Trainee Competence Research Articles

SP11.16 Development and Validation of a Novel Simulation-Based Assessment of Operative Skill for Higher Specialist Trainees in General Surgery

Abstract Introduction Simulation is an established training modality, though its use in high-stakes assessment is under-explored. This study sought to develop and validate a novel assessment of operative competence for higher specialist trainees in general surgery. Methods Content validity was derived from a previously conducted Delphi consensus study of trainers. Eight stations were created using a combination of virtual reality and bio-hybrid models. The assessment was designed to assess performance at the end of ‘phase 2’ of training. Performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure Based Assessment (PBA) tool. Validity evidence was analysed in accordance with Messick's validity framework. Both ‘junior’ (ST2 - ST4) and ‘senior’ trainees (ST 5 - ST8) were included to allow for comparative analysis. Results Thirteen trainees (six ‘junior’ trainees and seven ‘senior’ trainees) were observed and scored by a total of ten assessors across eight stations. Inter-station reliability was high (Cronbach's alpha 0.81). Inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004). Mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall’s tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all ‘senior’ trainees passing and 4/6 (66.66%) of junior trainees failing the assessment. Conclusion This study demonstrates the validity, reliability and feasibility of a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.

EVALUATING BASIC KNEE ARTHROSCOPY SKILLS IN ORTHOPAEDIC TRAINEES IN A LIMITED RESOURCE SETTING

AbstractBackgroundOrthopaedic training in Southern Africa is largely focused on trauma, although elective procedures, such as knee arthroscopy are increasing. This is especially true in the private sector where most trainees will practice. The primary aim of this study was to assess the arthroscopic competency of orthopaedic trainees in a setting of limited resources.MethodsA prospective observational cohort study was carried out. Orthopaedic trainees of a Southern African university hospital performed basic arthroscopy on a knee model. Their surgical competency was assessed by two surgeons proficient in arthroscopy using the modified Basic Knee Arthroscopy Skill Scoring System (mBAKSSS).ResultsA total of 16 trainees (12 male) were included (6 junior and 10 senior trainees). The median age of participants was 36 (34.8, 37). The median mBAKSSS was 28.0 (20.3, 32.5) but showed a large variability (12.0–42.5). The overall reliability was excellent with Cronbach's Alpha of 0.91 and interclass correlation of 0.91 [95% CI 0.75, 0.97].ConclusionsThe average knee arthroscopy proficiency of our trainees is comparable to those of international training programs, but there was great variability with inconsistent skills amongst the trainees. This calls for improved and reproducible arthroscopy training and skills transfer, exposure to procedures and ongoing assessment.

Design, implementation and assessment of a novel, introductory curriculum into female, neurological and urodynamic urology: a 7-year experience of urology simulation bootcamp course.

To present the seven-year experience of a multi-component and interactive module on female, neurological and urodynamic urology (FNUU) training at the UK National Urology Simulation Bootcamp Course (USBC) and demonstrate trainee satisfaction and competency progression. During the week-long USBC, a four-hour module on FNUU was designed which consisted of short interactive presentations with an emphasis on practical stations in urodynamics, intravesical botulinum toxin injection, urethral bulking injection, female pelvic examination and, initially, mid-urethral tapes (subsequently replaced with percutaneous sacral nerve evaluation). The trainee's level of knowledge, operative experience and confidence were assessed pre- and post-course. The practical assessment consisted of preparation and intravesical administration of botulinum toxin, female pelvic examination, urodynamic trace interpretation or mid-urethral tape simulation. Trainee feedback was also collected. Two-hundred sixty-one newly appointed urology trainees participated in the USBC during this period. A high level of satisfaction was constantly reported. The highest rated session was urethral bulking with 72% being very satisfied, followed by Botox and urodynamics. The final assessment showed 70% had achieved level 4 competency in cystoscopy and Botox. Qualitative feedback was also obtained. To our knowledge, this is the first module of its kind, and it shows that it is feasible to develop, implement and evaluate an introductory curriculum into FNUU that is reproducible over a 7-year period with very positive feedback.

