Knowledge Assessment Scores Research Articles

961. Implementing an HIV Ambulatory Curriculum in Internal Medicine Residency Programs

BackgroundThe advancement of anti-retroviral therapy (ART) has transformed HIV into a chronic disease and resulted in prolonging the lives of people living with HIV. Therefore, there is a projected shortage of HIV providers nationally and there is a need for increased training of primary care physicians in management of HIV over the lifespan as well as alongside common comorbidities found in aging HIV population.MethodsThe Yale AIDS program developed an interactive HIV ambulatory curriculum that included a set of didactics and workshops for trainees in internal medicine residency programs. This 3-hour interactive curriculum was implemented in 5 hospitals in Connecticut and was led by experienced HIV providers at the MD and RN levels. Trainees included PGY1, 2 and 3 residents. Knowledge areas encompassed HIV Epidemiology, Testing, ART Treatment, and prevention including Pre Exposure Prophylaxis (PrEP). In addition, 2 role-play sessions were integrated. Pre and Post Test knowledge assessment was evaluated including questions on practice regarding HIV screening and PrEP prescribing.ResultsIn this study, we report the results of knowledge assessments and professional practices administered prior to (pre-) and following (post-) interactive learning sessions.From July 2017 to June 2020, 15 HIV ambulatory curriculum sessions were held, with an average 5 sessions annually. A total of 170 residents attended this curriculum with an average of 10-15 trainees per session and 25% from underrepresented minority group. The pre-test and the post- test knowledge assessment score rates were 51% and 83% respectively with an estimated 63% improvement. A large proportion of trainees reported implementing routine HIV testing (97.2%). However, self-reported willingness to prescribe PrEP was low among residents prior to the educational intervention (12.5%) and increased considerably following education (93.3%).ConclusionFocused interactive HIV curriculum could represent a viable method to improve knowledge and practices in HIV medicine amongst primary care residents. This novel educational intervention has the potential to be disseminated an implemented in other residency programs curricula.Disclosures All Authors: No reported disclosures

Teaching psychiatric pharmacogenomics effectively: Evaluation of a novel interprofessional online course

AbstractIntroductionThe application of pharmacogenomic (PGx) testing to guide psychotropic use is increasing, but there is a lack of training opportunities for health care providers designed specifically around the unique issues impacting the use and interpretation of PGx in psychiatry. Furthermore, providing such education online greatly improves the accessibility of such training.ObjectiveThe objective was to design and evaluate a live online continuing education (CE) course on psychiatric PGx for health care providers.MethodsA multidisciplinary team of experts in psychiatry, PGx, and medical education research designed a three‐session online course to discuss key psychiatric PGx topics ranging from fundamental background material, selecting a test, and interpreting and applying results. A deliberate design of the program was to offer the course three times, in order to allow successive improvements to each iteration. To evaluate the course, pre‐ and post‐surveys were developed with the intent of capturing change in the four Dixon levels of CE evaluation on attendee perceptions and opinions, knowledge and attitudes, and impact on clinical practice and patient outcomes.ResultsIn the third course iteration, 32 health care providers registered. Among survey respondents, the course materials, speakers, organization, and online format were reviewed favorably by the majority of attendees. Perceived knowledge of PGx increased in every identified PGx topic domain and was largely reflected by improved knowledge assessment scores. A limited number of survey participants also indicated changes in clinical behavior and patient outcomes as a direct result of the material covered in this course.ConclusionsAmong survey respondents, this novel online PGx course proved effective at increasing provider understanding and confidence in key psychiatric PGx topic areas. It also demonstrated the viability of the online format, a vital characteristic to allow for future widespread dissemination.

Knowledge and Attitudes of Student Pharmacists Regarding Polypharmacy and Deprescribing: A Cross-Sectional Study.

