Internal Medicine Residency Curriculum Research Articles

A substance use disorder training curriculum for internal medicine residents using resident-empaneled patients.

Internal Medicine (IM) residents frequently encounter, but feel unprepared to diagnose and treat, patients with substance use disorders (SUD). This is compounded by negative regard for patients with SUD. Optimal education strategies are needed to empower IM residents to care for patients with SUD. The objective of this study was to evaluate a brief SUD curriculum for IM residents, using resident-empaneled patients as an engaging educational strategy. Following a needs assessment, a 2-part SUD curriculum was developed for IM residents at the University of Chicago during the 2018-2019 academic year as part of the ambulatory curriculum. During sessions on Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD), a facilitator covered concepts about screening, diagnosis, and treatment. In session, residents completed structured worksheets applying concepts to one of their primary care patients. A post-session assessment included questions on knowledge, preparedness & attitudes. Resident needs assessment (n = 44/105, 42% response rate) showed 86% characterized instruction received during residency in SUD as none or too little, and residents did not feel prepared to treat SUD. Following the AUD session, all residents (n = 22) felt prepared to diagnose and treat AUD. After the OUD session, all residents (n = 19) felt prepared to diagnose, and 79% (n = 15) felt prepared to treat OUD. Residents planned to screen for SUD more or differently, initiate harm reduction strategies and increase consideration of pharmacotherapy. A brief curricular intervention for AUD and OUD using resident-empaneled patients can empower residents to integrate SUD diagnosis and management into practice.

Implementation and Evaluation of a Pilot Narrative Medicine Curriculum for Internal Medicine Residents.

Background Narrative medicine has been integrated into medical training to enhance competencies such as observation, reflection, and self-care. However, few studies have assessed the impact of a single narrative medicine session using a pre- and post-test study design. The authors of this study sought to implement a pilot narrative medicine curriculum into a large internal medicine residency program and to evaluate its feasibility and impact. Methodology The curriculum consisted of a one-hour reading and writing workshop held during ambulatory academic half-days from 2021 to 2022. Resident participants completed a retrospective pre- and post-workshop survey evaluatingtheir interest and confidence in practicing narrative medicine skills, as well as their beliefs about theimpacts of narrative medicine on patient care and provider well-being. Descriptive statistics evaluated pre- and post-workshop differences using the Wilcoxon signed-rank test. Subgroup analyses were conducted based on postgraduate year, residency track, and workshop setting. Additionally, participants completed open-ended questions that were analyzed qualitatively. Results Of 218 resident participants, 152 (69.7%) completed the post-session survey. Participants noted significantly higher levels of confidence and interest in listening to patient stories, analyzing literary texts, and engaging in reflective writing after the workshop. They also expressed significantly higher levels of agreement that engaging in literary analysis and reflective writing could improve patient care, reduce provider burnout, and strengthen connectedness with colleagues. Qualitative analysis demonstrated that participants found the sessions to be worthwhile and appreciated how narrative medicine could enhance their medical practice. Conclusions Incorporating a brief narrative medicine curriculum into an internal medicine residency program is both feasible and valuable. A single narrative medicine session was practical and well-received by residents, as it promoted self-reflection, observational skills, and connection with colleagues. Future workshops should be customized for different training levels and residency tracks, and additional studies should evaluate whether the outcomespersist over time.

A Novel Curriculum for Internal Medicine Residents to Care for High-Need, High-Cost Patients.

High-need, high-cost (HNHC) patients represent a small proportion of patients in the US, but result in disproportionately higher healthcare utilization. Teaching Internal Medicine (IM) resident trainees to provide high value care for HNHC patients is critical. We sought to improve resident attitudes and increase clinical skills associated with treating HNHC patients by creating a curriculum that leveraged the UCLA Extensivist Program, a patient-centered medical home for HNHC patients. We developed a curriculum for PGY-2 and PGY-3 IM residents centered on caring for HNHC patients over the course of 6, 4h sessions during 1 academic year. Participants completed pre- and post-intervention surveys assessing self-rated attitudes and skills associated with caring for an HNHC patient population. Twenty-one IM residents completed the curriculum and 41 were in the control group. There were no statistically significant differences in assessed attitudes and skills, but there were trends of improvement, including a decrease in participants who agreed or strongly agreed they felt overwhelmed when seeing patients for posthospital discharge follow up (45.0% pre- to 41.7% post-intervention) and an increase in participants who agreed or strongly agreed they have the skills to successfully transition HNHC patients between inpatient and ambulatory settings (20.0% pre- to 33.3% post-intervention). Participants reported better understanding of resources available to HNHC patients, effective coordination of transitions of care, and comprehensive assessment of social determinants of health. A curriculum to improve resident attitudes and skills associated with caring for HNHC patients was successfully implemented in an IM program at a large academic medical center. The curriculum may be adapted for other training programs; long-term training woven throughout training may be important to significantly improve resident education on how to care for HNHC patients.

