Academic Health Science Centre Research Articles

Developing a customised set of evidence-based quality indicators for measuring workplace violence towards healthcare workers: a modified Delphi method

BackgroundWorkplace violence (WPV) is a complex global challenge in healthcare that can only be addressed through a quality improvement initiative composed of a complex intervention. However, multiple WPV-specific quality indicators...

Evaluation of alternate form reliability for the 9-item versions of the interprofessional socialization and valuing scale (ISVS-9A/9B)

BackgroundThe Interprofessional Socialization and Valuing Scale (ISVS) was developed to measure interprofessional socialization as one adopts and integrates learning into practice. While items for the ISVS-9A and 9B were drawn from three subscales of the original 24-item tool, these parallel forms were validated as a unidimensional measure using Canadian health professional and student populations. ObjectivesThe aim was to investigate if the ISVS-9A and ISVS-9B forms are interchangeable and examine their internal structure. DesignStudents completed an 18-question survey that included the nine items from the ISVS-9A followed by the nine items for ISVS-9B. SettingsTwo U.S. academic health science centers provided longitudinal interprofessional education (IPE) in a classroom setting. Participants625 students representing 13 programs from one institution and 512 students representing 7 health professions programs from the second institution were included in the study. MethodsParticipants completed the ISVS-9A and 9B as a single form. Intraclass correlation coefficients (ICC) and corresponding 95 % confidence intervals were calculated to measure the absolute agreement between the scores from the ISVS-9A and 9B forms. A factor analysis considering the original tool's three subscales was conducted. Results592 responses from one institution and 500 responses from the second institution were analyzed. ICC for the ISVS total scores demonstrated good reliability (0.75–0.90). However, the internal structure of the three factors demonstrated moderate reliability (0.5–0.75) and may need further investigation. ConclusionsThis study confirms the use of the ISVS-9A and 9B total score to measure interprofessional socialization in health professional students attending U.S. institutions. Additional research is needed to determine potential reasons for mixed outcomes from studies using ISVS-9A and 9B parallel forms.

Sociotechnical imaginaries in academic medicine strategic planning: a document analysis.

Purpose Along with other industries, healthcare is becoming increasingly digitized. Our study explores how the field of academic medicine is preparing for this digital future. Method Active strategic plans available in English were collected from faculties of medicine in Canada (n = 14), departments in medical schools (n = 17), academic health science centres (n = 23) and associated research institutes (n = 5). In total, 59 strategic plans were subjected to a practice-oriented form of document analysis, informed by the concept of sociotechnical imaginaries. Results On the one hand, digital health is discursively treated as a continuation of the academic medicine vision, with expansions of physician competencies and of research institutes contributions. These imaginaries do not necessarily disrupt the field of academic medicine as currently configured. On the other hand, there is a vision of digital health pursuing a robust sociotechnical future with transformative implications for how care is conducted, what forms of knowledge are prioritized, how patients and patienthood will be understood, and how data work will be distributed. This imaginary may destabilize existing distributions of knowledge and power. Conclusions Looking through the lens of sociotechnical imaginaries, this study illuminates strategic plans as framing desirable futures, directing attention towards specific ways of understanding problems of healthcare, and mobilizing the resources to knit together social and technical systems in ways that bring these visions to fruition. There are bound to be tensions as these sociotechnical imaginaries are translated into material realities. Many of those tensions and their attempted resolutions will have direct implications for the expectations of health professional graduates, the nature of clinical learning environments, and future relationships with patients. Sociology of digital health and science and technology studies can provide useful insights to guide leaders in academic medicine shaping these digital futures.

