META: An Innovative Course on Mindfully Evolving, Thriving, and Advocating for Beginning First-Year Medical Students

The fundamental task of medical education is to transform a novice learner into an empathetic, competent and effective physician. In recent years, the idea of professional identify formation (PIF) which is the process of how one comes to “think, act and feel like a physician” has been gaining momentum in the medical education literature. PIF conceptualizes the evolution of a learner from student to physician including the internalization of shared values and norms. In developing a curriculum that thoughtfully creates opportunities to further PIF by integrating the lens of racial disparities in healthcare, social determinants of health (SDOH), and wellness, a variety of methodologies must be employed.

At the University of Texas Medical Branch (UTMB), we developed a new course for all 1^st year medical students- Mindfully Evolving, Thriving, and Advocating (META). Although in Greek Meta- means “after” or “beyond,” the first and beginning course of medical school is called META to invoke the abstraction of the concept of the physician and the metatheory foundations and methods of learning how to be a physician. We give students a birds-eye view of what is to come in their metamorphosis to becoming compassionate and exceptional physicians.

META is a 6-week course with 4 main pillars: cultural humility, clinical skills, wellness and learning (see Table 1). The goals of the course are multifold: to facilitate the beginning of PIF, promote a patient-centered approach, cultivate empathy, reflect on the role of the physician and equip learners with the tools to thrive in medical school and beyond.

Table 1: META Course Pillars, Topics, Activities and Relevant PIF Skills

Pillars	Objectives	Topics	Activities	PIF Skills
Cultural Humility	Define character traits that make a good physician Describe the impact of implicit bias, privilege, racism, poverty, adverse experience, socioeconomic status and social determinants of health (SDOH) for individuals and populations Discuss the values of teams when learning and working in healthcare	Racism and anti-racism in medicine Implicit bias Adverse childhood experiences (ACE) SDOH Health disparities Introduction to US Healthcare	Lived experience patient panels (chronic disease, differently abled, incarcerated peoples, LGBTQI+, racism in medicine) Privilege/Resilience walk Reflective writing Small group break out rooms In Shock small group debrief Allies group training Anti-racism in medicine panel and small group case-based discussion	Listen to patient narratives Cultivate empathy Acknowledge one’s own biases, privileges and perspectives Develop the ability to have difficult and vulnerable conversations Reflect on the kind of person and physician they want to be through dialogue and writing Consider other views and perspectives Participate in the shared experience of reading and debriefing on In Shock Discuss the unique barriers to care for many populations (LGBTQI+, Disability) Examine the role of race and racism in medicine historically and in modern day Reflect on the role of the physician in being an agent of change
Clinical Skills	Define the importance of caring for the whole person from a biopsychosocial approach Compare and contrast doctor-centered versus patient-centered interviewing and perform a comprehensive history Demonstrate a complete physical exam on a patient utilizing trauma-focused technique Write a patient note Demonstrate professionalism	Patient-centered care Physical exam Interview Note writing Trauma-informed Care Clinical reasoning	Virtual standardized patient encounters Virtual physical exam sessions Soft chalk physical exam modules Peer evaluation of medical note Epic training Team Based Learning (TBL) Grab bag sessions: caring for others	Role-play taking of a medical history with feedback on each section Demonstrate patient-centered care in the medical interview and physical exam Demonstrate appropriate medical note documentation for a complete history and physical Complete Epic training Explain answers to peers during TBL Reflect on the role of the physician: what does “patient-centered” really care require
Wellness	Define wellness and identify strategies for maintaining one’s own mental and physical wellness during training Certify in Question Persuade Refer (QPR) Training Suicide awareness	Anxiety and self-care Grab Bag: Caring for self Shame resilience	Grab bag sessions: caring for self Mentoring sessions Weekly group challenges Question Persuade Refer (QPR) Training/Suicide Prevention Faculty panel on living through a pandemic Reflective writing	Develop a personal wellness plan through dialogue and writing Build camaraderie with upper level students and faculty Create opportunities to bond with peers Identify on-campus counseling resources for mental health and how to intervene effectively for others Destigmatize mental health Interact with diverse faculty who speak with vulnerability and honesty about their own struggles Acknowledge one’s resilience and sources of strength in difficult times Reflect on the role of the physician: caring for one’s wellness and mental health
Learning	Describe the importance of competency-based assessments and how to make use of effective feedback and self-reflection to improve performance Describe the most effective learning practice and the role of self-regulation, growth mindset and grit Develop a study plan Navigate the AAMCs Careers in Medicine website	Growth mindset How to make use of feedback Learning in Medicine Library resources and search Quality of self reflection Humanities, Ethics & Professionalism Medical Terminology	Learning in Medicine book Metacognitive Awareness of Reading Strategies Inventory (MARSI) Problem based learning, TBL, peer learning Reflective writing Writing SMART goals	Evaluate one’s study skills and habits through the MARSI Create an individualized learning and study plan Explain evidence-based, high-yield study strategies for lifelong learning Participate in all learning modalities in the pre-clinical years: PBL, TBL, peer learning Develop SMART goals Collaborate with peers to give and receive feedback respectfully Identify appropriate medical terminology Reflect on the role of the physician: professionalism and ethics

