ACGME Requirements Research Articles

A Nation-Wide Survey of Program Directors at a Large Health Care Organization: Prevalence and Perceptions of Resident Wellness Activities.

This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels. In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making. Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%). The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.

CORR Insights®: Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

CORR Insights®: Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

Impact of Changing ACGME Case Requirements on Radiation Oncology Resident Rotation Structure

The ACGME has updated case requirements for radiation oncology residents beginning with the graduating class of 2026, specifically introducing minimum cases across a wider range of disease sites. We aimed to assess the impact the ACGME update will have on residency rotation scheduling in our training program by retrospectively applying the case minimums to recent graduating classes and determining how rotations should be modified to meet the new standards. Our program utilizes the apprentice model where residents are assigned 1:1 or 1:2 to faculty supervisors. We abstracted case log information from residents graduating between 2020 and 2022, and cases were categorized based on the new ACGME requirements. We also abstracted total department treatment courses from our treatment tracking software which records disease site and resident participation. Hypothetical schedules were created to determine how resident rotations can be structured to ensure adequate exposure to meet all case minimums. The mean number of cases for graduating residents was 666 (range: 563-755). Six (67%) graduating residents would have not met at least one new ACGME site-specific requirement. The most common delinquencies were esophagus, anorectal, non-prostate genitourinary (GU), and lymphoma for which at least 3 residents each did not meet. Review of the treatment tracking software confirmed adequate case volume for these disease sites but that they were often not performed by a resident. We observed that these disease sites were less likely to be performed by a resident than other disease sites at our institution. Specifically, in 2022, 25% of all simulations went uncovered by residents but at-risk disease sites such as GI and GU each averaged 35% of simulations uncovered. We observed that when we retrospectively applied new ACGME minimums to recent graduating classes most residents would have been considered non-compliant despite adequate case volume at our institution. Case exposure, particularly for less common disease presentations, was highly dependent on rotation assignment. In the setting of increasing faculty-to-resident ratio requirements, conventional 1:1 assignments may not be adequate to meet new ACGME site minimums. We are currently comparing different resident coverage models that can be coupled with our traditional apprentice model to increase breadth of case exposure without compromising educational yield. Two models have arisen: a hybrid model where residents traditionally cover one attending and then cover the consults/simulations only of a second attending and a consult service model where residents are paired with 2 or more attendings but only see consults/simulations with these attendings. Coupling these models alongside the traditional apprentice model projects not only increased coverage of all simulations but improves coverage of traditionally "missed" simulations to at least 83% and upwards of 90% on most simulated schedules.

Psychological Safety as a New ACGME Requirement: A Comprehensive All-in-One Guide to Radiology Residency Programs

With the Accreditation Council for Graduate Medical Education recently updating their common program requirements to include components of psychological safety as a core principle, radiology training programs and academic radiology institutions will need to evaluate psychological safety within their residency programs and implement practices to sustain a safety culture. This article reviews current literature to present a concise guide for radiology programs on best practices for implementing psychological safety, considering the plethora of literature that is available. We searched PubMed for published studies evaluating safety culture in medical education and residency. The key words used were Psychological Safety, Education, Radiology, Workplace Culture, and Leadership. Ninety two studies were reviewed that contributed to the topics examined throughout this manuscript, including a brief history of psychological safety, evolving challenges, and a summation of best practices at the institutional, interpersonal, and individual levels that can result in a sustainable psychologically safe culture for radiology residents. This article will highlight unique considerations pertinent to a radiology residency program, including suggestions for creating a less stressful environment during case conferences, fostering and supporting residents who are struggling, and inclusive psychological safety practices that also consider non-resident contributors to a residency program, such as attending physician faculty and non-physician radiology technicians.

National Pediatrician-Scientist Collaborative Workgroup comment on new ACGME requirements' impact on pediatric physician-scientists.

