roles and teamwork. Students shadow a patient and their family through a care experience from “parking lot to parking lot” documenting every detail in the care process as it is experienced by the patient.

A subset of students (10 per class) in the LINC Scholar program interviews health system CEO, CFO related to operational, strategic, clinical roles and to explore personal leadership style and philosophy in leading a large health system. These students also interview health system leaders at various levels (i.e. department chairs, medical directors, nurse managers, senior leadership) to gain perspective of role of administrators in systems operations and improvement and participate in hospital quality improvement meeting to observe real-life application of quality improvement tools, change management, and leadership.



Students participate in longitudinal ambulatory practice preceptorships (10 half days per academic year), during which they take patient histories, learn about continuity practice, and identify systems issues (these issues are then reported in aggregate to health systems leaders as potential improvement opportunities).

Year 2

Students participate in a week-long intensive clinical experience in community practice setting in which they evaluate patients and learn about community impact of primary care. Students staff two community free clinics: one at local homeless shelter and one at community health center for Latino patients. These clinics run 3 nights per week for 3-4 hours each night. Students take vital signs, evaluate scheduled patients under faculty preceptorship, evaluate insurance status, make referrals to other healthcare providers or health navigators when appropriate, and document encounters in a clinical chart.

Students identify medical errors in the learning environment and complete reflections describing ways in which the clinical environment mitigates or contributes to them. A subset of students in the LINC Scholar program participates in ongoing clinical quality improvement project with a faculty mentor.

University of California, San Francisco School of Medicine

Year 1

Students participate in a longitudinal clinical skills course called Clinical Microsystems Clerkship (CMC) throughout their first two years. Students spend one half-day per week in their clinical microsystem in groups of 5-6. These sessions integrate patient care activities with systems improvement work. Students are assigned faculty coaches to oversee their progress and guide their clinical and systems learning. Students apply clinical skills learned in the simulation center and small groups to direct patient care under the observation and guidance of their coach. Some of this learning is integrated into the

The introduction to CMC includes a “CMC Immersion” week with built-in preceptorships with non-physician healthcare professionals. Students often engage in further patient care

Students are embedded in an interprofessional clinical team, where they define a specific role that allows them to contribute to systems improvement efforts using data to measure their work. The



half-day workplace learning sessions of CMC, and others are scheduled as a series of clinical preceptorships.

activity with their interprofessional team as part of their systems improvement work.

work may include quality improvement, patient safety, patient experience, improving access, care coordination, or health coaching.

Ongoing participation in weekly half-day workplace learning sessions as part of CMC with their same coach and CMC group.

Year 2

Ongoing clinical preceptorships in a clinical environment different from their assigned CMC site to ensure a variety of clinical settings and patient populations.

Continued systems improvement work in the same interprofessional team and CMC site from first year. This includes impact evaluation after implementing a change in practice, as well as scholarly dissemination of work over the prior year and a half.

University of California, Davis School of Medicine

Year 1

Students observe physicians in daily activities at private clinics (1 day per month).

A subset of students elects to rotate as a group through the Emergency Room where they observe systems and propose improvements to health system leadership (4 half-days over 4 weeks).

A subset of students elects initial exposure to a longitudinal clinical experience at one of eight free medical clinics for under- and uninsured adult patients where students take vital signs, evaluate scheduled patients under faculty preceptorship, evaluate insurance status, make referrals to other healthcare



providers, and document encounters in a clinical chart (one-half day per week).

Year 2

Students observe physicians in daily activities at private clinics (1 day per month).

A subset of students elects to serve as leaders in the aforementioned free medical clinics, assisting with clinic operations and preceptor scheduling.

A subset of students elects ongoing, exposure to a free medical clinic for under- and uninsured adult patients where students take vital signs, evaluate scheduled patients under faculty preceptorship, evaluate insurance status, make referrals to other healthcare providers, and document encounters in a clinical chart.