Development and Pilot Testing of a Longitudinal Skills-Based Feedback and Conflict Resolution Curriculum for Internal Medicine Residents.

Physicians in training are responsible for leading clinical teams, coordinating interdisciplinary management, navigating conflict, and supervising and giving feedback to junior learners. Giving feedback and resolving conflict are key leadership skills for internal medicine (IM) residents, many of whom desire additional training. Although these skills are integral to successful leadership for physicians in training, residents receive little explicit education and existing curricula have not established best practices for skill acquisition. Study authors designed a pilot longitudinal, skills-based curriculum to teach first- through third-year IM residents at the University of Pittsburgh how to give formative feedback and engage in conflict resolution. From February to May 2021, authors delivered a series of interactive lectures utilizing frameworks, workplace-based scenarios, skills practice, and discussion. Skills transfer was evaluated with novel pre- and postcurriculum objective structured clinical examinations (OSCEs) wherein participants played the role of senior resident. Each OSCE involved 2 feedback and 2 conflict resolution stations. OSCE performances were evaluated using an author-created checklist with a 1-4 rating scale. The exposure group comprised post-OSCE participants who attended the curriculum. Data were analyzed using a mixed effects regression model. Thirty-six residents participated in curriculum evaluation, and 23 were included in postcurriculum data analysis. Within feedback, the skill "explores feedback content" significantly improved for exposure group participants (precurriculum median, 2.64; postcurriculum, 3.24; P < .05). For conflict resolution, among the exposure group, the skill "identifies a common goal, value, or purpose" significantly improved (pre, 3.10; post, 3.62; P < .05). This curriculum and evaluation can serve as a stepping stone for further evidence-based leadership frameworks, curricula, and evaluations developed specifically for physicians within their unique leadership roles. The feedback and conflict resolution frameworks used in this curriculum can be applied to various medical specialties, with specialty-relevant scenario adaptations for interactive skills practice.

A Narrative Medicine Pilot Curriculum for Internal Medicine Residents.

Narrative medicine (NM) is the practice of reflecting on patient stories, which can improve physician empathy and has been linked to higher levels of well-being. We implemented a NM curriculum for a large internal medicine residency program and report the curriculum's positive effects.

The Virtual Visit: A Telehealth Curriculum for Internal Medicine Residents Featuring a Virtual Physical Examination.

During the COVID-19 pandemic, medical professionals were obligated to adapt to virtual care. Most resident physicians had no formal telehealth training. The virtual physical examination remained underutilized. We describe a needs assessment leading to the creation of a telehealth curriculum for internal medicine (IM) and internal medicine pediatric (IM/P) residents, and report changes in residents' confidence level as well as feasibility data. We hypothesized that residents' confidence in delivering virtual care would significantly improve after implementing a telehealth curriculum. A needs-based assessment for all University of California Los Angeles (UCLA) IM and IM/P residents was conducted in July 2020. Specific competencies were identified: (1) telehealth legal guidelines; (2) virtual physical examination; (3) health equity; and (4) telehealth chronic disease management. The curriculum was presented via 3 synchronous interactive online interventions between November 2020 and March 2021. Pre- and post-intervention learner assessments were conducted. Out of all 180 residents, 146 UCLA IM and IM/P residents completed pre- and post-Virtual Physical Examination curriculum surveys, which were not uniquely linked to individuals. Residents reported statistically significant increased confidence levels in performing a targeted virtual physical examination (P<.001; 95% CI 0.97-1.35), engaging patients or caregivers to assist in virtual examinations (P<.001; 95% CI 0.76-1.21), and using remote monitoring devices (P<.001; 95% CI 0.58-1.03). Our results demonstrate that, within our IM and IM/P residency programs, a formalized telehealth curriculum significantly improved residents' confidence in delivering virtual care.

