Lack Of Protected Time Research Articles

Learning experiences from an online QI fellowship programme during COVID-19 – a qualitative study

BackgroundDuring the COVID-19 pandemic in the United Kingdom, multiple aspects of everyday human existence were disrupted. In contrast, almost all levels of educational learning continued, albeit with modifications, including adaptation to virtual—or online—classroom experiences. This pedagogic transition also occurred in the National Institute of Health and Care Research Applied Research Collaboration Northwest London’s (NIHR ARC NWL) Improvement Leader Fellowship, an annual programme focusing on quality improvement (QI). This qualitative study aimed to understand how these changes impacted the Fellows’ learning experience.MethodsWe explored the experiences of two cohorts of programme Fellows (n = 18, 2020–2021 and n = 15, 2021–2022) with focus groups, analysed under a constructivist qualitative research paradigm.ResultsThe two primary and four sub-themes that emerged were: Online QI learning experience (benefits and challenges) and Implementing online QI learning (facilitators and barriers). While benefits had three further sub-themes (i.e., digital flexibility, connection between learners, and respite from impact of COVID-19), challenges had four (i.e., lack of interaction, technological challenges and digital exclusion, human dimension, and digital fatigue). While the facilitators had three sub-themes (i.e., mutual and programmatic support, online resource access, and personal resilience), barriers had one (i.e., preventing implementation and lack of protected time).ConclusionDespite challenges to in-person ways of working, online learning generally worked for action-orientated QI learning, but changes are needed to ensure the effectiveness of future use of virtual learning for QI. Understanding the challenges of the translation of learning into action is crucial for implementation learning, gaining insight into how improvement Fellows navigated this translation when learning remotely and implementing directly in their workplace is key to understanding the evolving nature of implementation over the pandemic years and beyond.

Mixed-Method Evaluation to Understand Clinician Perspectives of a Program to Implement High-Intensity Resistance Rehabilitation Into Skilled Nursing Facilities

ObjectiveTo assess rehabilitation clinicians’ viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation. DesignProspective convergent mixed-method design. SettingEight rural SNFs within the Department of Veterans Affairs. ParticipantsPhysical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38). InterventionsClinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks). Main Outcome MeasuresAcceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience. ResultsQuestionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience. ConclusionsAccording to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.

Are Nurses Aware of Their Contribution to the Antibiotic Stewardship Programme? A Mixed-Method Study from Qatar.

The antibiotic stewardship programme (ASP) is a new concept initiated by WHO, but nurses are not yet ready to adopt the program. The training and empowerment of nurses are the best strategies for enhancing their knowledge and engagement in ASP. This mixed-method study was used to assess perceived roles and barriers of nurses' involvement in ASP. An online survey was conducted among 420 clinical nurses to identify their role, and 23 individual interviews were performed among nurses and infection control practitioners to explore the barriers and recommendations to overcome the identified barriers. The majority of the nurses agreed with the sixteen identified roles in ASP, of which 'antibiotic dosing and de-escalation' (82.61%), 'IV to PO conversion of antibiotic, outpatient antibiotic therapy' (85.23%), and 'outpatient management, long-term care, readmission' of the patients (81.19%) had the lowest agreement from the participants. The major themes generated through the qualitative interviews were a lack of knowledge about ASP, poor communication between multidisciplinary teams, lack of opportunity and multidisciplinary engagement, lack of formal education and training about ASP, lack of ASP competency and defined roles in policy, role conflict or power/position, availability of resources, and lack of protected time. Nurses play an integral role in the successful implementation of antibiotic stewardship programs. The empowerment of nurses will help them to adopt the unique role in ASP. Nurses can significantly contribute to antibiotic stewardship efforts and improve patient outcomes through addressing these challenges.

E-learning Interventions for Quality Improvement Continuing Medical Education-A Scoping Review.