Indiana University School of Medicine

Year 1

Students spend 1 day at a local clinical site working with a healthcare team. During this time, they perform a variety of tasks (e.g., checking in patients, taking vital signs, gathering information from patients about their chief complaint).

Year 2

Students work with physicians and other healthcare team members in clinical settings for 5 half-days. During this time, they assist in obtaining or confirming vital signs and obtaining portions of the history in patient encounters (including social factors influencing access to healthcare). Students are also expected to observe and reflect on the dynamics of the patient/physician relationship and the patient/non-physician care team members through direct observation.


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Mayo Clinic School of Medicine

Year 1

Students spend one-half day observing interprofessional healthcare teams in a clinical setting and then submit a written reflection on professional roles and teamwork.

Initial exposure to a longitudinal clinical experience at a free medical clinic for under- and uninsured adult patients where students take vital signs, evaluate scheduled patients under faculty preceptorship, evaluate insurance status, make referrals to other healthcare providers or health navigators when appropriate, and document encounters in a clinical chart.

Students provide health coaching initially to peers (in triads) and then to a dialysis or obstetrics patient (individually or in dyads) for a total of six coaching sessions (pilot during 2015-2016 academic year).

Required participation in approximately 8 (of 11 possible) weeks of “selectives,” during which time students can engage in a wide variety of clinical, non-clinical, interprofessional, and systems activities of their choosing.

Year 2

Ongoing, approximately once every 3 weeks exposure to a free medical clinic for under- and uninsured adult patients where students take vital signs, evaluate scheduled patients under faculty preceptorship, evaluate insurance status, make referrals to other healthcare providers or health navigators when appropriate, and document encounters in a clinical chart.

Students work in groups to propose a project to address factors contributing to medically underserved populations (quality improvement project, development of health education materials, community



engagement activity, etc.). Groups are encouraged but not required to actually pilot their projects in the aforementioned free medical clinic. A subset of students serves as leaders in the aforementioned free medical clinic, assisting with clinic operations and patient/student scheduling.

Required participation in approximately 8 (of 15 possible) weeks of “selectives,” during which time students can engage in a wide variety of clinical, non-clinical, interprofessional, and systems activities of their choosing.

University of Michigan Medical School

Year 1

Students spend 10 half-days in an interprofessional clinical experience during which time they interact with faculty and staff from the other health professions, and work to understand the roles and responsibilities of health care team members within the system.

Students visit a patient and their family 4 times throughout the year at their home and in a clinical setting to reflect on how the patient’s care is affected by health care delivery systems.

Year 2

Students spend one half day at an underserved clinic as part of their Doctoring Curriculum


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Pennsylvania State University College of Medicine

Year 1

Students are integrated into interprofessional care teams at a clinical site (2-3 afternoons per month) with mentorship from a physician and/or another member of the healthcare team (e.g., care coordinator, nurse manager, nurse, social worker). During this time, students serve as patient navigators, a role in which they explore patients’ barrier to care, help patients navigate complex healthcare systems, provide health coaching, facilitate transition planning and implementation, and offer patient education via face-to-face meetings, telephone calls, and/or home visits.

Within the student patient navigator role, students are encouraged and supported in identifying, proposing, and when possible, implementing changes within the clinical site or program to improve care. For example, students have developed new intake assessment forms and created new system-wide community resource pages.

Vanderbilt University School of Medicine

Year 1

Students spend one half day per week in an assigned ambulatory clinic where they practice skills they are learning in their concurrent physical diagnosis class and also observe the clinic microsystem, including the composition of the interprofessional team in their assigned clinics. They also undertake activities related to the patient’s experience of care, and learn how to assess patients for structural vulnerabilities. They debrief and compare these experiences in monthly small group seminars. Most students participate as volunteers in a student-run free clinic where they perform patient care tasks, such as taking vital signs, and begin to perform histories and physicals.

A subset of approximately 15 students also serves as patient health educators or coaches for a panel of



patients with chronic illnesses. Some students also assist with social work services and investigate patient eligibility for insurance benefits. Students also have the option of participating in a variety of free monthly specialty clinics, including a prenatal clinic that transitions women to Medicaid-covered safety net services.

