Third Annual Medical Education Day - Feinberg School of Medicine

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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

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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

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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

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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

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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.

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Marianne Green, MD

Interest Group Moderator

Robert Kushner, MD

Session Leader

Jon Lomasney, MD

Session Leader

Christine Park, MD


Alice Salzman, PT, EdD


Mary Schuller, MSEd

Session Leader

Moderators & Session Leaders

Mark D. Adler, MD

Interest Group Moderator,

Session Leader

James Brucker, MSLIS



Interest Group Moderator,

Session Leader

Lauren Anderson, MEd

Interest Group Co-Moderator

Heather Haseley

Interest Group Co-Moderator

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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.

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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


-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


Pediatrics & Medical Education

Amer Z. Aldeen, MD

Assistant Professor in

Emergency Medicine

Joan M. Anzia, MD


Psychiatry & Behavioral

Sciences

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Patricia M. Garcia, MD, MPH

Professor in Obstetrics and

Gynecology

Michael A. Gisondi, MD


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



Pedicatrics & Medical

Education

Robert S. Feder, MD

Professor in Ophthalmology

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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


-Cardiology

Julie K. Stamos, MD


Pediatrics -Infectious Diseases

Marianne Tschoe, MD


-Hospital Medicine

Toshiko L. Uchida, MD



Geriatrics

Sharon M. Unti, MD


Pediatrics -Academic General

Pediatrics and Primary Care

Robert F. Kushner, MD

Professor in Medicine -General

Internal Medicine and

Geriatrics

Lee Ann Lindquist, MD, MPH



Geriatrics

Gary J. Martin, MD

Raymond J. Langenbach, MD,

Professor of Internal Medicine

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Rebecca M. Wurtz, MD, MPH


Preventive Medicine

Gaurava Agarwal, MD

Instructor in Psychiatry and

Behavioral Sciences

Katherine Barsness, MD

Assistant Professor in Surgery

Michael Carr, MD


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

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David Salzman, MD, MEd


Emergency Medicine

Suzanne Schmidt, MD

Instructor in Pediatrics-

Emergency Medicine

Jennifer Trainor, MD


Pediatrics -Emergency

Medicine

John Franklin, MD

Associate Dean for Minority

and Cultural Affairs

Josh Levitsky, MD


Medicine -Gastroenterology and

Hepatology

Mary McBride, MD


Pediatrics -Cardiology

Elaine Morgan, MD

Professor in Pediatrics-

Hematology, Oncology and

Stem Cell Transplantation

Mary Nevin, MD


Pediatrics -Pulmonary Medicine

Gail Randel, MD


Anesthesiology

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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

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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


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


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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

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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

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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<.001forcardiacauscultation;94.4%(SD=4.8%)vs.33.0%(SD=15.2%),p<.001forparacentesis;96.3%(SD=4.2%)vs.46.3%(SD=17.4%),p<.001forLP:89.0%(SD=7.4%)vs.74.8%(SD=14.1%),p<.001forICUclinicalskills;and76.5%(SD=13.9%)vs.53.2%(SD=26.9%),p<.05forcodestatusdiscussions.Thetrainingprogramwasratedhighlybylearners.

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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

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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.

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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.

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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

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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

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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

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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?

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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.

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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<30days.

Discussion:CreatingahealthcarequalityreportcardusingnationallyendorsedcertifiedforMeaningfulUsequalityimprovement(QI)metricsforamedicalstudentpatientpanelisfeasible.Interimanalysisdemonstratesthatourstudent-teamshavebeensuccessfulinrecruitingahigh-riskpatientpoolandthatthereissignificantvariationinadherencetonationalQImetricsatbaseline.ForeachoftheQImetricstrackedweaskedstudentstoreportend-of-yearperformancedatafrom2010,2011and2012.FutureresearchwillusethesethreedatapointsasabaselinetousestatisticalprocessimprovementandprospectivelytrackECMHquality.FurtherstudyisneededtoassesstheeducationalimpactofthisQItrackingcurriculumonmedicalstudentknowledge,attitudesandskillsregardingQIobjectives.

