Internal Medicine Residents Research Articles

Implementation and Assessment of a Curriculum for Renal Point of Care Ultrasound (POCUS) Training

Purpose: Renal ultrasound is a non-invasive method to assess for obstructive acute kidney injury (AKI). Point of care ultrasound (POCUS) has been shown to be a good screening tool for obstructive AKI, and with formal training, has high sensitivity and specificity. We aimed to evaluate the effectiveness and feasibility of integrating a novel renal POCUS curriculum into an existing two-week nephrology rotation for internal medicine residents. Methods: We enrolled internal medicine residents rotating on a two-week nephrology rotation between September 2022 and June 2023. Pre-recorded online lectures and a hands-on session on image acquisition were provided. Pre-and post-rotation confidence questionnaires and knowledge tests were collected. At the end of the rotation, participants were evaluated using a skills checklist. Evaluation for knowledge retention was assessed 6–12-months post-rotation with a post-survey and knowledge test. Results: Of the 16 residents that were enrolled, 12 residents completed pre- and post-rotation questionnaires and tests, and 15 residents completed the 6–12-month follow-up. The confidence level showed significant improvement post-test and at 6–12-month follow-up. Knowledge test scores showed a trend towards improvement that did not achieve statistical significance (pre- 6.0 [5.0-7.25], post- 6.5 [5.75-8.0], 6–12-months 7.0 [6.0-8.0] p=0.40). On the skills checklist, an average of 16.8 out of 18 steps were done correctly. Conclusion: Our study showed confidence improvement and a trend towards knowledge improvement after integrating a novel Renal POCUS curriculum into a nephrology rotation. Further iterative changes, such as deliberate practice, or practice with immediate feedback, should be considered.

Inside the November 2024 Issue

Dear Readers, We are thrilled to bring you the second issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. This issue features a variety of POCUS articles from around the world: from North America, South America, Europe, Asia, and even Australia. In addition to novel cases with striking POCUS images and video clips, this issue boasts a great deal of educational research at all levels: Danila et al. (page 80) report on their study of how POCUS can augment a medical student preclinical cardiovascular course while Piro et al. (page 93) studied the impact of just-in-time POCUS curriculum on internal medicine residents; Janjigian et al. (page 109) studied the longitudinal impact of a faculty POCUS training course. POCUS is a powerful tool with a wide range of applications: for example, it can be used both to diagnose musculoskeletal conditions (Doblinger et al. page 15 and Mack et al. page 27) and to treat musculoskeletal conditions (Bowling et al page 12, and McCreary et al. page 30). POCUS can also be used to predict heart failure readmission (Malagón et al. page 125). We are so excited to showcase pivotal POCUS scholarship like this in the November issue. I hope you enjoy this issue of POCUS Journal as much as I have. A huge thank you to our authors, editorial board, and publisher. Sincerely , Benjamin T. Galen, MD Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

Abstract 4135265: When the Beat Drops: A Pilot Project for a Case-Based Resident’s Guide to Cardiovascular Care

Residents care for patients with a vast array of cardiovascular (CV) diagnoses in settings ranging from primary care clinic to the cardiac intensive care unit. However, the resources available are mainly intended for advanced cardiology trainees. We created a resident-driven, case-based reference for residents to serve as a companion to traditional CV medicine educational resources. Methods: We surveyed residents, fellows, and cardiology attendings to identify topics within CV care for which residents are responsible. We recruited residents from multiple ACGME-accredited Internal Medicine residency programs to write a chapter on each identified topic that would be published on a central website. The chapters included a topic overview with key learning points, a case presentation, review questions, attending pearls, and high-yield articles for further reading. Chapters were reviewed for accuracy and completeness by cardiology fellows, pharmacologists, and attendings. The chapters were sent out to residents weekly via email and through social media platforms. Website analytics were used to track usage and monitor engagement. Each chapter concluded with a brief survey regarding learning gains, comprehension, and if the reader would recommend the resources to others. Results: A total of 52 cases were submitted by resident contributors from four residency programs. Topics included management of arrhythmias, structural heart disease, ischemia, cardiogenic shock, and post-procedure complications. Within the first two months of publication, the website was being accessed throughout 30+ states and 6 countries with more than 2,500 views and 1,500 unique visitors. Topics with high traffic included chapters regarding arrhythmias and post-procedural complications. The website was viewed throughout the entire day with no specific time pattern; however, there were significantly more views on days when each chapter was released via email and social media. Preliminary survey results show that residents and other trainees find this resource useful, and many want to get involved and help create more content. Conclusion: Our resident-created and cardiologist reviewed website is a unique resource created for residents caring for patients with CV disease. Using email and social media marketing has allowed this resource to be widely accessible to a large global audience. Survey feedback suggests the importance of this resource and need for continued CV resources for trainees.