The ACGME recently released its recommendation for updates to the program requirements for pediatrics. These updates proposed changes to allocation of resident clinical time and a greater emphasis on individualization. The potential impact of these changes on the training of physician-scientists is discussed. Discussion of the proposed changes was held within the members of the National Pediatrician-Scientist Collaborative Workgroup, a group that represents scientists, trainees, program directors, chairs, and physician-scientist educators at nearly 30 residency programs from across the US with a focus on understanding and developing optimal approaches to physician-scientist training. Consideration was given to the both the personal and institutional impact of the proposal for physician-scientist development. Both threats and opportunities were identified. Key opportunities include the enhanced individualized training time that could be used to explore research. Threats include re-allocation of clinical training time that may strain institutions financially, expand clinical service requirements for other early career stage individuals, and alter exposure to a broad range of pediatric specialists and sub-specialists that impact career development. The NPSCW encourages consideration of the impact of changing program requirements on physician-scientist development to include ongoing discussion amongst mentors, programs, and trainees to understand and mitigate impact of new program requirements on the development of pediatrician-scientists.

Family Medicine Advances Transition to Competency-Based Education.

By July 2023, family medicine residency programs will need to make major changes to their programs to meet new ACGME requirements. The 2023 requirements reflect the first major update for family medicine residencies in about 10 years.[1][1] The new requirements include several components that

Abstract HUP12: Promoting Scholarly Activity Of Trainees In Vascular Neurology And Bridging Gender Gaps In Stroke Publications Through Team Science

Introduction: Scholarly activity is important to achieving academic and clinical proficiency during residency and fellowship and an ACGME requirement. Team science is known to propel research productivity, but we found few programs within neurology using team science to promote scholarly productivity. Also, studies report that women are often under-represented as first or co-authors within publications. CREST is a team-science initiative developed and implemented in 2018 that is based on research-supported determinants shown to improve scholarly activity and involvement among trainees within vascular neurology. Here we assessed whether implementing the CREST Initiative improved involvement in scholarly activity amongst neurology residents and fellows in the field of vascular neurology by assessing the number of publications residents and fellows co-authored within the field of vascular neurology and the representation of women as first or co-authors of those publications following the introduction of CREST. Methods: This study used PubMed as a search engine for publications. Articles were included in data analysis if published between 2015-2021 by a Vascular Neurology faculty member, and authorship included at least one neurology resident or stroke fellow. Linear regression with Graph Pad was used for statistical analysis. Results: From 2015 to 2022, the number of stroke publications per academic year, including residents or fellows as authors or co-authors, increased from 0 per year to 9 per year, which linear regression demonstrated was a significant increase (βo 2.726, [Confidence Interval 2.130 - 3.283], R2 0.8854). Similarly, linear regression demonstrated that the number of women included as co-authors or first authors in publications increased from 0 in 2015 to 5 in 2022(βo 18.30, [Confidence Interval 15.56 - 21.04], R2 0.9722). Inpatient clinical service weeks did not change significantly over time (p-value 0.9485). Conclusion: Results of this study highlight the significance of initiatives geared toward career development and research in successfully promoting scholarly activity in post-graduate education.

Supporting a culture of patient safety: Resident-led patient safety event reviews in a pathology residency training program

Patient safety is a critical component of quality patient care at any healthcare institution. In order to support a culture of patient safety, and in the context of a hospital-wide patient safety initiative at our institution, we have created and implemented a new patient safety curriculum within our training program. The curriculum is embedded in an introductory course for first-year residents, in which residents gain an understanding of the multifaceted role of the pathologist in patient care. The patient safety curriculum is a resident-centered event review process and includes 1) identification and reporting of a patient safety event, 2) event investigation and review, and 3) presentation of findings to the residency program including core faculty and safety champions for the consideration of implementation of the identified systems solution. Here we discuss the development of our patient safety curriculum, which was trialed over a series of seven event reviews conducted between January 2021 and June 2022. Resident involvement in patient safety event reporting and patient safety event review outcomes were measured. All event reviews conducted thus far have resulted in the implementation of the solutions discussed during event review presentations based on cause analysis and identification of strong action items. Ultimately this pilot will serve as the basis by which we implement a sustainable curriculum in our pathology residency training program centered on supporting a culture of patient safety, and in line with ACGME requirements.

