1
Third Annual Medical Education Day
February 1, 2013
Center for Education in Medicine
Northwestern University Feinberg School of Medicine
Third Annual Medical Education Dayat Northwestern University Feinberg School of Medicine
5
4 3 2 1
Sponsored by the Center for Education in MedicineFaculty DevelopmentFeinberg Academy of Medical Educators (FAME)Translational Research and Innovation in Medical Education (TRIME)
Schedule of Events9:00am-10:30am
10:45am-12:00pm
12:00pm-1:15pm
1:30pm-2:30pm
2:45pm-3:45pm
4:00pm-4:30pm
Moderated Poster Session
Moderator: Mark Adler, MD, Director of TRIME
Location: 3 & 4
Interest Group Lunches• Curriculum Development, Moderator: Alice Salzman, EdD, PT• Assessment, Moderator: Marianne Green, MD• Program Evaluation, Moderator: Heather Haseley & Lauren Anderson, MEd• Research & Scholarship, Moderator: Mark Adler, MD• Simulation, Moderator: Christine Park, MD• Faculty Development, Moderator: Walter Eppich, MD• Educational Technology, Moderator: James Brucker, MSLISLocation: 1 & 2
Using Educational Technology to Facilitate Active Learning
Speaker: Derek Bruff, PhD, Director of the Center for Teaching at Vanderbilt University
Location: 3 & 4
Using Gallery Walks to
Facilitate Active Learning
Speaker: Robert F. Kushner, MD
Location: 2
Introduction to Just-In-
Time-Teaching (JITT)
Speaker: Mary Schuller,
MSEd
Location: 2
1:30pm-4:00pm
Teaching with Audience Response Systems (Clickers)
Speaker: Derek Bruff, PhD, Director of the Center for Teaching at Vanderbilt University
Location: 4
Small Group Teaching and Faciliatation
Speaker: Walter Eppich, MD, MEd, Director of Faculty Development
Location: 3
Recognition Ceremony
Speaker: Jon Lomasney, MD, Director of FAME
Location: 1
4:00-5:30pm Reception and Poster Session
Location: 1 & 5
4
Table of Contents
2 Venue Map
3 Schedule of Events
4 Table of Contents
5 Related Center Faculty & Staff
6 Keynote
7 Moderators and Session Leaders
8 FAME Members
14 Augusta Webster Faculty Fellowships
16 Branstad Distinguished Educator
17 Medical Education Posters
5
Related Center Faculty & Staff
Jon Lomasney, MD
Director of FAME
Faculty [email protected]
Feinberg Academy of Medical Educators (FAME)[email protected]
Translational Research and Innovation in Medical Education (TRIME)[email protected]
Contact Information
Mark D. Adler, MD
Director of TRIME
Walter Eppich, MD, MEd
Director of Faculty
Development
Lauren Anderson, MEd
Instructor in Medical
Education, Faculty
Development Specialist
Heather Haseley
Senior Manager, Medical
Education Research & Faculty
Development
6
Keynote Speaker
Derek Bruff, PhD
Director, Vanderbilt University Center for Teaching
Derek Bruff is director of the Vanderbilt University Center for Teaching and a
senior lecturer in the Vanderbilt Department of Mathematics. Bruff consults
regularly with faculty in a variety of disciplines about educational technology
and other teaching and learning topics. Bruff’s research interests include
classroom response systems (“clickers”), visual thinking, student motivation,
and social pedagogies. He blogs on these topics at derekbruff.org, and his
book, Teaching with Classroom Response Systems: Creating Active Learning
Environments, was published by Jossey-Bass in 2009. Bruff has taught at
Harvard University and has a PhD in mathematics from Vanderbilt University.
7
Marianne Green, MD
Interest Group Moderator
Robert Kushner, MD
Session Leader
Jon Lomasney, MD
Session Leader
Christine Park, MD
Interest Group Moderator
Alice Salzman, PT, EdD
Interest Group Moderator
Mary Schuller, MSEd
Session Leader
Moderators & Session Leaders
Mark D. Adler, MD
Interest Group Moderator,
Session Leader
James Brucker, MSLIS
Interest Group Moderator
Walter Eppich, MD, MEd
Interest Group Moderator,
Session Leader
Lauren Anderson, MEd
Interest Group Co-Moderator
Heather Haseley
Interest Group Co-Moderator
8
Feinberg Academy of Medical Educators MembershipFeinberg Academy of Medical Educators (FAME) plays a critical role at Northwestern Medicine in the recognition and support of outstanding educational contributions.
Who are the Members of the FAME?
The Members of the Feinberg Academy of Medical Educators (FAME) are teachers, leaders, researchers, scholars, and mentors. They are among the most outstanding and engaged medical educators at Northwestern University. FAME Members represent wide variety of departments and specialties, as well as a truly interdisciplinary cross-section of health professionals.
Membership Size
Our current Membership consists of 52 individuals. This number will continue to grow over the next few years of FAME to approximately 100-150 members. Term limits are 4 years, with a biannual review. FAME holds an annual call for new Members.
Membership Criteria
Any person involved in teaching in the greater academic medical center may be eligible. Faculty, nursing, allied health professional, physician assistant, fellow, research and staff appointments are all examples of potential members. FAME is designed to provide enrichment for all participants in education in the academic medical center. Candidates complete an educator’s portfolio. Contributions in: 1) direct teaching & learner assessment 2) curricular development, 3) mentoring, 4) scholarship in medical education, 5) leadership and administration, 6) professional development and teaching awards are evaluated by the FAME Membership Working Group.
Membership Benefits
• Collaboration, networking, and internal recognition.• Unique faculty development opportunities.• The APT Committee, at times of faculty promotion, will view membership in the Feinberg Academy of
Medical Educators favorably.• Mentorship from Feinberg Academy of Medical Educators leadership.• Membership can also enhance the opportunity to advance into leadership roles.
Membership Expectations
Members are expected to maintain their educator’s portfolio regularly, particularly before their biannual review. Members are also expected to promote the mission and values of FAME to their peers. They participate in a minimum of one faculty development workshop/ year.
9
James Baker, PhD
Professor in Physiology
Jeffrey H. Barsuk, MD
Associate Professor in Medicine
-Hospital Medicine
Irwin Benuck, MD, PhD
Professor of Clnical Pediatrics
James E. Butter, MD
Associate Professor in Medicine
-General Internal Medicine
Kenzie A. Cameron, PhD
Research Associate Professor
in Medicine -General Internal
Medicine and Geriatrics
Rowland W. Chang, MD, MPH
Professor in Preventive
Medicine
Larry R. Cochard, PhD
Assistant Professor in Medical
Education
Jamie Collings, MD
Associate Professor in
Emergency Medicine
Thomas C. Corbridge, MD
Professor in Medicine
-Pulmonary
Mark D. Adler, MD
Associate Professor in
Pediatrics & Medical Education
Amer Z. Aldeen, MD
Assistant Professor in
Emergency Medicine
Joan M. Anzia, MD
Associate Professor in
Psychiatry & Behavioral
Sciences
10
Patricia M. Garcia, MD, MPH
Professor in Obstetrics and
Gynecology
Michael A. Gisondi, MD
Associate Professor in
Emergency Medicine
Joshua L. Goldstein, MD
Associate Dean for Medical
Education
Ramadevi Gourineni, MD
Associate Professor in Ken
and Ruth Davee Department of
Neurology
Marianne M. Green, MD
Associate Dean for Medical
Education & Competency
Achievement
Kristine M. Healy, MPH, PA-C
Associate Professor in Medical
Education
Heather L. Heiman, MD
Assistant Professor in Medicine
-General Internal Medicine and
Geriatrics
Thomas Karolewski, CPO, FAAOP
Adjunct Instructor in Physical
Medicine and Rehabilitation
James A. Kozlowski
Professor in Urology and
Surgery
Julia F. Corcoran, MD
Associate Professor in Surgery
-Plastic
Walter Eppich, MD, MEd
Assistant Professor in
Pedicatrics & Medical
Education
Robert S. Feder, MD
Professor in Ophthalmology
11
Lanty O’ConnorProgram Manager, STIL
Donald R. McCrimmon, PhD
Professor of Physiology
William C. McGaghie, PhD
Adjunct Professor in Medical
Education
Alice Salzman, PT, EdD
Assistant Professor in Physical
Therapy and Human Movement
Sciences
Babette Sanders, PT, DPT, MS
Associate Professor in Physical
Therapy and Human Movement
Sciences
Sanjiv J. Shah, MD
Associate Professor in Medicine
-Cardiology
Julie K. Stamos, MD
Assistant Professor in
Pediatrics -Infectious Diseases
Marianne Tschoe, MD
Assistant Professor in Medicine
-Hospital Medicine
Toshiko L. Uchida, MD
Assistant Professor in Medicine
-General Internal Medicine and
Geriatrics
Sharon M. Unti, MD
Associate Professor in
Pediatrics -Academic General
Pediatrics and Primary Care
Robert F. Kushner, MD
Professor in Medicine -General
Internal Medicine and
Geriatrics
Lee Ann Lindquist, MD, MPH
Associate Professor in Medicine
-General Internal Medicine and
Geriatrics
Gary J. Martin, MD
Raymond J. Langenbach, MD,
Professor of Internal Medicine
12
Rebecca M. Wurtz, MD, MPH
Associate Professor in
Preventive Medicine
Gaurava Agarwal, MD
Instructor in Psychiatry and
Behavioral Sciences
Katherine Barsness, MD
Assistant Professor in Surgery
Michael Carr, MD
Assistant Professor in
Pediatrics -Cardiology
James A. Van Rhee, MS, PA-C
Associate Professor in Medical
Education
John A. Vozenilek, III, MD
Adjunct Associate Professor in
Emergency Medicine & Medical
Education
Donna Woods, EdM, MA, PhD
Research Associate Professor
in Center for Healthcare
Studies
New FAME Members 2013
13
David Salzman, MD, MEd
Assistant Professor in
Emergency Medicine
Suzanne Schmidt, MD
Instructor in Pediatrics-
Emergency Medicine
Jennifer Trainor, MD
Associate Professor in
Pediatrics -Emergency
Medicine
John Franklin, MD
Associate Dean for Minority
and Cultural Affairs
Josh Levitsky, MD
Associate Professor in
Medicine -Gastroenterology and
Hepatology
Mary McBride, MD
Assistant Professor in
Pediatrics -Cardiology
Elaine Morgan, MD
Professor in Pediatrics-
Hematology, Oncology and
Stem Cell Transplantation
Mary Nevin, MD
Assistant Professor in
Pediatrics -Pulmonary Medicine
Gail Randel, MD
Associate Professor in
Anesthesiology
14
Augusta Webster Faculty Fellowships
Augusta Webster, MD (1903-1993) A member of Northwestern’s Class of 1934, Augusta Webster, MD, the first woman to be named a full professor at the medical school and in 1960 became the first woman in the country to head a department at a major teaching hospital – the Obstetrics and Gynecology Department at Cook County Hospital. It was at “the County” that she earned her fame as a teacher of medical students and obstetrical residents, and as a dedicated physician and friend to the medically underserved people of Chicago. After internship and residency at Passavant Memorial Hospital, she practiced at County for over 40 years, including 15 years of non- salaried service.
Dr. Webster introduced at County the first nurse midwife program in Illinois in 1970. She was founder of the American College of Obstetrics and Gynecology, and of the (now defunct) Portes Cancer Prevention Center. In 1948 she received the Alumni Medal of Northwestern University, and in 1954 the American Medical Women’s Association named her “Woman of the Year”.
In 1991, a generous gift from Barbara Olin Taylor, PhD endowed the Augusta Webster Faculty Fellowships in Educational Innovation in her honor, with the intent of fostering the career development of innovative medical educators.
The Augusta Webster Faculty Fellowships Program
These awards are known as “Augusta Webster Faculty Fellowships for Educational Innovation,” and those individuals funded for substantial multi-year projects are known as “Augusta Webster Fellows.” These awards represent an opportunity for career development through investigator- proposed projects in medical education- related scholarship and research.
The funded projects address current issues and/or challenges in medical education, and represent every level of the medical education “continuum” – undergraduate (medical student), graduate (resident), and continuing medical education. Support for projects currently ranges from $5,000 to $15,000 annually, for a period of one to three years.
All fellows receive a senior faculty mentor, with the progress of the project monitored and the outcomes championed.