An innovative approach to comprehensive communication skills training for residents: a resident-led communication curriculum.

Innovations to enhance residency training in interpersonal and communication skills are needed and a resident-led strategy has not been well-described. In this study, we explored a resident-led comprehensive communication skills curriculum for internal medicine residents. Residents and faculty prepared the curriculum as part of an Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside Project and with "The language of caring guide for physicians." Employing active learning techniques, three residents led 43 internal medicine residents in seven 1 h sessions from 2019 to 2020. Using a 35-question survey, we assessed pre and post self-reported competence in: mindful practice, collaboration and teamwork, effective openings and closing, communicating with empathy, effective explanations, engaging patients and families as partners, and hard conversations. A Wilcoxon signed rank test was employed to explore differences in median scores after matching each person's pretest and posttest score. The median score for aggregate communication and the scores for all seven competencies assessed improved from pre to post (p < 0.05). This indicates that residents reported higher incidences of performing patient-centered communication skills after the curriculum compared to before. Using a five-point Likert scale, 100% of participants agreed the program improved their communication skills and improved confidence in bedside patient-centered communications. A resident-led comprehensive communication skills curriculum for internal medicine residents was implemented showing improvement in skills over the course of the curriculum. The curriculum was well-accepted by post-survey evaluation and was feasible with motivated resident-leaders, use of an existing guide to communication, and reserved didactic time to implement the program.

"I'm Not Good with Money" and Other Lies Residents Tell Themselves about Personal Finance.

Some physicians believe that they have difficulty managing their own personal finances, and many medical schools and residences do not have formal financial curricula embedded in education. Given that many medical students have >$200,000 in school loans, physicians are expected to navigate the complex financial world without guidance. In this article, the authors developed a personal finance curriculum for Internal Medicine residents with the aim of evaluating the proportion of residents engaging in active personal finance activities, increasing their knowledge of financial literacy and their comfort with personal finance concepts using a pre- and postintervention survey. The content of the curriculum included four modules structured around different financial themes and delivered to trainees in 45-minute sessions. A majority of the residents were able to participate in workplace retirement, log into their retirement account, possessed a Roth individual retirement account, manage a budget, and check their credit score. An area prompting concern postintervention was the level of discomfort engaging with personal finance that disproportionally affected the female trainees more than their male counterparts. It is likely that an individual's comfort level managing finances stems from money beliefs, rather than actual ability given the requirements to graduate from medical school and the demands of an Internal Medicine residency.

Education Research: The Inappropriate Consult

Background and Objectives As resident physicians specialize, they lose familiarity with knowledge central to other fields. This can yield what we term the dual fallacies: (1) the sense that their own expertise is common knowledge, and (2) unfamiliar clinical situations seem beyond their scope. In graduate medical education, these dual fallacies may engender the perception of inappropriate consults among specialties. This project evaluated biases in residents' perceptions of expected knowledge and inappropriate consults to improve interdisciplinary education among neurology residents (neurologists) and internal medicine residents (internists). Secondarily, we evaluated whether these biases were mitigated after implementing an educational intervention. Methods Resident neurologists and internists at a large, urban, academic medical center answered board-style questions reflecting neurology and medicine consultation scenarios. They then rated the extent to which each scenario reflected common knowledge to both specialties and whether a consult was warranted. After revising the internal medicine residency curriculum to include a neurology rotation, another cohort of residents was surveyed and participated in semistructured interviews. Paired sample t tests and qualitative data analysis were performed. Results Neurologists and internists participated in phase 1 (n = 23) and phase 2 (n = 42) of the study. Residents from both fields answered more questions correctly from their own specialty than the other in phase 1 (p &lt; 0.05) and phase 2 (p &lt; 0.001). Neurologists and internists in both cohorts thought that each other should know more neurology answers than they actually did (p &lt; 0.05). Neurologists were less likely to agree than internists that medicine questions deserved a consult (p = 0.014). Interviews revealed themes regarding perceived consult appropriateness, affected by educational, communication, clinical, and administrative factors. In addition, residents agreed that appropriate consults must pose a specific question and occur only after an initial investigation was performed, but that this rarely happens. Discussion Our findings support that discordant expectations of expertise contribute to a perception of inappropriate consults among neurologists. Nonclinical factors, from cognitive biases to contextual considerations, inform clinical consultation and interdisciplinary patient care. Implementing rotations on other services alone is insufficient to eradicate discordant expectations; however, we propose additional interventions that may prove valuable in medical education.