Pharmacists play a key role in deprescribing medications. Incorporation of this concept into pharmacy school curricula is important in ensuring that graduates can address the complex needs of an aging population. The aims of this study were to assess if and how student pharmacists were exposed to deprescribing within their curriculum, to assess students’ perceptions regarding their attitudes, ability and confidence in deprescribing, and to assess if reported curricular exposure to this topic resulted in improved perceptions or objective knowledge assessment scores. An electronic survey was distributed to third- and fourth-year pharmacy students at 132 schools of pharmacy. The survey included three sections including: (i) demographics and questions on their exposure to deprescribing and other experiences within their curriculum; (ii) questions regarding their attitudes, ability, and confidence regarding deprescribing on a 5-point Likert-scale; (iii) a knowledge assessment on polypharmacy and deprescribing in the form of 12 multiple-choice questions. Likert-scale questions were analyzed as scales utilizing the mean score for items measuring student perceptions regarding deprescribing attitudes, ability, and confidence. Comparisons were made on each variable between students with and without curricular exposure to deprescribing using t-tests. Ninety-one responses were included in the analysis. Only 59.3% of respondents reported exposure to deprescribing in their didactic coursework. The mean scores on the polypharmacy and deprescribing knowledge assessments were 61.0% and 64.5%, respectively. Those with exposure to deprescribing concepts within their curriculum were more likely to agree that their school’s curriculum prepared them to deprescribe in clinical practice (t(89) = −2.26, p = 0.03). Pharmacy schools should evaluate their curricula and consider the addition of specific deprescribing objectives and outcome measures for didactic and experiential training.

Abstract 16673: Empowering Heart Failure Patients Through Technology and Focused Education

Introduction: Heart Failure (HF) patient engagement after hospital discharge is key to preventing readmission and compliance. According to Medicare Hospital Compare the average rate of unplanned readmission is 21.6% Objective: The Rise Above Heart Failure™(RAHF) pilot program was created to identify strategies to reduce the burden of common HF complications and ultimately reduce hospitalization. The pilot included targeted quality improvement strategies, provider engagement, and a redesigned patient journey. Methods: Three North Texas pilot sites received quality improvement consultation and measured their progress towards improved guideline-directed care by tracking the impact to the 1,347 patients discharged with heart failure in Get With The Guidelines®-Heart Failure (GWTG-HF). The RAHF Pilot Program focused on engaging key stakeholders who working in partnership with AHA staff, developed a new patient journey for patients in the pilot. Results: The percent of HF patients who received 60 minutes of heart failure education by a qualified heart failure educator was analyzed and yielded the following results: the program hospitals saw an average adherence of 51.0% in Q2 and 53.9% adherence in Q4 (%Δ =5.8%). Additionally, the pilot program’s average of 50.47% during Q2-Q4 was more than 10% greater than the national average during the same time period. In the outpatient setting, HF PATH app users completed both a pre and post knowledge assessment between Oct 2019 - March 2020. A perfect score on the assessment is 19. The average pre-score for these participants is 16.33, while the average post-score for these participants is 17. Conclusions: Midterm results indicate that the program is successfully increasing HF patient education to increase patient awareness and understanding of HF, as represented by higher adherence to the 60 Minutes of Heart Failure Education measure and positive trends in the HF Path app knowledge assessment scores.

Disparities in fertility knowledge among women from low and high resource settings presenting for fertility care in two United States metropolitan centers

BackgroundFew studies have examined health literacy and fertility knowledge among women from low income, socio-culturally diverse communities presenting for fertility care in the United States. Our study sought to examine demographic predictors of fertility-related knowledge among infertile women from low and high-resource communities in two major metropolitan centers in the United States.MethodsFertility Knowledge Assessments were administered to women presenting for fertility care at county medical centers serving low-resource, largely immigrant patients and to women from largely affluent populations presenting to comprehensive fertility centers in two cities. The influence of demographic predictors on fertility knowledge was examined through regression analysis.ResultsA total of 143 women were included in our analysis. In the county hospital/low resource clinic (LR, n = 70), the mean age was 32.8 ± 6.1 years vs 35.0 ± 5.0 years in the fee-for-service/high resource clinic (HR, n = 73). Among the LR patients, 74% were immigrants, 71% had an annual income <$25,000 and 52% had completed high school. Among HR patients, 36% were immigrants, 60% had an annual income >$100,000, and 95% had some college or above. On average, women from HR settings scored 3.0 points higher on the Fertility Knowledge Assessment than their LR counterparts (p < 0.001). Upon multivariate analysis, education level remained the sole independent factor associated with fertility knowledge assessment score (p < 0.001). Stratifying by resource level revealed that income was highly associated with fertility knowledge (p < 0.01) among high resource individuals even when adjusting for education level.ConclusionsWomen from low resource, largely immigrant communities, seeking fertility care have greater disparities in fertility knowledge and lower health literacy compared to women from high resource clinical settings. Further studies are needed to understand these barriers and to develop targeted inventions to lower disparities and improve care for these vulnerable populations.