A subset of 10-13 students participate in the Vanderbilt Program for Interprofessional Learning (VPIL), which places teams of medical, nursing, social work and pharmacy students at clinic sites one half day per week for two years.

Year 2

Students begin core clinical clerkships in September of year 2.

VPIL teams design and carry out a quality improvement project based on observations they have made and in consultation with their clinic preceptors. These have resulted in a variety of process improvements and the creation of patient education materials.


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Abbreviations: CEO = chief executive officer, CFO = chief financial officer, CMC = clinical microsystems clerkship, LINC = Leaders in Innovative Care, VPIL = Vanderbilt Program for Interprofessional Learning

aExperiences were considered authentic if they occurred in actual workplace or community settings; activities listed in table were required of all students during both academic years unless otherwise specified



Supplemental Digital Appendix 2

2017 Survey of First- and Second-Year U.S. Medical Students at 9 Medical Schools Regarding Attitudes Toward Value-Added Medical Education, Desire to Participate in Value-Added Activities, and Factors Influencing Students’ Desire to Participate, From a Survey of Attitudes Toward Value-Added Education at 9 U.S. Medical Schools, 2017

Indicate how much you agree or disagree with the following statements. As a medical student at my current stage of training, I should...

Strongly disagree

Moderately disagree

Moderately agree

Strongly agree

Make meaningful contributions to patient care.

Learn how to analyze and improve the processes of care delivery.

Be held accountable for improving patient outcomes.

Focus on learning and not worry about whether my activities are improving patient outcomes.

Be integrated into healthcare teams as a contributing and valued member.

Work closely with individuals from other health professions (e.g., nurses, pharmacists, therapists).

Engage in activities that will help patients even if those activities are not typically performed by physicians.


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Considering everything that competes for your time as a medical student, rate your desire to participate in each of the following activities:

Very low desire

Moderately low desire)

Moderately high desire

Very high desire

Take vital signs (e.g., heart rate, blood pressure)

Perform basic cares for patients (such as assisting with meals, mobility, toileting, providing companionship)

Document patient encounters in an electronic medical record (ie, as a medical scribe)

Query patients about what medications they are taking to ensure this is accurately documented in the medical record

Call patients to review care plans Provide care in a free medical clinic for under-insured or uninsured patients

Interview patients to identify socioeconomic barriers to health and healthcare



Very low desire

Moderately low desire


Very high desire

Help patients make decisions about their care using a decision aid or other shared decision-making tool

Teach patients a skill they need to care for themselves or a family member (e.g., how to administer insulin, seizure first aid)

Coach patients over a period of time to make a health behavior change (e.g., weight loss, smoking cessation)

Arrange follow-up appointments for patients about to be discharged from the hospital

Connect patients with transportation services and other community resources


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Help people sign up for health insurance

Follow a patient throughout a hospitalization or outpatient evaluation to identify inefficiencies and improvement opportunities



Very low desire

Moderately low desire


Very high desire

Assess the needs of a community with respect to health and wellness

Investigate medical errors to identify potential contributing factors

Collect data to measure the quality of care provided to a group of patients (e.g., by extracting data from medical records or observing care processes)

Analyze the costs associated with caring for patients to identify cost-saving opportunities

Design and implement a small-scale quality improvement project and then measure its impact

Interview individuals likely to be affected by a quality improvement project to learn more about their roles, perspectives, and ideas


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. In the previous questions, you were asked to rate your desire to participate in a variety of activities that are considered by some to be ways medical students can add value to hospitals and clinics. To help medical schools optimize these experiences for students, rate how each of the following would influence your desire to participate.

Opportunity to interact with...

Greatly decrease

desire

Somewhat decrease

desire

No effect on desire

Somewhat increase desire

Greatly increase desire

Patients in a healthcare setting (e.g., hospital, emergency room, outpatient or urgent care clinic

Patients in their own homes

Patients in other community settings (schools, churches, shelters, etc.)

