Formal Didactics Research Articles

Rapid Detection of Significant Traumatic Brain Injury Requiring Emergency Intervention.

Moderate and severe traumatic brain injuries (TBI) are a major cause of severe morbidity and mortality; rapid diagnosis and management allow secondary injury to be minimized. Traumatic brain injury is only one of many potential causes of altered mental status; head computed tomography (HCT) is used to definitively diagnose TBI. Despite its widespread use and obvious importance, interpretation of HCT images is rarely covered by formal didactics during general surgery or even acute care surgery training. The schema illustrated here may be applied in a rapid and reliable fashion to HCT images, expediting the diagnosis of clinically significant traumatic brain injury that warrants emergent medical and surgical therapies to reduce intracranial pressure. It consists of 7 normal anatomic structures (cerebrospinal fluid around the brain stem, open fourth ventricle, "baby's butt," "Mickey Mouse ears," absence of midline shift, sulci and gyri, and gray-white differentiation). These 7 features can be seen even as the CT scanner obtains images, allowing the trauma team to expedite medical management of intracranial hypertension and pursue neurosurgical consultation prior to radiologic interpretation if the features are abnormal.

Transgender Surgery: Perspectives Across Levels of Training in Medical and Surgical Specialties.

Purpose: Approximately 1.4 million adults identify as transgender in the United States. Transgender patients face societal, legal, and medical discrimination that can lead to health disparities. The objective of this study was to evaluate knowledge and perceptions of transgender health care across various levels of medical training and specialties. Methods: Between April 1, 2019 and May 1, 2019, an anonymous survey was distributed to residents and attendings, in both medical and surgical specialties, at a university-affiliated hospital. Participants were recruited into the study with survey distribution by email to residency program directors, residents, and residency-affiliated attendings. Results: There was a response rate of 29.5% (118/400). Across all respondents, 34.7%, 31.4%, and 39% knew where to refer transgender patients for hormone replacement, psychotherapy, or surgery, respectively. Only 37.9% of residents and 46.2% of attendings reported that they were confident of providing care for a transgender patient (p=0.130). In addition, less than one-third of surgical respondents reported sufficient knowledge to describe transgender surgery. The most common reasons affecting comfort level when caring for transgender patients were lack of exposure (53.4%) and lack of formal education (47.6%), with other reasons being personal, moral, and religious reasons (11%, 8.5%, and 6.8%, respectively). Conclusion: Despite literature demonstrating the effectiveness of formal didactics and education in transgender health, there remain disparities in the knowledge and comfort of residents and attendings across all specialties. To deliver competent health care to transgender patients, efforts must focus on improving the availability of system-wide resources and educational opportunities for all specialties.

363 A National Survey of Workflow Efficiency Education among Emergency Medicine Residency Training Programs

Patient volumes in United States (U.S.) emergency departments (EDs) have been on the rise. Medical directors and employers seek emergency medicine (EM) physicians who have strong workflow efficiency (WFE) to help address high ED volumes without compromising patient care. Although WFE is a skill that EM residents should learn prior to graduation, it is not an Accreditation Council for Graduate Medical Education (ACGME) core competency, and there is no standard approach to measure and teach this skill during residency. Additionally, no studies have examined whether EM residency program leaders believe efficiency should be formally taught in EM residency programs. We sought to gain further insight into whether explicit teaching of WFE is important to EM residency program leadership, and the manner in which WFE is currently measured and taught to EM residents. We conducted a cross-sectional survey of all allopathic ACGME-accredited EM residency training programs in the U.S. The survey was conducted using SurveyMonkey® in the Fall of 2019. We invited all allopathic EM residency programs to voluntarily participate in the study, primarily by emailing their program directors (PDs). Assistant/associate program directors were invited subsequently if there was no response from the PD. We performed descriptive statistics on all survey data using SurveyMonkey® software. We received a total of 133 responses out of 190 total programs (response rate 70%) with proportionate representation from 3 & 4-year programs and all regions of the U.S. When asked “To what extent teaching efficiency should be a priority compared to other educational goals,” 65% of program leaders responded with “significant” or “moderate” priority. Most EM programs collect WFE data on their residents, either by tracking patients-per-hour (78%) or by written evaluations (59%). The top three methods for providing WFE data to residents were: individual data provided along with de-identified rank (35%), data provided only during private feedback meetings (26%), and no data or rank provided to residents (16%). Regarding targeted WFE teaching to residents, 88% reported utilizing general on-shift teaching, 48% reported teaching WFE during formal didactics, and 45% during dedicated private feedback sessions. WFE-focused simulations (15%), workshops (7%), and one-on-one observation shifts (14%) were uncommon. This national study of allopathic U.S. EM programs suggests that most EM program leaders value WFE teaching. However, we found no consistent approach among programs for tracking or distributing resident WFE data, and many programs lack a formalized way to teach efficiency to their residents. Given the importance of WFE to the clinical practice of EM, programs may benefit from devoting greater resources to teaching and tracking this essential skill set.