The Flipped Classroom: An Innovative Approach to Medical Education in Ophthalmology.

The aim of the study is to report the creation of a flipped ophthalmology course and preclinical medical student perceptions and knowledge gains before and after a flipped ophthalmology course. The form of the study discussed is an observational study. The subjects involved in the study are second-year (U.S.) United States medical students at the University of Miami, Miller School of Medicine (n = 401). Second-year medical students participated in a 1-week "flipped classroom" ophthalmology course geared toward primary care providers at the University of Miami, Miller School of Medicine. Eleven hours of traditional classroom lectures were condensed into 4.5 hours of short videos with self-assessment quizzes, small group discussions, and a large group case-based discussion. Fifty-seven short videos (<9 minutes) focused on major ophthalmology topics and common conditions were viewed by the students at their leisure. Students completed a pre- and post-course evaluation on their perceptions and opinions of the flipped classroom approach. Final exam scores in the flipped classroom cohort were compared with the final exam scores in the traditional didactic format used in years prior. The main outcome measures include: student final exam performance; student satisfaction, opinions, and perceptions. Over the course of 2 years, 401 second-year U.S. medical students participated in the flipped classroom ophthalmology course. The majority of students enjoyed the flipped classroom experience (75.3%) and expressed interest in using the approach for future lessons (74.6%). The flipped classroom videos were preferred to live lectures (61.2%). Over 90% of students stated the self-assessment quizzes were useful, 79% reported that the small group discussions were an effective way to apply knowledge, and 76% cited the large group case-based discussion as useful. Pre-course knowledge assessment scores averaged 48%. Final examination scores in the flipped group (average ± standard deviation [SD] = 92.1% ± 6.1) were comparable to that of the traditional group when evaluating identical questions (average ± SD = 91.7% ± 5.54), p = 0.34. The flipped classroom approach proved to be a well-received and successful approach to preclinical medical education for ophthalmology. This was achieved using 35% less course time than our traditional course. This innovative approach has potential for expansion to other medical schools, medical education abroad, and for other medical school modules.

Advanced Primary Care Orthopedics: Bridging the Gap in Musculoskeletal Education.

Musculoskeletal problems are common in primary care, yet many family physicians lack confidence and competence in this area. The Advanced Primary Care Orthopedics (APCO) course utilizes hands-on physical exam instruction, interactive cases, and intentional repetition to teach anatomy, a standardized exam, and important diagnoses. This study assesses the effectiveness of APCO in improving musculoskeletal exam knowledge and confidence. APCO is a 1.5-day course taught annually to family medicine residents. A 1-day course has also been conducted as a preconference workshop targeting faculty physicians. Participants completed pre- and postcourse assessments to evaluate their knowledge and confidence with the musculoskeletal exam. We compared results using mean differences with paired t-test statistics. In the 2018 and 2019 resident courses, 23 of 30 participants (77%) completed the knowledge assessment and 25 of 30 participants (83%) completed the confidence assessment. Knowledge assessment scores improved by 9.5 points (P&lt;.05) after completion of the course. Confidence in the musculoskeletal exam, as assessed on a 5-point Likert scale (1-not confident at all; 5-very confident), improved from 2.2 to 3.8 after the course (P&lt;.05). In the 2018 preconference workshop, 23 of 36 participants (64%) completed the confidence assessment. Confidence increased from 2.17 to 3.61 (P&lt;.05) after course completion. Participation in the APCO course increased short-term musculoskeletal knowledge and confidence. APCO has many potential applications for residency curricula, faculty development, and continuing medical education.