Patients via phone calls or electronic communication tools (e.g., online patient portal)

Other medical students


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Students from other professions

Residents or fellows Practicing physicians/attendings

Other healthcare professionals such as nurses, pharmacists, social workers, therapists, etc.

Community members


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. To help medical schools optimize these experiences for students, rate how each of the following would influence your desire to participate.

Opportunities to...

Greatly decrease

desire

Somewhat decrease

desire

No effect on desire



Make changes to the healthcare system without direct patient interactions

Work on my own

Work as part of a team

Tailor the activity to my interests

Select the activity from a menu of options


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. To help medical schools optimize these experiences for students, rate how each of the following would influence your desire to participate.

Timing of activity

Greatly decrease

desire

Somewhat decrease

desire

No effect on desire



No dedicated curricular time (i.e., activity occurs on evenings, weekends, lunch hours)

Dedicated curricular time concurrent with other courses (e.g., one half-day per week)

Dedicated curricular time that doesn't overlap with


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. other courses (e.g., a two- or four-week block)


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. What is your age?

Younger than 25 25 to 30 31 to 35 36 to 40 Older than 40

What is your sex?

Female Male



Supplemental Digital Appendix 3 First- and Second-Year U.S. Medical Student Attitudes toward Value-Added Medical Education by Sex, Age, and Year in School, 2017 survey, From a Survey of Attitudes Toward Value-Added Education at 9 U.S. Medical Schools, 2017

Moderately or Strongly Agree; Responses, no. (%)a

Sex Age Year in School

Female (N = 649)

Male (N = 578)

P value <25 years (N = 710)

≥25 years (N = 522)

P value Year 1 (N = 664)

Year 2 (N = 708)

P value

As a medical student at my current stage of training, I should…

Make meaningful contributions to patient care

517 (80) 418 (72) 0.002 524 (74) 414 (79) 0.03 481 (73) 562 (80) 0.002

Be integrated into healthcare teams as a contributing and valued member

568 (88) 473 (82) 0.004 591 (84) 454 (87) 0.08 541 (82) 607 (87) 0.01

Engage in activities that will help patients even if those activities are not typically performed by physicians

555 (86) 495 (86) 0.93 602 (85) 453 (87) 0.44 582 (88) 586 (83) 0.01

Be held accountable for improving patient outcomes

332 (51) 263 (46) 0.05 335 (48) 261 (50) 0.35 310 (47) 355 (51) 0.18

Focus on learning and not worry about whether my activities are improving patient outcomes

239 (37) 272 (47) <0.001b 323 (46) 190 (37) 0.002 277 (42) 302 (43) 0.71



Work closely with individuals from other health professions (e.g., nurses, pharmacists, therapists)

599 (93) 525 (91) 0.36 646 (91) 483 (93) 0.30 608 (92) 642 (91) 0.73

Learn how to analyze and improve the processes of care delivery

599 (92) 534 (93) 0.77 655 (92) 483 (93) 0.65 612 (93) 654 (93) 0.82

aPercentage calculations are not all based on the total N for each column because of missing responses to some survey items; percentages may not add up to 100% due to rounding

bStatistically significant (P < 0.001 was considered statistically significant after using the Bonferroni method to correct for multiple comparisons)


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. First- and Second-Year U.S. Medical Student Desire to Participate in Value-Added Activities by Sex, Age, and Year in School, From a Survey of Attitudes Toward Value-Added Education at 9 U.S. Medical Schools, 2017a

Moderately or Very High Desire to Participate; Responses, no. (%)b


Female (N = 649)

Male (N = 578)


≥25 years (N = 522)


Year 2 (N = 708)

P value

Provide care in a free medical clinic for under- or uninsured patients

615 (95) 527 (92) 0.009 658 (93) 489 (94) 0.65 607 (94) 637 (93) 0.36

Teach patients a skill they need to care for themselves or a family member (e.g., how to administer insulin, seizure first aid)