Minimally Invasive Surgery (MIS) fellowship website content: are applicants receiving enough information?

Advanced GI/Minimally Invasive Surgery (MIS) fellowships are one of the largest non-ACGME post-residency training pathways. MIS programs are highly competitive, with only 68% of applicants in the 2021 cycle successfully matching into fellowship positions. An evaluation of MIS fellowship program websites is warranted to determine if applicants are receiving adequate information to meet their needs. Using the Fellowship Council website, the authors identified 92 MIS fellowship programs that advertised open fellowships positions for general surgery residency graduates. These 92 fellowship websites were evaluated for 12 pre-identified variables based on published literature. 90% of websites included access to contact information for a program director/coordinator and 72% of websites displayed selection criteria; however, other recruitment information offered to applicants was limited. Only 25% of websites mentioned interview details, 34% of websites showcased current or past fellows, and 51% included a faculty directory. Regarding operative information, only 46% of MIS fellowship websites mentioned case volume, 23% mentioned locations of rotations, and 55% mentioned rotation schedule selection criteria. Didactic information was focused on research productivity with 80% of websites highlighting scholarly requirements; academic conferences were only mentioned in 40% of websites. Fellow wellness and career information was skipped on many websites, with 30% describing resident benefits and 16% dedicating a section to career development. Overall, the mean number of pre-identified variables present on a fellowship website was 6.57 ± 2.39 (54.75 ± 19.17%). General surgery residents turn to program websites when evaluating MIS fellowships. Although websites contain adequate information on several variables evaluated in the study, information on benefits and career development, fellow and faculty support, and case volume were limited. By including relevant information, MIS fellowship websites can align with ACGME requirements, strengthen existing frameworks, and help display data that are important to applicants.

26. Heavy Rotation: Changing Consensus in Integrated Residency Training Program Rotation Schedules

Background: As plastic surgery training evolves, ongoing appraisal of the 6-year integrated curriculum is warranted. We performed the current study to describe inter-program variance in structured US plastic surgery curricula. Methods: In August 2021, we obtained rotation schedules from plastic surgery training program websites. When unavailable, we requested schedules from program coordinators. Individual blocks were each recorded as one of 52 rotations and sorted as follows: led by plastics faculty (“Core Plastics”), hosted by non-plastic surgeons within the scope of plastic surgery (“Off-Service”), and rotations outside the scope of plastic surgery (“General Surgery”). Within these categories further characterization was performed using descriptive statistics. Results: Of 84 US programs, rotation schedules were obtained for 71.4% (n=60): 50.0% (n=42) listed complete data on their websites, 3.6% (n=3) listed partial data on their websites and provided additional data upon request, 17.9% (n=15) listed no data on their websites and provided data upon request, and 28.6% (n=24) provided no data online or upon request. The most common program structure was the “2 + 4” model (n=29, 48.3%) followed by the “1 + 5” (n=16, 26.7%), the combined “3 + 3” (n=13, 21.7%), and the “0 + 6” (n=2, 3.3%) models. Overall, programs offered 51.3 (SD±5.5) months of core plastic surgery, 12.4 (SD±4.1) months of general surgery, and 7.8 (SD±2.7) months off-service. All programs offered mixed plastic surgery [mean=28.5 (SD±14.2) months] followed by ENT and dermatology. The most common plastic surgery rotations were hand, mixed cosmetics, and craniofacial/pediatrics. Most programs offered either electives [n=31, 2.3 (SD±1.2) months] or research time [n=22, 2.0 (SD±0.9) months]. Many programs offered experience in areas beyond ACGME requirements such as neurosurgery [n=19, 1.0 (SD±0.1) months], thoracic surgery [n=14, 1.0 (SD±0.3) months], and/or urology [n=6, 1.0 (SD±0) months]. Conclusion: Our findings show that >75% of integrated plastic surgery training programs featured a majority (?4 years) of specialty-specific training with only 21.7% continuing the “3 + 3” model. While many programs provided data upon request, more than half did not include rotation schedules on their websites, potentially influencing competitive candidates’ decisions to apply. Continued transparency around plastic surgery training curricula can help program directors further refine their programs.