Are primary care physicians following National Institute of Allergy and Infectious Disease guidelines for the prevention of peanut allergy? A survey-based study.

Background: The 2017 addendum to the National Institute of Allergy and Infectious Diseases (NIAID) guidelines on peanut allergy prevention significantly altered recommendations for patients at risk of developing peanut allergies. It is unknown if primary care physicians are aware of or are following these guidelines. Objective: To assess the knowledge and practice of the NIAID guidelines among primary care physicians. Methods: A survey was developed to assess the knowledge, awareness, and practice behaviors of the NIAID guidelines. It was distributed to pediatric, family medicine, and medicine-pediatric residents and attending physicians at two large academic centers. Responses were analyzed with binary logistic regression. Results: The survey was distributed to 605 providers, with a response rate of 35% (n = 210). The average score was 4.8 of seven questions answered correctly. Of the participants, 53% incorrectly recommended at-home peanut introduction in patients with egg allergy. In addition, 40% of the participants incorrectly believed that the earliest age for peanut introduction was >1 year of age. More than half of the participants were unaware of the new guidelines. On logistic regression, factors associated with adequate knowledge assessment scores were awareness of the guidelines (odds ratio [OR] 2.98 [confidence interval {CI}, 1.34-6.60]), graduation from residency within 5 years (OR 3.60 [95% CI, 1.14-11.35]), and affiliation with the medicine-pediatrics department (OR 4.59 [95% CI, 1.07-19.65]). Conclusion: The primary care providers incorrectly answer one-third of the questions related to the prevention of peanut allergy. Increasing awareness of the 2017 NIAID guidelines may provide an opportunity to improve patient outcomes. There is an urgent need to develop innovative education strategies to publicize these guidelines.

The Implementation of Peer‐led Anatomy Review Sessions for USMLE Step 1 Examination Preparation

Medical residency programs place significant emphasis on USMLE Step 1 scores when determining which students to invite for interviews and when ranking candidates for residency positions. While Brody School of Medicine (BSOM) students have historically scored at or above the national Step 1 average, discipline‐specific data revealed that the same students consistently performed below the national average in the area of gross anatomy and embryology (GAE). This below average performance may be attributed to the time lapse between completion of GAE coursework in the first year of medical school and when students sit for the USMLE Step 1 examination prior to the start the third year of medical school. To bridge the time gap, peer‐led GAE review sessions were created for second‐year medical students preparing to take the USMLE Step 1. These sessions focused on high‐yield, clinically correlated GAE topics, specifically in the upper and lower extremities, including nerve lesions and musculoskeletal injuries. Pilot study data were used to optimize session logistics prior to deployment in spring 2019. This study describes the implementation of these revised peer‐led GAE laboratory review sessions, assesses effectiveness of session on GAE knowledge acquisition, and evaluates student perceptions of the review sessions. Two, 60‐minute, peer‐led gross anatomy laboratory review sessions were offered to all BSOM second‐year medical students. Session 1 and 2 reviewed high‐yield upper extremity and lower extremity gross and clinical anatomy topics, respectively. Both sessions were offered in six time blocks and limited to 8 students (n= 33) per time block. Of the 33 participants, 30 took part in both sessions. Each session included a pre‐session knowledge assessment, a clinically‐focused interactive chalk‐talk, hands‐on prosection laboratory stations, and a post‐session knowledge assessment. Each session was facilitated by the same near‐peer teacher for consistency in delivery. The pre‐ and post‐session knowledge assessments consisted of 4–6 multiple‐choice, board‐style examination questions focused on content delivered during the session. Participants were asked to complete a survey, designed to assess learner perceptions of the review, both immediately after the review session and after completion of USMLE Step 1—approximately two months after the sessions. Average knowledge assessment scores improved by 57.1% and 68.4% following the upper and lower extremity review sessions, respectively. Participants perceived the review sessions positively, with 77.7% reporting improved confidence with musculoskeletal content. Additionally, 88.8% reported increased comfort answering anatomy board‐style questions, and that the sessions were an efficient use of study time. Results suggest that near‐peer‐led review sessions improved medical student knowledge, confidence and comfort with the presented content. Future studies will examine the effect of participation on discipline‐specific performance on Step 1. Improved scores could support the development and delivery of additional peer‐led basic science review sessions during dedicated Step 1 study time.