Improving health care quality and patient safety are top priorities for the medical field. Robust continuing medical education (CME) programs represent major interventions to effectively teach quality improvement (QI) principles to practicing physicians. In particular, eLearning, a term describing online and distance learning interventions using digital tools, provides a means for CME interventions to reach broader audiences. Although there has been a focus on CME addressing QI, no knowledge synthesis has focused specifically on eLearning interventions. The purpose of this review was to examine the current landscape of eLearning interventions in QI-focused CME. We conducted a scoping review using the framework developed by Arksey and O'Malley as revised by Levac. We searched five databases and identified 2467 prospective publications, which two authors independently screened for inclusion. From each included article, two authors independently extracted data on the instructional modalities and QI tools used and met regularly to achieve consensus. Twenty-one studies were included. Most studies used blended instruction (n = 12) rather than solely eLearning interventions. Salient findings included the importance of coaching from QI experts and institutional support for planning and implementing eLearning interventions. Lack of protected time and resources for participants were identified as barriers to participation in CME activities, with small practices being disproportionately affected. Partnerships between CME developers and sponsoring organizations are vital in creating sustainable eLearning interventions for QI-focused CME. Remote coaching can be an effective strategy to provide ongoing support to geographically separated learners.

Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey.

Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs. We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020. The survey consisted of questions pertaining to the characteristics of the simulation centres, their faculty, learners, curriculum, and assessment processes. All 17 residency training programs participated in the survey and reported large variability in the number and formal training of simulation faculty and in content delivery. Five programs (29%) did not provide faculty recognition for curriculum design and running simulation sessions. Most programs offered one to four simulation sessions per academic year for each year of residency. All programs offered mannequin-based and part-task trainers for teaching technical and nontechnical skills. Fourteen programs (82%) offered interprofessional and interdisciplinary simulation sessions, and ten programs (59%) did not include in situ simulation training. Commonly reported barriers to faculty involvement were lack of protected time (12 programs, 71%), lack of financial compensation (ten programs, 59%), and lack of appreciation for SBME (seven programs, 41%). Large variability exists in the delivery of SBME in Canadian anesthesiology residency simulation programs, in part because of differences in financial/human resources and educational content. Future studies should explore whether training and patient outcomes differ between SBME programs and, if so, whether additional standardization is warranted.

Psychiatrists’ Engagement in Research as a Pathway towards the Expansion of Distributed Medical Education (DME): A Regional Analysis across Two Provinces in Atlantic Canada

In the context of Canadian medical education, Distributed Medical Education (DME) plays a crucial role in addressing healthcare disparities, particularly in rural areas. This study focuses on the Department of Psychiatry at Dalhousie University, analyzing psychiatrists’ engagement and willingness to participate in research at DME sites in Nova Scotia (NS) and New Brunswick (NB). The cross-sectional study, encompassing data from an environmental scan, surveyed 60 psychiatrists involved in medical education across seven health zones. Results revealed significant associations between gender, type of graduates, and specialist training. A majority of psychiatrists (68.3%) do not currently engage in mental health or translational research, citing barriers such as a lack of protected time and financial incentives. Notably, participants expressed interest in future research areas, including health services/quality improvement and addiction research. Geriatric psychiatry, predominantly female-dominated, lacked current research activities. The study emphasizes the need to address barriers and promote motivators, both intrinsic and extrinsic, to enhance psychiatrists’ research engagement. This strategic approach is essential for fostering active participation in research, thereby contributing to the expansion of DME sites in Atlantic Canada and beyond.

Cancer research in vulnerable populations: A call for collaboration and sustainability from MENATC countries.