374 Operationalization of a Translational Ethics Program

OBJECTIVES/GOALS: Within our CTSA hub, greater emphasis is on understanding innovation and human health impact of translational science writ large rather than focus on translational research projects. Our program is restructured to reflect distinguishing ethical features of translational science which are complimentary to traditional research ethics issues. METHODS/STUDY POPULATION: This descriptive analysis depicts the development of our ethics program as an exemplar of how to integrate into the research enterprise of an academic health science center that engages in translational research. Our relational approach is predicated on the embodiment of ethical values by all who are involved in research committed to proactive dialog, team building, and collaboration. This translational research culture is facilitated by a multidisciplinary ethics team who are embedded throughout the translational research enterprise. RESULTS/ANTICIPATED RESULTS: Our program is integrated into a translational science enterprise within a CTSA hub in four areas: relational structure (from leadership team to community engagement), education (from trainees to the research community to the public), support (through ethics consultation with multiple touchpoints in the translational science pathway), and team science (from team on-boarding and communication to D&I research of team science interventions). We have developed a research agenda examining research ethics topics that increase quality, applicability and downstream social impact of research; understanding translational science through historical and science & technologies studies lenses, and ethnographic and mixed-method approaches to understanding team science and the science of team science. DISCUSSION/SIGNIFICANCE: The integration of a translational ethics program provides attention to traditional research ethics issues regarding study conduct and integrity but also transcends those concerns to focus on the translational science enterprise itself through relationships, cultivating trust, team science, DEIA, and social responsibility.

How can academic health science centers help to increase diversity in the STEM professions?

In the United States, great inequities exist within the science, technology, engineering, and math (STEM) fields in individuals who self-identify as belonging to underrepresented groups (e.g., from socioeconomically disadvantaged backgrounds, people with disabilities, and Black/African American, Hispanic/Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander). Underrepresentation in STEM careers has been documented to be due to a lack of qualified and diverse teaching personnel, limited access to resources in disadvantaged schools, and implicit bias within US institutions. In recognition of these inequities, an interprofessional team of biomedical faculty members and diversity, equity and inclusion (DEI) educators from the Louisiana State University Health Science Center (LSUHSC) in New Orleans developed and implemented a STEM educational training pipeline for elementary, middle, and high school (K-12), undergraduate, and medical students, with accompanying DEI training for LSUHSC mentors and staff to mitigate implicit bias and promote a welcoming environment for participants from different backgrounds. Our findings focus on one social determinant of health: access and quality of education. Other institutions can implement a program as described in the present study to address the educational and health inequities in their own communities.

Comparison of electrodiagnostic findings in acute traumatic versus chronic non-traumatic ulnar neuropathy at the elbow.

A common concept is that traumatic nerve injuries are more likely axonal, and that compressive neuropathies are more likely demyelinating. The purpose of this study was to compare traumatic versus non-traumatic ulnar neuropathy at the elbow (UNE) to look for electrodiagnostic differences between the two groups. A retrospective 3 year review of UNE patients at two academic health science centers was conducted. Patients were grouped into acute traumatic UNE versus chronic non-traumatic UNE based on clinical history. Electrodiagnostic measurements were compared between the two groups. There were 50 subjects with acute traumatic UNE and 41 with chronic non-traumatic UNE. Mean age and sex distribution were similar but those with traumatic UNE had a 7 month duration of symptoms, while those with chronic UNE had 29 month duration (p < .001). All electrodiagnostic measurements were similar between the two groups including compound muscle action potential amplitudes, motor conduction velocities, frequency of conduction block, sensory nerve studies, and needle electromyography. We did not find a difference between the two groups. One should not make inferences regarding acuity or etiology based on electrodiagnostic features alone.

Effect of Mixed Reality on Delivery of Emergency Medical Care in a Simulated Environment

Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility. To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment. This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022. Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group. The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability. A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = .02), technical (1.95 [1.40] vs 3.65 [2.03] errors; P = .01), and safety (0.37 [0.96] vs 0.96 [0.85] errors; P = .04) domains. MR resulted in significantly greater scenario completion rates vs SC (22 scenarios [100%] vs 14 scenarios [63.6%]; P = .003). It also led to significant improvements in the overall quality of teamwork and interactions vs SC as measured by mean (SD) OTAS (25.41 [6.30] vs 16.33 [5.49]; P < .001) and T-SAW-C (27.35 [6.89] vs 18.37 [6.09]; P < .001) scores. As reported via mean (range) NASA-TLX score, there were significant reductions for MR-SC vs SC in participant temporal demands (38 [20-50] vs 46 [30-70]; P = .03) and significant improvements in self-reported task performance (50 [30-60] vs 39 [10-70]; P = .01). Overall, 19 participants (86.4%) reported that they were more confident in making clinical decisions and undertaking clinical procedures with MR support. This study found that the use of MR technology reduced error, improved teamwork, and enhanced practitioner confidence when used to support the delivery of simulated emergency medical care. ClinicalTrials.gov Identifier: NCT05870137.