618 (96) 513 (89) <0.001c 647 (92) 489 (94) 0.18 580 (93) 615 (92) 0.29

Interview patients to identify socioeconomic barriers to health and healthcare

580 (90) 472 (82) <0.001c 595 (84) 461 (88) 0.03 551 (85) 592 (86) 0.60

Help patients make decisions about their care using a decision aid or other shared decision-making tool

552 (85) 473 (82) 0.11 580 (82) 446 (85) 0.09 508 (81) 570 (85) 0.11

Coach patients over a period of time to make a health behavior change (e.g., weight loss, smoking cessation)

543 (84) 446 (77) 0.003 571 (81) 422 (82) 0.68 509 (81) 533 (80) 0.39



Follow a patient throughout a hospitalization or outpatient evaluation to identify inefficiencies and improvement opportunities

513 (79) 437 (76) 0.11 553 (78) 401 (77) 0.71 492 (79) 514 (76) 0.29

Assess the needs of a community with respect to health and wellness

506 (78) 412 (71) 0.008 529 (75) 391 (75) 0.91 459 (75) 487 (74) 0.65

Query patients about what medications they are taking to ensure this is accurately documented in the medical record

499 (770) 412 (71) 0.02 513 (73) 399 (76) 0.12 478 (74) 509 (74) 1.00

Investigate medical errors to identify potential contributing factors

429 (66) 415 (72) 0.03 468 (66) 379 (73) 0.01 428 (70) 441 (67) 0.21

Call patients to review care plans

464 (72) 356 (62) <0.001c 460 (65) 362 (70) 0.08 419 (65) 475 (69) 0.10

Collect data to measure the quality of care provided to a group of patients (e.g., by extracting data from medical records or observing care processes)

392 (60) 381 (66) 0.05 435 (61) 341 (65) 0.14 397 (65) 402 (61) 0.14

Interview individuals likely to be affected by a quality improvement project to learn more about their roles, perspectives, and ideas

411 (63) 362 (63) 0.80 448 (63) 328 (63) 0.92 403 (66) 396 (60) 0.03

Design and implement a small-scale quality improvement project and then measure its impact

389 (60) 380 (66) 0.04 444 (63) 328 (63) 0.91 404 (66) 396 (60) 0.03



Take vital signs (e.g., heart rate, blood pressure)

408 (63) 344 (60) 0.25 440 (62) 316 (61) 0.60 460 (71) 367 (54) <0.001c

Analyze the costs associated with caring for patients and identify opportunities to reduce costs

341 (53) 353 (61) 0.003 396 (56) 299 (58) 0.60 350 (57) 368 (56) 0.72

Document patient encounters in an electronic medical record (i.e., as a medical scribe)

367 (57) 287 (50) 0.01 354 (50) 303 (58) 0.005 343 (53) 365 (53) 0.94

Arrange follow-up appointments for patients about to be discharged from the hospital

353 (55) 283 (49) 0.05 369 (52) 269 (52) 0.87 310 (50) 360 (54) 0.17

Connect patients with transportation services and other community resources

358 (55) 246 (43) <0.001c 347 (49) 257 (49) 0.91 317 (51) 318 (47) 0.22

Help people sign up for health insurance

316 (49) 265 (46) 0.28 339 (48) 242 (46) 0.62 307 (49) 302 (45) 0.13

Perform basic cares for patients (such as assisting with meals, mobility, toileting, providing companionship)

245 (38) 178 (31) 0.009 243 (34) 183 (35) 0.76 225 (35) 231 (34) 0.69

aStudents were asked to consider everything that competes for their time as a medical student when rating their desire to participate in value-added activities

bPercentage calculations are not all based on the total N for each column because of missing responses to some survey items; percentages may not add up to 100% due to rounding

cStatistically significant (P < 0.001 was considered statistically significant after using the Bonferroni method to correct for multiple comparisons)


Supplemental digital content for Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-added activities in medical education: A multi-site survey of first- and second-year medical students’ perceptions and factors influencing their potential engagement. Acad Med. Factors Influencing Desire to Participate in Value-Added Roles Among First- and Second-year U.S. Medical Students by Sex, Age, and Year in School, 2017 surveya