Abstract 4133830: Uncovering the Gaps: Analyzing Prescribing Patterns of Combination Therapy with SGLT2-inhibitors and GLP-1 Receptor Agonists in Established Atherosclerotic Cardiovascular Disease (ASCVD) and Type 2 Diabetes (T2DM)

Introduction: Combination therapy with SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA) reduces major cardiovascular events (MACE) and improves HbA1c, blood pressure, weight, and renal disease progression. The European Society of Cardiology recommends this therapy for ASCVD and T2DM, independent of HbA1c. This study evaluates prescribing patterns in the Internal Medicine Residency Clinics for patients with ASCVD and T2DM. Aims: To investigate demographic and social determinants of health (SDOH) influencing the prescription of combination therapy versus no therapy in an outpatient population and identify factors affecting prescribing patterns and guideline adherence. Methods: We reviewed 828 electronic records of T2DM and ASCVD patients from March 2024. Patients were grouped into combination therapy (SGLT2i and GLP1RA) and no therapy groups. Data on demographics (Table 1) and SDOH (Table 2) were analyzed. Patients on monotherapy or those who did not complete the SDOH questionnaire were excluded. Descriptive statistics were used to summarize demographics. Welch’s t-test compared continuous variables, and chi-square or Fisher’s exact tests compared categorical variables. Analyses were done with SAS 9.4 with significance at 0.05. Results: Age significantly differed between groups (t = 4.56, p < .05), with older patients less likely to receive therapy. Sex was also significant (p < .05); more females were in the no therapy group. No significant association was found between SDOH and combination therapy (p > .05). Conclusion: Over 90% of patients with T2DM and ASCVD were not on optimal medical therapy to reduce MACE, with nearly half on no medications. This highlights the need for increased awareness and targeted interventions to improve outcomes. Future research will explore insurance status and physician awareness to address prescription discrepancies. Limitations: Patients with a GFR <30 are precluded from SGLT2i usage but were not excluded from this study.

Abstract 4136636: Analysis of Racial Disparities in the Training Path to Cardiology: Trends from 2012 to 2022

Introduction: Substantial evidence indicates that racial and ethnic diversity among the physician workforce bridges cultural gaps and improves patient care. Trends in racial diversity across the full training pipeline from undergraduate to practicing cardiologist are not yet well-characterized. Aims: We analyze racial disparities at each stage of training towards becoming a practicing cardiologist, and identify changes in these disparities between 2012 and 2022. Methods: We conducted a retrospective analysis of data specifying the racial composition of medical trainees acquired from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and Electronic Residency Application Service. Population data was acquired from the US Census Bureau. We computed the representation quotient (RQ) for each racial group at each stage to compare representation among the trainees or physicians to age-matched segments of the US population. Results: RQ decreases from undergraduate to active cardiologist for African Americans (0.719 to 0.314), Hispanics (0.660 to 0.359), American Indians (0.551 to 0.221), and Native Hawaiians (1.121 to 0.512). The lowest RQs of 0.133 and 0.137 were observed for American Indian active internal medicine residents and cardiology fellows, respectively. Racial disparities in medical education declined between 2012 and 2022, with RQs increasing from 0.541 to 0.735 for African American medical school matriculants and from 0.444 to 0.578 for Hispanic medical school matriculants. Similar increases were seen in the active cardiologist population for African Americans (2013 RQ: 0.227, 2022 RQ: 0.342) and Hispanics (2013 RQ: 0.283, 2022 RQ: 0.375). Conclusion: While racial diversity in the cardiology training pipeline has increased over the last decade, significant disparities persist for under-represented minorities. Addressing these barriers will help achieve a cardiology workforce reflective of the diverse population it serves.