Transferability of a diabetes escape room into an accelerated pharmacy program

Background and purposeEducational games can be used to increase students' knowledge of diabetes management. Students perceive educational games to be valuable learning tools. This study evaluated the transferability of a serious game, the diabetes escape room, between skills laboratories in a traditional program and an accelerated program. The authors believe that this is a valuable addition to educational methods for students in any pharmacy program. Educational activity and settingFaculty at an accelerated, three-year pharmacy program replicated a diabetes escape room previously used by a traditional, four-year pharmacy program. The diabetes escape room required students to compete in a team-based educational game in which they solved diabetes-themed puzzles. Students completed pre- and post-game knowledge assessments and a perception survey linked to activity participation. The accelerated program students completed an additional delayed post-game knowledge assessment. FindingsStudents showed a statistically significant difference between pre- and post-game knowledge assessment scores at both institutions as well as in the delayed post-game knowledge assessment implemented at the accelerated program. Perception survey results were statistically significantly higher for the accelerated program, however both cohorts suggested positive perceived engagement with and usefulness of the escape room. SummaryThe use of a diabetes escape room resulted in statistically significant gains in knowledge and positive student perceptions. The diabetes escape room is a transferrable activity that can be used by other colleges or schools of pharmacy.

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

BackgroundWe describe an on-site clinical mentoring program aimed at improving emergency obstetrical and new-born care (EmONC) in Nepal and assess its effectiveness on nurses’ knowledge and skills. In Nepal, both the maternal mortality ratio (MMR, 239/100,000 live births) and the neonatal mortality rate (NMR, 21/1000 live births) were among the highest in the world in 2016, despite impressive progress over recent decades considering the challenging environment.MethodsFrom September 2016 to April 2018, three experienced nurses conducted repeated mentoring visits in 61 comprehensive or basic EmONC centers and birthing centers located in 4 provinces of Nepal. Using updated national training manuals and teaching aids, these clinical mentors assessed and taught 12 core EmONC clinical skills to their nurse-mentees. Clinical mentors worked with management mentors whose goal was to improve the nurses’ working environment. We assessed whether the cohort of nurse-mentees performed better as a group and individually performed better at the end of the program than at baseline using relevant tests (chi-square test, Wilcoxon matched-pairs signed-rank test, and Kruskal-Wallis equality-of-population rank test).ResultsIn total, 308 nurses were assessed, including 96 (31.2%), 77 (25.0%) and 135 (43.8%) who participated in all three, two or only one mentoring session, respectively. In total, 225 (73.0%) worked as auxiliary nurse-midwives (ANMs), while 69 (22.4%) worked as nurses. One hundred and ninety five (63.3%) were trained as skilled birth attendants, of which 45 (23.1%) were nurses, 141 (72.3%) were auxiliaries and 9 (4.6%) had other positions. The proportion of ANMs and nurse-mentees who obtained a knowledge assessment score ≥ 85% increased from 57.8 to 86.1% (p < 0.001). Clinical assessment scores increased significantly for each participant, and therefore for the group. SBA-trained mentees had better knowledge of maternal and new-born care and were better able to perform the 12 core clinical skills throughout the program.ConclusionsOur study suggests that on-site clinical mentoring of nurses coupled with health facility management mentoring can improve nurses’ clinical competences in and performance of maternity and new-born care. Assessing evidence of impact on patient safety would be the next stage in evaluating this promising intervention.