Abstract 12334: A Systematic Review and Meta-analysis Curriculum for Internal Medicine Residents Interested in Cardiology

Introduction: Internal Medicine (IM) residents face major challenges in conducting original research due to inadequate instruction in research methodology and lack of mentorship during the traditional research electives offered during residency. Hypothesis: A novel systematic review curriculum (SRC) can improve resident satisfaction and research productivity. Methods: 8 IM residents interested in cardiology were selected to participate in a 4-week elective focused on conducting systematic reviews and meta-analyses. Didactic lectures, online tutorials, and problem-based exercises were delivered by a multidisciplinary team of educators including a clinical researcher, librarian, and biostatistician. Results: Demographics are presented (Table 1). As compared to 16 residents that underwent traditional research electives, the SRC participants reported higher satisfaction, completed a mentored research project within 4 weeks, presented 4 posters at AHA annual meeting 2020, and finished manuscripts for publication (Figure 1). Conclusions: A focused research curriculum delivered by multidisciplinary educators is better than a traditional research elective and improves resident satisfaction.

PSUN224 Resident Education for Improved Quality and Confidence in Inpatient Hyperglycemia Management

Abstract Background Hyperglycemia is widely prevalent in hospitalized patients and has been associated with adverse outcomes and increased mortality. Guidelines for inpatient management of hyperglycemia in non-critically ill adults are inconsistently implemented within our hospital system in a large academic center in New York. Thus, we strove to develop a formal curriculum for our internal medicine program to improve the level of confidence in trainees when managing inpatient hyperglycemia and to promote appropriate subspecialty consultation. Methods We designed a three-phase educational curriculum for internal medicine residents of all training levels. The first phase consisted of a pre-intervention questionnaire distributed online, examining the self-reported level of confidence and knowledge of hyperglycemia management in non-critically ill patients. The second phase consisted of a 50-minute lecture providing background on the prevalence and risk of inpatient hyperglycemia, standard guidelines for inpatient hyperglycemia management, appropriate insulin regimen initiation and adjustment and practice questions reviewed in real time. The third phase consisted of an online post-intervention questionnaire which, in addition to reassessing confidence and knowledge, examined change in individual confidence level in hyperglycemia management and the ability to recognize situations appropriate for endocrinology consultation. In the context of convenience sampling, all residents were eligible to participate in the second questionnaire independent of their participation in the first questionnaire or educational intervention. Results There were 57 total respondents for the pre-intervention questionnaire and 54 total respondents for the post-intervention questionnaire. 26 (48%) of the post-intervention questionnaire respondents completed the initial questionnaire and 22 (41%) attended the lecture. In examining confidence in managing inpatient hyperglycemia on a four-level scale (not comfortable, somewhat comfortable, comfortable, and very comfortable), there was an overall increase in percentage of "comfortable" responses (26% to 52%) with a subsequent decrease in "somewhat comfortable" responses (65% to 37%) when comparing post- to pre-intervention questionnaires. In addition, there was a higher percentage of "comfortable" responses in those who attended the lecture versus those who did not (59% vs. 47%). Furthermore, 21 of the 22 respondents who attended the lecture felt "more confident" in their ability to treat inpatient hyperglycemia. Lastly, those who attended the lecture were more likely to identify situations in which endocrinology should be consulted. Conclusion Currently, there is no formal longitudinal curriculum established for resident education in inpatient diabetes care and hyperglycemia management. The objective of this intervention was to identify and bridge the gap in practical knowledge and confidence level across all training levels. In a small sample size of residents, data revealed higher confidence in management and ability to recognize the necessity of endocrinology consults. Future research will focus on analyzing concrete data in a target unit to assess translation of the intervention to improved quality of inpatient glycemic control. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

ODP410 Exposure to Transgender Teaching in Internal Medicine Residents and Established Providers