TAVAC: choledochoscopy disposable scopes, and the single-stage vs. two-stage approach to choledocholithiasis.

Previous studies have been published evaluating the benefits and drawbacks of clearing the common bile duct of stones using a single-stage approach (LCBDE + LC) versus a two-stage approach (ERCP followed by LC). These studies have demonstrated that a single-stage approach offers similar outcomes and morbidities as a two-stage approach, with the added benefit of a lower cost and shorter length of stays. However,it is significant we understand why LCBDE is not commonly performed currently and also the lapse in surgical trainee exposure and competence in LCBDE. This paper aims to address the lapse in surgical trainee exposure to LCBDE,evaluate the scopes currently available to perform LCBDE, and review current data evaluating the risks and benefits of single-stage versus two-stage approaches to. We utilized PubMed to analyze all publications related to the various disposable scopes utilized to perform choledochoscopy. We also discuss the need for disposable scopes and how this new market niche is transforming the choledochoscopy space. We analyzed the data related to single-stage and two-stage approach to choledocholithiasis. We noted an overall shorter length of stay and also decreased costs in favor of a single-stage approach. A single-stage LCBDE is the most cost-effective treatment option for choledocholithiasis in patients with choledocholithiasis undergoing a cholecystectomy. In addition, single-stage approach is associated with shorter length of stay.Knowledge of the available choledochoscopes and tools available to surgeons to perform choledochoscopy is significant.The evidence does support the use of disposable choledochoscope from a cost and cross-contamination perspective.Additionally, efforts should be made to incorporate LCBDE into the teaching paradigm of surgical training programs.

Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context

Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa. Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach. Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022. Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees. Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.

Learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents: A cumulative sum analysis.

Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency. This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation. Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation. Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees. Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.

Skills for the aspiring surgeon in Australia: A needs assessment

Introduction: The increasing duration of time before the commencement of formal surgical education training (SET) in Australia has emphasised the need for pre-SET “aspiring” surgical trainees to develop greater competency in both generic and specialty-specific skills to fulfil these public hospital positions, however there is no formalised curriculum or guide. This paper investigates current inconsistencies in the training of Australian pre-SET aspiring surgical trainees and attempts to define which skills are required. Methods: We conducted semi-structured interviews with pre-SET supervisors in general and specialty surgery fields at a large tertiary teaching hospital in Sydney, Australia, to assess expectations and competencies of pre-SET surgical trainees. A mixed-method analysis was used with inductive content analysis used for the rich interview data and quantitative analysis of 5-point Likert scale scores for the essential skills syllabus and eligibility requirements. Results: Eighteen interviews were conducted. Three major themes arose from inductive content analysis: participants perceived that pre-SET trainees met basic expectations, significant variability in skill level exists between trainees, and simulation was suggested as a potential solution to address gaps in training. Quantitative analysis of Likert scores suggests that trainee competency was inadequate (or not required) for several skills. For general surgery, trainee competency was deemed inadequate for proctoscopy, rigid sigmoidoscopy and appendicectomy. Conclusions: There is a critical need to clearly define the skills expected of pre-SET trainees and their role within the healthcare system. This study provides insights into the content of that skillset, which could be used to design relevant and useful training programs for pre-SET trainees. The value of simulation training was universally noted by participants. They believed that this could improve competency for pre-SET trainees in technical and non-technical skills.

A Novel Simulator for Teaching Endobronchial Ultrasound-guided Needle Biopsy.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become standard for the diagnosis of lung cancer, and there is an increasing need for procedural competence in trainees. We evaluate a low-cost, gelatin-based EBUS-TBNA training simulator to assess pulmonary fellows' baseline skills and facilitate procedural development. A low-cost ($30) gelatin-based, high-fidelity simulator was created to represent the airways, major vessels, and lymph node stations essential to identify for EBUS-TBNA. Trainees had a baseline skills assessment using the simulator and were then provided a 1-hour didactic session on EBUS-TBNA and additional practice time with the simulator. Trainees then underwent a postsimulation skills assessment using a modified endobronchial ultrasound (EBUS)-Skills and Tasks Assessment Tool (STAT) performance assessment tool. Simulator fidelity and trainee procedural confidence was assessed using a 10-point scale. Ten fellows received training on the EBUS-TBNA simulator. First-year trainees scored the lowest on the 18-point performance scale with a mean score of 9, while third-year trainees scored highest with a mean score of 17.5. Mean 18-point performance score improvement after simulator training and didactics was 4.31 points for all trainees with the largest change in first-year trainees amounting to 8.25 points. First-year trainees experienced the greatest improvement in EBUS procedural confidence by a mean of 2.5 points on a 10-point confidence survey. A low-cost EBUS simulator effectively differentiated early and advanced learners based on graded procedural performance scores. Simulation-based practice significantly improved learners' procedural performance, and the degree of improvement correlated with learner inexperience. The simulation significantly increased early learner confidence in EBUS-TBNA technique.