Gauging Medical Students' Interests in Infectious Diseases.

Infectious diseases is a crucial specialty in medicine, yet applications for fellowship have declined even as the United States faces an imminent shortage of infectious disease physicians. Career interests often develop in medical school, but little is known about which interests and experiences are associated with interest in ID. Evaluate interest in ID among medical students and identify factors associated with interest and disinterest in ID careers. We developed a 26-question survey to gauge interest in infectious diseases (ID). All 16 medical schools in Texas were contacted and invited to participate. A total of 262 students across 9 medical school campuses completed the survey. Those interested in ID as a career had a significantly higher interest in public health (p<0.0001) and global (p<0.0003) health. The presence of an ID campus interest group (p<0.0015) and direct experience with the ID profession (p<0.0001) were also associated with interest. The most common reasons for lack of interest were lack of interest in pursuing internal medicine or pediatric residency, lack of compensation, and lack of procedures. Those interested in ID expressed interest in a wide variety of career pathways within ID, the most common being general inpatient and outpatient ID, as well as medical microbiology and global health/tropical medicine/travel medicine. Based on this survey, recruitment efforts for new ID fellows might include focusing on students with interests in public and global health, as well as increasing direct exposure to ID at the medical school level.

Exploring Factors Influencing US Medical Students’ Choice of Internal Medicine Residency

Exploring Factors Influencing US Medical Students’ Choice of Internal Medicine Residency

Work-Family Conflict Among Resident Physicians: A Comparative Analysis of Surgical and Internal Medicine Specialties

Aims: To investigate whether there is a difference in work-family conflict between surgical and internal medicine residents and to determine the factors associated with work-family conflict Materials and Methods: A cross-sectional, questionnaire-based survey study was conducted with 443 resident physicians working at a university hospital. A form about demographic data and a Turkish version of the Work-Family Conflict Inventory (WFCI) were used to gather data during in-person interviews. Results: Three-hundred-forty-eight residents responded (76.8%). Weekly working time was significantly more in surgical medical sciences (SMS) residents than in internal medicine sciences (IMS) residents (62.3±13.8 vs 53.2±13.6 hours respectively, p

Evaluating the impact of structured POCUS training during internal medicine clerkship and residency training

Background: Point of Care Ultrasound (POCUS) is a vital tool in rheumatology for detecting pathologies like osteophytes and joint effusion. Its integration into rheumatology electives during internal medicine clerkship and residency is limited, despite its emphasis in pre-clinical years. Methods: In this QIRB-approved, single-center, prospective study (2022–2023), third- and fourth-year medical students and internal medicine residents in a two-week rheumatology elective voluntarily completed online surveys. These surveys assessed their confidence using POCUS in rheumatology, using a 5-point Likert scale. Results: A survey of 25 residents and 10 medical students found that 84% of residents and 90% of students rated POCUS training as valuable or very valuable. Both groups felt more confident identifying knee joint effusion (average scores: 3.5 for students, 2.6 for residents) compared to other ultrasound techniques and pathologies. Confidence was lower in hip ultrasounds (2.20 for students, 1.68 for residents) and chondrocalcinosis identification (2.20 for students, 1.76 for residents). Among participants, 28% of residents and 70% of students had prior informal POCUS training. Previous training significantly increased comfort levels, with average scores of 2.86 for students and 2.30 for residents, compared to 2.69 and 1.91 for those without prior training (P-values: &lt;0.001). Conclusion: Prior experience significantly enhances confidence and comfort, reinforcing the need for early, comprehensive, and targeted POCUS training in medical curricula to address proficiency gaps. Keywords: Education, medical, undergraduate, rheumatology, point-of-care systems, ultrasonography

Check, Please! Supervisor-Learner Dyads Using "Checking" for Clinical Support During Indirect Supervision.