Virtual Journal Club Beyond the Pandemic: An Enduring and Fluid Educational Forum

ObjectiveSince its inception, journal club has been a cornerstone to the life-long process of medical education. The virtual journal club (VJC), initiated as a robust solution to many educational challenges encountered during COVID-19 pandemic-related distance learning, provides an enduring and fluid forum for multilevel teaching and learning. Materials and MethodsIn this manuscript we share our institutions' reasoning and methods to implement a VJC for multi-level learners. A standardized format applicable to all VJC sessions was adopted to ensure reproducibility from presenter to presenter. Sessions were held via video conference platforms. Pedagogy regularly emphasized in undergraduate medical education was adopted. Informal assessment of each session's strengths and areas for improvement was performed. ResultsA total of 30 sessions were held prior to manuscript submission, including discussion of 36 refereed journal articles from March 26, 2020, to April 20, 2021. The virtual journal club was very well received by all participants. The medical students and residents found the information current and engaging. The fellows stated that the journal club strengthened their knowledge base and enhanced communication and teaching skills. The attendings learned from its encouraged frank discussion of differing practice patterns. The format of these sessions offers an ideal setting to teach medical students and residents how to evaluate and employ evidence-based medicine and meets multiple LCME and ACGME requirements. ConclusionsThis VJC forum allows for development of essential nonclinical skills including lifelong active learning and analysis, peer collaboration, and technology adaptation and usage.

EDITORIAL COMMENT

Resident involvement in research has long been a critical component of academic productivity as well as a time to get future urologists involved in research for their own education and future endeavors. It is also an ACGME requirement that residents must participate in scholarship.1 However, residents and programs face a challenging educational landscape with increasing pressures to decrease work hours. Given the time constraints, residents often prioritize the learning of the surgical and clinical care of patients, often relegating research to the back burner.

Implications of COVID-19 Pandemic on Family Medicine Residency Training Program and ACGME Requirements in Qatar

Implications of COVID-19 Pandemic on Family Medicine Residency Training Program and ACGME Requirements in Qatar

31. IMPLEMENTING A CLINIC IMMERSION BLOCK BOOSTS INTERN CONFIDENCE AND EARLIER OUTPATIENT CLINICAL EXPERIENCES

Background In United States pediatric residency programs, there is a wide range of interpretations of the ACGME requirement to educate residents in community pediatrics and advocacy. Previous iterations of our required month-long intern advocacy rotation included disjointed learning experiences without opportunities for clinical integration. Few programs utilize an integrated curriculum to approach this topic. We sought to integrate early clinical and advocacy experiences to increase their impact. Methods 20 interns participated in a “clinic immersion and advocacy” rotation during block 1 or 2. Interns were scheduled for continuity clinic in the morning (n=20 sessions in 1 month) and experiential community advocacy activities in the afternoon. We utilized Kern's Six Step Approach as a conceptual framework for our intervention. Curriculum was developed using an iterative process; community activities were selected using the AAP's Community Health and Advocacy Milestones Profile (CHAMP). Data was collected from a pre-intervention cohort (class 2021) and compared to our post-intervention cohort (class 2022). Interns completed a survey using visual analog scales to rate their confidence in managing conditions, and in using clinical tools and community resources. They also completed yes/no items verifying whether they had encountered specific types of visits or performed certain skills. The paired t-test was used to assess pre/post intervention confidence measures. Pearson's chi-squared test was used to compare clinic experiences. Significance was assessed at p Results Response rate was 75% (15/20 interns) for the pre- and post-intervention cohorts. Confidence measures were not statistically different between the two groups on 22/23 items. The intervention group rated their confidence in knowledge about community resources significantly higher than the non-intervention group (p=0.008). Clinic experiences were statistically similar between cohorts (1-month vs. 1 year). Discussion This study shows our success in increasing clinical confidence and experiences earlier in intern year as, after 1 month of daily continuity clinic, the post intervention cohort was directly comparable to the pre-intervention cohort after 1 year of weekly continuity clinic. Future directions include whether our curriculum will lead to increased confidence in clinic skills longitudinally, retained confidence in knowledge of community resources, and generalizability to other residency programs.