Abstract Background Transgender competent care is not a formal learning requirement for trainees in Internal Medicine. The National Transgender Discrimination Survey noted that up to 50% of respondents had to teach their medical provider about transgender care (1). The National LGBTQ Task Force appealed to urgently train practitioners on effective and respectful treatment of transgender patients. Endocrinologists are in a unique position to provide this learning content. It is important to understand the learner audience to develop curricula that meet the needs of different learners. Methods In developing a transgender competent curriculum for internal medicine residents and established primary care providers, an anonymous 5 question survey was performed. Questions included training level or primary medical degree, prior transgender learning experience and transgender patient exposure. Results 81% of the residents were between age 20-30 years. 83% of residents had received at least 2 or more hours of transgender competent care training in medical school. However, 71% reported zero transgender training in internal medicine residency despite 83% having medically cared for a transgender patient and 24% having initiated or continued gender affirming care. In a primary care provider population, 83% of respondents were age 41 years or older. Most were MDs but included CRNP and PA providers. 39% reported prior transgender competent care training. 88% reported having medically cared for at least 1 transgender patient, 25% having cared for at least 6 or more transgender patients and 21% having initiated or continued gender affirming care. Residents were more likely than established providers to have had exposure to transgender teaching, X2 (1, N = 60) = 15.6, p &amp;lt;0. 001. There was no statistical difference between the groups in exposure to transgender patients. Conclusions Resident trainees are more likely to have received transgender competent care training compared to established primary providers. This group of residents report more transgender training exposure in medical school than previous cohorts (2). Resident teaching is remote, having occurred primarily in medical school. Established providers have poor exposure to training despite similar exposure to transgender patients as resident trainees. Both groups appear to have more exposure to transgender patients than prior studies have reported (2). A curriculum geared towards advanced learners with minimal training since medical school but increasing exposure to transgender patients should be pursued. Grant, Jaime M., Lisa A. Mottet et al. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. Dubin SN, Nolan IT, Streed CG Jr et al. Transgender health care: improving medical students’ and residents’ training and awareness. Adv Med Educ Pract. 2018 May 21;9: 377-391. Presentation: No date and time listed

Point-of-Care Ultrasound Curriculum for Internal Medicine Residents During the COVID-19 Era: A Pilot Study.

Introduction: The use of point-of-care ultrasound (POCUS) by internal medicine physicians and residents is increasing. We present the results of a pilot study to implement a POCUS curriculum that was interrupted by the Coronavirus Disease 2019 (COVID-19) pandemic at an internal medicine residency program at a community hospital. The purpose of this study is to inquire about the attitude and interest of our medical residents in POCUS. Additionally, we also plan to examine whether a curriculum that lacks some practical aspects due to COVID-19 restrictions can still improve the residents’ confidence in recognizing common POCUS applications and improve image interpretation skills.Methods: We conducted a prospective, pre-, and post-curriculum pilot study to examine the POCUS skills of categorical internal medicine residents in Post-Graduate Years (PGY) 1 through 3 at a community hospital. The two POCUS-related skills examined were self-reported confidence level in recognizing certain POCUS examination findings and POCUS image interpretation skills. Due to social distancing guidelines, we were unable to host hands-on sessions as originally planned, but residents did receive lectures via Zoom regarding POCUS training and also organ-specific diagnoses. Three primary outcomes were measured: (1) baseline difference in confidence level between interns (PGY-1) and senior residents (PGY-2 and 3) at the beginning of the curriculum, (2) improvement in POCUS confidence level before and after the curriculum considering interns and senior residents all together and also separately, and (3) improvement in image interpretation skills before and after the curriculum.Results: Of 41 residents, 23 participants completed the pre- and post-curriculum test. Of the 23 participants, 12 participants were interns, and 11 were senior residents. Overall, interns showed a statistically significant improvement in the confidence level in almost all diagnoses except pulmonary embolism (p = 0.084). For image interpretation tests, significant improvement was found only in recognizing the two signs of pneumothorax: pleural line absent sliding (X2 = 4.00, p < 0.05) and the barcode sign (X2 = 6.13, p < 0.05). The pre-curriculum confidence level questionnaire included a question about residents’ interest in learning POCUS during residency. It showed that the vast majority of residents (21 residents [91%]) are either extremely or mostly interested in POCUS. Most of our residents (18 [78%]) did not have formal exposure to POCUS during medical school.Conclusion: A POCUS curriculum that lacks hands-on workshops and longitudinal image saving and reviewing due to the COVID-19 pandemic restrictions did not improve the residents’ image interpretation skills, although the confidence levels of the interns statistically improved. After the pandemic, we plan to implement the full curriculum and examine whether it will improve the residents' image acquisition and interpretation skills.