Effect of colchicine on perioperative atrial fibrillation and myocardial injury after non-cardiac surgery in patients undergoing major thoracic surgery (COP-AF): an international randomised trial

Higher levels of inflammatory biomarkers are associated with an increased risk of perioperative atrial fibrillation and myocardial injury after non-cardiac surgery (MINS). Colchicine is an anti-inflammatory drug that might reduce the incidence of these complications. COP-AF was a randomised trial conducted at 45 sites in 11 countries. Patients aged 55 years or older and undergoing major non-cardiac thoracic surgery were randomly assigned (1:1) to receive oral colchicine 0·5 mg twice daily or matching placebo, starting within 4 h before surgery and continuing for 10 days. Randomisation was done with use of a computerised, web-based system, and was stratified by centre. Health-care providers, patients, data collectors, and adjudicators were masked to treatment assignment. The coprimary outcomes were clinically important perioperative atrial fibrillation and MINS during 14 days of follow-up. The main safety outcomes were a composite of sepsis or infection, and non-infectious diarrhoea. The intention-to-treat principle was used for all analyses. This trial is registered with ClinicalTrials.gov, NCT03310125. Between Feb 14, 2018, and June 27, 2023, we enrolled 3209 patients (mean age 68 years [SD 7], 1656 [51·6%] male). Clinically important atrial fibrillation occurred in 103 (6·4%) of 1608 patients assigned to colchicine, and 120 (7·5%) of 1601 patients assigned to placebo (hazard ratio [HR] 0·85, 95% CI 0·65 to 1·10; absolute risk reduction [ARR] 1·1%, 95% CI -0·7 to 2·8; p=0·22). MINS occurred in 295 (18·3%) patients assigned to colchicine and 325 (20·3%) patients assigned to placebo (HR 0·89, 0·76 to 1·05; ARR 2·0%, -0·8 to 4·7; p=0·16). The composite outcome of sepsis or infection occurred in 103 (6·4%) patients in the colchicine group and 83 (5·2%) patients in the placebo group (HR 1·24, 0·93-1·66). Non-infectious diarrhoea was more common in the colchicine group (134 [8·3%] events) than the placebo group (38 [2·4%]; HR 3·64, 2·54-5·22). In patients undergoing major non-cardiac thoracic surgery, administration of colchicine did not significantly reduce the incidence of clinically important atrial fibrillation or MINS but increased the risk of mostly benign non-infectious diarrhoea. Canadian Institutes of Health Research, Accelerating Clinical Trials Consortium, Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Population Health Research Institute, Hamilton Health Sciences, Division of Cardiology at McMaster University, Canada; Hanela Foundation, Switzerland; and General Research Fund, Research Grants Council, Hong Kong.

Seeking Education, Equity, and Diversity (SEED)

Introduction Health care work cultures that embrace diversity, equity, and inclusion (DEI) foster innovations, synergy, and appreciation for differences. To promote DEI, health care systems have encouraged professional development on cultural humility, which is awareness of one’s values, beliefs, and social position, given the current cultural context while mindful of history. The national SEED Project (Seeking Educational Equity and Diversity) is a professional development program that prompts reflection and perspective shifting about workplace culture and systemic change. However, reports that examine the SEED learning experience and the participants’ intention for behavior change are lacking. The purpose of our study was to examine: (a) The SEED learning experience, (b) How personal views can foster cultural humility, and (c) The impact of SEED on intentions to effect change. Methods A purposive sample of eight (N = 8) faculty and staff from a SEED cohort at an academic health science center, with regional programs, participated in in-depth interviews to explore their personal views of how to foster cultural humility in health care and the impact of SEED to prompt intentions for behavior change. The investigators conducted a thematic analysis using an inductive, iterative method. Independently, they read each transcript and created codes for each comment. Subsequently, they compared findings, developed a coding frame, and grouped codes into potential themes. They then individually applied the coding frame to the data and considered themes. Finally, they built consensus on codes and synthesized codes into themes. Results Thematic analysis indicated the participants had a profound learning experience, which prompted them to develop cultural humility by re-framing cultural experiences and resolving to become more proactive about DEI in the workplace. They found small group discussions were insightful and provocative. These discussions led to new perspectives and behavior change or intentions for behavior change. Our analysis generated three themes: (1) Connecting with diverse perspectives, (2) Developing new perspectives, and (3) Being proactive with advocacy and new strategies. Conclusion Health care professionals and organizations can use our findings to encourage professional development that potentially stimulates behavior change, the ultimate goal of professional development, related to DEI. Future studies should examine the impact of this professional development within their organization and in the delivery of health care.