TeachingFiberopticIntubationSkillswithaniPhoneApplication:ARandomizedControlledTrial

RaymondGlassenberg,MD;GildasioS.DeOliveira,MD

Wedevelpoedafreeapplication,ILarynx,thatenablesmedicalstudentsandresidentstopracticebronchoscopicintubationsusinganiPadoriPhone.TheiPhone’sbuilt-inaccelerometersareusedtoduplicatethetwistingofthescopeasitismanipulatedintothelarynx.FollowingIRBapproval,twentymedicalstudentswererandomlyassignedtoreciveeitheradidacticlectureonairwayanatomyorweregivenaniPadtopracticevirtualrealityintubations.Bothgroupswerethengivenarealbronchoscopeandtimetosuccessfulintubationonastandardairwaymanikinwasrecorded.Medianintubationtimewassignificantlyless(35vs100secsp<.005)forthestudentsthatusedtheiLarynxapp.Over50,000copiesoftheapplicationweredownloadedworldwidemakingthisthemostwidelyusedairwaysimulator.

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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

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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.

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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

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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.

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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

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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

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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:TenclinicaleducationfacultymembersparticipatedinastandardsettingworkshoptoestablishtheMPSforeachofthesixcases.PanelistsusedAngoffandHofsteestandardsettingprocedurestodeterminethefinalMPSforeachcase.TheMPSsrangedfrom66%to-70%ofitemscorrect.Onehundredforty-sixof170(86%)second-yearstudentsconsentedtoparticipateinthestudy.Studentscompletedacurriculumofonlinelearninganddeliberatepractice.Followingtheintervention,eachstudentverballypresentedoneofthesixcasesduringaclinicalskillsexamination.Studentsconstructedtheiroralpresentationbasedonstandardizedinformationfromvideotapedinterviewsandwrittenphysicalexams.Presentationswerescoredbytrainedfourth-yearstudentsusingdichotomouschecklists(donecorrectly/doneincorrectly).StudentswhodidnotmeettheMPSinitiallyreturnedforadditionaldeliberatepracticeandwerere-assesseduntiltheymettheMPS.

Results:Onehundredthirty(89%)ofthe146studentsmetorexceededtheMPSatinitialposttest.Thesixteenstudents(11%)whodidnotmeettheMPSwereallabletosuccessfullyremediatetheoralpresentationclinicalskillsexaminationafteroneadditionaldeliberatepracticecase.

Conclusion:Amasterylearningmodelwassuccessfulatboostingoralcasepresentationskillsofmedicalstudents.Themasterymodelallowsallstudentstoreachapredeterminedstandardpriortobeginningclinicalrotations.Furtherstudyisneededtodeterminehowthiscurriculumimpactsactualcasepresentationskillsduringthird-yearclerkships.

ResponsibleElectronicDocumentation:AnActiveLearningCurriculumtoImproveProgressNotes

JenniferA.Bierman,MD;KathrynG.Kinner,MD;DanielB.Evans,MD;HeatherL.Heiman,MD

Needsandobjectives:TheAllianceforClinicalEducationrecommendedin2012thatallmedicalschoolsdevelopcompetenciesrelatedtoelectronichealthrecords(EHRs),includingexpectationsaboutchartdocumentation.Ina2011survey,third-yearFeinbergstudentsreportedoftenusingdocumentationshortcuts,suchastemplatesandcopyandpaste.

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Studentssaidthatfacultyfeedbackonnoteswasuncommon.Inresponsetotheseneeds,wedevelopedanactive-learningcurriculumtoteachthirdyearmedicalstudentstowriteinpatientEHR-basedprogressnotesandtoassesstheirnotewriting.

Description:Insummer2012,allthird-yearstudentsreceivedtwohoursoflargegroupinstructioninwritingprogressnotesduringtheirintroductiontoclinicalclerkships.Usingrealexamples,wetaughtstudentsthe“COURTS”mnemonic,whichwecoinedtoindicatethatnotesshouldbe“concise,organized,updated,reasoned,truthful,andstewardly.”Studentsthenwatchedarole-playofmorningroundsandwroteasampleprogressnote.Infall2012,wepilotedacurriculumofdeliberatepracticeandfeedbackfor5studentsontheirmedicinerotation.ThesestudentsutilizedatestversionoftheEHR,constructingaprogressnotebasedonacase.Wethenmetindividuallywitheachstudenttwicetogivefeedbackonhisorheractualnotes.Usingachecklistdevelopedbyamultidisciplinarygroupofeducators,weassessedonenotefromeachstudentbeforeandafterthiscurriculum.Wesurveyedstudentsbeforeandafterthecurriculumwithaneight-itemquestionnaire.