41. CREATING A STANDARDIZED TEMPLATE FOR LEARNING GOALS AND OBJECTIVES IN RESIDENCY ELECTIVE CURRICULA

Background ACGME accreditation requires residency programs have curricula with competency-based goals and objectives at each educational level. Prior published attempts at standardizing learning goals and objectives (LGO) mostly focus on specific fields, thus limiting generalizability for programmatic use. The recently published ACGME accreditation criteria prompted our institution to review our elective LGOs and develop a process to facilitate both ease of LGO creation and accreditation compliance. Objectives 1) Identify published standards for residency elective curricula; 2) evaluate the current state of our program's elective LGOs, and 3) pilot a process to implement LGO best practices. Methods We designed an electronic form (e-form) to compare our institution's elective LGOs to those reported in the literature. Two authors independently evaluated and scored our program's electives. Results informed the design of a second e-form for guiding elective directors in creating LGOs meeting accreditation expectations. This form was piloted by 5 elective directors. Results Review of prior studies revealed two major types of elective LGO features: common “core” characteristics, and less frequent “secondary” characteristics. Core characteristics included: demonstration of learner progression over time, inclusion of ACGME's core competencies, measurable deliverables, and expected outcomes. Secondary characteristics included: orientation and reference materials, formal didactics, milestone calendars, and scholarly products. We evaluated 55 unique electives at our program using these characteristics. Twenty percent of our current electives did not have LGOs available. Over 94% of LGOs had not been updated for at least 2-3 years. We also identified gaps between best practices and the current state of our elective LGOs (Figure 1). The new electronic form was piloted by 5 elective directors. Director feedback from our pilot included: checkboxes for common responses; free-text options in all areas; and providing a customizable “sample week” calendar. Conclusions While electives are highly customized by design, establishing LGO guidelines helps to define goals for learner progression, minimizes the difficulties in the transition process, and provides a framework for elective directors as they strive to design the best experience. Our next step will be to implement the e-form for all of our electives.

COVID-19: Neurology residents’ perspective

Throughout this pandemic, neurology resident education and service has, and will continue to be, affected during this unprecedented time. Balancing the safety of our residents as well as the anticipated inpatient service demands, we have, and continue to, make changes to meet the needs of our community. Education certainly has been affected but we have made great effort to maintain normalcy. We are leveraging web-based technologies to continue formal didactics. The American Academy of Neurology has provided program directors with various tools to share to provide high-yield academic education. AAN Synapse, distance learning modules, and podcasts are a few examples. Each residency training program will likely face different challenges depending on location and community structure. We have an obligation to help all of our colleagues in the hospital in providing quality and compassionate care during this time of need. Our training and education will only benefit from this experience teaching us lessons on adaptability, the importance of teamwork, and self-sacrifice.