Indirect supervision is essential for granting autonomy to learners. Sometimes referred to as leaving the learner "unsupervised," there is growing recognition that learners and supervisors engage in clinical support through ongoing interactions, albeit at a distance. To understand how the complementary activities of asking for and providing clinical support at a distance come together as indirect supervision by identifying the natural language used between learners and supervisors. A collective case study of 15 attending physician-senior medical resident dyads from 2018 to 2023. Each case consisted of 2 full days of ethnographic observation of the resident on an internal medicine clinical teaching unit in one of three metropolitan hospitals; 2 end of day interviews with each dyad member; and a third interview with the attending after the 2-week rotation. Fifteen internal medicine residents (PGY-2 and PGY-3) who were scheduled to work for the first time with 15 attending physicians. Data collection was iterative with deductive and inductive analysis to identify patterns of communication. The language of "checking," such as checkpoints, checking on, and checking in, was central to communications within dyads. Indirect supervision included attendings using scheduled checkpoints and backstage oversight activities to check on the senior resident's patient care while expecting residents to access their support, as needed, by checking-in with them. Residents checked in with their attending to relay patient information updates, ask questions, and hint at needing their plans doublechecked; these communications had similar formats making them difficult to distinguish but functioned to preserve resident independence while accessing clinical support. Indirect supervision creates clinical support through ongoing communication between learners and supervisors at a distance. It is a collaborative process for mutual reassurance that safe patient care is being provided and that support is available when needed.

Large language models in internal medicine residency: current use and attitudes among internal medicine residents

BackgroundArtificial intelligence (AI) uses in healthcare changed dramatically with large language models. While work is underway to integrate generative AI safely and effectively into medical practice, little is known about how resident physicians are already using these tools in their work.ObjectivesTo characterize the current usage patterns and attitudes towards large language models among internal medicine residents in North Carolina.MethodsCross-sectional survey-based study of Internal medicine residents in North Carolina.Results152 of 523 total residents completed the survey (29% response rate). Many identified a role for LLMs in both clinical (56%) and non-clinical medicine (72%) today, although only 26% reported current use. More perceived a future role in clinical (71%) and non-clinical (80%) medicine. None had received formal training, but 94% expressed interest in learning more and 87% thought residencies maybe or definitely should have formal curriculum. Top clinical uses include forming a differential diagnosis, researching treatments, and creating educational materials. Top non-clinical uses included self-directed learning, scientific writing, and summarizing literature.ConclusionsMedical educators and administrators should be aware that residents are using generative AI in professional settings. Residents believe in a current and future role for AI in medicine and desire curriculum and learning opportunities during training.

Patient Panel Handoffs for New Interns in Internal Medicine Residency Continuity Clinics

Patient Panel Handoffs for New Interns in Internal Medicine Residency Continuity Clinics

Process Groups for Supporting Resident Wellbeing: Factors Influencing Resident Wellness amid the COVID-19 Pandemic.

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors.

Effects of a Gender-Balancing Strategy on Resident Panels in a Primary Care Setting.

Patients oftenprefergender concordance when choosing a primary care practitioner. In a trainee setting, this may lead to unequal training opportunities for male and female resident physicians. Residency leadershipmay be interested in ways to promotebalance in patient empanelment. To assess the efficacy of an intervention to equalize imbalance in patient gender on resident primary care panels. Observational cohort study. Categorial internal medicine residents beginning residency in 2020. The panels of internal medicine residents were manually rebalanced at the beginning of training for a new cohort of residents with the goal of having similar numbers of male and female patients on each resident's panel. Panel data was observed for 2 years following intervention. Number of male patients, number of female patients, and overall panel size were compared between male and female residents at baseline, 6 months, and 24 months. The analysis included 28 female residents and 20 male residents. After rebalancing, baseline panels had similar numbers of male patients (median of 50 on both male and female residents' panels; average panel 54.7% male) and female patients (median of 41.5 on female residents' panels and 41 on male residents' panels; average panel 45.3% female). At the end of the follow-up period, a significant difference was observed in the median number of male patients (59.5 and 43.5; p < 0.001) and female patients (33.5 and 48.5; p < 0.001) between male and female residents, but no difference was observed in overall panel size. A steady drift towards gender concordance was observed over 2 years following a rebalancing intervention. Program leadership overseeing primary care empanelment for resident physicians may consider periodic rebalancing of panels in addition to other interventions to ensure equal training opportunities and best prepare residents for future practice.

Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency.

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared to their 4-year MD (4YMD) counterparts. Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies. Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 8.3 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared to all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones. The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.

(Mis)Alignment in resident and advisor co-regulated learning in competency-based training.

In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will "monitor and advise" residents. We sought to clarify how AA-resident dyads collaboratively interpret assessment data from multiple sources, co-create learning goals and action plans and attempt to enhance residents' SRL skills. Shortly after each of their six meetings during two years of Internal Medicine residency, we conducted individual, brief interviews with AAs (N = 10) and residents (N = 10). We analysed transcripts using an abductive framework with theory-based and evidence-based sensitizing concepts. We collected 49 residents and 36 AA 'meeting debriefs', which produced rich data on how dyads variably engaged in SRL and Co-RL. Residents and AAs adopted "learning stances" that oriented their perceptions and approaches to Co-RL. Their stances did not always align within dyads. We found unique patterns in how stances evolved or devolved over time, and in how these changes impacted dyads' Co-RL processes. While some dyads evolved to engage in proactive co-regulation, most stayed consistent or oscillated reactively in their relationships, with little apparent Co-RL focused on helping residents to develop clinical competencies through SRL. We catalogued multiple influential sources of regulation of learning. The conceptually ideal form of Co-RL was not consistently achieved in this well-intended implementation of AA-resident dyads. To better translate 'coaching over time' from intention to practice, we recommend that residency programmes use Co-RL principles to refine CBME processes, including refining assessment tools, resident orientation sessions and faculty development practices.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

9376 Successful Implementation Of Continuous Glucose Monitoring In An Internal Medicine Residency Clinic

Abstract Disclosure: A.E. Manov: None. A. Donepudi: None. A.S. Dhaliwal: None. J. Tam: None. Y. Badi: None. M. Sharaf: None. R. Haddadin: None. A. Wang: None. K. Mefferd: None. Abstract In this 3-year retrospective observational cohort study, data from fifty-one patients with type 1 or type 2 Diabetes Mellitus (DM), receiving a minimum of 3-to 4 insulin injections per day, and self-monitoring their blood glucose (SMBG) 4-times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a Continuous Glucose Monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. In consultation with our endocrinologist, the resident assessed the patients' glucose management data and adjusted their treatment regimens bi-weekly by calling the patients, and monthly by seeing them in the clinic. The rationale of the study which was confirmatory was to show that in the Internal Medicine Residency clinic in a project governed by the medicine residents, the CGM will lead to improvement in diabetes mellitus control compared to SMBG and this can be done not only in specialized endocrine clinics. The inclusion criteria for selecting the patients were as follows: Age-18-90, diagnosis of Type 1 or type 2 Diabetes Mellitus using 3-4 Injections of Insulin per day +/- other per oral antidiabetic medications and SMBG 4 times a day, HbA1c above 7% while using SMBG, patients who can use the CGM device and receive their primary medical care in our Internal medicine Residency clinic.To assess for differences in A1C, TIR, average blood glucose, percent of time spent in mild hypoglycemia, and percent of time spent in pronounced hypoglycemia, five paired t-tests were conducted. A Bonferroni correction set the new accepted alpha level at 0.01. Significant results from the study include a reduction of HbA1c from 9.9% to 7.6%, average blood glucose decrement from 242 mg/dL to 169 mg/dl, reduction of the incidence of mild hypoglycemia below 70 mg/dl to 54 mg/dl from 4.68% to 0.76% per day, and more pronounced hypoglycemia with glucose less than 54 mg/dl from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week.This study affirms that CGM devices significantly improved glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of this kind in a residency clinic in the USA. Presentation: 6/1/2024

6631 A Week With Diabetes: Using Real-Time Continuous Glucose Monitoring In A Simulation Activity With Residents And Fellows