Assessing Knowledge And Confidence In Musculoskeletal Medicine Among Primary Care Specialties

Prior studies suggest primary care clinicians lack knowledge and confidence in how to diagnose and treat musculoskeletal (MSK) disorders. One showed 64% of academic primary care attendings scored <70% on an MSK knowledge exam, while another noted that primary care residents scored an average of 56% on an MSK competency exam. Few studies examine differences among Family Medicine, Internal Medicine, and Pediatrics in knowledge and confidence in diagnosing and treating MSK conditions. PURPOSE: To determine if a significant difference exists between primary care specialties for both residents and non-fellowship trained attendings in knowledge and confidence in diagnosing MSK conditions. To assess whether a focused lecture series can increase resident knowledge and confidence in diagnosing MSK disorders. METHODS: An anonymous shoulder, hip, knee, and ankle survey was emailed to Pediatric, Internal Medicine, and Family Medicine residents and attendings at a local teaching hospital. Sports Medicine Fellows lectured Internal Medicine and Pediatrics residents, focusing on exam and common conditions for each joint. Family Medicine was excluded from the lectures, as MSK education is a part of their ACGME requirement. Pre and post lecture surveys with 5 knowledge questions and two 5-point Likert scale confidence measures were administered to Pediatric and Internal Medicine residents. Two-tailed t-tests were used with a p value set at <0.05. RESULTS: Pediatric residents showed a significant increase in shoulder knowledge scores (60% vs 72.8%, p=0.04), shoulder confidence scores (2.2 vs. 3.11; 2.13 vs. 2.94; p<0.001), and confidence in doing an appropriate knee exam post lecture (2.6 vs. 3.4, p=0.03). There was no significant difference between Family Medicine, Internal Medicine, or Pediatrics regarding general MSK knowledge and confidence. There was no significant difference for Internal Medicine between pre and post lecture scores for all joints. There was no significant difference for pre and post lecture scores on the hip and ankle for Pediatrics. CONCLUSION: Dedicated lectures related to the MSK exam and common MSK conditions can increase the knowledge and confidence among primary care residents, but further studies with a greater number of subjects are needed.

Radiation oncology program directors’ attitudes towards 27 discrete palliative care skills.

62 Background: Dedicated conferences in palliative care have been proposed as an ACGME requirement for radiation oncology (RO) residency programs. We assessed RO program directors’ attitudes towards discrete palliative care skills. Methods: In April 2019, we surveyed 93 United States RO residency program directors. The survey assessed program directors’ views of 27 discrete palliative care skills in eight domains adapted from the American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine guidance statement defining high-quality palliative care in oncology. Using a nine-point scale, respondents rated each skill on three constructs: 1) importance to high-quality cancer care, 2) scope within RO practice, and 3) importance in RO residency education. Skills were categorized as “Included” (median score ≥7 for all constructs), “Excluded” (median score ≤3 for all constructs), or “Uncertain” (all other skills) using a composite score of all constructs. Results: Twenty-nine program directors (response rate 31%) completed the survey. Of the 27 skills, respondents rated 100% of the skills as important to care (median score ≥7), 70% of the skills as within the scope of RO practice, and 81% of the skills as important to resident education. No skills were rated as unimportant to care, out of scope, or unimportant to resident education (median score ≤3). Seventy percent of skills were categorized as “Included.” The domains of Caregiver Support (100%), End of Life Care (66%), and Spiritual/Cultural Assessment and Management (33%) had the highest proportions of skills rated as “Uncertain.” Time limitations (28%) and lack of education (28%) were rated as the main barriers to further integration of palliative care into RO. Conclusions: RO program directors value palliative care skills within RO. The majority of the assessed skills were rated as important to care, within scope of practice, and important to resident education.