Assessing operative competence in core surgical training: A reliability analysis

BackgroundThis study quantifies the number of observations required to reliably assess the operative competence of Core Surgical Trainees (CSTs) in Ireland, using the Supervised Structured Assessment of Operative Performance (SSAOP) tool. MethodsSSAOPs (April 2016–February 2021) were analysed across a mix of undifferentiated procedures, as well as for three commonly performed general surgery procedures in CST: appendicectomy, abdominal wall hernia repair, and skin/subcutaneous lesion excision. Generalizability and Decision studies determined the number of observations required to achieve dependability indices ≥0.8, appropriate for use in high-stakes assessment. ResultsA total of 2,294 SSAOPs were analysed. Four assessors, each observing 10 cases, can generate scores sufficiently reliable for use in high-stakes assessments. Focusing on a selection of core procedures yields more favourable reliability indices. ConclusionTrainers should conduct repeated assessments across a smaller number of procedures to improve reliability. Programs should increase the assessor mix to yield sufficient dependability indices for high-stakes assessment.

Varied Trainee Competence in Cold Snare Polypectomy - Results of the COMPLETE Randomized Controlled Trial.

Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback to conventional apprenticed-based concurrent feedback. We hypothesized that video feedback would accelerate competence. We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1cm, comparing video to conventional feedback. We randomly assigned de-identified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool (CSPAT). We shared cumulative sum (CUSUM) learning curves every 25 CSPs with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume. We enrolled and randomized 22 trainees; 12 to video and 10 to conventional feedback, and evaluated 2339 CSPs. The learning curve was long; two trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control (p=0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSPs (P=0.0004). Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine if such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov: NCT03115008.

Teaching how to navigate difficult conversations: A combined palliative care–oncology didactic simulation intervention for hematology/oncology fellows.

11028 Background: ASCO strongly endorses the integration of palliative care to improve patient outcomes and support patients in their cancer trajectories. Developing core palliative care skills for trainees is therefore essential, with few ACGME approved pilot programs offering combined fellowship training. Our institution’s Heme/Onc fellows reported a need for additional education in leading difficult conversations. Methods: We piloted a didactic simulation (sim) session for each fellowship class, led by a faculty member who is dual board-certified in Medical Oncology and Hospice/Palliative Medicine. Trainees received a lecture on validated communication tools and oncology-specific language to help navigate difficult conversations. Trainees then role-played in small groups using sample cases, with Heme/Onc faculty supervision and real-time feedback, followed by class reflection. Pre- and post-sim surveys were electronically administered to assess knowledge of communication tools and comfort in discussing difficult topics. Comfort questions were scored on a 5-point Likert Scale, using student t-tests to detect differences pre- and post-sim, and ANOVA to compare responses among classes. Results: A total of 16/21 (76.2%) fellows completed both pre- and post-sim surveys. Knowledge of communication tools increased from 21.9% pre-sim to 79.7% post-sim. Comfort significantly increased for explaining palliative-intent chemotherapy, hospice, and discussing an uncertain prognosis (Table). There was a significant difference among classes pre-sim for addressing negative emotions (mean comfort level: 1st years 2.8, 2nd years 3.4, 3rd years 3.83; p=0.046) and for discussing an uncertain prognosis (mean comfort level: 1st years 2.6, 2nd years 3.6, 3rd years 3.83; p=0.043); however, these interclass discrepancies were eliminated post-sim. Overall, fellows reported that the sim sessions were effective for developing their knowledge and comfort in having difficult conversations. Conclusions: A novel sim intervention led by a physician who is dual board-certified in palliative care and medical oncology improves trainee competency with navigating difficult conversations. Analysis of the intervention’s durability of response and iterative refinement of its curriculum are ongoing. [Table: see text]