Understanding the Shades of Gray in Diagnosis-An Online Course in Bayesian Reasoning.

Foundational skills in Bayesian reasoning may aid clinical decision-making, decrease overreliance on single diagnostic tests, and improve patient care. However, clinicians are often unskilled in applying Bayes' rule at the bedside, such as using likelihood ratios to calculate posttest probabilities.1While published literature measures clinicians' abilities to update conditional probabilities based on dichotomous test results, many diagnostic tests used in clinical practice are not dichotomous.1 One of the gaps in clinical decision-making revolves around the interpretation of continuous tests such as D-dimer, troponin, and procalcitonin. Although often dichotomized as “normal” and “abnormal” for simplicity, the test's degree of abnormality may have a profound effect on how the result changes the disease probability. Explicit instruction in understanding the “shades of gray” in diagnostic test interpretation is lacking.Clinicians who are deficient in knowledge of Bayesian reasoning are often involved in trainee education. Faculty development initiatives to improve Bayesian reasoning would presumably have positive downstream effects on learners. Educational efforts may be limited by faculty time, availability, and lack of local experts in Bayesian reasoning. Furthermore, the recent COVID-19 pandemic has presented additional challenges to designing and delivering in-person educational curricula.We developed an online, self-paced, asynchronous, case-based curriculum in Bayesian reasoning. The course uses a flipped classroom approach and revolves around 10 core clinical cases. Each case represents a realistic patient scenario. The learner reads each scenario and answers a series of questions assessing a range of skills involved in Bayesian reasoning. The learner is asked to incorporate various findings in the estimation of disease probability, updating disease probability based on new information and integrating this information to guide subsequent management decisions. Each case is followed by video explanations that guide learners through the fundamentals of Bayesian reasoning. The course gradually builds from simple test characteristics, such as sensitivity and specificity, to understanding multilevel likelihood ratios, receiver operating characteristic curves, and action thresholds when making decisions under uncertainty. Course completion is estimated to take 6 to 8 hours. All course materials were created by the study authors.The course was piloted to faculty volunteers beginning June 2021 for the Division of Hospital Medicine faculty at the University of Colorado. Informed consent was obtained. Each participant took 15-question pre- and posttests to evaluate the baseline and gained knowledge. Participants also self-assessed their prior knowledge, ranked the importance of Bayesian reasoning in their clinical care, and noted their satisfaction with the course on a 4-point Likert scale that excluded neutral responses. The Colorado Multiple Institutional Review Board granted the study an exempt status.As of October 2021, 18 out of 20 invited faculty members started the course, and 12 (67%) completed it. Overall, 11 of 12 (92%) faculty members rated their prior knowledge in Bayesian reasoning as “somewhat” or “very weak.” Most (10 of 12) participants rated the importance of Bayesian reasoning in clinical care as “very important,” and the rest rated it as “somewhat important.” All participants (100%) reported feeling “very satisfied” with the course and indicated that it is “very likely” they would recommend the course to a colleague. The pretest assessment demonstrated serious deficiencies in all tested domains, and the posttest assessment showed marked improvement in all of them (Figure). This online course is now integrated into the internal medicine residency curriculum, and all trainees completed the course by February 2022. Further dissemination is planned to medical schools, residency training programs, and faculty outside of our institution.

Insight from a novel humanities-based education intervention to teach empathy to internal medicine residents locally

The medical humanities have the potential to develop empathy in junior doctors through perspective taking and critique of deep-seated beliefs. An education intervention to develop empathy was integrated into an internal medicine residency curriculum in Singapore. All junior residents currently in the programme were invited to participate in individual interviews after the humanities sessions. Data collected was analysed qualitatively using thematic analysis. A total of three sessions were conducted over one year from April 2020. Two participants were recruited successfully for the study. A total of 4 interviews were completed and themes relating to the role of the humanities in empathy education, barriers to its implementation, and cynicism to the sessions were elicited. The results provided insight about how residents experienced a novel humanities-based postgraduate medical education program. However, the low recruitment is a major limitation in this study and data collected may not be confidently interpreted. There is still significant work needed to create greater awareness about the role of the humanities in medical education and research. Improvement in the pandemic situation may also improve participation in future studies.

Flipping the Acute Care for Elders Teaching Sessions (FACETS): A competency-based curriculum for internal medicine residents.

