Many thanks to this year's presenters and authors for sharing their educational research and making the 2nd annual Spotlight on Scholarship a great celebration of educational innovations. The presentations were energetic and fast-paced; presenters were given eight minutes to share their research and two minutes for questions. In case you missed it, we encourage you to take a look at the presentations.
Clinical IPE in a Student-Run Free Clinic: The GOODLIFE ModelPresenter(s): William Hay, MD; Timi Barone, PhD; Samantha Ammons, PhD
Abstract: The GOODLIFE Clinic at the University of Nebraska Medical Center (UNMC) is an interprofessional student-run free clinic providing diabetic care. The clinic brings together student volunteers from medicine, pharmacy, physical therapy, nutrition, nursing, physician assistant, behavioral health and medical lab sciences. For many participating students, the clinic may be their most interprofessional educational experience at UNMC. Several years ago, GOODLIFE instituted several changes to improve the interprofessional educational environment. How have these changes affected the students’ educational experience? To answer this question, researchers from family medicine, sociology, and anthropology have been collaborating for three years on a mixed methods project consisting of pre and post clinic surveys, interviews, observation, and time-use data. Combining survey results (N=305) with 360 hours of observation and interviews reveals that students are learning at GOODLIFE. Survey data shows significant (p<.05) improvement in knowledge and attitude towards interprofessional collaboration. Observational, interview and time-use data allows us to fill in how this learning occurs. Our data show that team collaboration and interprofessional learning varies because of structure and environment. Specifically, team collaboration improved with explicit interaction instructions from faculty preceptors. Our data show missed “learning opportunities” and role ambiguity within interprofessional teams. These findings suggest small changes can be made to improve interprofessional learning, but overall the GOODLIFE model works well.
Innovations in Addiction Training: Creating Competence While Decreasing StigmaPresenter and Author: Alena A. Balasanova, MD, FAPA
Introduction: Amidst the ongoing opioid crisis, it has become clear that U.S. ACGME residency programs do not adequately prepare physicians for treating substance use disorders (SUDs). The elements of effective clinical training have been described as the clinician’s triad: an adequate knowledge base, a positive attitude toward the patient and treatment, and a sense of professional responsibility for treating SUDs (Renner 2004). Although addiction is a chronic disease, most required addiction psychiatry rotations take place in short-term, high-acuity settings where patients may be at their lowest point. Such experiences negatively impact physicians’ attitudes towards patients and reinforce the abdication of responsibility for treating these conditions. Trainees seldom have supervised opportunities to treat patients in long-term recovery.
Methods: We developed a year-long, half-day clinical elective for general psychiatry residents designed to expose them to long-term care of patients with SUDs and co-occurring psychiatric disorders. Specifically, we aimed to teach necessary clinical skills including Medication Assisted Treatment, foster appropriate attitudes and enhance trainees’ sense of responsibility for treating this population.
Conclusion: Prior to this rotation residents had no exposure to longitudinal management of addiction; the integrated and multidisciplinary format of this rotation is unique within our state and region. Positive feedback from trainees completing this elective shows that a half-day longitudinal clinical experience can sufficiently prepare psychiatry residents to feel comfortable and confident in treating patients with SUDs. Future directions should continue to explore novel approaches to addiction training in residency.
Effectiveness of Blended Learning for Resident Education in Neurology: Experience from Movement Disorder CoursePresenter: Danish Bhatti, MD
Objective: To evaluate feasibility and usefulness of Blended Learning for resident education in Neurology. Background: Modern teaching tools and methodologies have not been commonly adopted for residents. Their impact and challenges of using them during residency are not clear.
Design/Methods: Neurology residents participated in a 5-week blended learning course including traditional face-to-face weekly lecture and online materials using Canvas learning management system. Coursework included weekly modules with required and optional reading material, task assignments (such as mind map, memory matrix), formative quizzes, discussion forums, twitter feeds and podcast. Course performance was evaluated with blinded pre-test and post-test questionnaire.
Results: Of 16 residents 15 completed pre-test and 11 completed post-test for evaluation. There were 5777 online page views over 5 weeks (mean 385/resident, range 32-1319). Residents made 167 submissions with timely submission rate of 55% (CI 37-73, range 0-100%), completed 5 weekly quizzes with average score of 65.9% overall as a group (range 58.9-71.3%). There were 86 responses posted within 12 discussion topics. Eleven residents completed post-test with 100% showing an improvement on the score (average 23.8% CI 20.4-27.2, range 10-46%). Pre-test score average was 41% (n=15, range 2-72%) and post-test score average was 72.7% (n=11, range 48-86%). Combined Score for all assessments (total 410) for all 15 residents was 35.8% on average (mean 147, CI 113-180, range 1.2-80.8%) showing large spread of results due to variable participation. Improvement on post-test scores (n=11) show a correlation with timely assignment submission (coefficient 0.52, CI 0.6 to -0.11), weekly quiz scores (coefficient 0.5, CI 0.6 to -0.14) and number of page views (coefficient 0.48, CI 0.6 to -0.16).