Impacts on Surgery Resident Education at a First Wave COVID-19 Epicenter.

Purpose:This study aims to identify the effects of the COVID-19 pandemic on surgical resident training and education at Danbury Hospital.Methods:We conducted an observational study at a Western Connecticut hospital heavily affected by the first wave of the COVID-19 pandemic to assess its effects on surgical residents, focusing on surgical education, clinical experience, and operative skills development. Objective data was available through recorded work hours, case logs, and formal didactics. In addition, we created an anonymous survey to assess resident perception of their residency experience during the pandemic.Results:There are 22 surgical residents at our institution; all were included in the study. Resident weekly duty hours decreased by 23.9 hours with the majority of clinical time redirected to caring for COVID-19 patients. Independent studying increased by 1.6 hours (26.2%) while weekly didactics decreased by 2.1 hours (35.6%). The operative volume per resident decreased by 65.7% from 35.0 to 12.0 cases for the period of interest, with a disproportionately high effect on junior residents, who experienced a 76.2% decrease. Unsurprisingly, 70% of residents reported a negative effect of the pandemic on their surgical skills.Conclusions:During the first wave of the COVID-19 pandemic, surgical residents’ usual workflows changed dramatically, as much of their time was dedicated to the critical care of patients with COVID-19. However, the consequent opportunity cost was to surgery-specific training; there was a significant decrease in operative cases and time spent in surgical didactics, along with elevated concern about overall preparedness for their intended career.

Resident Education in End-of-Life Communication and Management: Assessing Comfort Level to Enhance Competence and Confidence

Our primary objective was to understand residents' baseline comfort with end-of-life (EOL) communication and management and to compare this with their comfort after completion of their surgical intensive care unit (SICU) rotation. We also evaluated the association between prior training with perceived level of comfort with EOL issues, and whether the resident believed in the concept of a "better death." As a quality improvement initiative, we conducted surveys of trainees before and after their rotation in the Yale New Haven Hospital SICU. Prerotation and postrotation surveys were administered to all residents who rotated during the 2016-2017 academic year and the first half of 2017-2018. The survey consisted of 34 questions querying residents on their level of training in EOL care, their comfort with management and discussions in different EOL domains, and their beliefs about what measures would have improved their ability to provide EOL care. Residents surveyed were from general surgery, emergency medicine, or anesthesia departments. Our study demonstrates that there is a significant correlation between resident comfort with EOL communication and experience providing EOL care. However, concepts in medicolegal aspects of palliative care could be taught through formal didactics, and structured training may allow residents the opportunity to reflect on the importance of a "better death."

Radiation oncology resident education in palliative care.

Palliative and supportive care education for radiation oncologists in training is essential to deliver comprehensive care to patients. Surveys on palliative care education among radiation oncology program directors and residents demonstrate a disparity in formal teaching and didactics. Integration of formal didactics, communications skills programs, and teaching modules are being piloted at academic centers. A dedicated palliative radiation oncology service has been implemented and the experience evaluated. Future directions to improve resident education in palliative care include improving access and time dedicated to formal didactics, online and interactive modules, rotation in a palliative care service, emphasis on board examinations, and consideration of an advanced palliative care fellowship for radiation oncologists. This is the first review of the available literature reviewing formal palliative education in radiation oncology training programs in the United States.

Engaging Medical Students in Leadership Development.

Leadership development plays a critical role in preparing collaborative, systems-based physicians. Medical schools across the globe have dedicated significant effort towards programming for medical student leadership development. Students report a variety of existing leadership opportunities, ranging from formal didactics to leadership positions within the community. Students identify lack of time, funding, and the hierarchy of medicine as significant barriers for engaging in leadership opportunities. Students favor a formal leadership curriculum coupled with hands-on opportunities to practice leadership skills. In order to train medical students to be engaged physician leaders, it is imperative to foster practical opportunities for leadership development.