Impact of the RESPOND Toolkit on community pharmacists’ opioid safety attitudes, self-efficacy, and knowledge

ObjectivePharmacists are well positioned to reduce risks from opioid-prescribing but often lack resources and training to effectively support these activities. The Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit is an educational package developed to provide community pharmacists with a comprehensive education program and practice resources on prescription drug misuse, prescription drug monitoring programs (PDMPs), and naloxone dispensing. Our objective was to evaluate the effectiveness of the RESPOND Toolkit to improve pharmacists’ knowledge and assess changes in pharmacists’ attitudes and beliefs toward opioid use disorder (OUD) and PDMPs across a diverse pool of Oregon community pharmacists. MethodsPharmacists were recruited using an electronic mailing list of Oregon-licensed pharmacists. Pharmacists were asked to complete a preintervention survey, 3 online educational modules with pre- and post-module quizzes (optional), and a postintervention survey. Data were analyzed using paired t tests, chi-square analyses, and effect size calculations (Cohen’s d). ResultsA total of 131 pharmacists completed the 3 educational modules and postintervention survey. Respondents were aged 37.6 ± 11.0 (mean ± SD) years and mostly frontline pharmacy staff (n = 86; 65.6%) with 10.5 ± 11.6 years of pharmacy experience. Pharmacists’ knowledge and attitudes toward OUD, perceived behavioral control to address OUD, resources to address OUD, and perceptions regarding PDMP-associated difficulties improved significantly as a result of the intervention (all P < 0.001). In addition, 120 pharmacists completed the optional module quizzes, and aggregate knowledge assessment scores improved significantly (P < 0.001). ConclusionThe RESPOND Toolkit is an effective and scalable training resource for community pharmacists, with the potential to promote behavioral shifts that support opioid safety among patients. The results demonstrated improved attitudes, knowledge, and perceived behavioral control. Future work on the RESPOND Toolkit should evaluate the effect of implementation on pharmacist clinical activities and dispensing outcomes.

A Community-based Intervention Study to Assess the Effectiveness of Awareness Imparted on Earthquake Preparedness among the Residents of South Delhi, India.

Background:New Delhi is located in seismic zone IV, and the occurrence of earthquake is fairly common. Previous disasters have shown that only sustained and timely action to reduce risk can prevent or mitigate the impact of a disaster.Objectives:The objective was to assess the knowledge and preparedness regarding earthquake among the residents of South Delhi and to impart the awareness and assess the effectiveness of the awareness imparted.Methodology:One group pretest–posttest quasi-experimental research was done among 300 respondents on earthquake preparedness.Results:As per the study, 89% of participants felt that earthquake is a concern for Delhi. It was observed that majority of the population are not prepared to handle large scale disaster. Significant association was found between pretest and posttest knowledge assessment scores of the study population.Conclusion:Disasters due to their unpredictable occurrence are difficult to tackle, but awareness and preparedness to face the calamity will help to reduce the burden of disaster.

Using immersive simulation to engage student learners in a nonsterile compounding skills laboratory course

Background and purposeAlthough immersive simulation has been applied successfully in multiple pharmacy education settings, none have been used thus far in nonsterile compounding. The objective of this study was to increase student knowledge and confidence when compounding a natural nonsterile product during an immersive simulation. Educational activity and settingThe immersive simulation activity was taught over two weeks in a third year advanced nonsterile compounding elective. The first week focused on the extraction of an active ingredient from yarrow, a natural product. The second week immersed the students into an apocalypse simulation to compound a product using the concentrated yarrow extract for a patient who developed a dental infection, using limited resources and supplies. Knowledge and confidence changes were assessed with a pre- and post-assessment. Students' compounded nonsterile products were assessed with the course rubric. Student feedback on the activity was obtained with two open-ended questions. FindingsAll 30 students extracted the active ingredient from yarrow leaves and created a unique mouthwash scoring an average (SD) of 8.1 (1) out of 10 points on their graded compounded product. There was a significant increase in the overall knowledge assessment score. All student confidence assessment questions increased on the post-assessment. Student feedback was overwhelmingly positive for the immersive simulation. SummaryAn immersive simulation improved students' overall knowledge and confidence in compounding a natural nonsterile product. Schools can utilize a similar approach to teach compounding skills for emergency preparedness.