Flipping the Acute Care for Elders Teaching Sessions (FACETS): A competency-based curriculum for internal medicine residents.

"Building Your Neurology Acumen": A Flipped Classroom Approach for Internal Medicine Residents.

Globally, internal medicine (IM) residents often feel they lack the knowledge and skills to approach patients presenting with neurologic issues. We conducted a multiple method needs assessment to determine the feasibility of a novel neurology flipped classroom (FC) curriculum for internal medicine residents. Our primary findings include participants: (1) finding neurology a useful rotation; (2) feeling uncomfortable with the neurological examination; and (3) endorsing flipped classroom as a potential alternative but with significant barriers. Our findings elucidate upon the various extrinsic/intrinsic motivators for resident education and illustrate the need to re-examine the way in which neurology is being taught to off-service residents.

A Video- and Case-Based Curriculum on the Management of Alcohol Use Disorder for Internal Medicine Residents.

IntroductionAlcohol use disorder (AUD) is commonly undertreated. Physicians cite discomfort with AUD medication as a barrier to treatment. While several curricula teach and assess screening and brief interventions, few teach and assess learner knowledge of treatment options.MethodsWe created a video- and case-based curriculum for internal medicine residents delivered by 16 internal medicine faculty in three 30-minute sessions at four clinic sites. Learner knowledge, attitudes, and confidence were assessed before and after the curriculum. We used qualitative methods to evaluate learner reflections. We also assessed faculty satisfaction with the curriculum.ResultsOf 153 residents receiving the curriculum, 35 (23%) completed both pre- and postsurveys. Median percent correct on knowledge questions improved from 67% pre- to 80% postcurriculum (p < .001). Confidence increased for all three items assessing it, with a notable increase in confidence with pharmacotherapy (2.9 pre- vs. 4.5 postcurriculum on a 7-point Likert scale with high scores indicating greater confidence, p < .001). Positive attitudes toward people with AUD increased from 3.4 pre- to 3.9 postcurriculum (p < .001) on a 7-point Likert scale. Learners continued to express concerns about prescribing logistics, the role of primary care, and management of ongoing use. Thirteen of 16 faculty (83%) completed the postcurricular survey; all said they would be happy to facilitate again.DiscussionImplementation of this curriculum for the management of AUD improved resident knowledge, attitudes, and confidence in AUD treatment. The curriculum was acceptable to faculty and is ideal for programs looking to expand teaching about AUD.

Longitudinal, Spaced-Learning POCUS Curriculum for Internal Medicine Residents to Improve Knowledge and Skills

Point-of-care ultrasound (POCUS) is defined as “a goal-directed, bedside ultrasound examination performed by a provider to answer a specific diagnostic question or to guide the performance of an invasive procedure.”1 Utilization of POCUS by practitioners has been shown to improve procedural outcomes, diagnostic accuracy and patient satisfaction.2

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System.

BackgroundHealthcare organizations seeking to promote a safety culture depend on engaged clinicians. Academic medical centers include a community of physicians-in-training; however, medical residents and fellows are historically less engaged in patient safety (PS) than are other clinicians. Increased attention has been focused on integrating PS into graduate medical education. Nonetheless, developing curricula that result in real-world system changes is difficult.ObjectiveTo develop an interactive PS curriculum for internal medicine (IM) residents that analyzes real-word PS problems.MethodsA multidisciplinary group developed a five-session, case-based PS curriculum for IM residents in the context of a 3-year, longitudinal quality-improvement, PS, and high-value-care curriculum. The curriculum was facilitated by a PS analyst and incorporated mock root cause analysis (RCA) based on actual resident-reported PS events. Each mock RCA developed an action plan, and outcomes were tracked. Pre- and postcurriculum assessments with participating residents were conducted to evaluate the curriculum.ResultsTwenty-eight IM residents completed the curriculum during four iterations from 2017 to 2020. The curriculum identified multiple potential PS risks, led to tangible changes in clinical processes, and enhanced resident confidence in improving systems of care.ConclusionsWe describe an active-learning PS curriculum for IM residents that addressed actual resident-reported PS problems. Through RCA, action items were identified and meaningful system changes were made. Leveraging the expertise of local PS experts in the design and delivery of PS curricula may improve the translation of learner recommendations into real system changes and cultivate a positive PS culture.