The effects of nordic walking, high-intensity interval training, and moderate-to-vigorous intensity continuous training on arterial stiffness in patients with coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The investigator-initiated research was supported by the Innovations Fund of the Alternate Funding Plan for the Academic Health Sciences Centres of the Ministry of Ontario (PIs: Pipe, Reed) and Heart and Stroke Foundation of Canada (PI: Reid). Background Coronary artery disease (CAD) is a leading cause of mortality worldwide. Arterial stiffness, a process associated with aging, arteriosclerosis, and arterial remodeling, is a strong and independent predictor of cardiovascular and all-cause mortality in patients with CAD. Moderate-to-vigorous intensity continuous training (MICT) has been shown to improve arterial stiffness parameters, including pulse wave velocity (PWV, i.e., the speed at which arterial pressure waves travel along the aorta and large arteries) and augmentation index (AIx: i.e., aortic pressure waveform) in the CAD population. Yet, the role of alternative exercise training approaches on arterial stiffness in patients with CAD has not been elucidated. Our recent study demonstrated greater improvements following Nordic walking (NW) compared to high-intensity interval training (HIIT) and MICT in functional capacity, quality of life, and depression severity in patients with CAD. No previous trial has compared the efficacy of NW, HIIT, and MICT in improving arterial stiffness in patients with CAD. Alternatives to traditional MICT, such as NW and HIIT, may provide superior understudied benefits on vascular health in patients with CAD. Purpose We compared the effects of 12 weeks of NW, HIIT, and MICT on arterial stiffness in patients with CAD. Methods Patients with CAD were randomly assigned to: (1) NW (walking with NW poles at a resting heart rate [RHR] + 20–40 bpm), (2) HIIT (aerobic exercise equipment: 4 × 4-min of high-intensity work periods at 85%–95% peak HR), or (3) MICT (aerobic exercise equipment: RHR + 20–40 bpm) twice weekly for 12 weeks. At baseline and week 12, aortic stiffness parameters were measured using a non-invasive device by stroke volume (SV), total vascular resistance (TVR), AIx with and without normalization for a HR of 75 bpm (AIX@75), and PWV. Linear mixed-effects models with repeated measures were used to compare groups over time. Results A total of 130 patients with CAD (aged 61 ± 7 years; male: 85%) were randomized to NW (n = 43), HIIT (n = 43), or MICT (n = 44). Table 1 shows that significant main effects of time were observed for SV (∆: 5.485 m/L, F = 8.530, p = 0.004), with a time × group interaction (F = 3.710, p = 0.027) revealing a greater improvement in SV following NW compared to HIIT (F = 5.748, p = 0.019) and MICT (F = 5.494, p = 0.022). A significant time × group interaction (F = 3.700, p = 0.028) was observed in AIx@75, with a greater reduction following NW than MICT (F = 7.388, p = 0.008). No significant differences were observed in TVR, AIx, and PWV. Conclusion Our findings show that NW facilitated greater improvements in SV and AIx@75 parameters of arterial stiffness, an important predictor of future cardiovascular events, when compared to HIIT and MICT in patients with CAD. NW may be considered as an alternative exercise training to improve vascular health in those with CAD.