Pedagogy: META introduces students to each type of instruction they will experience during medical school- large group lectures (utilizing active discussion, including lived-experience panels), TBL, PBL, hands on active practice (role-play interviews, physical exam with SPs), experiential learning, small group discussion, self-reflection, peer and near-peer teaching, peer and self-assessment and simulation. Students are oriented to different teaching modalities with an emphasis on how best to learn from them.

Self-Study: Significant blocks of time are unscheduled for independent use of educational materials, readings, and prompted self-reflections. The required textbooks are Peter Wei & Alex Chamessian’s book Learning in Medicine: An Evidence-Based Guide (this reviews the cognitive psychology of learning as applied to medical student education), Smith’s Patient-Centered Interviewing (this explains person-centered care), and a contemporary novel, Dr. Rana Adwish’s In Shock which reinforces the themes of the course (humility, empathy, patient-centeredness). Students are required to select certain “grab-bag” activities in the domains of “Caring for Self” (i.e wellness opportunities to explore cooking, fitness, yoga, pets, gardening, etc) and “Caring for Others” (i.e interviewing victims of trauma, having difficult conversations with patients, etc).

Course Development: The META course was derived in part as an evolution of the pilot SEA Change Curriculum, in which a cohort of students had a separate integrated curriculum of basic science and clinical content with significant time for self-reflection. Medical students have long identified the need for more curricula on SDOH as core to the physician mission. Though themes of empathy and patient-centeredness are present in the longitudinal practice of medicine (POM) year 1 and 2 courses, a concerted effort to shine a spotlight on those qualities front and center in the curriculum was made. As META is not given concurrently with basic science courses, students are able to prioritize the material without competing pressures. Important threads from META are being integrated into the doctoring courses as touchpoints. The course committee has diverse membership of community members and faculty from medicine, humanities, public health and social work. META also has an active student committee who develops and co-delivers content, reviews material, and advises on curricular needs.

Broader applicability: Though this course was developed for first year medical students at UTMB, there are several components that have general applicability to other institutions and health professions education.

The first is being very intentional about goals, design, focus and how to create opportunities for connection and discussions about what kind of professional students hope to be- not only among students but also with faculty. The meaningful integration of learners in course design, content, delivery and review so their voices are valued and represented allows courses to benefit from student insights, needs and ideas.
Any program or school can pull the veil back on the hidden curriculum through explicit discussions from the very beginning.
Incorporating a diverse and interprofessional course committee, lecturers and panel members plants the seeds of the importance of interprofessional education.
Creating space for formative assessments allows students to develop skills and focus on learning and growing from the experience rather than getting a good grade.

Though the course is still evolving, we hope to continue integrating the experiences of patients, students and the community in setting the stage for our highest hopes for the future of medicine.

–Premal Patel MD, MSc (META Co-Director), NCEAS CoP Member

–Dawnelle Schatte MD (Previous META Co-Director)

META: An Innovative Course on Mindfully Evolving, Thriving, and Advocating for Beginning First-Year Medical Students

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