Too Many Learners? Do Students Belong in Resident Continuity Clinics?

PURPOSE: Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting. BACKGROUND: Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other. METHODS: We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018. RESULTS: Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116 (68.1%) for students and 21/24 (87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was “Agree” or “Strongly Agree.” Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001). DISCUSSION: Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.

30. THE BENEFITS OF A TRULY INDIVIDUALIZED CURRICULUM

Background In response to the 2013 ACMGE Program Requirements that mandated “a minimum of six educational units of an individualized curriculum determined by the learning needs and career plans of each resident and... developed through the guidance of a faculty mentor,” many pediatric programs developed career-based tracks. Because tracks have the potential to introduce unnecessary and potentially harmful rigidity, our program aimed for each resident to develop a truly individualized schedule. Objective Allow each resident in our program to develop a unique individualized schedule through faculty guidance. Methods A new position, the Director of Individualized Education (DIE) was created with 0.05 FTE departmental support, which translates to approximately 100 hours of protected time, or approximately 2.5 hours per resident in a program of approximately 40 total residents. A new resident block schedule was created that is broadly divided into three categories: A) Required rotations (94 weeks) include those mandated by ACGME requirements plus other rotations required by the program. B) Selectives (12 weeks in the third year) are chosen from a limited menu based on hospital staffing needs. C) Electives (38 weeks, available as 2- or 4-week experiences) are structured to meet ACGME requirements for “key subspecialties,” “additional educational units,” and the “individualized curriculum,” following the “double counting” rules from prior ACGME FAQs. For the 32 such weeks that occur in the PGY2 and PGY3 years, rotations are chosen after a meeting between the resident and the DIE. A flowsheet for each resident is reviewed annually by the DIE and semi-annually by the Program Director or an Associate Program Director to ensure compliance with ACGME requirements. Results 54 residents have completed our program under the current scheduling system, and no two residents have had identical schedules. On the ACGME annual survey of PGY3 residents from 2016 to 2018: 1) 97.4% of our residents (vs. 86.6% nationally) chose Agree or Strongly Agree for the question, “In my training program, a portion of my training is based on my learning needs related to my career plans.” 2) 94.8% of our residents (vs. 92.9% nationally) chose Agree or Strongly Agree for the question, “My training program provides a faculty mentor or advisor to help develop learning activities to meet my learning needs related to my career plans.” Outcomes A relatively small investment (0.05 FTE for the DIE) has been sufficient to allow each resident to receive proper mentoring in the context of thoughtful discussions about both career goals and current strengths/weaknesses. The DIE has also had time to invest in building relationships with divisions and departments throughout our childrens hospital and academic medical center, resulting in many new and innovative rotations, including GI pathology, transport (prehospital) medicine, maternal-fetal-medicine, complex primary care, and many others. Ultimately, we have been able to provide each resident with a unique schedule and a high level of satisfaction with the individualized curriculum.