Palliative Care Education in U.S. Adult Neuro-Oncology Fellowship Programs (S854)

1.Describe the current need for palliative education in neuro-oncology fellowship programs as identified by program directors.2.List the preferred education methods and tools of neuro-oncology fellowship program directors for teaching palliative care to fellows.3.Know which barriers program directors face when providing palliative care education for neuro-oncology fellows. Palliative care (PC) for patients with neuro-oncological diseases positively impacts morbidity and mortality. No studies have evaluated whether neuro-oncology fellows receive formal PC education during fellowship. The purpose of this study was to describe the PC education and identify education needs of US neuro-oncology fellowship programs. Program directors (PDs) of US neuro-oncology fellowships were surveyed. The electronic survey included qualitative and quantitative questions. Of 26 programs fellows, 17 completed surveys (65% response rate) of which 3 (18%) offered no formal PC education. The methods most utilized were formal didactics (seminars/conferences) and self-directed reading materials. One-third of programs have developed their own teaching materials. Communication was the domain identified as most important, the domain fellows were most well-trained in, and the domain PDs felt most comfortable providing for their own patients. Addressing spiritual distress and initiating life-prolonging therapies were the domains PDs identified as being least important, fellows were least well trained in, and PDs were least comfortable providing for their own patients. Most programs (83%) were satisfied with the PC education available at their program. Time for teaching and faculty availability were the most common barriers. Neuro-oncology PDs recognize the need for PC education, which is currently offered in some form by most programs, but the content and methods of delivery are heterogeneous. Interdisciplinary educational teams and nationally-available PC educational material may improve implementation of PC education in neuro-oncology.

Palliative care education in U.S. adult neuro-oncology fellowship programs.

Palliative care (PC) for patients with neuro-oncological diseases positively impacts morbidity and mortality. No studies have evaluated whether neuro-oncology fellows receive formal PC education during fellowship. The purpose of this study was to describe the PC education and identify education needs of US neuro-oncology fellowship programs. Program directors (PDs) of US neuro-oncology fellowships were surveyed. The electronic survey included qualitative and quantitative questions. Of 26 programs with fellows, 17 completed surveys (65% response rate) of which 3 (18%) offered no formal PC education. The methods most utilized were formal didactics (seminars/conferences) and self-directed reading materials. One-third of programs have developed their own teaching materials. Communication was the domain identified as most important, the domain fellows were most well-trained in, and the domain PDs felt most comfortable providing for their own patients. Addressing spiritual distress and initiating life-prolonging therapies were the domains PDs identified as being least important, fellows were least well trained in, and PDs were least comfortable providing for their own patients. Most programs (83%) were satisfied with the PC education available at their program. Time for teaching and faculty availability were the most common barriers. Neuro-oncology PDs recognize the need for PC education, which is currently offered in some form by most programs, but the content and methods of delivery are heterogenous. Interdisciplinary educational teams and nationally-available PC educational material may improve implementation of PC education in neuro-oncology.

Educational Exposure to Transgender Patient Care in Otolaryngology Training.

Gender dysphoria is estimated to occur in over 1 million people in the United States. With decreasing stigma regarding the transgender population, it is likely more patients will seek medical and surgical gender transition as parts of their treatment. However, otolaryngologists may lack training in gender-confirming surgery. This study aims to determine the current state of transgender-related education in the United States otolaryngology training programs and to evaluate trainee perceptions regarding the importance of such training. A cross-sectional survey was performed among the United States otolaryngology training programs. A representative sample of 22 training programs divided within 4 US Census regions completed a cross-sectional 9-question survey between March and May 2017. Respondents were queried regarding demographics, transgender curricular exposure (didactic and/or clinical), and perceived importance of training in transgender patient care. A total of 285 trainees responded (69.3% response rate). Thirty percent of respondents reported education on or direct exposure to transgender care during residency. Among those with experiences in gender-confirming surgery, more than half were exposed to facial (masculinization or feminization) or pitch alteration surgery. Overall, the majority of respondents believed training in gender-confirming surgery is somewhat important and 63.2% supported incorporation of transgender patient care in existing subspecialty fellowship training. Less than one-third of otolaryngology trainees are exposed to transgender patient care. The majority of trainees endorsed the importance of residency and subspecialty fellowship training in gender-confirming surgery. To better serve the transgender population, formal didactics on gender-confirming surgery should be offered.