Palliative Care–Related Knowledge, Attitudes, and Self-Assessment Among Physicians in Vietnam

ContextPalliative care is rarely accessible in low- and middle-income countries, and lack of adequate training for health care providers is a key reason. In Vietnam, the Ministry of Health, major hospitals and medical universities, and foreign physician-educators have partnered to initiate palliative care training for physicians. ObjectivesTo measure the baseline palliative care–related knowledge, attitudes, and self-assessment of Vietnamese physicians as a basis for curriculum development and to enable evaluation of training courses. MethodsBefore palliative care training courses in Vietnam from 2007 to 2014, we collected data on the participating physicians' demographics, self-assessed competence in palliative care, and palliative care–related knowledge and attitudes. Scores were calculated in three outcome categories—knowledge, attitudes, and self-assessment—and in two subcategories related to physical and psychological symptoms. Associations between the demographic, education, and practice factors and these scores were assessed using linear regression. ResultsAmong the 392 physicians surveyed, concern about untreated suffering was highly prevalent. 85% felt that most patients with cancer in Vietnam die in pain. On self-assessment, only 8% felt adequately trained in palliative care and the mean knowledge assessment score was 44%. Although 77% had prescribed an opioid in the past year and most had appropriate attitudes toward the use of morphine for pain, the majority reported explicit or implicit restrictions on prescribing morphine. ConclusionThere is a great need among Vietnam's physicians for training in palliative care and especially in nonpain and psychological symptom control. Rational, balanced, and clear opioid-prescribing policies are needed to enable physicians to treat pain without fear of repercussions.

Knowledge and socio-demographic profile of Anganwadi workers in Mangalagiri rural Integrated Child Development Services project, Guntur

Background: Integrated Child Development Services (ICDS) today represents one of the world’s largest programmes for early childhood development. The Anganwadi workers and Anganwadi Helpers are the grass root level functionaries responsible for delivery of services.Methods: A field based cross sectional observational study was conducted in Mangalagiri rural ICDS project to assess the knowledge levels and the socio-demographic profile of the Anganwadi workers, all the Anganwadi workers who are working in Mangalagiri rural ICDS project area have been included in the study.Results: Out of 212 AWWs, majority of AWWs were from the age group of between 30-49 years; 123 (58%) AWWs have education qualification from 6th class to 10th class standard and 135 (63.7%) workers had an experience of more than 10 years. About 142 (67%) AWWs had a good knowledge assessment score. They had best knowledge about immunization (96.7%), referral services (93.4%), growth monitoring (82.5%), health check-ups (75.1%) and nutrition and health education (70%). AWWs complained problems like infrastructure related, excessive work overload and record maintenance.Conclusions: The majority of the AWWs are in the age group of 30 to 49 years. More than half of them belong to lower middle socio-economic class. Maximum number of workers has experience of 10 years or more. All the AWWs in our study had 50% and above knowledge about Anganwadi services. Best knowledge is seen regarding immunization followed by referral services. Least knowledge is seen regarding supplementary nutrition. Major problems reported were excess work and record maintenance.

647-P: Role of Diabetes Educators in Providing Insulin Pump Training for School Nurses and School Physicians—Kuwait Experience

Objective: to investigate the impact of basic insulin pump training for school nurses and physicians on knowledge and confidence in caring for type1 diabetes[T1D] students using insulin pump therapy [IPT]. Methods: In groups of 15 healthcare professionals, a pediatric diabetologist and 3 diabetes educators (who are certified pump trainers) provided basic pump training for 137 healthcare providers, who were novice to IPT. For a duration of 4 hours, the training included 2 interactive lectures about IPT, management protocols of hyperglycemia, hypoglycemia and ketosis, followed by hands-on insulin pump workshop. Pre and post knowledge assessment about IPT management was performed using a 10-item knowledge questionnaire. Pre and post confidence level were assessed with a 9-item questionnaire using Likert’s scale T. Results: 62 school nurses (7males) mean age 41.5 ± 11.7, with school experience of 8.8 ± 9.1 y and 75 school physicians (13 males), mean age 36.25 ± 6.2, with school experience 3.4 ± 1.5 y; attended the mentioned training. Pre and post knowledge assessment and confidence level scores were compared using Pearson’s correlations. Significant improvement in knowledge were found for both schools' physicians (r=0.007) and nurses (r=0.01). Additionally, significant improvement in confidence in caring for T1D students on insulin pump were found for both school physicians (p-value=0.047) and school nurses (p-value=0.018). Conclusion: Pre-assessment showed the lack of knowledge and low confidence of school healthcare professionals about IPT. Significant improvement in knowledge and confidence in caring for T1D students who are on IPT resulted from the delivery of these workshops, which proved the effective role of diabetes educators to pump the knowledge and skills and enhanced their confidence in providing essential management for students at schools. Disclosure Z. Rahme: None. N. Mesbah: None. F. Aljaser: None. E. Saad: None. N.A. Taha: None.