Augusta Webster 2011-2012 Winners
Assessment of Medical Student Achievement: Development of Simulation-Based Gateway Examinations for Implementation in the Feinberg School of Medicine Curriculum Renewal 2011-2014David Salzman, MD, Assistant Professor in Emergency Medicine
15
Validity Evidence for a Competency Based Resident OR Instruction and Assessment System2011-2014Debra DaRosa, PhD, Professor in Surgery and Medical Education and Faculty Development;Jonathan Fryer, MD, Associate Professor in Surgery- Organ Transplantation; Shari Lynn Meyerson, MD, Associate Professor in Surgery- Thoracic Surgery and Medicine- Pulmonary
Responsible Electronic Documentation (R-E-D): A Needs Assessment and Curricular Intervention to Teach Medical Students Optimal Note Writing Skills Using the Electronic Health Record2011-2014Jennifer Bierman, MD, Assistant Professor in Medicine- General Internal Medicine; Heather Heiman, MD, Assistant Professor in Medicine- General Internal Medicine
Augusta Webster 2012-2013 Winners
Teamwork and Communication in a Pediatric Cardiac Intensive Care Unit2012-2015Mary E. McBride, MD, Assistant Professor in Pediatrics-Cardiology
Does a faculty development project in cardiac auscultation lead to sustained improvement in cardiac exam skills for the faculty, and does that translate into an improvement in the cardiac exam skills of medical student learners? 2012-2013Eric W. Schaefer, MD, Assistant Professor in Medicine-Hospital Medicine
Developing and Evaluating a Mastery Learning Program for Code Status Discussion Skills2012-2015Rashmi K. Sharma, MD MHS, Assistant Professor in Medicine-Hospital Medicine
Utility of an errors-based curriculum to improve advanced skill acquisition in surgery2012-2015Shari L. Meyerson, MD, Associate Professor in Surgery-Thoracic Surgery and Medicine-Pulmonary
Augusta Webster 2012-2013 Winners
16
Christine and Paul Branstad Family Foundation Distinguished Primary Care Educator in Honor of Dr. Noel A. DeBacker, MD
This prestigious position and distinction within the Feinberg Academy of Medical Educators (FAME) signifies excellence and expertise in primary care. A Primary Care Steering Committee chose the Branstad Family Foundation Distinguished Primary Care Educator awardee from a competitive pool of applicants.
The qualities that exemplify a Branstad Family Foundation Distinguished Primary Care Educator are:• Excellent Clinician• Emphasis on history, with heavy reliance on physical examination as the first, best test.• Conducts a complete assessment—history and physical examination—on new patients.• Long established primary care practice with many long-time patients.• Practices and demonstrates patient-centered care—takes into account personal values, lifestyle,
cultural traditions, and family situation. Collaborative relationship with patient and family. Empowers patients, when possible, to take responsibility for their own health care.
• Reduces patient schedule, as appropriate, when student is there to allow time for discussion.• Allows students a mix of independent interaction, observed interaction, and observation of the
clinician.• Follows patients in multiple venues, across transitions of care—office, hospital, nursing home, end-
of-life.• Demonstrates coordination of care.• Demonstrates patient advocacy—communicates with subspecialists as necessary.• Demonstrates the model of “chief contractor” analogy with consultants—the only physician that
sees the entire picture. Big decisions are made between the primary care physician and the patient. The subspecialist advises the primary care physician, and the primary care physician and the patient make the decision.
• Demonstrates compassion—physician’s motto (cure sometimes, help often, comfort always).
Andrew Repasy, MDAssistant Professor of Clinical Medicine -Internal Medicine and Geriatrics
Current Branstad Distinquished Educator
17
Medical Education Posters Therelationshipbetweencognitive-affective-behavioralcomponentsofattitudetowardmedicalsimulations
StephenJohnCico,MD,MEd;KellyD.Black,MD,MSc;JenniferReid,MD;DonStephanian;KimberlyStone,MD,MS,MA
Background:High-fidelitysimulationisusedtoeducate,evaluate,andaccreditmedicalprofessionals.Itisexpensivetoincorporatethisnewtechnologyineverydayuseandrequiressignificanttimeinvestmentsfrombotheducatorsandstaff.Concernsexistregardingtheeffectivenessofsimulationandwhetherthereisbuy-inforthistrainingmethod.Studentswithapositiveattitudetowardlearningmaybenefitmorefromsimulation.Littleisknownregardingattitudetowardhigh-fidelitysimulationinthehealthcaresettingandhowthismayaffectlearning.
Methods:Thisstudywasdesignedtoassesswhetherthereisarelationshipbetweenthecognitive,affectiveandbehavioral(CAB)componentsofattitudewithregardtosimulation.TheCABcomponentsofattitudewereassessedusingananonymouscross-sectionalsurveyofparticipantsinsimulationsatSeattleChildren’sHospital.
Results:697surveyswereanalyzed(452nurses,245physicians).AsignificantrelationshipwasfoundbetweentheCABdomainsofattitudewithregardtosimulation.Themajorityofparticipantshadapositiveviewofsimulation,includingbeingeffective,usefulandmeetingexpectations.Whetherexperiencedornot,participantsdidnotdifferintheirabilitytotreatthemannequinasarealpatient,theirbeliefintheusefulnessandeffectivenessofsimulation,ortheirbeliefinsimulation’sroleinaccreditationinpediatricmedicine.
Conclusions:AnoverallpositiverelationshipbetweentheCABcomponentsofattitudewasfound.Physicianshadamorepositiveviewofsimulationthannurses,althoughherewasanoverwhelminglypositiveviewofsimulationbyallparticipants.ThepositiverelationshipbetweentheCABdomainsofattitudestressestheimportanceandacceptanceofsimulation,whetherornotparticipantscanacceptthemannequinasarealpatient.Havingcleargoalsandobjectivestailoredtotheaudiencemayincreasetheeffectivenessofsimulationsinthemedicalsetting.
DevelopmentandParticipantAssessmentofaPracticalQualityImprovementEducationalInitiativeforSurgicalResidents
MorganM.Sellers,BA;KristiHansonBA;MarySchuller,PhD;KarenSherman,MD,MS;RachelR.Kelz,MD,MSCE;JonathanFryer,MD;DebraDaRosa,PhD;KarlY.Bilimoria,MD,MS
Background:Withanexpandingfocusonpatientsafetyandqualitythroughouthealthcare,theneedforphysicianinvolvementiscriticalandwillcontinuetoincreaseforthenextgenerationofsurgeons.Structuredtrainingprogramsinsafetyandqualityarestilluncommoninsurgicalresidencyprograms.Ourobjectivewastodevelopalongtermqualityimprovementcurriculumforsurgicalresidentsthatincludedaformaldidacticcurriculumandastructuredpracticalexperience.
Methods:Startinginthethirdyearofresidency,surgicaltraineescompletedan8-hourformaldidacticprograminhealthcarequalityimprovementandtheDMAIC(Define,Measure,Analyze,Improve,Control)methodology.Then,teamsof2-3residentsdevelopedapracticalqualityimprovementprojectbasedonneedsidentifiedthroughtheirclinicalexperienceatourinstitution.Withtheassistanceofthehospital’sprocessimprovementteamandsurgicalfaculty,theresidentsworkedthroughtheDMAICprocessontheirselectedprojectsoverthecourseofthenextyear.Residentswereanonymouslysurveyedaftertheirparticipationtoassesstheexperience.
Results:Duringthefirstthreeyearsoftheprogram,17residentsparticipated,with100%completingthesurvey.Sevenqualityimprovementprojectsweredeveloped,with57%completingallphasesoftheDMAICprocess.Initiallyprojectsgenerallyinvolvedimprovingclinicalefficiencyissuessuchasimprovingthecodeteamprocess,facilitatingproperidentificationofresidentsandsurgeonsoncall,anddecreasingoperatingroomturnovertime,butprojectsbecamemoreclinicalovertime.Residentsnotedthattheexperiencewaseducationallyimportant(65%)andtheyfeltwell
18
equippedtoleadasimilarinitiativeinthefuture(70%).Basedonfeedbackfromthesurvey,theprogramtimelinewasexpandedfrom12to24monthsandchangedtostartinthesecondyearofresidency.
Conclusion:Developinga1-2yearlongstructuredcurriculumthatemploysbothdidacticsessionsandappliedprojectstoeducateresidentsinthetheoryandimplementationofqualityimprovementinitiativesispossibleandeffective.ItaddressestheACGMEcompetenciesofpracticebasedimprovementandlearningaswellassystemsbasedpractice.Ouriterativeexperienceoverthepastthreeyearswiththedesignandimplementationofsuchacurriculumcanserveasaguideforotherprograms.
ReproductiveEthicsandtheLaw:ABaselineSurveyofResidents,Fellows,andAttendings
KavitaShah,MD,MBE
Objective:Thefieldofobstetricsandgynecologyisfraughtwithethicalandlegaldifficulties.Inordertoassessbaselineknowledgeandattitudesregardingreproductiveethicsandthelawpriortoa10-week,2hoursperweekcurriculum,weperformedanonlinesurvey.
Methods:A22-questionsurveywithbothmultiple-choiceandopen-endedquestionswasadministeredtoresidents,fellows,andattendings.
Results:Atotalof62subjectscompletedthesurveywith64%ofrespondentsasresidents,5%asfellows,and27%asattendings.21%statedtheywereCatholic,26%non-CatholicChristian,21%Jewish,21%Agnostic/Atheist,5%Hindu,and6%Otherwithapproximatelyaquarterofrespondentsstatingtheirreligionaffectstheirmedicaldecision-making.66%ofrespondentsthoughtethicswasextremelyimportantinclinicalpractice,butthesamepercentagealsoreportednoformaltraining.Respondentswereasked5case-basedquestionstoassessbaselineknowledgeandonly6%answeredallquestionscorrectly.
Conclusions:Despitetheimportanceplacedonreproductiveethicsandthelawbysurveyrespondentsincludingitsimpactontheirclinicalpractices,therecontinuestobeadeficiencyinformalethicseducationinobstetricsandgynecology.Weanticipateanimprovementinknowledgescoresafterthecompletionofthecurriculum.
MakingJulySafer:TheImpactofaThree-dayMasteryLearningEducationalPrograminProceduralandClinicalSkills
DianeBWayne,MD;AashishDidwania,MD;ElaineRCohen,MEd;YusraCheema,MD;FarzadMoazed,MD;MichaelKriss,MD;NicholasFuriasse,MD
Background:Studiesshowthatinternalmedicineresidentsoftenlackconfidenceandtheabilitytocapablyperformrequiredproceduresandskills.Concernsaboutpatientsafetyduringresidencytransitions(theJulyEffect)suggesttheneedforfurtherskillspreparationforincomingPGY-1residents.
Purpose:Ouraimwastodevelopandevaluatetheeffectivenessofa3-dayintensiveeducationaltrainingprogramwithrigorousevaluationanddefensiblestandardstopreparePGY-1spriortotheirfirstclinicalrotation.
Methods:Thiswasacohortstudyof47PGY-1internalmedicineresidentsinJuly2011.Allparticipatedinthe3dayinterventionpriortostartingresidency.Skillstaughtandassessedwere:cardiacauscultation,paracentesis,lumbarpuncture,ICUclinicalskillsandcodestatusdiscussioncommunicationskills.PGY-1residentsweretrainedandevaluatedusingsimulation-basededucationanddeliberatepractice.EachPGY-1completedtrainingsessionsandaclinicalskillsexaminationforeachskill.Allsubjectswererequiredtomeetorexceedaminimumpassingscore(MPS)setpreviouslybyanexpertpanel.ThosewhodidnotachievetheMPSunderwentmoredeliberatepracticeandwereretesteduntiltheMPSwasreached.Toevaluatetheprogram’seffectiveness,2011PGY-1scoreswerecomparedtoscoresof2010PGY-1residentswhoservedashistoricalcontrols.
Results:Aftersimulation-basededucation,2011PGY-1residentssignificantlyoutperformed2010PGY-1historicalcontrolsonallmeasuredskills:91.0%(SD=14.5%)vs.76.9%(SD=14.6%),p
19
DiscussionorConclusion:PGY-1residentswhoparticipatedina3-daycoursepriortostartingresidencyperformedsignificantlybetteronavarietyofclinicalskillsthanPGY-1historicalcontrols.Furtherstudyisneededtoassessskillretentionandtolinkthisinterventiontoimprovedpatientcare.