Assessment of Radiology Training During Radiation Oncology Residency.

A strong foundation in diagnostic imaging is essential to the practice of radiation oncology. This study evaluated radiology training in radiation oncology residency. An online survey was distributed to current radiation oncology residents in the USA by e-mail in 2017. Responses were summarized using frequency and percentages and compared with chi-square test and Spearman's rank correlation when appropriate. One hundred five residents completed the survey. Although most residents felt that a strong knowledge base in diagnostic radiology was moderately or extremely important (87%, n = 90/104), the majority were only somewhat confident in their radiology skills (61%, n = 63/104) and were only somewhat, minimally, or not at all satisfied with their training (79%, n = 81/103). Although there was an association between increasing post-graduate training and confidence level (p = 0.01062, ρ = 0.24959), the majority of graduating residents feel only somewhat confident in radiology skills (63%, n = 12/19). Residents were most commonly exposed to radiology via multidisciplinary conferences (96%, n = 100/104), though only 15% (n = 16/104) of residents ranked these as the most beneficial component of their radiology training and 13% (n = 13/101) of residents felt these were the least beneficial. Most residents (60%, n = 63/105) believe there is a need for dedicated radiology training during residency, preferring monthly formal didactics (68%, n = 71/105) co-taught by a radiologist and radiation oncologist (58%, n = 61/105). Radiation oncology residents feel their radiology training is suboptimal, suggesting a need for more guidance and standardization of radiology curriculum. A preferred option may be monthly didactics co-taught by radiologists and radiation oncologists; however, future studies should assess the effectiveness of this model.

Fellowship training in extracorporeal life support: Characterization and educational needs assessment

PurposeAdult Extracorporeal Life Support (ECLS) use is rapidly increasing. The structure of fellowship ECLS education is unknown. We sought to define current ECLS education and identify curricular needs. Materials and methodsAn anonymous survey with Likert, binary and free response questions was sent to Critical Care Program Directors (CCPDs). ResultsA total of 103 CCPDs responded, a response rate of 31. ECLS training was provided by 64% (66/103) of fellowships. Importantly, 50% (52/103) of CCPDs agreed or strongly agreed that fellows should be competent in ECLS and 70% (72/103) agreed or strongly agreed that ECLS will be an important part of critical care in the next 10years. Only 28% (29/103) and 37% (38/103) of CCPDs agreed or strongly agreed their fellows could independently manage veno-arterial or veno-venous ECLS, respectively. Formal ECLS education was 5h or less in 85% (88/103) of programs. Desired curricular improvements were: simulation 50% (51/103), patient volume 47% (48/103), and didactics 44% (45/103). ConclusionsCCPDs identified ECLS as a critical care skill, but believe that a minority of fellows are prepared for independent practice. Simulation, formal didactics and clinical volume are key needs. These data will guide the development of ECLS curriculum.