Evaluation:Studentsratedthesessionduringintroductiontoclinicalclerkshipsas4.0,orgood,onascaleof1-5with1poorand5excellent.Thefivestudentsengagedinthepilotcurriculumreportedmarkedimprovementinconfidencewritingprogressnotesandintheconcisenessandreasoningoftheirnotes.(Tablestobeincluded).Notequalitydidnotchangeafterthecurriculum,however,withstudentsachievingameanof73%ofthechecklistitemsexpectedbeforethecurriculumand69%after.

Discussion:StudentswanttolearnhowtowriteprogressnotesintheEHR.Individualfeedbackyieldedstrongimprovementinperceivedability,butactualprogressnotequalitydidnotimprove.Webelievethatifweaddresstheteamasawhole,notonlythestudents,wemayseeimprovementinnotequality.Weplanateam-basedpilotinearly2013.

EthicsTraininginOrthopedicSurgery

CharlesCarrollIV,MD;MarkYaffe,MD;DanFuchs,MD

TheAmericanAcademyofOrthopedicSurgeonspolledamajorityofnationalprogramsfortrainingoforthopedicsurgeryresidentsonthetopicofethicstraining.Methodsandtechniquesvaried.Inresponsetothis,anonlineprogramhasbeendevelopedandisimplementation.Acasepresentationiscombinedwithawrittendocumenttopromoteconversationandtrainingbetweenresidentsandfaculty.50%hasbeendevelopedandisonthewebontheAAOSwebsite.Thisexhibitdemonstratestheprocessandimplementationofthisfreeandavailabletraining.Furtherdevelopmentisunderwayandishopedtobecompletedinthenext12months.Theposterwilldiscusstheprocessandthemodulesavailableforreview.

ComeTogether,RightNow,OverPD:PartneringwithStakeholderstoDevelopaComprehensiveProfessionalDevelopmentProgram

LaurenAnderson,MEd;HeatherHaseley;KatrinaLynch;MadelineHinkamp;JonLomasney,MD

BackgroundandPurpose:Professionaldevelopment(PD)isessentialtoachievingdefinedlearningoutcomes.TheFeinbergAcademyofMedicalEducators(FAME)conducteda360degreeneedsanalysis,basedontheliterature,educatorsurvey,andfocusgroupswitheducationalleadersandlearners.Sincetheundergraduatemedicaleducation(UME)programattheFeinbergSchoolofMedicineiscurrentlyundergoingextensiverevision,PDwillbenecessaryforimplementingthenewcurriculum.

Methods:Usingafour-pointexpertisescale(1=novice,2=experienced,3=expert,4=N/A)andafive-pointimportancescale(1=unimportant,2=important,3=veryimportant,4=N/A,5=don’tknow)participantswereaskedtoratethemselvesonanumberofitemsincludingpreferencesforfuturetopics,timing,formattinganditemswithinthecategoriesof1)teaching,2)learnerassessment,3)timemanagementandmentorship,4)researchandeducationalscholarship.

Afterbeingpresentedwiththedatafromtheneedsassessment,consideringtheneedsofthenewcurriculum,andfactoringintheirpersonalexperienceswiththefacultytheysupervise,theleadershipoftheUMErenewal,inconjunctionwithFAME,determinedtheinitialareasoffocus:1)largegroupteachingandfacilitation(effectivepresenting,teambasedlearning,audienceresponsesystems,usingmultimedia),2)writingtestquestionsand3)feedback.Thefindingsoftheabovewillbepresentedforfeedbacktolearnerfocusgroups.

Results:ManyoftheinitialUMEareasoffocuswereratedofhighimportanceyetdidnotyieldasignificantamountofexpertiseintheneedsassessment.Incorporatingnewteachingstrategies(e.g.TBL)wasrated2.2/3forimportanceand1.4/3forexpertise.Similarly,usingtechnologyeffectively(e.g.ARS,multimedia)wasrated2.1/3forimportanceand1.4/3forexpertise.