Somewhat or Greatly Increase Desire to Participate; Responses, no. (%)b


Female (N = 649)

Male (N = 578)


≥25 years (N = 522)


Year 2 (N = 708)

P value

Opportunities to…

Interact with practicing physicians / attendings

619 (96) 542 (94) 0.13 669 (95) 497 (95) 0.54 575 (96) 607 (94) 0.20

Interact with residents or fellows

608 (94) 537 (93) 0.59 668 (94) 482 (93) 0.23 565 (94) 601 (93) 0.55

Interact with other healthcare professionals such as nurses, pharmacists, social workers, therapists, etc.

532 (82) 479 (83) 0.58 576 (81) 439 (84) 0.16 508 (85) 520 (81) 0.09

Interact with students from other professions

411 (63) 396 (69) 0.04 483 (68) 326 (63) 0.04 410 (69) 411 (64) 0.07

Interact with other medical students 406 (63) 370 (64) 0.54 483 (68) 296 (57) <0.001c 389 (65) 403 (63) 0.41

Interact with community members

396 (61) 327 (57) 0.14 420 (59) 306 (59) 0.95 372 (62) 367 (57) 0.08



Work as part of a team 514 (80) 469 (81) 0.41 565 (80) 421 (81) 0.82 479 (81) 509 (80) 0.43

Interact with patients in a healthcare setting (e.g., hospital, emergency room, outpatient clinic, urgent care clinic)

616 (95) 540 (94) 0.26 672 (95) 489 (94) 0.49 573 (95) 604 (94) 0.19

Interact with patients in their own homes

354 (55) 258 (45) 0.001 355 (50) 261 (50) 0.96 317 (53) 304 (47) 0.05

Interact with patients in other community settings (e.g., schools, churches, shelters)

454 (70) 349 (60) <0.001c 466 (66) 340 (65) 0.93 408 (68) 407 (63) 0.08

Tailor the activity to my interests

616 (95) 542 (94) 0.27 669 (95) 494 (95) 0.92 566 (96) 599 (94) 0.07

Select the activity from a menu of options

514 (80) 460 (80) 0.98 571 (81) 408 (78) 0.23 468 (79) 513 (81) 0.60

Work on my own

209 (32) 234 (41) 0.003 253 (36) 193 (37) 0.65 217 (37) 229 (36) 0.75

Make changes to the healthcare system without direct patient interactions

217 (34) 266 (46) <0.001c 282 (40) 203 (39) 0.73 244 (42) 241 (38) 0.18



Interact with patients via phone calls or electronic communication tools (e.g., online patient portal)

213 (33) 174 (30) 0.30 225 (32) 164 (32) 0.95 197 (33) 198 (31) 0.44

Timing of activity within the medical school curriculum

No dedicated curriculum time (i.e., activity occurs on evenings, weekends, lunch hours)

147 (23) 153 (27) 0.12 183 (26) 118 (23) 0.20 168 (28) 133 (21) 0.002

Dedicated curriculum time that doesn’t overlap with other courses (e.g., a two- or four-week block)

497 (77) 433 (75) 0.47 543 (77) 392 (75) 0.55 453 (77) 484 (76) 0.68

Dedication curriculum time concurrent with other courses (e.g., one half-day per week)

472 (73) 394 (66) 0.01 502 (71) 357 (69) 0.39 410 (69) 449 (70) 0.73

aStudents were asked to rate how each factor would influence their desire to participate in value-added activities

bPercentage calculations are not all based on the total N for each column because of missing responses to some survey items; percentages may not add up to 100% due to rounding

cStatistically significant (P < 0.001 was considered statistically significant after using the Bonferroni method to correct for multiple comparisons)


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Supplemental Digital Appendix 1 - download.lww.com · A subset of students participates in running two free clinics (one-half day per week) in Rhode Island. Duties include rooming