Antecedents of graduates’ competence in the agro-food processing technical and vocational training system of Ethiopia as perceived by graduates and their trainers

The purpose of this study was to scrutinize the interdependence among training quality, graduate demographic characteristics, and graduate competence and employability in the agro-food processing sub-sector of the TVET system in Ethiopia. To that effect, the commitment and competence of graduates and trainers, the quantitative and qualitative aspects of resource supplies, training and assessment practices including industry involvement or cooperative training, and the relationships with and influence of the human and material resources on graduate competence were examined. The descriptive survey design of the quantitative approach that involved 637 participants was employed. Data analyses through descriptive and inferential statistics revealed that colleges were challenged with trainer skill gaps, poor material resource supply, and poor cooperative training. It was also found that the human inputs (trainer competence, trainer commitment, and trainee characteristics) significantly predicted the core competence of graduates whereas material resources had a very weak predictive power. In addition, an inverse relationship between employment status and all forms of graduates’ competence was found. Accordingly, it is plausible to conclude that poor institutional capacity that denied to pay necessary attention for the input and process of the training delivery has obstructed the competence of graduates.

Scaled Performance on the Vascular Qualifying Examination Does Not Correlate With Vascular Certifying Examination First Attempt Pass in a National Cohort of Residents and Fellows

Specialty board certification is an important indicator of surgeon competence and necessary for residency and fellowship programs to maintain accreditation with the Accreditation Council for Graduate Medical Education. Thus, identification of trainees at risk of board certification failure is important for both vascular surgery graduates and their parent program. Passing the written Vascular Qualifying Examination (VQE) is a prerequisite for eligibility to take the Vascular Certifying Examination (VCE). However, the association between performance on the VQE and ability to pass the VCE has not been examined. We sought to examine the correlation of VQE performance on first-time pass achievement of VCE. We utilized American Board of Surgery data to examine predictive associations of a national longitudinal cohort of all vascular surgery integrated residents (VIR) and fellows (VSF) who completed the VQE and VCE from 2016 through 2021. Descriptive statistics were used to examine trends. Chi-squared tests were used to examine proportional group differences. Predictive associations between VQE scaled score performance and first-time pass achievement on subsequent VCE attempts were examined using logistic regression. VQE scaled score performance and VCE pass rates were obtained for all VIR and VSF (n = 579; 176 residents and 403 fellows) from 151 programs (47 residency and 104 fellowship) during the study period. First-attempt pass rate for the VQE was 94% in the study cohort, while first-attempt pass rate for the VCE was 93%. There were no significant differences in pass-fail rates between VIR and VSF candidates taking the VQE (P = .133) or the VCE (P = .501), respectively. Trainee scaled score performance on VQE was not predictive of subsequent first-attempt pass achievement on VCE (odds ratio, 1.00; 95% confidence interval, 1.00-1.01; P = .077) (Figure). Stratified subgroup analyses by VIR and VSF cohorts also showed no significant predictive first-attempt VCE pass achievement (P = .125 and P = .171, respectively). In this national cohort of vascular trainees taking the VQE and VCE, VQE performance was not predictive of subsequent VCE first-time pass achievement. Although this finding highlights the necessity to identify other measures of trainee competence in order to indicate preparedness of trainees for board certification examinations, it is also reflective of the ability to assess distinctive competencies between the two examinations, with VQE focused on medical knowledge, and VCE on clinical judgement and interpersonal communication skills. This ensures certification of well-rounded vascular surgeons and maintenance of high-quality standards within our specialty.

Exploring gender influences in the quality of workplace-based assessments.