ActiveLearning:TextbookChicago
RebeccaWurtz,MD,MPH;SarahAllen;DavidAlanKlein,MSEB
AspartoftheFoundationsofHealthandSocietycourseintheFeinbergSchoolofMedicine’snewcurriculum,first-yearstudents(guidedbyafacultysmallgroupleader)didacommunityhealthassessment(CHA)ofaChicagocommunityarea(CA).TheoverallgoalsoftheCHAwereto:1.Illustrateconnectionsbetweenhealth,socioeconomicstatus,environment,andcommunity.2.Enablestudentstolearnmoreaboutthecommunitieswheretheirpatientslive.3.Teachstudentshowtoassemble,display,andreportmultilayeredhealthdata.4.Producearesourceguideforthestudents(andothers)tousetoassistpatients.
Inweeklydiscussionsections,studentsstudieddifferentaspectsofhealthandsociety,includingvitalstatistics,healthcareresourcesandhealthoutcomedata,nutritionalresources,theenvironment,andsocialstressorsandcapital.Prompts,called“requiredelements,”guidedtheirdatadiscoveryanddiscussion.
StudentsvisitedtheirCAasagroup,metwithacommunityrepresentative(representativesincludedapoliceofficerbornandraisedandnowworkinginoneCAandastatelegislatorforanother),tookphotos,recordedstreetnoise,andhadamealinaneighborhoodrestaurant.Theresultingmaterial—censusstatistics,analysisofthehealthinfrastructure,photos,restaurantreviews—wasuploadedtoawiki.Awikiisawebsitewhichallowsuserstoadd,edit,andsharecontent.Althoughwikisarenaturalteachingandlearningtools,theiruseinmedicaleducationhasbeenlimited.
GoogleAppswaschosenasthehostingandtechnicalback-endtothewikibecauseFeinbergSchoolofMedicinehasanexistingimplementationofGoogleAppsforEducation(GoogleAppsforEducation,http://www.google.com/enterprise/apps/education/),whichisintegratedintoFeinberg’ssecuredaccount-basedauthenticationsystem.TheGooglewikiapplicationprovidedpre-madewebsitetemplatesandfunctionality,whichwerecustomizedforthisproject.StudentsusedotherGoogletools,includingGooglemaps,spreadsheetsandshareddocuments,tointegratecontentintothewiki.Studentswereencouragedto“stroll”throughothergroups’CAwikisitesandcomparehealthoutcomesbasedonsocialandenvironmentaldeterminantsofhealth.
ItishopedthatthewikiwillserveasahealthdataresourceforstudentsintheirclinicalhomesandforothercliniciansintheNUsystem.Forsubsequentiterations,weplantoincludetheabilityto“tag”dataelementswithkeywordsandcompileaggregatorpagesabouthealthresourcesfornon-geographiccommunities(e.g.,theLGBTcommunity,theBurmeserefugeecommunity,thediabeticcommunity).
AssessmentofResidentPerceptionsofMedicalSimulationinaResource-PoorSetting:ARichExperience?
MollyShane,MD;MichaelB.Pitt,MD
Background:Globalhealthandsimulationtrainingarequicklybecomingcommoncomponentsofpediatricgraduatemedicaleducation.AneedsassessmentofLurieChildren’sinternationalelectivesiteinMwanza,Tanzaniarevealedpotentialforacombiningsimulationandglobalhealththroughthedevelopmentofalow-resourcepediatricmedicalsimulationcurriculum.LurieChildren’sresidentsnowundergosimulationanddebriefingtrainingpriortotravelingabroadinordertoeffectivelyimplementthecurriculumaspartoftheelective.Onceabroad,simulationiscarriedoutsolelywiththeaidofaninflatablemannequinandone-pagecases,makingforalowcost,easilyportable,regionallyandinstitutionallyapplicableeducationaltool.
Objective:Ourgoalistoformallyassessresidentperceptionsofconductingmedicalsimulationinaresource-limitedenvironment.
Methods:LurieChildren’sresidentswhotookpartintheTanzaniaelectivefromSeptemberof2011toMarchof2012wereaskedtotakeanon-linesurvey.Thesurveyconsistedofnineclosedresponsequestions,scored1-5.Inadditiontotheordinaldatacollection,severalfocusgroupswereconductedconsistingoffiveopenformatquestions.Responseswererecordedandthentranscribedintoaunifyingdocumenttolookforcommonthemes.Allsurveyandsmall-group
20
questionswereapprovedforusebytheInstitutionalReviewBoard.
Results:QuantitativeData:13outof14(93%)eligibleresidentscompletedtheon-linesurvey.AllreportedthatconductingmedicalsimulationinTanzaniawasapositiveexperienceandperceivedtheexperiencetobepositivefortheTanzanianparticipants.Allfoundtheformattedsimulationsheetstobehelpfulwhilethesimulationmannequinwasreportedassomewhatneededby61%ofresponders.Allreportedthattheleveloflanguageusedintheformattedsimulationsheetswasappropriateandthatfortheleveloflearnersinvolved,thecasescenariosusedwereappropriate.Thelengthofcaseswasdeemedappropriateby84%ofresponders.Ninety-twopercentreportedsufficienttimefordebriefing.Eighty-fivepercentofsurveyrespondersreportedthatdebriefingsessionswerewell-receivedbytheTanzanianparticipants.QualitativeData:Successesofsimulationincludedmedicalstudentparticipationandhavingadefinedrolewhileabroad.Problemswiththecurriculumincludeapaucityofcasesandaneedformorebeginner-levelcases.
Conclusions:Theimplementationoflow-resourcepediatricmedicalsimulationtraininginTanzaniawasoverwhelminglyreportedasapositiveexperienceandaffordsresidentsawell-definedroleforparticipationinmedicaleducationduringtheirrotationabroad.
Residents’perspectivesoncesareansectiontrainingthroughcomputer-enhancedvisuallearning
MelissaKeene,M.D.,SloaneYork,M.D.,MaxMaizels,M.D.,WilliamMcGaghie,Ph.D.,DanaR.Gossett,M.D.,M.S.C.I.
Objective:Simulation-basedmedicaleducationistransformingresidencytraining,improvingknowledgeacquisitionandclinicalskillspriortopatientcontact.Acomputer-enhancedvisuallearningmodulewascreatedtotrainobstetricsresidentsincesareansection(CEVLCesarean).First-yearresidents’perspectiveswereassessedaftercompletionofoneyearofthisintervention.
Methods:Twelvefirst-yearresidentsweretrainedusingCEVLCesarean,astep-by-steponlinetutorialdetailingthecomponentsofacesareansection.Themoduleprovidedeachresidentwithfeedbackontheiroperativecasesandallowedforreviewandremediationofdifficultsteps.Afterayearofuse,eachresidentcompletedawrittenevaluationofthetraining.ResidentfocusgroupsexploredtheirperceptionsofthestrengthsandlimitationsofCEVL.
Results:AlltraineesviewedtheCEVLmoduleashelpfulinunderstandingthestepsofacesareansection.Theyreporteditimprovedoperatingroomconfidenceandfacilitatedmasteryofcesareansectionsteps.Allfirst-yearresidentsrequestedthattheprogrambeexpandedtootherprocedures.Residentspreferredtoreceivelivefeedbackintraoperativelyratherthanthroughacomputerizedassessment.
Conclusions:AllresidentsreportedCEVLCesareanwasacrucialcomponentinlearningcesareansectionandrequestedthatadditionalCEVLmodulesbedevelopedforothersurgicalprocedures.Suchtraineefeedbackpromptsmedicaleducatorstotailorsurgicaltrainingprogramstomeettheneedsofresidentphysicians.
ABriefPediatricInternshipBootcampfor4thYearMedicalStudents
RebekahBurns,MD;MarkAdler,MD;WalterEppich,MD,MEd;WilliamMcGaghie,PhD;JenniferTrainor,MD
Introduction:Thetransitionfrommedicalstudenttointernisachallengingprocesscharacterizedbyasteeplearningcurve.Increasedclinicalresponsibilitiesrequirestrongcommunication,organizationalskillsandtheabilitytoapplymedicalknowledge.Focusedcoursestargetingskillsnecessaryforsuccessasaresidenthaveincreasedself-perceivedpreparedness,confidenceandmedicalknowledge.Relativelylittletimeisdevotedtopediatricsinundergraduatemedicaleducation.Literatureonpediatric-specificbootcampsislacking.Asimulation-basededucationalcurriculummayhelppreparestudentsenteringpediatrictraining.
Description:Wedevelopedanovel,3½dayelectivecourseentitled“PediatricInternshipBootcamp”usinginputfromeducationexperts,feedbackfromrecentgraduatesofNorthwesternUniversityFeinbergSchoolofMedicine(FSOM)whomatchedinPediatrics,Medicine/PediatricsorFamilyMedicine,andthemedicalliterature.Thecoursewasofferedto4thyearFSOMstudentswhomatchedintopediatric-relatedinternshipsinMayof2012.Weusedacombinationoflongitudinalcases,simulation,didactics,videos,role-play,smallgroupdiscussionsanddebriefings.Studentsworkedingroupsoffourledbyacoursefacilitator.TopicsaredelineatedinTable1.Feedback,self-reflectionanddiscussionwereencouragedthroughoutthecourse.
21
Attheconclusion,eachparticipantcompletedamulti-stationobjectivestructuredclinicalexamutilizingastandardizedparentandtask-trainer.Wepilotedassessmentinstrumentstoevaluatehistorytakingandinformationsharingwithaparent,datasynthesis,assessmentandplanformulation,informedconsentandperformanceofaninfantlumbarpuncture..Afacultymemberdebriefedstudentsindividually.Allparticipantscompletedapost-courseevaluationform.
Twelvestudentsparticipatedinthecourse.Allagreedwiththestatements,“Thefacilitatorspresentedthematerialinaneffectivemanner,”“ItookawayideasIplantoimplementininternship,”and“Ithinkallstudentsshouldparticipateinasimilarexperience.”Whenaskedaboutthemostusefulcomponentsofthecoursestudentshadpositiveresponsesincluding,“Theopportunitiestopracticewerethebestpart–[we]oftendon’tgettimetopracticetasksthatresidentsconsidermundane(callingconsults,answeringpages,etc.)anditwasgreattobeabletodothatandhavesomediscussion/feedbackaroundit”and“SomanyskillsIdidn’tevenknowwerelearnable…Beingarmedwiththeseskillshelpsus.”
Conclusions:Afocusedbootcampaddressingthekeyknowledgeandskillsrequiredforpediatric-relatedresidencieswasvaluedbygraduatingmedicalstudentsenteringintoPediatric,Medicine/PediatricandFamilyMedicineresidencies.Futuredirectionsincludevalidatingassessmentinstrumentsandtargetingbothshortandlong-termoutcomegoals.
PediatricFluoroscopySimulatorasaToolforTeachingRadiologyResidentsHowtoDiagnoseMalrotationandMidgutVolvulus
EllieHawkinson,BS;VikramNandan,BS;MaryWyers,MD;EllenBenyaMD
Acommonapplicationofpediatricfluoroscopyisfortheevaluationoftheuppergastrointestinal(UGI)tractinchildrenwithemesis.PediatricUGIstudiesarefrequentlyperformedwiththeoraladministrationofcontrastmaterialforevaluationofinfantswithnonbiliousemesis.Howeverwhenaninfantpresentswithbiliousemesis,theprocedureisperformedinamodifiedfashionusinganenterictubetofacilitatetherapiddiagnosisorexclusionofmalrotationwithmidgutvolvulus,apotentiallylife-threateningconditionduetocompromisedbloodsupplytothebowel.ThegoalofthisprojectistobuildasimulatorthattrainsallradiologyresidentstoperformhighqualityUGIexaminationsininfantswithbiliousemesisandtoimprovethisconfidenceandskillindiagnosingorexcludingmalrotationwithmidgutvolvulus.
Collaborative,Cross-DisciplinaryApproachtoDPTStudentCareerDevelopment
BabetteSanders,PT,DPT,MS;BrettBoettcher,EdD;JeffJenkins,MS,LPCP
ThisprogramwasdevelopedtoassistDPTstudentstopreparetosearchfortheirfirstprofessionalpositionasaphysicaltherapistThisenhancedtheprocessthatwaspreviouslyinplace.ThisactivityrepresentscollaborationbetweenNU’sPTHMSandUniversityCareerServices(UCS)toincreasethecareerdevelopmentskillsinDPTstudents.Basedonmodelsthatcombinebestpracticeincareersearchwithphysicaltherapyspecificexamples,thestudentsdevelopskillsthatallowthemtoprepareacoverletterandresumeandpracticeinterviewskills.