e13649 Background: Cancer is a major burden across the Middle East and North Africa including Turkey and Cyprus (MENATC). Many MENATC countries experience acute and chronic emergencies, including COVID-19 pandemic, disasters, political instability, fragility, as well as chronic conflict that result in cumulative vulnerability to the region. This study examines the current level and the potential for cancer research among vulnerable populations in the MENATC, including its challenges, and gaps. Furthermore, it tries to ascertain cancer practitioners’ views on what defines vulnerability in the MENATC. Methods: Recurrent expert-driven meetings were held to conceptualize the study approach and highlight the barriers to conducting clinical cancer research among vulnerable populations in the MENATC. A self-administered online survey questionnaire was circulated to over 500 cancer practitioners in twenty-three MENATC countries. The survey covered: Demographic and general information, Clinical practice, Research capacity, Vulnerable populations, and logistics. Results: Half of the respondents considered clinical research in vulnerable cancer patients a key concern, while 24.5% did not. Out of the total respondents, 21.8% had worked on research that explicitly included vulnerable populations. About 60% of respondents reported seeing vulnerable populations during their daily practice. Lack of funding (60%), lack of protected time (42%), and lack of research training (35%) were the top three main reasons for research scarcity and major research challenges. Over half of the respondents agreed that recent wars/conflicts worsened the conditions for vulnerable populations. The top five ranked vulnerability groups were geriatric, terminally ill, mental health-related, chronically ill, and socioeconomically deprived patients, while the lower five ranked groups were LGBTQ+ community, veterans, divorced individuals or widowed women, prisoners, and ethnic minorities patients. Conclusions: This is the first study in the MENATC region to look at the status of and potential for research among vulnerable populations. The study highlights the challenges faced by cancer practitioners in the MENATC in research, especially among vulnerable populations. We believe that these limitations in research will negatively impact the outcomes for vulnerable communities in the region. Lack of research funding and training of cancer practitioners in the MENATC are major factors negatively affecting cancer outcomes which could lead to health improvement failure. Geopolitical, economic, and cultural differences clearly define the most vulnerable populations in cancer research. Addressing cancer disparities in the MENATC is a complex and pressing issue. By working together and providing the necessary resources, we can improve cancer research outcomes for the most vulnerable populations in the region.

“I’m almost opioid-a-phobic”: family medicine residents’ perceptions of enhancing opioid analgesic and agonist treatment training in a Canadian setting

ABSTRACT Purpose As deaths from the illicit drug poisoning crisis continue to rise in Canada, increasing the number of healthcare professionals qualified to effectively prescribe opioids could be beneficial. The willingness of family medicine residents to undertake structured training in prescribing opioids for Opioid Agonist Treatment (OAT) and pain management have not been well described. Materials and methods Family medicine residents (n = 20) in British Columbia, Canada, were asked about their experience with and willingness to enrol in OAT training. Informed by the Consolidated Framework for Implementation Research, data were analysed thematically using NVivo software. Results Four themes were identified: (1) challenges to training implementation, (2) feelings and attitudes on prescribing practices, (3) helpful learning spaces and places of substance use training, and (4) recommendations for implementing training. Preparedness, exposure, and supportive learning environments for substance use education increased willingness to pursue OAT accreditation, while ineffective learning experiences, mixed feelings about opioid prescribing, and lack of protected time were the most common reasons for unwillingness. Conclusions Protected time and a range of clinical experiences appear to facilitate residents’ willingness to complete OAT and opioid training. Implementation strategies to enhance the uptake of OAT accreditation in family medicine residency must be prioritised.

Recruitment and retention of radiography clinical practice educators

IntroductionClinical Practice Educators (CPEs) play a vital role in radiography education, fostering the development of students’ clinical competence and creating positive learning experiences. In recent years, there has been a high turnover and difficulties recruiting radiography CPEs in Ireland. This is the first study to explore issues surrounding recruitment and retention of radiography CPEs. MethodA cross-sectional, mixed-method study was conducted to gain a better understanding of the issues surrounding recruitment and retention of radiography CPEs. Current and former CPEs affiliated with undergraduate radiography training in Ireland were recruited. CPEs completed an online questionnaire detailing demographics and career background. Online semi-structured focus groups were conducted with current CPEs and interviews with former CPEs. ResultsNineteen current CPEs completed the questionnaire and participated in focus groups (95% response rate). Ten CPEs who had resigned within the last five years were interviewed. The main motivators for CPEs were an interest in teaching, inspiration from role models, personal learning goals and the appeal of part-time employment. Job satisfaction was influenced by efficacy in the role, professional growth, autonomy, and relationships with stakeholders. The main disincentives were the CPE grade not being commensurate with work involved, lack of protected time and lack of support from colleagues. A variety of reasons for resignation were provided, many of which related to grading of the CPE post and lack of career progression opportunities in the role. ConclusionThe findings outline the key motivators for radiography CPEs and disincentives relative to recruitment and retention of radiography CPEs in Ireland. Implications for practiceBy understanding the disincentives relative to CPE recruitment and retention, along with the motivators, employers can devise initiatives that reduce turnover and increase CPE retention.

Exploring the experiences and views of doctors working with Artificial Intelligence in English healthcare; a qualitative study.