Conclusions: Blended learning is a feasible and effective for training neurology residents. Online tracking allows formative assessment and detailed performance analysis. Factors influencing resident participation and adoption require further study.
Teaching Pupillary Examination Using the Advanced Pupil SimulatorPresenter: Sachin Kedar, MD
Authors: Sachin Kedar, MD; Jideofor K. Ndulue, MBBS, MSPH; Deepta Ghate, MD
Background: We recently designed a virtual reality-based application, the Advanced Pupil Simulator ® (APS), for training students and residents in performing pupillary examination. We report results for trainee self-perceived confidence and competence to perform pupillary examination after proctored training using the APS.
Methods: 145 trainees (126 first-year medical students, 15 neurology and 4 ophthalmology residents) completed pupillary examination training as part of a Clinical Skills Session. All trainees reviewed an online power-point module and practiced pupillary examination in groups of 3 assigned to the APS and expert faculty for 30 minutes. All trainees completed a Likert-type questionnaire (1 = not confident, 5 = very confident) before and after the session to assess confidence in performing pupillary examination. All trainees were also objectively assessed for knowledge, comprehension, application and analysis by the faculty using test mode on the APS. Differences in pre-and post-training confidence was tested using Wilcoxon sign rank test. Group differences in objective scores were tested using Fischer’s exact test.
Results: 97% (122) students and 10 (52%) residents reported improved confidence in performing pupil examination following training on APS. 80% (101) students and 89% (17) residents were able to correctly list and demonstrate all steps in pupillary examination. 77% (97) students and 74% (14) residents correctly identified relative afferent pupillary defect (RAPD) while 88% (111) students and 95% (18) residents correctly identified Horner’s syndrome. 97% (123) students and 95% (18) residents correctly used appropriate pharmacological drops to confirm Horner’s pupil. Post training, students reported improved confidence in identification of all 5 pupillary abnormalities (p=0.00), while residents reported improved confidence in diagnosing Adie pupil (p=0.00) and using pharmacologic agent to confirm anisocoria (p=0.00).
Conclusion: All trainees showed improved confidence and competence in pupillary examination after using the APS. Virtual-reality based practical training can shorten time to competency for critical medical examination techniques.
3D Printed Phantom Chest with Contrast Improves Training for Cardiovascular Interventional Radiology TechnologistsPresenter: Blair Kauzlarich, RT(R)(CI)(ARRT)
Authors: Lincoln M. Wong, MD; Blair Kauzlarich, RT(R)(CI)(ARRT); R. Gabe Linke, BSRT, RT(R)(MR)
Abstract: Training radiology technologists on using new imaging equipment proficiently prior to using it on live patients can be challenging. Without a live patient, the training environment can be unlike the actual procedure environment. The learning curve can be steep. Technologists get limited training prior to live cases, but oftentimes continue to learn how to use complicated angiographic equipment during a live case nevertheless. This places unnecessary risk and burden on the patient by prolonging procedure times, increasing operating costs, increasing use of anesthesia and increasing radiation dose. The challenge is to train technologists in a simulated environment that is realistic enough to give them the confidence in using the equipment on live patients without incurring these risks. We have 3D printed a pediatric chest phantom capable of accepting contrast to simulate a patient with an aortic coarctation. This model was used by cardiovascular interventional radiology technologists to familiarize themselves with using a new Siemens ARTIS pheno robotic angiography system with post processing software prior to performing the procedure on a live patient. This presentation will discuss the obstacles faced when using new imaging equipment, the process of 3D printing a chest phantom with contrast, and how this model can help accelerate technologist training.