Representativesofbothdepartmentscollaboratedonthedevelopmentofatwohourinteractiveclasssessionwherestudentscritiqueamockcoverletterandresume,comparetheirowndraftcoverletterandresumewithmoreappropriateexamples,andpracticeinterviewskillsbasedonalistofpotentialinterviewquestions.Thestudentsarealsopresentedwithinformationonbothappropriateandinappropriatebehaviorsbefore,duringandafteraninterview.Followingthisclass,thestudentssubmitacoverletterandresumeforreviewbytheDPTfacultyforfeedback..Afinaldraftissubmittedanddistributedtolocalclinicianswhovolunteertheirtimetoperform1:1mockinterviewswiththestudents.Formoststudents,thisisthefirstopportunitytheyhavehadtointerviewasaprofessional.
Thestudentsevaluatethisclasssessioninspecificandthecourseasawhole.Theparticipantsgivethissessionhighmarksastheyfeelithelpstopreparethemfortherealworld.Followingthemockinterviews,thecliniciansremarkthatthestudentswerewellpreparedfortheinterviewandthattheirresumeslookedprofessionalandcontainedappropriateinformationorganizedinaconciseformat.Whenthestudentsactuallybegintheirsearchforaposition,theyreaffirmthatthisclasssessionwasextremelyhelpfulintheirpreparation.StudentsalsofeelcomfortableutilizingtheservicesofUniversityCareerServicesforadditionalpreparationastheyprogressintheircareers.Thiswasnotsomethingthathappenedpriortotheinitiationofthiscollaborativeprogram.
ThisprogramhelpedtomeettheobjectivesoftheDPTprogrambyhelpingtoprepareourstudentstoentertheworkforce.
22
FurtheroutcomesofthiscollaborationalsohelptomeettheobjectivesofUniversityCareerServicesbyincreasingreferralstocareerservicespractitionersforindividualstudentappointments,developingsimilarsessionsinotherprofessionaleducationprogramsthroughfacultyreferrals,andsatisfyingDivisionofStudentAffairsgoalsofincreasedacademicdepartmentpartnerships.
CollaborationinSimulation:TheDevelopmentandInitialValidationofaNovelThoracoscopicNeonatalSimulator
KatherineABarsness,MD;DeborahMRooney,PhD;LaurenMDavis,BA;JohnAVozenilek,MD
Purpose:Wesoughttocreateandvalidateahighfidelity,anatomicallycorrectrealtissuesimulationmodelforthoracoscopicesophagealatresia/tracheoesophagealfistula(EA/TEF)repair.
Methods:Ascalereproductionofaneonatalribcagewascreated.Surgicallymodified(EA/TEF)fetalbovinetissuecompletedthesimulator.Ninepediatricsurgeryfellowsandtwoattendingpediatricsurgeons(n=11)performedthesimulatedthoracoscopicEA/TEFrepair.Participantscompletedaself-reportratingscale,rangingfrom0(Don’tknow)to4(Highlyrealistic).Constructvalidityrelevanttotestcontentwasevaluatedbyexaminingtheratingsusingthemany-FacetRaschmodel.
Results:Analysesindicatednodifferenceswhencomparingfaculty(ObservedAverage(OA)=3.5/4.0)tofellow(OA=3.3)ratings,p=.71.Indescendingorder,observedaveragesofthedomainswere3.9(Relevance),3.75(Value),3.5(Physicalattributes),3.5(Realismofmaterials),3.4(Realismofexperience)and3.32(Abilitytoperformtask).TheobservedGlobalopinionratingindicatedthesimulatorcanbeconsideredforteachingthoracoscopicEA/TEFrepair,butcouldbeimprovedslightly.
Conclusions:Fellowandfacultyratingsindicatedthesimulatorwasvaluableasalearningtool,withminormodifications.Commentswereconsistentwithhighphysicalattributeratings.SimulatingOn-CallPagesasanAssessmentToolofSeniorPediatricResidents
KarenMangold,MD;MarkAdler,MD
Introduction:Residentsspendalargeamountoftimeansweringpages.Thereareonlyafewpublisheddescriptionsofeducationalsessionsthatincludedansweringpages.Publishedstudieshaveshownthatresidentsfeelmoreconfidentafterthistypeoftraining.Nopublishedworkdescribestheassessmentofresidentperformanceinansweringpages.
Objectives:Toassesspediatricseniorresidentsintheirabilityto:1.RecognizewhenpatientisnotstableforfloormonitoringandneedstransfertoPICU2.Givecleardirectionstojuniorresidentandnursewithinstructionsforpatientcareandfurthercommunication3.Communicateclearlywithseniorphysicianandeffectivelyexpressconcernsaboutapatients’clinicalcondition
Methods:Second-yearresidentsinpediatricsparticipatedinaformativeassessment.Aspartofalargerassessmentevent,residentsreceivedsign-outonaseriesofpatientsandthenrotatedthroughsixOSCE-stylestationsthatuseddifferentsimulationmodalities.Oneofthestationsinvolvedthemansweringaseriesofpagesaboutpatientsfromtheirsign-out.Conversationswererecordedandanalyzedlaterfortheirresponsestothenurseandinternsinquiries.Residentswereallowedtocallany“consults”togatherinformationormobilizeresourcestoevaluatepatients.Weevaluatedeachresidentontheirclinicalmanagementofeachscenario,aswellastheircommunicationskillsanddecision-makingabilities.Weusedanchoredratingscalestoassesstheresident’sresponsetoeachpage.
Results:Thirty-twosecond-yearpediatricresidentsatChildren’sMemorialHospital(nowAnn&RobertH.LurieChildren’sHospitalofChicago)completedtheassessmentfromMarchtoMayof2012,andallparticipatedinthepagersimulation.Alltelephoneconversationswererecordedfromboththeresidentandconfederatepoint-of-viewforlateranalysis.Residentswereallowedtocallany“consults”togatherinformationormobilizeresourcestoevaluatepatients.Allscenarioswerecompletedinunder15minutes.Kappascoresfortheglobalratingscorerangedfrom0to1,with9/13questionshavingaKappagreaterthan0.7.
Conclusions:Pagersimulationsofferanovelapproachtoassessresidentskills,suchasdecision-making,resourcemanagementandcommunication.Simulationprovidesanidealwaytoassessalloftheseskillsbyprovidingresidentswithbriefclinicalscenariostheymusthandleonthephone.Theirconversationswithinterns,nursesandconsultsgave
23
auniqueopportunitytoassesstheirleadershipandteachingskills,aswell.Theanchoredratingscaleshowedgoodrateragreementon9/13questions,andforfutureassessmentstheremaining4questionswillbeedited.
InterprofessionalLearningExperience:PerceptionsofPhysician–PhysicianAssistantTeamPractice
KristineM.Healy,MPH,PA-C;JamesA.VanRhee,MS,PA-C;PatriciaNiemeckGeorgas,BA;JohnL.Gatta,PhDandCorinnaCrane,PhD;GiaDiGiacobbe,BS;LindaL.Lang,MPAS,PA-C;MichaelJ.MacLean,MS,PA-C
Purpose:First-yearmedicalandphysicianassistant(PA)studentsmatriculatingin2010and2011weresurveyedto1)assessperceptionsofinterprofessionaleducation(IPE),2)knowledgeofandattitudestowardsthephysician–PAteamand3)toevaluatewhetherIPEimprovesknowledgeandacceptanceofeachother’srolesbeforeandafteraninterprofessionaleducationinnovationinaclinicalethicscourse,whichpriorto2010onlyincludedmedicalstudents(M1s).Thiscoursewasselectedbecauseitiscoretobothcurriculaandethicalpracticeisacompetencyexpectedofbothprofessions.Thecourseincluded14-weekly1-hourlargegrouppresentations,then1-hoursmallgroupcasediscussions.
Methods:Twostudentcohortsweresurveyedandcombinedresultsanalyzed.Ineachcohort,medicalstudents(~170/year)weredividedinto4sections;PAstudents(30/year)wereincludedintwo.Sectionswerefurtherdividedintomedicalstudentonlygroups(thecontrolgroup)andintegratedsectionsofM1sandPAstudents(interventiongroup).Atunitstartandend,allreceivedthesamequestionnaire,including5questionsfromtheReadinessforInterprofessionalEducationPerceptionsScaleandothersfocusedonphysician-PAteampractice.//Among467students,295pre-andpost-surveyswereeffectivelylinked.T-testanalyses(usingSPSS)wererun.Statisticalsignificanceisdefinedas.05orlower;marginalsignificanceisdefinedas.1orlower.
Results:Bothmedicalstudentgroups(theinterventiongroupintegratedwithPAstudentsandM1onlycontrolgroup)werestatisticallysimilarinperceptionsandknowledgeofphysician-PApracticepriortotheintervention.T-testsrevealthatinterventiongroupM1sscoredsignificantlyhigheronthepost-knowledgeportionofthesurveythanthecontrolM1group(t=2.3,p=.022).Inaddition,interventiongroupM1sscoredmarginallyhigheronthepost-opinionportionofthesurveythanthecontrolgroupM1s(t=1.71,p=.088).
Discussion:Throughinformalcoursecontacts,IPEimprovedknowledgeandperceptionsaboutteampractice.TheresultsmayhelpinitiateandguidefutureIPEcollaborations.
References:1.NationalCommissiononCertificationofPhysicianAssistants.PhysicianAssistantCompetencies:OnlineCenter.http://www.nccpa.net/PAC/Competencies_home.aspx.AccessedJune3,2012.2.BarnsteinerJH,DischJM,HallL,MayerD,etal.PromotingInterprofessionalEducationNursOutlook2007;55:144-150.3.HegmannTE,KassonBG,StaffordHA,etal.ComparisonofMedicalandPhysicianAssistantStudentPerformanceinInterprofessionalPharmacologyandClinicalMedicineCourses.JPhysAsstEducation2009;20(4):21-25.4.McFadyenAK,Websterv,StrachanKetal.TheReadinessforInterprofessionalScale:Apossiblemorestablesub-modelfortheoriginalversionofRIPLS.JInterprofCare2005;19(6):595-603.EffectivenessofthePatient-CenteredMedicalHomeasCurricularModel:FinalDatafromtheEducation-CenteredMedicalHome2011-2012Pilot
BruceL.Henschen,MD,MPH;PatriciaGarcia,MD,MPH;BernaJacobson,BA;ElizabethR.Ryan,EdD;AlishaThomas,MD;DonnaM.Woods,PhD;DianeB.Wayne,MD;DanielB.Evans,MD
ThePatient-CenteredMedicalHome(PCMH)modelaimstoprovidepatient-centeredcare,lowercosts,andimprovehealthoutcomes.However,medicalstudentshavenotbeenmeaningfullyintegratedinthismodel.WedevelopedalongitudinalclerkshipbasedonthePCMHprinciplesof:a)continuitywithapersonalphysician;b)team-basedcare;c)carecoordinationandintegration;d)qualityandsafety;ande)enhancedaccess.Wepilotedtheclerkshipduringthe2011-2012academicyearattwocommunity-basedfamilymedicineclinics,oneacademicinternalmedicineclinic,andonepediatricclinicaffiliatedwithanurbanmedicalschoolwiththeparticipationof56medicalstudentvolunteers.Weembeddedstudentteamsinthesefourfacultypracticesandrecruitedahigh-riskpatientpanelforeachteam.Teamsdeliveredpatientcarethroughatraditionalclinicpreceptormodelthatwasaugmentedby3rdand4thyearstudentsdirectlyobserving1stand2ndyearstudents.Studentsdevelopedcohesivecareteams,coordinatedcareforcomplexpatients,andservedaspeereducators.DidacticcontentincludedmonthlyGrandRoundsconferences.Overall,studentsattended699clinics,recruited273continuitypatients,andparticipatedin9GrandRoundsconferences.Student
24
confidencewithPCMHprinciplesincreasedandattitudesregardingcontinuitywerehighlypositive.“Continuity,”“earlyclinicalexposure,”and“peerteaching”werethemostpowerfulthemesexpressedbystudents.Facultyresponsetothepilotwashighlypositive.WebelievethatanEducation-CenteredMedicalHome(ECMH)isfeasibleandeffective;itishighlyratedbystudentsandfaculty.Expansionofthismodelisunderway.