Abstract Disclosure: T. Gallagher: None. C. Donelly: None. R.E. Amori: None. Background: Continuous glucose monitor (CGM) use in managing diabetes mellitus is increasing rapidly. Fellows and residents often prescribe these devices, but most do not themselves have diabetes mellitus and do not use these devices personally. A real-time simulation activity can help physicians in training learn about using the technology in diabetes management and the patient experience living with diabetes mellitus. Objective: Assessing learner’s experiences using a one week real-time CGM simulation. Methods: A real-time simulation using CGM and elements of role playing can enhance knowledge of CGM use and overall diabetes care. Voluntary participants included endocrinology fellows, internal and family medicine residents, and one health professions student. One common structured learning task per day was assigned to all participants over a single seven day period of use in academic year 2022-23. Assessment of each task occurred via personal observations and reflections. Data was collected in an anonymous form and in a group debrief. Results: Eight of 10 participants completed the deidentified post simulation survey and 8/10 participated in the live debrief. Participants reported ease of CGM placement and use. They reported improved insight into the impacts of diabetes on daily activities and increased awareness of diet and exercise impact on glucose levels. Insulin dose calculations were largely correct but errors were seen. All felt the activity was beneficial to their learning. Conclusions: Real-time CGM simulation improves student, resident, and fellow knowledge of the technology and allows the learner to gain insight into a patient’s diabetes self-management. Presentation: 6/3/2024

12242 Enhancing Continuous Glucose Monitor Utilization In Lower Economic Community Hospital Outpatient Clinics: A Quality Improvement Initiative

Abstract Disclosure: V. Mehta: None. S. Deshpande: None. M. Nieman: None. K. Pereira: None. B. Agrawal: None. S.R. Russell: None. Continuous glucose monitors (CGM) measure the blood glucose level (BGL) and have been used for better glucose control, especially in patients requiring insulin. Primary care physicians (PCP) manage diabetic patients on a large scale in the US, especially in rural settings, and data shows that CGMs are prescribed less in PCP settings than in endocrine clinics. Our study aimed to understand internal medicine (IM) residents' knowledge about CGMs and their application in a community hospital outpatient clinic serving lower-economic populations and demonstrates how a clinical pharmacist (PharmD) led educational intervention successfully increased the adoption of CGMs. A survey was done using a form with multiple-choice questions. 50 residents participated and responded anonymously. Data was analyzed by calculating percentages based on answers, providing understanding of their perspectives on CGMs. 78% knew about and correctly identified CGM. When asked to name indications of CGM, answers varied and included uncontrolled diabetes (34%), insulin-dependent diabetes (34%), elderly and non-compliant patients (14%), any diabetic (12%), and others. Only 14% reported to have had formal training in use and interpretation of CGMs, 70% had prescribed, 34% knew how to apply the device, and 42% knew how to interpret the BGL. More than 95% self-reported having either poor/beginner or fair knowledge about the usage, application, and interpretation, whereas more than 80% professed to need more training to be more confident about prescribing the device. After the survey, our PharmD conducted session demonstrating the indications, types, usage, application, and interpretation of CGM. Following this, an impactful increase in patients who were appropriately prescribed and received CGM was observed. Technologies used in medicine have increased, CGM, being one of them. More than 100 million Americans have prediabetes or diabetes, with more than 10 million using insulin. Hence, access to CGM is crucial for patients for better management. Despite the benefits, many factors play a role in limiting their use, including prescription, cost, insurance coverage, social factors, willingness of the patients, discomfort, and decreased knowledge. Non-compliance, difficulty in application and picking the device from pharmacy was also observed in our clinic. A study by Sherrill et al. on use of CGMs (2014-2020) showed that use of CGM increased almost ten times in 2020 (v/s2014); most patients were younger, employed, and had better insurance coverage.With advances in technology, easier and more efficient devices are available to assess patients' glycemic control. Pharmacists play key role in ensuring continued education among practitioners and trainees. Continued efforts to increase awareness is required to ensure that latest advances are adequately incorporated into graduate medical education. Presentation: 6/3/2024