Creation and Evaluation of an Anesthesiology and Critical Care Podcast

Podcasts have become an integral part of Free Open Access Medical education. After only 1 year since launching the Anesthesia and Critical Care Reviews and Commentary (ACCRAC) podcast, more than 7000 people were listening to unique content monthly. The study goal was to capture the listeners' views of their use of educational podcasts in general and of the ACCRAC podcast in particular. After institutional review board exempt status was obtained, a request was posted on the ACCRAC site inviting users to participate in an anonymous survey. The cross-sectional survey of listeners included 18 items and was open for 2 months between April and June, 2017. A total of 279 listeners of this podcast responded with a 43% response rate. Of those, 196 (71%) were between the ages of 25 and 34, and 153 (56%) indicated that podcasts were the most beneficial education modality outside formal didactics. About half, 128 (47%), reported using podcasts 1 to 2 times per week, and 88 (32%) listened at least 3 times per week. Listeners indicated that on average they had heard 18 episodes (SD = 11.7, 40 total) in this series, and over 90% reported high levels of satisfaction with the podcast. The popularity of the podcast indicates a clear need for this type of educational modality in anesthesiology. The results suggest that there is a demand for podcasts among learners and that those who listen to podcasts do so frequently and value them because they support multitasking and provide flexible access to pertinent information.

Back to basics – The importance of enterostomal therapy education for general surgery residents

Background and Objectives: General surgery residents' perceived knowledge base and comfort with intestinal stomas and enterostomal therapy are profiled through a national survey. Subjects and Methods: General surgery residents were surveyed to explore the existence of formal didactics and training in ostomy creation and stomal care, to examine the residents' perceived knowledge base of clinical indications for enterostomal care approaches, and to elicit the residents' comfort with performing enterostomal surgeries and managing complications. Results: A total of 734 US residents were surveyed. 218 respondents completed the survey (30%): 40% Northeast, 22% Midwest, 22% South, 16% West, and 82% with direct university affiliation. Only 12% experienced formal enterostomal therapy training and only 15% attended related lectures. Most (86%) routinely worked with enterostomal therapists. Only 11% of chiefs felt “very confident” in their knowledge base of clinical indications for enterostomal care, and 61% felt “very comfortable” with surgical procedures of ostomy creation and closure. Merely 4% of all residents felt “very comfortable” dealing with common ostomy complications. Conclusions: In an era of surgical subspecialization and advanced nursing practice in enterostomal therapy, general surgery residents lack confidence in their knowledge base and comfort when approaching enterostomal therapy and stomal complications. US resident education should be reformed to enhance training in these fundamental principles essential to general surgery practice.

Resident Practices Regarding Prenatal Contraceptive Counseling

OBJECTIVE: Prenatal contraceptive counseling has been associated with effective postpartum contraceptive use; therefore, proper training in providing this service is paramount. The purpose of this cross-sectional study is to determine obstetrics and gynecology (ob-gyn) residents' prenatal contraceptive counseling practices. METHODS: Data were obtained via anonymous surveys completed by University of Texas, Medical Branch in Galveston (UTMB) ob-gyn residents. RESULTS: Twenty-one of 25 residents (84%) completed the survey. Five (20%) PGY-1, seven (28%) PGY-2, five (20%) PGY-3, and four (12%) PGY-4 residents participated. With regards to prenatal contraceptive counseling practices, 11 (52%) reported initiating prenatal contraceptive counseling in the third trimester or later, 20 (95%) described spending 10 minutes or less on contraceptive counseling during all prenatal care, and nine (43%) respondents reported counseling about all four major contraceptive categories (oral pills/patches/rings, injections, long-acting reversible contraceptives/IUDs/implant, and sterilization). When asked for reasons for not doing prenatal counseling, residents cited either time-constraints and simply forgetting to counsel. One-third of the residents felt that they “miss[ed] some aspects of proper counseling.” Finally, one 3rd year and one 4th year stated they had no formal training in contraceptive counseling, and only four (16%) residents reported formal didactics on contraceptive counseling specific to the prenatal period. CONCLUSION: Prenatal contraception counseling was inadequate in one ob-gyn residency program. Our findings suggest that further research and uniform guidelines regarding resident education on contraceptive counseling are warranted.

Racism as a Unique Social Determinant of Mental Health: Development of a Didactic Curriculum for Psychiatry Residents.