MelanomaSimulationModel:PromotingOpportunisticScreeningforMelanomawithDermoscopicAssessmentofLesions
JuneRobinson,MD;AndrewAn,BS;HanzBlatt,MA;PoojaPatel;JenniferBierman,MD;WilliamMcGaghie,PhD;MaryMartini,MD;JamesColgate,PhD;JuneK.RobinsonMD
Physicianeducationaboutmelanomaisusuallyprovidedbydidacticlectures.Therelianceondidacticeducationispartlyduetotherelativerarityofmelanomainclinicalcare.Imagespresentedduringthelecturesbyprojectionontoalargescreen(3ftx5ft)requirethestudentsto“translate”informationfromhighlymagnifiedimagestothesizeandclarityobtainedinclinicalpractice,i.e.underdermoscopicanalysis.
Dermoscopy,ortheuseofahand-heldmagnifyinglens(10X)andlightsource,(1)eliminatesreflectionfromtheskinsurface;(2)allowsforthevisualizationofnetworkpatternsformedbypigmentandbloodvessels;(3)clarifiesborderirregularity;(4)andenhancesthecontrastbetweencolorspresentinaskinlesion.Clinically,dermoscopyadaptationcanreducethenumberofunnecessaryexcisionsinmelanomascreeningandimprovediagnosticefficiency,ortheexcisionratioofbenigntomalignantlesions.1AmongAustralianPrimaryCarePractitioners(PCP),dermoscopytrainingimprovedthebiopsyratiofrom82:1intheyoungestpatientsand34:1intheoldestpatientsto3.5:12-4.Further,a45-minutelectureonskincancerexaminationanddermoscopyimprovedthediagnosticabilityof2ndyearmedicalstudentsintherecognitionofmelanoma.5
Inordertoassurethatallmedicalstudentsdevelopdermoscopicskillstodiagnosepigmentedlesions,andtohelpmakethetransitionfromknowledge-basedlearningtoskillsacquisitionwithimplementationinclinicalcare,wedevisedasystemtosimulatevisualassessmentofpigmentedlesionswithdermoscopicevaluationwiththesamespeedofassessment,andmagnificationandclarityofimageasisobtainedwithdermoscopy.Afteraseriesofstructuredusabilitytestswereperformedwithmedicalprofessionalsofvariouslevelsofexperience,acohortof4thyearmedicalstudentsand2ndyearPAstudents(n=30)reviewedthesysteminmoderator-guidedinterviews.Whencomparedtoanearlierdidacticlearningsessionthecohortofstudentsfavoredthedermoscopysimulation,citingamorefocusedandmore“hands-on”approach.
PatientSafetyKnowledgeandAttitudesofMedicalStudentsatVariousStagesofTraining:ACross-SectionalAnalysis
PaulS.Jansson,BA;DavidH.Salzman,MD,MEd;YuemiAn-Grogan,MD;LindsayA.DiMarco,MPH;DonnaM.Woods,PhD,EdM
Background:MedicalerrorisaleadingcauseofmorbidityandmortalityintheUnitedStates.Formaltraininginpatientsafetyisavital,yetneglected,componentofundergraduatemedicaleducation.Thisstudyreportstheinitialresultsofacross-sectionalanalysisofmedicalstudentpatientsafetyknowledgeandattitudesatasinglemedicalschoolatvariousstagesoftraining.
Methods:StudentsatNorthwesternUniversity’sFeinbergSchoolofMedicinewererecruitedtoparticipateinthisIRB-approvedstudyduringthe2012-13academicyear.Firstyearstudents(M1)wererecruitedontheirseconddayofmedicalschool,secondyearstudents(M2)inthesecondmonthofclasses,andfourthyearstudents(M4)duringtheEmergencyMedicineClerkship.Allparticipantscompletedtwovalidatedassessments:AttitudestoPatientSafetyQuestionnaire,3rdedition(APSQ-III),whichmeasuresninesub-scoresandaglobalscoreofpatientsafetyona1-7Likertscale,andtheRiskManagementFoundation(RMF)PatientSafetyKnowledgeTest,a14-itemmultiple-choiceassessment.
Results:155M1,75M2,and84M4studentscompletedbothassessments(N=314).M4studentsscoredmodestlyhigherthanM1andM2studentsontheknowledgeassessment,59.5%vs.51.0%and51.6%,respectively(p<0.05).TherewerenostatisticaldifferencesintheglobalscoresbetweentheM1,M2,andM4studentsontheAPSQ-III(5.46,5.33,5.44,respectively).TherewerenosignificantdifferencesbetweenclassesintheErrorReportingConfidence(4.94,5.02,4.94),ErrorInevitability(6.33,6.24,6.34),DisclosureResponsibility(5.48,5.22,5.21),orPatientInvolvementinReducingError(5.43,5.39,5.62)sub-scores.WhileM4studentshadlessfavorableattitudesthanM1orM2studentsinWorkingHoursasErrorCause(4.90vs.5.67and5.39),theM4studentshadmorefavorableattitudesonPatientSafetyTraining
25
Received(5.41vs.4.28and4.44),andProfessionalIncompetenceasErrorCause(5.38vs.4.99and5.05).M1shadmorefavorableattitudesthanM2andM4studentsinImportanceofPatientSafetyinCurriculum(6.05vs.5.48and5.40).
Conclusions:Whiletherewasamodestpositiveshiftinknowledgeandsomeattitudesub-scoresinthedomainsofpatientsafetyacrossthefouryearsofmedicaltraining,theM4scoresdonotdemonstratecompetence,supportingtheneedforatargetedcurriculuminpatientsafety.Furtherstudywillusethesebaselinedatatoassessknowledgeandattitudesfollowingimplementationofapatientsafetycurriculum.
NorthwesternUniversity’sTransplantResearchStudentSummerImmersionProgram
AlexandraBrown,BA;AmnaDaud,MD,MPH;KathleenHoke,BA;DanielaLadner,MD,MPH
Introduction:NorthwesternUniversityTransplantOutcomesResearchCollaborative(NUTORC)isaninterdisciplinary,multi-departmentalcollaborationoftransplantclinicians,healthservicesandoutcomesresearchers,andinvestigatorswithexpertiseintransplantrelatedresearchmethodologies.Inordertointroduceskillsrequiredforbiomedicalandclinicalresearchtostudents,weofferatransplantresearchsummerimmersionprogramtostudents,whichofferafertileenvironmenttolearnandgrowacademicallyoverasummerterm.
Methods:Wehavedevelopedadistinctcurriculumforallsummerstudentsinterestedinourprogram,whichincludeshighschoolstudents,collegestudents,medicalschoolandengineeringstudents.Everystudentisgivenasuccinctprojectandassignedamentorforthesummertodesignanoriginalresearchstudy,whichincludesthedevelopmentofatestablehypothesis,acriticalreviewofrelatedliterature,collectionofdata,andawrittenscientificthesiswithresultsandconclusions.Inthefirstweek,allstudentsaretrainedtonavigatePubMedsearchesandutilizetheEndnotecitationsoftware,andgivenabasicunderstandingoftransplantation.Duringtheirsecondweek,studentsbeginfocusingonthetopicoftheirresearchprojectthroughreadingandface-to-faceteachingwiththeirmentor.Projectspecificworkstartsafterthisintroductoryintensecoursewiththreeobjectives:1)Tocompletetheirspecificprojectwithclosementorguidance,2)preparationofaposterandanATCabstracttobesubmittedinDecember,and3)thepreparationofafirstmanuscriptdraft.Throughoutthesummer,allstudentsparticipateintheweeklyNUTORCmeetings,andpartakeinmulti-disciplinarymorningroundsonceaweek.Inaddition,lecturesareheldonaweeklybasisbytransplantcliniciansontopicsrelevanttotransplantation.Furthermore,studentsareencouragedtoshadowsurgeriesandclinicsonceaweek.
Results:SincetheinceptionofNorthwesternUniversity’sTransplantResearchStudentSummerImmersionProgram2yearsago,1highschoolstudent,5undergradstudents,1engineeringstudent,15medicalstudents,and1businessgraduatestudenthaveparticipatedintheprogram.Thestudent’ssummerresearchprojecthaveresultedin14abstractsthathavebeenpresentedatlocal(Landsbergetc.)andnational(AASLD,ATC,ASNetc.)conferences.Studentsarealsoworkingtowardspreparingmanuscriptstobepublishedinhighimpactfactorjournals.
Discussion:Webelievethatanessentialcomponentofanystudents’educationalexperienceinmedicineshouldincluderesearch.Ourprogramallowsstudentstodelveintoresearchwiththerareopportunitytobecomeanexpertintransplantationaswellasapublishedscholaratsuchanearlystageoftheirmedicalcareerdevelopment.
AnEthicalModelofInternationalServiceandResidentSurgicalTraininginanOB/GYNresidencyprogram:AClinicalRotationinBorongan,EasternSamar,Philippines
ElizabethPatton,MD,PGY4
ObstetricsandGynecologyisauniquefieldinmedicine.Bothmedicalandsurgical,itisalsosimultaneouslybothaspecializedareaofmedicineaswellasaprimarycarespecialty.Inmanyunder-resourcedsettings,lackofaccesstomedicalmanagementorminimallyinvasivesurgeryforconditionslikeuterinefibroidsorovarianmassesmeansthatbythetimethepatientarrivesatthelocalclinic,theonlyavailableinterventionissurgical,oftenviaanopensurgicalapproach.Surgicalcarethusbecomesprimarygynecologiccare.Atthesametime,intheUnitedStates,manyobstetricandgynecologyresidencyprogramsarefacedwithaneedtoprovidetraineessufficientsurgicaltraininginopenproceduressuchashysterectomyinthefaceofasmallerpoolofcandidatesneedingsuchsurgery,becauseofbetteraccesstomedicalmanagementandminimallyinvasivesurgicaltechniquesavailablehere.Giventhemutuallycompatibleneeds,cananinternationalrotationfulfillbothserviceandeducationalgoalswhileprovidingthepatientwiththehighestqualitycareavailable?
26
InFebruary2012IcompletedaobstetricandgynecologicalsurgicalrotationattheEasternSamarProvincialHospital,Borongan,EasternSamar,PhilippinesunderthesupervisionofDr.VictorTrinkus,attendingphysicianinthedepartmentofObstetricsandGynecologyatStrogerHospitalofCookCounty(aNorthwesternObstetricsandGynecologyResidencyclinicalsite)withthefinancialsupportoftheNorthwesternUniversityGlobalHealthInitiative.Weperformedover30majorgynecologicsurgeriesand2cesareansections,aswellasperformingonevaginal/breechextractionofpretermtwins.Wealsosawmanypatientsintheclinicsettingwithavarietyofgynecologiccomplaints.
ThepatientsweredrawnfromBoronganitself(acityofapproximately50,000residentsandtheprovincialcapitalofEasternSamar)aswellastheentireprovince,andmanytravelledhourstoreachtheclinic.InthePhilippines,governmenthospitalsguaranteeabed,andabasicevaluationbystaff,butpatientsandfamiliesmustpayoutofpocketforallsuppliesneededforsurgeryortreatmentincludingmedications.ThekeytothelongtermofsuccessoftheBoronganmission(nowinitstenthyear)areaclosecollaborationwithlocalhospitalstaff,theabilitytotakehighqualitymedicationsandanaesthesiamachinestoprovideeffectiveandsafeanaesthesia,andthecarefulselectionofcasesappropriatetothesetting,resourcesandtimeavailable.Withtheappropriatestepsandstrongrelationshipsbetweenvisitingsurgeonsandlocalstaff,internationalgynecologicsurgicalrotationscanbothfulfilltheclinicalneedsofthelocalcommunitywhileprovidinganexceptionalarenaforresidenttrainingingynecologicsurgery.
ComputerAidedDesignasaToolforDevelopmentofaNeonatalChestTubeSimulator
JohnVozenilek,MD;LaurenDavis,BA;SandraCadichon,MD
Variouscomplicationscanbecausedbyimproperchesttubeinsertiononneonates.However,theonlywaytolearnthisskillistopracticewhentheopportunityispresentedintheneonatalintensivecareunit.Asimulationdeviceforchesttubeplacementisonewaythatcomplicationscanbeavertedwhileteachingtheprocedure.Themodelthatwasdevelopedsimulatesatermneonate.Aneonatalmodelwiththiscapabilitydoesnotcurrentlyexist.Usingtheneonatalchesttubesimulator,medicalprofessionalsandstudentscanpracticeplacingachesttube,emergencyneedlethoracentesis,andremovingfluidinthepleuralspace,onaneonatalpatientbeforeattemptingtheprocedureclinically.