Workplace-based assessments are an important tool for trainee feedback and as a means of reporting expert judgments of trainee competence in the workplace. However, the literature has demonstrated that gender bias can exist within these assessments. We aimed to determine whether gender differences in the quality of workplace-based assessment data exist in our residency training program. This study was conducted at the University of Ottawa in the Department of Emergency Medicine. Four end-of-shift workplace-based assessments completed by men faculty and four completed by women faculty were randomly selected for each resident during the 2018-2019 academic year. Two blinded raters scored each workplace-based assessment using the Completed Clinical Evaluation Report Rating (CCERR), a published nine-item quantitative measure of workplace-based assessment quality. A 2 × 2 mixed measures analysis of variance (ANOVA) of resident gender and faculty gender was conducted, with mean CCERR score as the dependent variable. The ANOVA was repeated with mean workplace-based assessment rating as the dependent variable. A total of 363 workplace-based assessments were analyzed for 46 residents. There were no significant effects of faculty or resident gender on the quality of workplace-based assessments (p = 0.30). There was no difference in mean workplace-based assessment ratings between women and men residents (p = 0.92), and no interaction between resident and faculty gender (p = 0.62). Mean CCERR score was 25.8, SD = 4.2, indicating average quality assessments. We did not find faculty or resident gender differences in the quality of workplace-based assessments completed in our training program. While the literature has previously demonstrated gender bias in trainee assessments, our results are not surprising as assessment culture varies by institution and program. Our study cautions against generalizing gender bias across contexts, and offers an approach that educators can use to evaluate whether gender bias in the quality of trainee assessments exists within their program.

Supervision of redeployed surgical trainees during the COVID-19 pandemic: what have we learnt and how can we improve?

ObjectiveWhen cases of patients presenting with Coronavirus Disease 2019 (COVID-19) overwhelmed existing services in the United Kingdom (UK), surgical trainees were redeployed to assist frontline efforts. This project characterises the effects of redeployment on the supervision of these trainees. The resulting generation of practical recommendations could be implemented for future crises.DesignA qualitative approach was utilised, comprised of seven phenomenological interviews with surgical and intensive care consultants, as well as redeployed surgical trainees. Interview recordings were transcribed and subsequently analysed using Thematic Analysis.SettingThe project utilised participants currently in surgical training within the London deanery across a variety of surgical specialties representing several UK National Health Service (NHS) Trusts.ParticipantsThree types of participants were interviewed. Four interviews were conducted with redeployed surgical trainees, across all stages of training, in full time employment who were redeployed for two weeks or more. One interview was conducted with an educational supervisor of multiple redeployed trainees. The third group comprised two consultant intensivists who supervised redeployed trainees within their respective departments.ResultsFour themes were developed: ‘Responding to an unforeseen crisis’, ‘Maintaining surgical identity and culture; A fish out of water?’, ‘Trainee supervision and support’ and ‘Preparation and sequelae’. Participants described a sense of obligation to the pandemic effort. Many described a significant interruption to training, however communication of this to surgical supervisors was suboptimal with minimal mitigation. Supervisors on the frontline were challenged by the assessment of trainee competence and acceptance into a new community of practice. Both trainees and supervisors described the management of uncertainty, advocating for the use of reflective practice to ensure preparation for the future.ConclusionThis project presents an insight into several potentially long-lasting effects on surgical training. The recommendations generated may be applicable to trainees returning to work from time out of training, increasing the utility of this work.

P33 Development of an interactive, e-learning resource to improve trainee competence in the management of difficult and failed intubation in obstetrics

P33 Development of an interactive, e-learning resource to improve trainee competence in the management of difficult and failed intubation in obstetrics

Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program.

The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.