The effects of high-intensity interval training and moderate-to-vigorous intensity on cardiorespiratory fitness in patients with permanent or persistent atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): the Innovations Fund of the Alternate Funding Plan for the Academic Health Sciences Centre of the Ministry of Ontario. Background Lower cardiorespiratory fitness (CRF) in atrial fibrillation (AF) is associated with higher risk of mortality. Moderate-to-vigorous intensity continuous training (MICT) increases CRF; however, growing evidence indicates that high-intensity interval training (HIIT) elicits similar or greater improvements in CRF in people with cardiovascular disease. Purposes The purposes of this study were to: (1) compare the effects of HIIT and MICT on CRF in patients with persistent and permanent AF; and, (2) assess the proportion of participants who achieved a clinically meaningful increase in CRF (i.e., 3.5 mL/kg/min, associated with significant reduction in mortality in AF). Methods This was a subanalysis of an RCT to examine the effects of HIIT and MICT on functional capacity. Participants completed cardiopulmonary exercise test (CPET) and were randomly assigned to 12-week, twice weekly supervised HIIT or MICT. Each HIIT session was 23 min in duration, completed on a stationary bike, and consisted of: (1) a 2-min warm up; (2) two blocks of 8 x 30-sec high-intensity work periods at 80-100% peak power output interspersed with 30-sec active recovery periods, with 4 min active recovery between the blocks; and, a 1-min cooldown. Each MICT session consisted of (1) a 15-min warm up; (2) 30-min of continuous aerobic exercise; and, (3) a 15-min cooldown. A subset of willing participants completed follow-up CPET. Repeated measures ANOVA was used to compare the changes in CRF between HIIT and MICT. Descriptive statistics was used to assess the proportion of patients meeting the clinically meaningful increase in CRF. Results Of 94 patients consented, 13 in HIIT (67±4 years old, 26% females) and 10 in MICT (71±9 years old, 40% females) completed pre and post CPET. Exercise adherence (i.e., % of sessions attended) was 91% for HIIT and 85% for MICT, respectively, and did not differ between the groups. At week 12, 76% of participants in HIIT and 80% in MICT achieved the prescribed exercise intensity targets. Our per-protocol analysis showed no overall change in CRF (pre: 19.0±5.1 vs. post: 19.4±4.6 mL/kg/min, p=0.461). No significant differences in changes in CRF were observed between HIIT (pre: 20.1±5.3 vs. post: 20.3±4.5 mL/kg/min) and MICT (pre: 17.6±4.8 vs. post: 18.4±4.7 mL/kg/min, interaction effect p=0.681). Two participants in HIIT (15.4%) and two in MICT (20.0%) achieved clinically meaningful increases. Conclusions Twice weekly HIIT or MICT for 12 weeks did not improve CRF in patients with persistent and permanent AF who completed CPET. Further, a small proportion of these patients (≤ 20%) achieved clinically meaningful increase in CRF. Considering a greater increase in CRF (3.2±2.5 mL/kg/min) in patients with non-permanent AF following high-volume HIIT (a total of 16 min at high intensity per session, three times per week) in a previous RCT, a larger exercise volume may be required to improve the CRF of patients with persistent and permanent AF.

480 Integrating a Research Ethics Program within an Academic Health Science Center

OBJECTIVES/GOALS: Research ethics services are critical to the clinical, research, and educational missions of an academic health science center. Our ethics program aims to develop a culture where investigators are as intellectually engaged in ethical issues of scientific integrity as they are in study design, data collection, and implementation. METHODS/STUDY POPULATION: This descriptive analysis depicts the historical development, from 2010 to 2022, of our research ethics program as an exemplar of ethics integration into the research enterprise of an academic health science center that engages in translational research. In this culture, clinicians, translational researchers and their scientific peers, research participants, and community members become involved in ethics investigation, deliberation, and innovation. RESULTS/ANTICIPATED RESULTS: There are four pillars to our research ethics program: 1) research ethics consultation service, which fosters the development of ethical best practices and standards for the practice of translational research; 2) education, which provides customized training and educational opportunities in research ethics to diverse stakeholders; 3) leadership, through collaboration and partnerships; 4) scholarly engagement, in the pursuit of innovative ethics research and professional development. Through these initiatives we can engage a broad constituency of stakeholders, become an integral component of research oversight, engage as active participants in the research enterprise, and have a critical role in guiding institutional culture. DISCUSSION/SIGNIFICANCE: The integration of our ethics program mirrors the translational science continuum which promotes the multidirectional flow of ideas among ethics consultants, laboratory/clinical scientists, implementation researchers and the community.