A model to predict NAPLEX outcomes and identify students needing additional preparation

IntroductionStudies have been conducted to identify factors that may predict North American Pharmacist Licensure Examination (NAPLEX) outcomes, but there is no proposed single or combination of predictors that can be implemented reliably in academia. We aimed to develop a NAPLEX outcomes predictive model that could be practical, measurable, and reliable. MethodsThe study cohort consisted of students who graduated from 2012 to 2016 who had taken NAPLEX and whose first-attempt examination scores were available to the school of pharmacy. Students were considered to have poor performance on NAPLEX if they received an overall score of less than or equal to 82. Linear and logistic regression analysis were utilized to identify independent predictors. ResultsSeventy of 433 (16.2%) students were identified as poor performers. Independent factors that were associated with a poor outcome on NAPLEX were: age >28 years at graduation, Pharmacy College Admission Test scaled score <74, High Risk Drug Knowledge Assessment score <90, third-year Pharmacy Curriculum Outcome Assessment scaled score <349, and grades of <74 in more than three courses. These predictors were utilized to stratify students into four risk groups: Low, Intermediate-1, Intermediate-2, and High. Mean NAPLEX scores for these groups were 106.4, 97.4, 87.1, and 75.1, respectively. ConclusionsThe model can be used as a practical tool to identify students who are at risk for poor performance on NAPLEX. Four of the five predictors in the model could be generalizable to other schools of pharmacy.

Simulation-Based Education for Urgent Medical Complications Common to the Rehabilitation Setting: An Educational Program for Physical Medicine and Rehabilitation Residents.

Simulation technology is being increasingly adopted into medical education and is consistently associated with positive effects on knowledge, skills, and patient-related outcomes. There is little evidence on the use of simulation technology for the instruction of urgent medical complications to physical medicine and rehabilitation (PM&R) residents. To examine whether a simulation-based educational program can improve PM&R resident confidence and knowledge in the assessment and management of urgent medical complications. Pretest-posttest design. Academic freestanding acute inpatient rehabilitation hospital. Twelve Post-Graduate Year (PGY)-2 PM&R residents at the start of the academic year. Residents completed an integrated didactic and simulation-based curriculum on the assessment and management of five urgent medical complications: seizures, agitation, ventricular assist device (VAD)-associated complications, sympathetic storming, and autonomic dysreflexia. Simulations were conducted using a high-fidelity manikin. Surveys and knowledge assessments were completed at baseline and immediately following training. Survey responses were recorded on a Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Multiple-choice knowledge assessments were scored out of 100%. Within-group differences from baseline to postintervention were analyzed. There was a positive correlation between baseline experience and baseline confidence scores (r = 0.877). Improved confidence was demonstrated in the assessment and management of all five topics (P < .05). Knowledge assessment scores significantly improved from 57.8% (95% confidence interval [CI] 50.6% to 65.4%) at baseline to 85.0% (95% CI 81.6% to 88.4%) following the course (P < .001). The education program was rated highly by both learners (mean satisfaction score, Likert score [LS] = 4.6) and instructors (mean satisfaction score, LS = 4.5). Application of a simulation-based educational model to the instruction of urgent medical complications to PM&R residents resulted in increased knowledge with added benefits of confidence building and high levels of enjoyment. II.

Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model

BackgroundTraditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning.MethodsThe intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted.ResultsLecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3–6, maintained at 31% through months 6–12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site.ConclusionWe demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.