TheFeinberg“Education-CenteredMedicalHome:”OrganizingPrinciples,ProgramEvaluation,andFutureDirections
MaryA.Friedman,BA;BruceL.Henschen,MD,MPH;PatriciaGarcia,MD,MPH;ElizabethR.Ryan,EdD;DonnaM.Woods,PhD;RicardoRosenkranz,MD;DanielB.Evans,MD
Background:ThePatient-CenteredMedicalHome(PCMH)modelaimstoprovidepatient-centeredcare,lowercosts,andimprovehealthoutcomes.Despitethemodel’spotential,medicalstudentshavenotbeenmeaningfullyintegrated.Fragmentationanddiscontinuityplaguebothpatientcareandtraditionalmedicaleducation;however,thecontinuityofcarecentraltothePCMHmodelisanidealfoundationforanewlongitudinalclerkshipstructure.
Aim:TopresenttheorganizingprinciplesandstructureofFeinberg’sEducation-CenteredMedicalHome(ECMH);topresentprogramevaluationdatagatheredacrossourthirteenclinicalsites,andtodiscussfuturedirectionsfortheprogram.
ProgramDescription:TheECMHisalongitudinal,ambulatoryexperiencedesignedtomaximizethreeoverlappingaspectsofcontinuityforstudents:a)continuityofcare(stablepatientpanel),b)continuityofsupervision(stablepreceptor/mentorrelationship)andc)continuityofteamwork(stablepeergroups).ClinicaleducationintheECMHoccursthroughatraditionalclinicpreceptormodelandisaugmentedby3rdand4thyearstudentsdirectlyobserving1stand2ndyearstudents.DidacticcontentonthepillarsofthePCMHmodelarereviewedatmonthlyGrandRoundsconferences.Trackingofhealthcarequalityisaccomplishedbystudentreportingofde-identifieddataon25nationallyendorsedMeaningfulUsequalitymetrics.
ProgramEvaluation:Currently,theECMHprogramaccommodates50studentsfromeachclass–or30%ofFeinberg’sstudentbody–atacostof$1,905perstudentperyear.AsofDecember2012,95%ofECMHstudentsagreedorstronglyagreedwiththestatements:“Ifeelwelcomed”,“teammoraleispositive”and“IlookforwardtogoingtomyECMH.”Inqualitativeanalysis;“Continuity,”“earlyclinicalexposure,”and“peerteaching,”werethemostfrequentpositivethemesexpressedbystudents.Facultyresponsetotheprogramhasbeenhighlypositive.Formalassessmentofthepatientreactiontothemodelisunderway.AssessmentofECMHhealthcarequalitymetricdataisprogressing(308patientsloggedtodate)andcreatingaqualityreportcardforstudentsseemsfeasible.
27
Discussion:TheFeinbergEducation-CenteredMedicalHome(ECMH)isanevolvingmodelaimedtomitigatediscontinuityinmedicaleducationandprepareourgraduatestopracticeinthePCMHenvironment.TheECMHfosterscontinuitywithpatients,preceptorsandpeers.TheECMHmodelblendsaspectsoflongitudinalintegratedclerkshipswiththelearningobjectivesofthePCMHcaremodel.ExpansionofFeinberg’sECMHhasbeenwellreceivedbystudentsandfaculty,andweareenteringtheplanningphaseforfurtherexpansionin2014.
EducatingFuturePhysicianstoTrackHealthcareQuality:FeasibilityofaHealthcareQualityReportCardforMedicalStudents
PaulJansson,BA;PietroBortoletto,BS;DonnaWoods,PhD,EdM;SeanO’Neill,PhD;ErinUnger,MD;KristineM.Gleason,MPH,RPh;DanEvans,MD
Background:ThePatient-CenteredMedicalHome(PCMH)modelaimstoprovidepatient-centeredcare,lowercosts,andimprovehealthoutcomes.Inspiteoftheincreasednationalemphasisonhealthcarequalityandoutcomemeasurement,medicalschoolsdonotroutinelyprovideeducationalopportunitiesforstudentstotrackqualitymeasuresoroutcomesforpatients.
Aim:TotestthefeasibilityofaqualitymetricreportcardformedicalstudentsaspartofalongitudinalEducation-CenteredMedicalHome(ECMH)curriculumbasedonthePCMHmodel.
Setting:ThirteenECMHstudent-teamsacrossnineexistingChicagoareaprimarycareclinics.
Participants:202medicalstudents.
Methods:Weembeddedteamsofstudentsinexistingfacultypracticesandrecruitedahigh-riskpatientpanelforeachteam,assigningstudentstobe“healthcoaches”for2-5patients.FromDecember2012throughJanuary2013,studentsenrolledintheECMHcurriculumperformedretrospectivechartreviewsandreportedde-identifiedpatientdataon20+nationallyendorsedMeaningfulUsequalitymetrics.
Results:143studentssubmitteddata(71%responserate)foratleastonepatient(315patientstotal,meanof2.2submissionsperstudent).HealthconditionsoftheECMHpatientpanelincluded:66%abnormalbody-massindex,58%hypertension,26%diabetes,23%activesmokers,21%coronaryarterydisease,9%moderatetosevereasthma,7%atrialfibrillation,and5%systolicheartfailure.Initialperformanceonqualitymeasuresrangedfromahighof93%adherencetobeta-blockersandACE-inhibitorsinsystolicheartfailuretoalowof13%ondocumentationofdilateddiabeticeyeexams.AmongtheECMHpatientpanel,68patients(22%)wereadmittedtoahospitalin2012(132totaladmissions)with32re-admissionsat
28
UseoftheDelphiMethodandSimulationtoPilotDifferentiatedMilestonesforCardiovascularEmergenciesforEmergencyMedicineResidents
LaurenGallagher,MD;NicholasHartman,MD;KristenGrabow,MD,MEd;DavidSalzman,MD,MEd;PeterS.Pang,MD
Background:TheACGMEhasrecentlyevolvedfromacompetency-basedcurriculumtotheachievementofmilestones.Giventhisrecentchange,milestoneshavenotyetbeenestablishedforEMresidentsregardingcardiovascular(CV)emergencies.TheEMmodelofclinicalpracticeprovidesguidelines,butnotspecificlearningobjectives,methodsofteaching,orcriteriaformasteryofcontent.
Objectives:1)DevelopdraftmilestonesforEMresidentsregardingCVemergencies2)Establishdifferentiatedobjectivesforknowledgeandskillsbetweenjuniorandseniorresidents3)Incorporateinnovativeteachingmethodsusingsimulation
Methods:UsingtheDelphimethod,wewillestablishobjectivecriteriaformilestonesinfourareasofCVemergencymanagement:atrialfibrillation,acuteheartfailure,AVNRT/AVRTandSTEMI/NSTEMI.ExpertEMfacultymemberswilledititerativesurveyscontainingobjectivesdifferentiatedbyPGY,distributedweeklyforsixweeks.Groupconsensuswillbeobtainedtoachievealistofcomprehensive,differentiatedobjectives.Macrosimulationsdesignedtoassesscriterionfulfillmentofmilestonesforeachofthe4CVencounterswillbecreatedforbothformativeandsummativeevaluation.
Conclusion:ThiscurricularframeworkmayaidinmilestonedevelopmentforspecificCVemergenciesandleadtoimprovedclinicalperformancebyEMresidents.Ifso,thisframeworkmaybeusedtoremodelotherunitswithinourEMcurriculum.
ImprovingAdultVaccinationRatesThroughMedicalStudent-LedWaitingRoomEducation
AndreaBaumgartner,MD;StevenZhao;JuliaFiuk;EvelynAngulo;BayardCarlson;ErikaDaley;ArmandoDavila;LaurenIrizarry;MarysaLeya;NataliaLlarena;AndrewKaraba;SaraKaraba;RitiMahadevia;ElizabethWong;JenniferYoung
Background:AdultvaccinationratesremaindismallylowasseenbytheHealthyPeople2010initiative(goal:80%observed:25%).Thecurrentstudyexaminestheimpactofamedicalstudent-ledvaccinationeducationprograminalow-income,high-riskcommunity.
Methods:BeginninginJuly2009,studentsfromNorthwesternUniversityFeinbergSchoolofMedicineparticipatedinweeklyvisitstoCHC,Chicago.ThestudentsfirststudiedCDCimmunizationrecommendations,vaccinepreventablediseases,andcounselingstrategies.Underfacultysupervision,studentsgavewaitingroompresentationsonadultvaccinationsinthetargetlanguagesoftheclinicpopulation:English,SpanishandPolish.Studentsalsoinitiatedone-on-onecounselingwithinterestedpatientstomakepersonalizedlistsofrecommendedvaccinestodiscusswiththeirphysicians.Theonehoureducationsessionswerefollowedbyfaculty-studentdebriefing.
Results/Discussion:Underfacultyguidance,studentswereabletodevelopaprogramthataimedtoincreasevaccinationratesatCHC.Pneumococcalvaccinationratesincreasedby219%(from73to233)andtetanusvaccinationratesincreasedby180%(from123to344).In2010,150patientsreceivedone-ononecounselingwith66(44%)oftheseobtainingavaccinationinthesubsequent10months.
Studentsalsogainedexperiencesincommunityengagement,systemawareness,medicalknowledge,andqualityimprovementthroughissuesofsupplyanddemand,culturaldifferencesandlogisticconsiderations.•CommunityEngagement:Studentslearnedaboutculturaldynamicsinhealthcareastheynotedadifferenceinresponsivenessbasedonpresentationlanguage.BothPolishandSpanishspeakersweremorelikelytoengageindiscussionaboutvaccinationswithnativespeakingmedicalstudentsthanwithtranslatorsandEnglishspeakingstudents.•MedicalKnowledgeandScholarship:TheprojectrequiredstudentstounderstandtheCDCguidelinesanddiseaseprevention,inordertocounselpatientsandaddressconcernsaboutvaccinations.•SystemAwareness:Studentscollaboratedwiththeclinicstafftocreateasuccessfulprogram,learningtoworkaround
29
limitedsuppliesandstaffschedulestodeliverpatientcare.•ContinuousLearning/QI:Studentsgainedskillsinself-directedlearningtostaycurrentwithchangingguidelines.Dataanalysis,draftingabstractsandposterpresentationsprovidedopportunitiesforgrowthasphysician-scientists.
Conclusions:ThedatagatheredatCHCoverthepast3yearsshowthatthroughthisfaculty-mentoredvolunteerwork,studentswereabletodevelopaprogramthatsuccessfullyincreasedthevaccinationratesatthisfreecommunityclinic,whileimprovingproficiencyincorecompetencies.
Acknowledgements:WewouldliketothankCommunityHealthClinicandToshikoL.Uchida,MD.UsingSystemsIntegrationSimulationtoReassessEmergencyResponseTeams
BonnieMobley,RN,BSN;MarkAdler,MD
Asanexclusivepediatricfacility,whichexpandedfromacompact9storystructuretoauniqueandnew24storycampus,wewerefacedwithanincreasednumberofemergencyresponsecallsforoutpatientsandadultvisitors.Uponreviewofcodedatafromourpreviousfacility,42%ofcodeswerefornon-inpatients.Inresponsetotheseconcerns,anewEmergencyResponsemodelwasdeveloped,theNon-InpatientEmergencyAssessment&Response(NEAR)Team,asmallerresponseteamthatcanquicklyandefficientlyrespondtonon-inpatientandadultcoderesponses.Thechallengewastoefficientlyandeffectivelyeducatetwogroups,asmallgroupofrespondersandalargermorediversegroupencompassingallhospitalstaff,inordertosuccessfullytransitionnon-inpatientresponsefromaCODEtoaNEARcall.
Objectives:TousesystemsintegrationsimulationtoefficientlyandeffectivelydevelopaNEARresponseteamandeducationthatwould:1)ensurefeasibilityofaresponsetimeof<5minutes;2)ensure100%compliancewithEmergencyRespondersresponseof<5minutes;3)ensure100%availabilityofemergencyequipment;4)eliminatebarrierstocallingaNEARresponse.