Interprofessional Pain Curriculum for an Academic Health Science Center

AIMThe aim of this project is to develop a comprehensive pain curriculum to educate a diverse group of students across health care disciplines who care for those in pain. The outcome goals for participants of this educational program are to have increased knowledge and skills associated with the management of pain. This poster will describe the process of team development, development of the grant proposal, conducting a gap analysis, designing and developing the content of the program, and finally the integration of technology as we prepare for program delivery. METHODSThe team developing the program include representatives from the disciplines of nursing, physical therapy, social work, and psychology. The curriculum is based on the Interprofessional Pain Curriculum developed by the International Association for the Study of Pain. Holographic technology will be used to optimize participant engagement and interest. Additional modes of content delivery include synchronous video meetings, asynchronous discussions, and the use of case studies in both modes, all completed in multidisciplinary teams. RESULTSContent has been developed and loaded into a Canvas course shell. Delivering parts of the program via hologram technology will be recorded within the next 3 months. CONCLUSIONSThis content will be delivered to student groups in the Spring 2023 semester during an Interprofessional Education (IPE) event focused on the management of pain. Health disciplines represented at the IPE event will include Medicine, Nursing, Physical Therapy, Psychology, Social Work, and Pharmacy. Outcome assessments related to knowledge, beliefs and attitudes about pain from IPE participants will be collected. Based on that data, further tweaking of the education program will be considered. ACKNOWLEDGEMENTThis project was made possible through funding from the Elizabeth Morse Genius Foundation, Grant number: AWD00001443

Seeking Education, Equity, and Diversity (Seed)

Introduction Health care work cultures that embrace diversity, equity, and inclusion (DEI) foster innovations, synergy, and appreciation for differences. To promote DEI, health care systems have encouraged professional development on cultural humility, which is awareness of one’s values, beliefs, and social position, given the current cultural context while mindful of history. The national SEED Project (Seeking Educational Equity and Diversity) is a professional development program that prompts reflection and perspective shifting about workplace culture and systemic change. However, reports that examine the SEED learning experience and the participants’ intention for behavior change are lacking. The purpose of our study was to examine: (a) The SEED learning experience, (b) How personal views can foster cultural humility, and (c) The impact of SEED on intentions to effect change. Methods A purposive sample of eight (N = 8) faculty and staff from a SEED cohort at an academic health science center, with regional programs, participated in in-depth interviews to explore their personal views of how to foster cultural humility in health care and the impact of SEED to prompt intentions for behavior change. The investigators conducted a thematic analysis using an inductive, iterative method. Independently, they read each transcript and created codes for each comment. Subsequently, they compared findings, developed a coding frame, and grouped codes into potential themes. They then individually applied the coding frame to the data and considered themes. Finally, they built consensus on codes and synthesized codes into themes. Results Thematic analysis indicated the participants had a profound learning experience, which prompted them to develop cultural humility by re-framing cultural experiences and resolving to become more proactive about DEI in the workplace. They found small group discussions were insightful and provocative. These discussions led to new perspectives and behavior change or intentions for behavior change. Our analysis generated three themes: (1) Connecting with diverse perspectives, (2) Developing new perspectives, and (3) Being proactive with advocacy and new strategies. Conclusion Health care professionals and organizations can use our findings to encourage professional development that potentially stimulates behavior change, the ultimate goal of professional development, related to DEI. Future studies should examine the impact of this professional development within their organization and in the delivery of health care.

LEADS+ Developmental Model: Proposing a new model based on an integrative conceptual review.

Leaders in academic health sciences centres (AHCs) must navigate multiple roles as an inherent component of their positions. Changing accountabilities, varying expectations, differing leadership capabilitiesrequired of multiple leadership roles can be exacerbated by health system disruption, such as during the COVID-19 pandemic. We need improved models that support leaders in navigating the complexity of multiple leadership roles. This integrative conceptual review sought to examine leadership and followership constructs and how they intersect with current leadership practices in AHCs. The goal was to develop a refined model of healthcare leadership development. The authors used iterative cycles of divergent and convergent thinking to explore and synthesise various literature and existing leadership frameworks. The authors used simulated personas and stories to test the model and, finally, the approach sought feedback from knowledge users (including healthcare leaders, medical educators and leadership developers) to offer refinements. After five rounds of discussion and reformulation, the authors arrived at a refined model: the LEADS+ Developmental Model. The model describes four nested stages, organising progressive capabilities, as an individual toggles between followership and leadership. During the consultation stage, feedback from 29 out of 65 recruited knowledge users (44.6% response rate) was acquired. More than a quarter of respondents served as a senior leader in a healthcare network or national society (27.5%, n = 8). Consulted knowledge users were invited to indicate their endorsement for the refined model using a 10-point scale (10 = highest level of endorsement). There was a high level of endorsement: 7.93 (SD 1.7) out of 10. The LEADS+ Developmental Model may help foster development of academic health centre leaders. In addition to clarifying the synergistic dynamic between leadership and followership, this model describes the paradigms adopted by leaders within health systems throughout their development journey.