Teaching Neurology Trainees to Provide a Terminal Diagnosis Using Objective Structured Clinical Examinations (OSCE) (P1-2.004)

<h3>Objective:</h3> To prepare neurology resident to deliver news of a terminal illness through use of simulation. <h3>Background:</h3> Ensuring trainee competency in communication with patients is required by the ACGME. Delivering bad news is a particularly challenging but essential communication skill to master. Various methods are used to teach and assess resident competency on this topic, but the best way to teach this skill, particularly when the neurologic diagnosis is terminal, is unclear. <h3>Design/Methods:</h3> We developed an objective structured clinical examination (OSCE) in our simulation center that focused on delivering news to a patient about a terminal neuromuscular illness. Third-year neurology residents (N=15) interacted with a standardized professional (SP) playing a patient presenting to discuss the results of his electro diagnostic study showing evidence of amyotrophic lateral sclerosis. Residents received feedback from faculty observers and the SP regarding their ability to develop a relationship with the patient, communicate bad news effectively, and provide adequate education and counseling. Additionally, residents were surveyed about the value of their experience (scale 1–5, least to most). <h3>Results:</h3> A majority of residents completed a post-OSCE questionnaire (N=8, 53%). Most felt unprepared (2.87±0.99), though the majority found the OSCE useful (4.37±0.91). The SP felt that most residents acknowledged feelings and emotions appropriately (91%), provided clear explanations and information (84%), collaborated to plan for next steps (77%), identified an immediate support system (75%), and helped the SP understand the nature of their symptoms (77%). However, residents less frequently prepared the SP for the news by giving a “warning shot” (64%). <h3>Conclusions:</h3> Simulation is a powerful tool that allows residents to learn through an interactive experience, direct observation, and timely feedback. We have demonstrated the feasibility of utilizing simulation in training residents to deliver a diagnosis of a terminal neurologic illness, and that this method is well received by trainees. <b>Disclosure:</b> Dr. Smith has nothing to disclose. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience. Dr. Pleninger has nothing to disclose. Dr. Lillemoe has nothing to disclose. Dr. Sabadia has nothing to disclose. Dr. Giglio has nothing to disclose. Sondra Zabar has nothing to disclose. The institution of Dr. Zakin has received research support from American Board of Psychiatry and Neurology. Dr. Kurzweil has nothing to disclose.

Ethiopian Health Extension Workers' Training Status and Perceived Competency.

Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre-service training status and perceived competency in Ethiopia. The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross-sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs.

Construction of Soft Prep Cadaver Pericardiocentesis Training Model and Implementation Among Emergency Medicine Residents.

This procedure training model is designed for all levels of emergency medicine residents. Pericardiocentesis is a relatively uncommon but potentially life-saving procedure within the scope of Emergency Medicine practice. As such, the Accreditation Council for Graduate Medical Education (ACGME) designates its competency as a requirement within emergency medicine residency programs. Because of its relative rarity, simulation-based training is often utilized to fill the gaps in clinical experience during emergency medicine residency training. There have been several models of pericardiocentesis training, including gel-based models that can be purchased or constructed,1-3 non-gel models,4 and cadaveric models.5 In this paper, we describe the fabrication of a high-fidelity cadaveric model and report emergency medicine resident experience with this model. Training programs can use this model to increase trainee competence and confidence with this high-acuity, low-frequency procedure. By the end of this session, residents will gain increased procedural competence and confidence with pericardiocentesis. Residents will be able to identify necessary supplies for the procedure, identify relevant surface anatomy and ultrasound views, and successfully aspirate fluid from model effusion. We created a pericardial effusion in a soft prep cadaver by placing a catheter into the pericardial sac and then infusing normal saline via intravenous fluid tubing. Learners were then able to practice aspiration of pericardial fluid via landmark and ultrasound-guided approaches under observation by facilitators able to offer real-time feedback. Learners were asked to complete a survey assessing pre-intervention and post-intervention subjective confidence in their ability to perform pericardiocentesis and were asked for qualitative feedback on the experience of using the training model. All residents were able to successfully visualize the pericardial effusion and perform needle aspiration via parasternal and subxiphoid approaches under dynamic ultrasound guidance, allowing needle visualization. All residents reported a subjective increase in procedural confidence and competence after practicing with this training model. Overall, the primary benefit of this training model cited by emergency medicine residents was that it closely approximates reality. This model is re-usable, relatively durable, and reproducible. Emergency medicine residencies associated with academic medical centers that already utilize cadavers for education may relatively easily incorporate this training model into their procedure training curriculum. Pericardiocentesis, simulation, task trainer.