Methods:Usingaformalprocessimprovementmethodologyasystemsintegrationprojectusingsimulationwasdeveloped.ANEARTeamResponsewasimplementedinthreepilotareasofthehospitalthatwerepre-identifiedashavinghighnon-inpatientrelatedcalls.Aftertestingtheprocess,amendingandre-evaluatingitwithfurthersimulations,theprocesswasimplementedhousewidewithfurthersimulationtoeducateandreinforcethechange.Simulatedcodeeventsandfocuseddebriefinginthethreepilotareaspromptlyidentifiedprocessissuesanddepartmentalpoliciesthatcreatedbarrierstomeetingtheobjectivesandallowedforiterativerevisionandimprovementoftheprocess.ImpromptuNEARresponsesimulationswereheldinhighrisklowincidentareastoreinforcetheprocessimplementationandpreventdecayofeducation.Post-implementationreviewofactivationsofboththenewandfullcodeswerecollectedfor6monthsandreviewedagainatayear.NewHospitalPreparednessProcessIntegratingSimulation-BasedTestingandTraining
BonnieMobley,RN,BSN;MarkAdler,MD
Openinganewtertiary-carechildrenshospitalpresentssubstantialchallenges:Howtotestplannedprocessesandproceduresbeforethefacilityisopen,particularlywhenoneisfacednewandunfamiliarconstraints?Howtoprepareafullcohortoffacultyandstafftoworkonopeningday?Ourinstitutionintegratedsimulationintotheorientationandsystemstestinginordertoaugmentorientationandcorrectissuesidentifiedpriortoopening.Wewillreviewourplanningsteps,implementationandlessonslearned.
Objectives:1)Describehowsimulationcanbeusedtotestnewsystems.2)Describebenefitsofimmersivelearningtoorienttonewenvironments.3)Proposebarrierstosimulationbased-testingandmethodstoovercomethem.
Methods:Movingtoa22-storyhospitalentailssubstantivechangestoeveryworkprocess.Wedevelopedcomplementarysimulation-basedmethodstoachievetwogoals.First,weconductedsimulationsinhigh-riskclinicalareaswithunitleadersandstaff.Identifiedproblemswerecollectedandreportedbacktoleadershipforpossibleremediation.Second,weprovidedcliniciansopportunitiestoworkintheirclinicalsettingbycaringforsimulatedpatients.Toachievethis,about1-2hoursofsimulationswasaddedtoon-sitetrainingforcliniciansinmosthigh-risksettings.Inaddition,simulation-basedcodeteamtrainingwasconducted.Ineverycasepossible,bothmethodssoughttoinvolveinter-professionalteamstoobtaindifferentviewpoints.
30
Results:Overfivemonths15clinicaleducatorsandkidSTARfacultydelivered258hoursofsimulation-basedactivities.641uniqueissueswereidentifiedpriortoopeningandwerecategorized.Afteropening,4489problemswerereportedtotheMoveCenter,ofwhich1724issueswererelatedtoclinicalcareareasthatwerethesubjectofthesimulations.Thus,thisprocesswaseffectiveintheearlyidentificationofmanypotentialissuespriortoopening.Intheinitialsurvey,100%ofparticipantsreportedthesimulationswerehelpfulinorientationtotheirunitandnewfacility.95%oftheparticipantsreportedatleastonevaluabletakeaway,thatpreparedtheirstaff/department.100%oftheparticipantsfeltitwouldbevaluabletocontinuesimulationsafterthehospitalopened.
Conclusions:Simulationisavaluableandusefultooltoconductsystemtestingandprovidertraining,inwhichthefirststepinformsthesecond.Issuesidentifiedwereaddressedandstaffperceivedthat“dayone”transitionwassmootherinareaswheresimulationwasconducted.Staffviewedtheirsimulationtimeasavaluableadditiontotheirorientationyieldinganunexpectedresultofincreasedbuyininareaswherepreviousinteresthadnotbeenasstrong.On-going,unannouncedsimulationstoreinforceeducationandtorefineprocessestoensurehighquality,safe,andreliablehealthcareweredevelopedandsupportedhousewide.UtilizingaCommunity-Academicpartnershiptoexposestudentstocommunityhealth
GailHuber,PT,PhD;MoniqueReed,PhD,RN;WilliamHealey,PT,EdD,GCS
ImplementingQualityCareforLesbian,Gay,Bisexual,andTransgenderpatientsintoFamilyMedicineResidencyTraining
AnujShah,MD,MPH;KameronMatthews,MD;MeredithHirshfeld,MD
CaringforLGBTQpatientsisanimportantcomponentofprimarycarepractice.ManyprimarycarephysiciansarenotfamiliarwithkeyaspectsofLGBQandparticularlyTransgendermedicine.Additionally,manyclinicalenvironmentsarenotdesignedtobesensitivetotheneedsofthesepopulations.Thismaybeparticularlytrueinunderservedareasincludingtheurbancommunityinwhichwepractice.StaffwhoarenotadequatelytrainedandroutineclinicalpracticesmayunintentionallydiscourageLGBTQpatientsfromseekingthecaretheyneed.Transgenderpatientswhoareunabletoaccessqualitymedicalcareincludinghormonetherapymaybedriventousing“street”hormonesandotherpotentiallyhazardouspractices.AtourFQHCresidencytrainingsitewehaveundertakenamulti-facetedapproachtoassessingandtrainingresidents,faculty,andclinicalsupportstafftoestablishawelcomingenvironmentandhighqualityprimarycareforLGBTQpatients.OurfirststepwastocreateaLGBTQTaskForce.Initiallycomposedofproviders,theyTFhasgrowntoincludeotherclinicstaffaswellascommunityleadersinLGBTQadvocacy.Theprimarygoalofexpandingaccessandimprovinghealthcarequalityforsexualminoritypopulationsinthecommunitiesweservewasestablished.Wethenembarkedonseveralinitiativestoachieveourgoal:(1)Weperformedaformalassessmentoftheclinicstaff’sattitudesandopennesstowardsservingLGBTpatients,andbeganpartneringwithcommunityorganizationstoprovidetraininginLGBTQcare;(2)WebeganreachingouttolocalLGBTorganizationstoengagethecommunityintheclinic’sdevelopment;(3)Weplantoofferhormonetherapiesforpeopleingendertransitionandarecreatingsystemsforthiswithassistancefromleadersintransgenderprimarycare;and4)WecreatedaLGBTHealthelectiveforresidentsnotonlytogainskillsandknowledgesurroundinghealthofspecialpopulations(includingfamiliaritywithhormonetherapyforgendertransition),butalsotogainexperienceinclinicalqualityimprovementandcommunityengagement.WehopetotrainthenextgenerationoffamilymedicineresidentsandotherclinicalstafftomeettheneedforhighqualityLGBTQcareforallpatientsregardlessofincome.Inpartnershipwithlocaladvocacyorganizationsweseektointegratethiscarewiththecareofthewholecommunityratherthanisolatingthesepopulationssothattheyseekcareonlyinspecialtycenters.WealsohopetoofferamodelforotherresidencyprogramsseekingtointegrateLGBTQcareintoprimarycaretraining.
UtilizingaCommunity-Academicpartnershiptoexposestudentstocommunityhealth
GailHuber,PT,PhD;MoniqueReed,PhD,RN;WilliamHealey,PT,EdD,GCS
Background:RacialdisparitiesinhealthacrosstheUnitedStatesremainandinsomecities(e.g.,Chicago)haveworseneddespiteincreasedfocusatfederalandlocallevels.Oneapproachtoaddressinghealthinequityiscommunity-basedparticipatoryresearch(CBPR).Healthcareprovidersmustimprovetheirunderstandingofhealthinequitiesandworkinginthecommunityisonewaytointroducestudentstotheseissues.Objectives.Thepurposeofthisposteristodescribethedevelopmentofanongoingcommunity-physicaltherapypartnership(WestsideHealthAuthorityandFSMDepartmentof
31
PhysicalTherapyandHumanMovementSciences)focusedonphysicalactivity(PA),whichaimedtoimprovethehealthofAfrican-Americancommunitymembersandengagephysicaltherapist(PT)studentsinCBPR.Methods.Threemainresearchprojectsinvolvingstudentsthatresultedfromaninitialpartnership-buildingseedgrantincluded1)communityfocusgroups,2)trainingofcommunityPAPromoters,and3)pilotinvestigationofPAPromotereffectiveness.LessonsLearned.Resultsfromeachprojectinformedthenext.FocusgroupsfindingsledtodevelopmentofaPAPromotertrainingcurriculum.PAPromoterswereacceptedbythecommunity,withpotentialtoincreasePA.Conclusions.Communityandacademicpartnersbenefittedfromfunding,structureandtimetocreatemeaningfulandsustainablerelationships.EngagingPTstudentswithcommunityresidentsprovidedlearningopportunitiesthatpromoterespectandappreciationofthesocial,economic,andenvironmentalcontextoftheirfuturepatients.
CancerDisparitiesResearchNetworkLearningNetworkPilot
MelissaSimon,MD,MPH;AvaPhisuthikul,BA;ErikaE.delaRiva,BA;LindaFleisherPhD,MPH;WarrenKibbe,PhD;RayBergan,MD;PiotrKuleszaMD,PhD;Region5G/BMaPPartners
Background:TheCancerDisparitiesResearchNetwork(CDRN),fundedbyNCI’sCentertoReduceCancerHealthDisparitiesRegion5GeographicManagementProgram/BiospecimenManagementProgram(GMaP/BMaP),isaregionalpartnershiprepresenting30NCI-fundedinstitutions.ThegoalsofG/BMaParetofostercollaboration,information-andresource-sharing,andcapacity-buildingamongcancerhealthdisparitiesprofessionalstoadvancecancerhealthdisparitiesresearchandtraining.BMaPaimstodevelopanetworkthatprocureshigh-qualitybiospecimensfrommulti-ethniccommunitiesandprovidetrainingandresearchopportunitiestohelpgrowthetalentpoolofinvestigators,includingthosefromunderrepresentedpopulationsskilledincancerhealthdisparities.DatafromourregionalassessmentdemonstratethatourRegion’sparticipatinginstitutionsprovidesomelevelofcancerdisparitiesresearchtrainingandcareerdevelopmentsupportforstudentsand/orscientistsfromunderrepresentedbackgrounds.Despitethesefindings,thedeliveryofeducationandtrainingtothefuturepipelineofresearchersthatiscollaborativeandfocusedonthemanynuancesofbiospecimen/biobankingresearchremainstobeacriticalneed.
Objective:Weaimtoleveragetheexpertiseofpartnersinourregiontoenhancethepipelineofminorityscientistsfocusedonimprovingcollaborativebiospecimenandbiobankingresearchinvolvingunderrepresentedpopulationsacrosstheregion.Throughthispilot,wewillcreateahubwherejuniorfaculty/traineescanaccessinformationoncrucialdomainsofbiospecimen/biobankingresearch.
Methods:Usingacommunity-engagedapproach,wewillcanvasstheRegiontoidentifyexistingcareerdevelopmentprogramsthatincorporateclinicaltrialsandbiospecimenresearch.Careerdevelopmentprogramsthatincludetrainingonlegalandethicalissues,regulatory-IRBpartnerships,biospecimencollectionandbankingpractices,andrecruitmentpracticesforunderservedpopulationswillbeindicatedbysitepartners.Informationabouttheprogramlength,participantpopulation,andresourcesofformalandinformalprogramsthroughouttheRegionwillbecollectedthroughaninventory.
Results:Todate,informationaboutcareerdevelopmentprogramshavebeencollectedforamajorityoftheRegion.Additionally,aninventorytocollectinformationabouttheseprogramshasbeendevelopedandwillbedistributedpromptly.
Nextsteps:Thecareerdevelopmentinventorywillbedistributedtoall30institutionsandwillidentifyareasofexcellenceinbiospecimenresearchwithintheRegion.Theresultsofthisinventorywillguidethedevelopmentoftraininghubsthatwillcomplementcurrenttrainingandresearchprogramswhilesharingbestpracticesonbiospecimen/biobankingresearchwiththepipelineofminorityscientists.
QualityImprovementLearningofEducationCenteredMedicalHomeStudents–StudentQuestionsandSelf-EvaluationofQISkills
KristenUnti;AdrianNicholasGaty;LindsayDimarco,MPH;DanielBEvans,MD;DonnaWoods,EdM,PhD
Background:Accuratelyassessingthequalityofhealthcareisanever-growingconcernamongallpeopleinvolvedwiththefinances,delivery,andeffectivenessofhealthcare.Yet,inthemajorityofcurrentmedicalschoolcurricula,littleeffortisputforthintheeducationofmedicalstudentsregardinghowtoassessthequalityofcarethattheyareproviding.
32
Methods:Inapioneeringendeavortobringcontinuityofcaretostudents’medicaleducation,NorthwesternUniversity’sFeinbergSchoolofMedicinebeganaprojectinSeptember2011calledtheEducation-CenteredMedicalHome(ECMH),combiningtheideasbehinda“patient-centeredmedicalhome”withanemphasisoncomprehensiveeducationincludingcontinuity,team-basedcare,andpatientsafetyandqualityimprovement.Thereare213studentsin13ECMHclinicpracticesthatparticipated.AsofDecember2012,ECMHstudentscompletedtheirfirstreportingofqualitymetrics.Aten-itemsurveyconsistingofLikert-scalequestionsandfreeresponsequestionsaskingforself-evaluationoftheirqualityimprovement(QI)skills.