A182 PREDICTING HIGH DIRECT HEALTHCARE COSTS IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN THE FIRST YEAR FOLLOWING DIAGNOSIS

Abstract Background The incidence of inflammatory bowel disease (IBD) continues to rise rapidly among Canadian children. The care of children results in higher direct healthcare costs than adults with IBD. It is imperative that we identify individuals who will become the highest-cost users of the health system in order to intervene early and decrease the individual- and system-level burden of IBD. Purpose To develop a predictive-model for high-cost health system users and (2) identify factors associated with high-cost healthcare use. Method Incident cases of IBD diagnosed ≤17y residing in Ontario and enrolled in the Canadian Children IBD Network (CIDsCaNN) between Dec 31 2013 and Jan 31 2019 were linked deterministically using health card number to health administrative data. Using a validated algorithm, direct healthcare costs accumulated between the 31st and 365th day after diagnosis were calculated using data from CIDsCaNN (medications) and health administrative data (health system encounters, including surgery). A predictive model was created to determine high-cost (≤25th percentile) and medium-cost (26th to 75th) users, compared to low-cost users (&amp;gt;75th) using ordinal logistic regression. Potential predictive variables were determined a priori based on clinical significance and magnitude of univariable association, based on sample size-informed degrees of freedom. Variables from CIDsCaNN data included: IBD type, age at diagnosis, sex, first line of therapy (steroids, aminosalicylates, exclusive enteral nutrition; yes or no, not mutually exclusive), disease activity (severe vs. moderate vs. none/mild based on PUCAI [UC] or wPCDAI [Crohn’s]). Predictive variables from the health administrative data included: rural/urban residence, hospitalization at diagnosis, intestinal resection or colectomy within 3 months of diagnosis, emergency department visit ±1 month of diagnosis, and a mental health encounter within the first year following diagnosis. Anti-TNF treatment was excluded from models due to the strong correlation with the outcome (direct costs). Overall model fit was estimated with a c-statistic. Result(s) Among the 487 (57% Crohn’s) children included in the study, the mean (sd) direct costs accumulated between the 31st and 365th days following IBD diagnosis was $14,451 (14,665). The mean cost among high-cost users was $33,533 (16,530); medium-cost users, $11,038 (5322); low-cost users, $2530 (831). The predictive model identified high-cost users of the health system with acceptable model fit (c-statistic 0.69). The relative contribution of individual variables, as measured by odds ratio (OR), is reported in the Table. Image Conclusion(s) The direct healthcare costs of pediatric IBD are substantial. Children with IBD who become high-cost users of the health system were identifiable using characteristics at diagnosis (e.g., need for mental health care, emergency visits, older age). Further research should assess whether interventions in patients at-risk for becoming high-cost users may help to reduce costs. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Ontario Academic Health Sciences Centres Alternate Funding Plan Innovation Fund Disclosure of Interest E. Kuenzig: None Declared, R. Duchen: None Declared, T. Walters Grant / Research support from: Janssen, Abbvie, Psfizer, Ferring, Amgen, Consultant of: Janssen, Abbvie, Psfizer, Ferring, Amgen, D. Mack: None Declared, A. Griffiths Grant / Research support from: Abbvie, Consultant of: Abbvie, Amgen, BristolMyersSquibb, Janssen, Lilly, Takeda, Speakers bureau of: Abbvie, Janssen, Takeda, C. Bernstein Grant / Research support from: Research grants from Abbvie Canada, Amgen Canada, Pfizer Canada, and Sandoz Canada and contract grants from Janssen, Abbvie and Pfizer, Consultant of: Abbvie Canada, Amgen Canada, Bristol Myers Squibb Canada, JAMP Pharmaceuticals, Janssen Canada, Pfizer Canada, Sandoz Canada, Takeda, Speakers bureau of: Abbvie Canada, Janssen Canada, Pfizer Canada and Takeda Canada, G. Kaplan Grant / Research support from: Ferring, Consultant of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, Speakers bureau of: AbbVie, Janssen, Pfizer, Amgen, Sandoz, Pendophram, and Takeda, A. Otley Grant / Research support from: Research support: AbbVie Global. Research site: AbbVie, Pfizer, Eli-Lily, Janssen, Consultant of: AbbVie Canada, W. Yu: None Declared, X. Wang: None Declared, J. Guan: None Declared, S. Fung: None Declared, E. Benchimol Consultant of: McKesson Canada, Dairy Farmers of Ontario (unrelated to medications used to treat inflammatory bowel disease)