Mental health disparities based on minority racial status are well characterized, including inequities in access, symptom severity, diagnosis, and treatment. For African Americans, racism may affect mental health through factors such as poverty and segregation, which have operated since slavery. While the need to address racism in medical training has been recognized, there are few examples of formal didactic curricula in the psychiatric literature. Antiracism didactics during psychiatry residency provide a unique opportunity to equip physicians to address bias and racism in mental health care. With advocacy by residents in the Massachusetts General Hospital/McLean Psychiatry residency program, the Division of Public and Community Psychiatry developed a curriculum addressing racial inequities in mental health, particularly those experienced by African Americans. Four 50-minute interactive didactic lectures were integrated into the required didactic curriculum (one lecture per postgraduate training class) during the 2015-2016 academic year. Of residents who attended lectures and provided anonymous feedback, 97% agreed that discussing racism in formal didactics was at least "somewhat" positive, and 92% agreed that it should "probably" or "definitely" remain in the curriculum. Qualitative feedback centered on a need for more time to discuss racism as well as a desire to learn more about minority mental health advocacy in general. Teaching about racism as part of required training conveys the explicit message that this is core curricular material and critical knowledge for all physicians. These lectures can serve as a springboard for dissemination and provide scaffolding for similar curriculum development in medical residency programs.

Opinions Regarding Benzodiazepine Teaching and Prescribing Among Trainees in Psychiatry.

Benzodiazepines are widely prescribed for a variety of symptoms and illnesses. There has been limited investigation on the training psychiatry residents receive regarding benzodiazepine prescribing. This study surveyed US psychiatric trainees about their didactic and clinical experience with benzodiazepines, investigating how experience with benzodiazepines may shape trainees' opinions and likelihood to prescribe. The 14-question online survey was distributed to residents and fellows at US training programs through an invitation from their training directors. Of 466 programs contacted, with an estimated 1345 trainees, a total of 97 programs (20.8%) and 424 trainees (31.5%) responded. The analyses focused only on the 342 general psychiatry trainees who responded. Most trainees reported having formal didactics on benzodiazepines, and earlier training was correlated with higher trainee quality of instruction assessments (p<0.01). Most trainees rated their instructors as Above or Well Above Average. Trainees cited the observation and opinion of supervisors as the two most important factors affecting likelihood of future benzodiazepine prescribing. Trainees commonly reported pressure from patients to prescribe benzodiazepines but were split on perceived pressure from supervisors about prescribing and whether a bias exists against prescribing at their program or in general. The survey indicated that psychiatry trainees generally feel adequately trained through didactic and clinical experience with benzodiazepines. Trainees perceived pressure by patients to prescribe benzodiazepines, but generally felt comfortable in managing benzodiazepine usage. Psychiatry attendings' opinions on benzodiazepines most impacted trainees. Influences on trainees' prescribing patterns are important variables that can impact future benzodiazepine prescribing.

An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback

While diminishing nephrology fellow recruitment is a known issue, more work is needed to evaluate possible interventions to reverse this trend. We designed and implemented a curriculum to increase exposure to ambulatory nephrology among internal medicine interns. The curriculum focused on key aspects of outpatient nephrology practice, including supervised clinic visits, formal themed didactic content, and an online interactive forum with assigned evidence-based readings and small-group responses to relevant cases. We obtained postcourse surveys from all participating interns. Of the 43 interns who took part in the first year of the ambulatory nephrology curriculum, 100% reported a positive didactic experience and 91% reported a positive interactive online experience. 77% reported an improvement in their familiarity with clinical nephrology practice (median 2-point increase in familiarity score on a 7-point scale, P<0.001 by signed rank testing). Qualitative feedback included praise for the high-yield topics covered by the lectures and energizing teachers. In conclusion, we successfully implemented an ambulatory nephrology curriculum using a framework that integrated formal didactics, interactive online learning, and key clinical components of outpatient nephrology care. Future investigation will evaluate whether early implementation of this curriculum is associated with increased pursuit of nephrology as a career.