Human Connection as a Tool to Improve Medical Student Well-Being and Make Medical School "Worth It"Presenter: Kelly MacArthur, PhD
Authors: Kelly MacArthur, PhD; Jonathon Sikorski, PhD
Abstract: By all indications, well-being among physicians is poor, as studies consistently show they have elevated rates of psychological distress that manifest in various outcomes, including burnout, depression/anxiety, low life satisfaction, alcohol/substance abuse, suicide ideation, and suicide. Despite the vast literature on physician burnout and related health outcomes, there is relatively little research on how early experiences in medical school may be an antecedent to subsequent poor health among physicians. To assess risk of early burnout, this study utilizes the metaphor of the Coping Reservoir as a theoretical framework to analyze 105 pre-clinical medical students’ reflective writings. Specifically, we use a data analytic process consistent with an interpretive description approach, in which we engaged in a hierarchical 3-step coding process to identify the main negative and positive factors—or depleting and replenishing inputs— into students’ coping reservoirs. Results indicate that the two main negative factors are curricular stress and social-psychological barriers. That is, students experience a great deal of stress due to the amount and fast pace of the material they need to learn and, in particular, the focus on grades. Furthermore, they are often crippled with various forms of self-doubt that negatively frame their experiences. Conversely, results show the main three positive factors to be psycho-social resources, social support, and relationships with patients. Thus, what allows students to frame their experiences with hope and optimism, as opposed to self-doubt, are the human connections they make with their medical student peers and, most notably, with patients. The prolonged stress of medical school is made “worth it” in hopes that it will “get better” with more meaningful patient interaction. These results are discussed in regards to their practical implications for medical education and, ultimately, for interventions to improve medical student and physician well-being.
Simulation to Improve Critical Care Fellows' Confidence in IntubationPresenter: Rorak Hooten, MD
Authors: Rorak Hooten, MD; Tammy Wichman, MD; Kelly Cawcutt, MD; Craig Piquette, MD
Background: Airway management is a core competency for Critical Care Medicine (CCM) fellows as prescribed by the ACGME. Intubation experience has been cited by recent graduates of the CCM program as a weakness. Simulation has been shown to improve first pass success rate and decrease adverse events while intubating in the ICU. We hypothesized by implementing a similar course we could improve fellows’ confidence and experience in airway management.
Methods: A ten session simulation course was created modeling a course previously described in the literature. The course focuses on airway evaluation, pharmacology, and decision-making strategies early, and progresses to needing advanced techniques like fiberoptic intubation or emergent cricothyrotomy. The course also incorporates principles of crew resource management, leadership, and effective communication in order to improve outcomes. Pre-course surveys evaluating confidence in increasingly difficult airway situations were obtained prior to initiation of the course will be compared with the same survey post-course. Billing codes were used to estimate the number of intubations performed by the fellows in the ICU prior to the initiation of the course.
Results: Over the past 3 years, the average number of intubations billed for by CCM faculty was 34 per year. Data tracking began after the first 3 sessions of the course as these cover the basics of intubation. In 4 months, the fellows have performed 25 intubations. This rate estimates 75 intubations or a 2.2 fold increase in the number of intubations performed since starting the simulation curriculum. Pre- and post-course confidence surveys will be compared at the end of the year upon completion of the course.
Conclusions: While billing codes may slightly underestimate the number of procedures completed by the fellows, there is a clear increase in the number intubations performed by the CCM fellows. This increase suggests that their confidence and willingness to do intubations has improved due to the start of a difficult airway simulation curriculum.
Balancing Act: College-Wide Implementation of Holistic AdmissionsPresenters: Sarah McBrien, PhD; Maggie Winnicki, MPH
Authors: Sarah McBrien, PhD; Maggie Winnicki, MPH; Sara Bills, PT, DPT, GCS; Greg Karst, PhD, PT; Kyle Meyer, PhD, MS, PT
Abstract: Over the past few years, the College of Allied Health Professions (CAHP) has considered strategies for incorporating holistic admissions practices into their existing procedures. Holistic admissions considers applicants’ experiences and attributes alongside their academic skills. By balancing the weight of academic and non-academic metrics during the admissions process, we hoped to admit a more diverse group of students who bring varied life experiences to the classroom. We consulted with the American Association of Collegiate Registrars and Admissions Officers (AACRAO) to establish a reliable, valid method for measuring such experiences and attributes. In the fall of 2018, every CAHP program implemented the AdMISSION Bio into their admissions process. The AdMISSION Bio requires applicants to respond to prompts meant to measure eight non-cognitive variables (NCVs) that are associated with success in graduate and professional school (e.g., positive self-concept, successful leadership experience). Forty-four (44) readers were trained to score responses. Readers were CAHP faculty and staff, IAE members, and other stakeholders. AdMISSION Bio readers underwent training that included an overview of holistic admissions, diversity and bias training, and scoring practice. Each response was scored by two readers; a third reader was required should the variance between the initial readers’ scores reach an identified threshold. At the time of this proposal, 815 applicant responses have been scored. On a scale of 1-32 (4 points for each prompt), the average score was 21.94 (µ=3.09). Correlations between the total score and individual prompt scores range from 0.619 to 0.689. Preliminary data suggests we successfully measured something other than academic skill by incorporating the AdMISSION Bio, as applicants’ NCV scores were poorly correlated with academic metrics such as GPA or GRE. Additional data analysis is underway to measure the effect of the AdMISSION Bio on three established focus areas: socio-economic status, geographic location, and first generation status.