A Sense of Urgency in 2023: A New Iceberg Awaits Us.

From my vantage point as a senior academic leader and manager in a college of nursing in an academic health science center, I recently read Our Iceberg Is Melting (Kotter & Rathgeber, 2006) as part of preparing for an adm.

An interprofessional education approach to pain management through a standardized patient encounter

Interprofessional education and collaborative practice requirements of professional health programs have resulted in collaborative learning programming in nearly all health professions. Due to recent initiatives for contemporary education of health professionals on pain science education, an academic health science center at a large public southeastern university created a focused interprofessional learning activity on pain science education within its curriculum. The learning objectives for this session aligned with both the core competencies from the Interprofessional Education Collaborative and the International Association for the Study of Pain. In a two-year period, nearly 750 students participated in this interprofessional pain science education session from medicine, nursing, pharmacy, physical therapy, and behavioral health. The session involved a standardized patient encounter for a patient presenting with chronic pain. Both faculty observers and the standardized patients assessed student teams on their interprofessional competencies during the activity, who then discussed findings prior to faculty-student debriefings. Faculty and standardized patient raters agreed that student groups demonstrated very strong skills in communication, information sharing, and solicitation of patient/client input during the event. Other skills were met with some level of disagreement. This session identifies the potential impact of interprofessional learning that can transpire through a standardized patient experience with modeling of activities in association with contemporary pain science education competencies. Future models of this program should include further assessment of interprofessional learning from students of all health care disciplines as well as continued solicitation of input from the patient or standardized patients.

Innovation: It's in Our DNA.

Colleen M. Kigin, PT, DPT, MS, MPA, FAPTA, the 52nd Mary McMillan Lecturer, is a consultant focused on innovation. She is a visiting clinical professor at the University of Colorado physical therapy program, University of Colorado School of Medicine, and an adjunct associate professor at the MGH Institute of Health Professions (MGH IHP). From 1998-2014, she held the positions of chief of staff and program manager for the Center of Integration of Medicine and Innovative Technology, a 12-institution consortium based in Boston, Massachusetts, developing innovative solutions to health care problems. She subsequently has served as a consultant to such efforts as the University of Manchester, Manchester Academic Health Science Centre, United Kingdom, to develop an innovation culture. In 1994, she joined the newly formed Partners HealthCare System in Boston, coordinating the system's cost reduction efforts through 1998. Kigin previously served as director of physical therapy services at Massachusetts General Hospital (MGH) (1977-1984) and as assistant professor at MGH IHP (1980-1994). While at MGH, she was responsible for the merger of 2 separate physical therapy departments, the establishment of the first nonphysician specialist position, and practice without referral for the physical therapy services. Kigin has held numerous positions within the American Physical Therapy Association (APTA), serving on the Board of Directors from 1988-1997, including as vice president; co-chair of The Physical Therapy Summit in 2007; and co-chair of FiRST, the Frontiers in Rehabilitation, Science and Technology Council. She also served as prior chair of the APTA Committee on Clinical Residencies and served on the American Board of Physical Therapy Specialties. Kigin earned a bachelor of science degree in physical therapy at the University of Colorado, a master of science degree at Boston University, a master's degree in public administration from the Harvard Kennedy School of Government, and a doctor in physical therapy degree from the MGH IHP.

Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review

ObjectiveTo describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia.DesignScoping review with systematic methods.Data sourcesOvid MEDLINE, ProQuest Central, Wiley online...