107. PATHWAYS INITIATIVE TO IMPROVE TRANSITION CARE IN A MED-PEDS RESIDENCY PROGRAM

Background Approximately 750,000 adolescents with special health care needs graduate to adulthood annually, often with their health suffering. Less than half receive the services needed for a successful transition. In Illinois the Division of Specialized Care for Children Family Survey revealed that only 18.2% of youth ages 14-21 received transition services. A recent review demonstrated that almost two thirds of HCT evaluation studies had statistically significant positive outcomes. Another study demonstrated that providing HCT services resulted in a 28% reduction in per member per month total cost driven by reductions in hospitalization and ED visits. Aim Statement 1. Increase HCT services for youth and young adults with special health care needs (YASHCN) in a Med-Peds residency practice (10% per year). 2. Increase HCT consultations for YASHCN (10% per year). 3. Improve HCT knowledge, attitudes and practices among Med-Peds residents. (improve annually). 4. Provide Med-Peds residents with a longitudinal QI project aligned with ACGME requirements. Interventions PATHways is a residency-based HCT consultative service founded to improve health for YASHCN and provide HCT education to residents. PATHways’ QI initiatives are modeled after Gottransition's Six Core Elements. A HCT policy was disseminated. EMR tools were developed to assess HCT skills and create portable health summaries. A registry of over 200 YASHCN aged 14-26 in the practice was created. Formal HCT education was provided to residents through HCT consultations. Measures 1. Baseline and annual follow up HCT knowledge, attitude, and practices survey of residents 2. Baseline and annual follow up audits of patients in the HCT registry addressing key elements (readiness assessment, HCT planning, creation of portable health summaries) 3. Tracking of consultations: Requesting services, diagnoses, HCT services provided. Results 33 consultations were provided over 18 months and were received from 9 different services with Pediatrics comprising 70%. Autonomy planning and completion of portable healthcare summaries comprised the majority of consults (80%). Consultations also aided in guardianship (43%), insurance and income support planning (67%), and identifying adult providers (20%). Residents surveys demonstrated increased HCT knowledge. Residents correctly identified the ages to introduce HCT, begin HCT planning, and prepare for transfer (scores increased by 8%, 21%, and 8%, respectively). They were able to identify specific tools for HCT including the clinic's policy and registry. After one year, 42% of residents stated that they addressed HCT readiness often in their practice, increased from 18%, and no residents reported not ever addressing HCT, improved from 38%. Residents reported providing more frequent guidance on education, insurance planning, registering for adult services, guardianship assessment, and identifying adult providers. Residents reported feeling more empowered and engaged in caring for YASCHN. Baseline and follow up chart audits demonstrated that readiness assessment improved from 10 to 50%, transition planning improved from 20 to 60% and creation of portable health summaries improved from 5 to 45%. Conclusions and Next Steps The PATHways initiative is a feasible way to improve HCT for YASHCN and resident HCT knowledge, attitudes and practices. Next Steps: 1. Utilize the EMR's new feature, Slicer Dicer for transition registry management and chart audits. 2. Mailers and EMR messages will be sent to all patients in the transition registry directing them to schedule a HCT appointment. 3. Continue to raise awareness about the PATHways consultation services.

FAMILY MATTERS: CULTURAL PROFICIENCY IN THE PRESENT DAY

Introduction The United States is projected to have over 78 million people over the age of 65 by the year 2035, with an increasing rise in culturally, ethnically, and racially diverse population largely driven by international immigration. An important aspect of assessment and treatment in geriatric psychiatry is the ability to include family members into evaluations and treatment plans. Cultural sensitivity about beliefs, traditions, and perceptions on aging and mental illness play an important role in understanding and treating psychiatric disorders and increases the probability of a therapeutic relationship by enhancing trust and improving communication between clinicians and patients. Although there is mention of “family” and “sociocultural” in all six ACGME core competencies, these are not explicitly expanded upon. With the changing demographics in the US in the years to come, it is imperative to recognize and incorporate more elements of family and culture into training. Methods Demonstrate, through a series of case vignettes, the impact of addressing cultural expectations and context with family members and patients to improve clinical outcomes. Personal factors of race and ethnicity, along with cultural biases, will be identified to show how these factors influence the therapeutic alliance and interventions. Results These vignettes illustrate how establishing a sense of cultural safety allowed both the families and patients to collaborate more openly with the treatment team to provide effective therapeutic outcomes for culturally diverse older adults. Recognition and understanding of how culture influences family dynamics, beliefs, and support systems allowed trainees to more comprehensively understand the cultural formulation and guide treatments that were more culturally sensitive and pertinent to various psychiatric disorders. Conclusions In depth training during psychiatry residency regarding family and culture are often lacking, especially since the ACGME requirements for training related to diversity and culture are broad and not explicitly stated. By recognizing the important role that families and culture play in the treatment of older adults, residents can more easily address sensitive issues that affect treatment outcomes. As such, training programs should have more detailed didactics and curriculum to help residents feel more comfortable sitting with and including families, as well as understanding and acknowledging how culture influences the care of diverse older adults.