However,thiswasnotthecaseforallofthetopicsidentifiedasprioritiesbytheeducationalleadership.Forexample,writingtestquestionswasratedonaverageas1.7/3forbothexpertiseandimportanceshowingthattheleadershipidentifiedhigh-priorityareasinwhichfacultyfeeltobeoflowimportance.

PertheliteratureweextrapolatedthatwhilesomeofthePDneedsareuniversalamongallacademicinstitutionsothersareprogramspecific.AflowchartwascreatedtomaptheprogressionofexpertisewithineachtopicandcreateacommonframeworkforallPDactivities.

Conclusion:AlthoughtheneedsassessmentdatawasusefulindeterminingthepriorityareasforPD,itdoesnotpresentacompletepictureofactualeducatorneeds.Multipleperspectivesincludingthoseofthefaculty,theleadership,andthelearnersarerequiredtoproduceacomprehensiveinterprofessionalandlongitudinalplan.IntroducingtheToolsforResearchThroughCommunityOutreach

KatherineWright;LaurenAnderson,MEd;FrankCastillo,MD

CurrentlytheCollegeCurriculumFocus(CCF)isarequired,culminatingprojectforeachM1collegelastingsixweeks.Traditionally,CCFprojectsexploreasingletopicchosenbythephysicianmentorofthecollege,andresultinstudentpresentationstotheirpeers.

Pairingageriatricscurriculumwitharesearchendeavor,CastilloCollegeconductedaneedsassessmentfortheCenterHomeforHispanicElderlyatCasaCentralastheirCCFexperience.Inadditiontoprovidingstudentsalearningopportunityaboutresearchmethodology,thedatageneratedfromtheassessmentisintendedtoprovideguidancetosecondyearresidentsinthefamilymedicineresidencyprogramastheycompletetheirgeriatricsrotationattheCenterHome.

Todividetheeffort,studentcommitteesformedtoworkindependentlyandreportbacktothewholeclass.Guestspeakerswerebroughtintosupplementstudentcommitteepresentations.Topicsincluded:palliativecare,functionalassessment,dementia,restraints,medical-legalpartnerships,socialwork,andbackgroundontheextendedcarefacility.

Studentswereexposedtothedifferentstepsintheresearchprocess,fromconductingaliteraturereviewtodatacollectionandanalysis.Guidedbyfacultyandexpertsinthefield,studentsnavigatedtheirwaythroughtheIRBprocess,humansubjectstraining,interviewdevelopment,anddatamanagement.Witheachcommitteecompletingonestepintheprocessandreportingtheirprogressbacktothegroup,theclasswasexposedtoallaspectsofconductingtheneedsassessmentandprovidedinputalongtheway.Additionally,thiswasanopportunityforstudentstolearnaboutnewandinnovativepracticesthataren’tcoveredinanyothercurriculum,suchasmedical-legalpartnerships.Havinginterdisciplinaryteammembersspeakontheirprofessionandhowtheyassistdoctorsinhealthcarepresentedaneducationalopportunityforthemedicalstudents.

ThoughtheCastilloCollegeCCFprojectwasmoretime-consumingthanothers,thefinalproductwasmorevaluabletothestudentsandcommunity.TheprojectwasabletoaddressseveraloftheNUFSMCompetenciesincluding1)communityengagementandservice,2)professionalbehavior,3)medicalknowledgeandscholarship.Currently,NorthwesternUniversityFeinbergSchoolofMedicine(NUFSM)integratedthecollegesystem(1/4ofeachclassmakesup1“college”)into“societies”,(asocietyiscomprisedofverticallystacking4colleges(M1-M4)).Thereispotentialtobuildupontheprojectyeartoyear,sothatanothercollegewithinthesamesocietycanextendtheworkcompletedthisyeartostrengthentheconnectionwithourcommunity.

Center for Education in MedicineNorthwestern University Feinberg School of MedicineMcGaw Pavilion240 East Huron StreetChicago, Illinois 60611

Email: [email protected]

Phone: 312-503-7700

cem.northwestern.edu

simulation.northwestern.edu

Third Annual Medical Education Day - Feinberg School of Medicine

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