Results:AcrossalloftheassessedqualitymeasurementandimprovementskillsintheLikert-scalequestions,32%ofstudentssaidtheyweremoderatelytoextremelycomfortablewiththeirQIskillsandonly23%saidnotatall.Overhalfofthestudentsfeltmoderatelytoextremelycomfortablewith“Writingaclearproblemstatement(goal,aim),”andapproximatelyathirdofthestudentsfeltmoderatelytoextremelycomfortablewith:“Applyingthebestprofessionalknowledge”(38%);“Usingmeasurementtoimproveyourskills”(39%);“Identifyingbestpracticesandcomparingthesetoyourlocalpractice/skills”(34%);“Implementingastructuredplantotestachange”(32%);and“Buildingyournextimprovementuponpriorsuccessorfailure”(37%).Studentsreportedbeingonlyslightycomfortablewith:“Makingchangesinasystem”(42%)and“Usingsmallcyclesofchange”(49%).Thestudentsfelt“notatall”comfortablewith:“UsingthePDSAmodelasasystematicframeworkfortrialandlearning”(59%).Aftercodingandanalyzingcommonthemesinthestudents’freeresponsesandnotecards,22%oftheECMHstudentsreportedneedingmoretrainingandpracticeinhowtorecordqualitymetrics.Additionally,14%ofthestudentswantedtolearnmoreabouthowtoapplythefindingstheyuncoverwiththeirqualitydata.Intermsofvalidityofthedata,7%ofstudentswereconcernedwithcomprehensivenessandaccuracyofthestandards.Interestingly,17%ofthestudentsreportedhavingnofurtherquestionsorconcerns,butthatislikelyduetonotevenknowingwhattoask.
Conclusions:Aninitialexperienceofreportingqualitymetricsforpatientsbeingseeninthestudents’ECMHisastronglearningvehicleforlearningthenuanceofabstractingdataforqualitymetricsandconstructingthequalitymeasures.Thisexerciseopenedmanyquestionsforstudentsthattheymaynothaveotherwiseconsideredhowtoincorporatequalityassessmentintoclinicalpractice.Studentself-assessmentresultssuggestthataskingstudentstoactuallyconstructqualitymeasuresisagoodintroductiontoqualityreporting.
NUNEIGHBORS:ASocialSciencePartnershiptoReduceCancerHealthDisparities
MelissaSimon,MD,MPH;DaveCella,PhD;MoriaStuart,PhD;MarianGidea,PhD;EmilyMalin,MSW
CancerhealthdisparitiesremainprominentandwelldocumentedthroughoutthecityofChicago.Inanefforttoaddressthesedisparities,theRobertH.LurieComprehensiveCancerCenterofNorthwesternUniversity(RHLCCC-NU-aNationalCancerInstitutedesignatedcancercenter)iscollaboratingwithNortheasternIllinoisUniversity(NEIU-theonly4-yearHispanicServingInstitutionintheMidwest).Thecollaborationleveragesthestrengthsoftheprivateresearch-intensiveinstitution(NU),withthoseofthepublicteaching-intensiveinstitution(NEIU)toreducethecomplexissueofcancerhealthdisparitiesthroughsynergizingresearchandeducationinitiatives.NUNEIGHBORSaimstobuildcapacityfor:1)NEIUfacultytoconductcancerresearch;2)coursesatNEIUandNUtobemodifiedandincludeareasofcancerdisparitiesandresearch;3)NUfacultytoconductmorecommunityengagedcancerdisparitiesresearch;and4)astrongpipelineofminorityandunderrepresentedstudentsandresearcherswhopursuehealthandscience-relatedcareerswithaspecialfocusonpopulationswithdifferentialcanceroutcomes.Anongoing,iterativeneedsassessmentandcurriculummodificationwilloccurthroughoutthefour-yearprojecttimeline.Processandoutcomesevaluationswillfocusonapproachestofillinggapsrelatedtocancerhealthdisparitiesincurriculaateachuniversity,programmingtargetingstudentandfacultyengagementincancerhealthdisparitiesresearch,andfacultycareerdevelopment.Todate,thepartnershipfundstwopilotresearchprojects.Eachpilotinvestigatorhascompletedcareerdevelopmentplans,andhasreceivedresearchguidanceandmentoringfromseniorfacultymembersofbothinstitutions.SixprofessorshavegivenguestlecturesattheirpartneringinstitutionandtwoNEIUinvestigatorsreceivedapprovaltobeginincorporatingcancerdisparitieseducationintotheircourses.ThesenewcoursesincludetheNEIUeconomicscourse,“ApplicationsinHealthResearchandPolicy”andtheNEIUcommunityhealthcourse“HealthDisparities:Individuals,Communities,andSystems”.SixNEIUstudentshavesecuredpositionsasstudentresearchassistantsonapilotprojectandthreeNEIUstudentsobtainedsummerinternshipsatRHLCCC-NU.Thepartnershipwillbefundingathirdinter-institutionalresearchpilotprojectthataddressescancerinthetopicsofaccesstohealthinformation,healthbehaviorchange,andhealthcommunication.CancerdisparitiestopicswillcontinuetobeincorporatedintocoursesatNEIU,andahealthdisparitiessymposiumwilloccuronNEIU’scampusduringthespringsemester.NEIUstudentswillalsobeofferedavarietyofresearchinternshipsandlearningopportunitiesatNUduringthesummer.Furthermore,thepartnershipwillcontinuebuildasustainableinfrastructuretohousefuturejointcancerresearchandeducationaleffortsbetweenthe
33
partneringinstitutionsbeyondtheP20fundingmechanism.
AModelGraduate-LevelCurriculuminHealthcareQualityandPatientSafety
DonnaWoods,EdM,PhD;StephenPersell,MD;CynthiaBarnard,MBA;JohnVozenilek,MD;DavidLiebovitz,MD;MeetalAcharya;KevinWeiss,MD,MPH
Background:Formaleducationinhealthcarequalityandpatientsafetyiscentraltothedeliveryofsafe,highqualityhealthcareandisnecessarytotrainaworkforceinthekeyknowledgeandskillsrequiredtomakethetransformativechangesnecessarytoimprovethequalityandsafetyofhealthcare.
Curriculum:FeinbergSchoolofMedicineatNorthwesternUniversityestablishedtheinterdisciplinarygraduate-leveleducationprogramsforhealthcareprofessionalsandbeganenrollmentin2006.Thecurriculumconsistsofreadings,lecture,discussion,hands-onexercises,engagementinpractice,andtheapplicationoftheacquiredknowledgeandskillsthroughaCapstoneprojectinwhichstudentsdesign,implement,andevaluateareal-worldqualityorsafetyimprovementactivitywhichisfocusedoneitherthehealthcaredeliverysystemorhealthprofessionseducation.Thestudentcomefromacrossthecountrytoattendaseriesofintensiveclassroombasedinteractivesessions.Currently,threeprogramsareoffered:MasterofSciencedegree,FacultyDevelopmentprogramandCertificateprogram.TheCorecoursesinclude:•IntroductiontoHealthcareQuality•IntroductiontoPatientSafety•AdvancedHealthcareQuality•AdvancedPatientSafety
Thesecoursesfocusontheknowledge,skills,andmethodsrequiredforimprovinghealthcaredeliverysystems.Thetopicscoveredinclude:healthcarequalitycontextandmeasurement,changingsystemsofcaredelivery,healthcaredisparities,accountabilityandpublicpolicy,safetyinterventionsandpractices,healthinformationtechnology,simulation,thescienceofteamwork,humanfactors,riskassessment,leadershipandgovernance,andthelegalandpolicycontextforpatientsafetyatthestateandfederallevels.Additionally,studentslearnabouttheexternalenvironmentthatshapeshealthpolicy,theimportantstakeholdersinthehealthcareindustry,howtheyinteractwithoneanotherandhowmanagerscansuccessfullycreateanddelivervaluetokeystakeholders.Studentsgainworkingknowledgeofbasicdatacollectionandanalyticaltechniquesthatarecommonintheimplementation,evaluation,andstudyofhealthcarequalityandsafetythroughthefollowingcourses:•IntroductiontoHealthManagement•FundamentalMethodsforHealthcareQualityandPatientSafety
Anewcoursewasaddedtotheprogramtofurtherdeveloptheleadership,operations,changemanagementandnegotiationskillswhichwhilenotdirectlyrelatedtoqualityandsafetyimprovementaddsignificantvalue.Thiscourseis:•HQS510:TheBusinessofQualityandSafetyImprovement
Conclusion:Thisisamodelcurriculumwhichhasnowbeentestedover6yearsinwhich,studentsandgraduates,havedevelopedleadershipinqualityandsafetyandhavedevelopedtheknowledge,skills,andtoolsnecessaryforqualityimprovement,educationaldevelopmentandsystemredesign.
StudentreactiontotheECMH–qualitativeanalysisofthestudentstoriesandreflections:September2012-November24,2012
ElizabethRyan,EdD;DanEvans,MD;JenniferBierman,MD;JohnGatta,PhD;JuliaFiuk;ChelseaCarlson;MaryniaKolak,MFA
Background:TheEducationCenteredMedicalHome(ECMH)aimstoprovidemedicalstudentsauniqueclinicallearningexperienceviacontinuitywithfacultymembers,peers,andpatients.Todate,thismodel’ssuccessofachievingthisaimhasnotbeensystematicallyassessed.
Aim:ToqualitativelyassessthestudentexperienceatourEducationCenteredMedicalHomeinregardstobothmeetingECMHobjectivesandinafulfillingpersonalexperience.
Participants:151firstthroughfourthyearmedicalstudents
34
Methods:Atotalof290surveys(151pre-surveys,139post-surveys)wereadministeredtofirstthroughfourthyearmedicalstudentsparticipatingintheECMHprogram.Ofthese,90pre-andpost-surveyswerelinked;allresultsreportedreflectonlythesematchedsurveys.Bothpre-andpost-surveysconsistedoftwoidenticalarraysofagreementscaleitems,addressingECMHobjectivesandpersonalexperience.Agreementscaleitemswereanalyzedonascaleof1to5(1denotesstrongdisagreement,5strongagreement);9positivethemesand13“areasforimprovement”themesweredevelopedbyonegroupmemberfromthenarrativeresponses.Threeadditionalratersreviewedthedataandcodednarrativesusingthedevelopedcodelist.Aninter-raterreliabilitycoefficientwillbegeneratedtodeterminethevalidityofthecodedthemes.
Results:Preliminarily,thequalitativeanalysisshowsthatstudentsinanEducation-CenteredMedicalHome(ECMH)ratecontinuityofcare,teamwork,andpeer-to-peereducationveryhighly.WhenaskedtosubjectivelydescribetheirECMHexperience,theyconsistentlychosethesesimilarthemes.
Discussion:MedicalstudentsrateTheEducation-CenteredMedicalHome(ECMH)programasavaluableanduniqueexperience.Areasofpotentialimprovementincludebetterstudentandfacultyorientationpriortobeginningtheprogramandmoreeffectivepatientscheduling.
MasteryLearningofOralCasePresentationSkills
HeatherL.Heiman,MD;ToshikoUchida,MD;JohnButter,MD;DianeB.Wayne,MD;WilliamC.McGaghie,PhD;GaryJ.Martin,MD
Background:Theoralcasepresentationisachallengingyetessentialskillformedicalstudents.Wepreviouslyshowedthatacurriculumofon-linelearninganddeliberatepracticeimprovedtheoralcasepresentationskillsofsecond-yearstudents.Deliberatepracticeisanimportantcomponentofmasterylearning.Masterylearningischaracterizedbyuniformeducationoutcomeswhilethetimeforeachlearnertoachievethepre-determinedstandardvaries.Themasterymodelimprovesclinicalskillsinadvancedcardiaclifesupport,centralvenouscatheterinsertion,andcardiacauscultation.Westudiedtheeffectofthemasterylearningmodelinoralcasepresentationskills,amorecognitiveskill.Thecurrentstudyhadtwoaims.First,tosetaminimumpassingstandard(MPS)forasetofsixoralcasepresentations.Second,toevaluatetheimpactofaneducationalinterventiongroundedindeliberatepracticeonskilldevelopmenttomasterystandards.
Methods:TenclinicaleducationfacultymembersparticipatedinastandardsettingworkshoptoestablishtheMPSforea