The National Health Service (NHS) aspires to be a world leader of Artificial Intelligence (AI) in healthcare, however, there are several barriers facing translation and implementation. A key enabler of AI within the NHS is the education and engagement of doctors, however evidence suggests that there is an overall lack of awareness of and engagement with AI. This qualitative study explores the experiences and views of doctor developers working with AI within the NHS exploring; their role within medical AI discourse, their views on the implementation of AI more widely and how they consider the engagement of doctors with AI technologies may increase in the future. This study involved eleven semi-structured, one-to-one interviews conducted with doctors working with AI in English healthcare. Data was subjected to thematic analysis. The findings demonstrate that there is an unstructured pathway for doctors to enter the field of AI. The doctors described the various challenges they had experienced during their career, with many arising from the differing demands of operating in a commercial and technological environment. The perceived awareness and engagement among frontline doctors was low, with two prominent barriers being the hype surrounding AI and a lack of protected time. The engagement of doctors is vital for both the development and adoption of AI. AI offers big potential within the medical field but is still in its infancy. For the NHS to leverage the benefits of AI, it must educate and empower current and future doctors. This can be achieved through; informative education within the medical undergraduate curriculum, protecting time for current doctors to develop understanding and providing flexible opportunities for NHS doctors to explore this field.

Engaging Trainees by Enriching Nephrology Elective Experiences.

Engaging Trainees by Enriching Nephrology Elective Experiences.

Improving Feedback for Hematology and Oncology Fellows Via Virtual Workshops: Sustainability Analysis

BackgroundEffective feedback is an important tool in medical education for the learning and growth of trainees and for faculty development. It allows learners to remain on course in reaching competence in clinical, research, and interpersonal skills, yet the impact of teaching feedback during hematology-oncology training has not been studied in depth. To tackle the lack of effective constructive feedback within our hematology oncology fellowship program, we initiated a quality improvement (QI) project to identify barriers in delivering and receiving high-quality feedback in the program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. In the initial phase of the pilot study, a pre-intervention survey identified the two main barriers for effective feedback in our program as discomfort in giving feedback and lack of protected time. A virtual workshop improved quality of feedback by addressing these barriers and providing tools necessary to give and receive constructive feedback. We aimed to highlight the sustainability of these interventions.MethodsUtilizing the results of the pre-intervention survey, we built three 2-hour interactive virtual workshop sessions conducted through the ASCO Quality Training Program. Skills that were emphasized and practiced included appropriate set-up, low-inference observations, dialogic feedback conversations and a structured approach to reinforcing and modifying feedback. A follow up session was conducted three months later allowing for reinforcement of the skills. Post-intervention surveys were given immediately after the initial workshop and after the follow-up session. All surveys were identical employing Likert scale and open-ended questions. Weekly email reminders for protected feedback time were also set up. This project was developed through the ASH Medical Educators Institute.ResultsEleven out of 15 attendees completed each of the questionnaires. At baseline, 81.8 % of the participants reported they do not have protected time to complete evaluations. This decreased to 63.6% immediately post-intervention and to 27.3% at the three-month point. Similarly, only 65.5% of the participants reported they were comfortable giving feedback prior to the workshop, increasing to 81.8% immediately after the intervention and was sustained at 81.8% at three months. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Majority of the participants agreed that the workshop helped address barriers for effective feedback in our program.ConclusionsThis study showed the sustainability of positive changes, even during the COVID-19 pandemic, for giving and receiving quality feedback implemented in our fellowship program. Its outcomes are salient given that it utilizes a simple intervention that could be expanded to other training programs as feedback is a systemic problem in medicine. It also underscores the importance of formal workshops in overcoming barriers for effective feedback. Limitations of this QI study include the small sample size and single-institutional design. Our future goals include incorporating a formal yearly curriculum assigning weekly protected time for feedback to ensure these results are sustainable and reproducible with incoming fellows. DisclosuresNo relevant conflicts of interest to declare.

Improving feedback for hematologists and oncologists in training.

11025 Background: Feedback is an integral part of the learning process, allowing learners to remain on course in reaching competence in clinical, research, and interpersonal skills. However, the impact of teaching feedback during hematology-oncology training has not been studied. We aimed to identify barriers in delivering and receiving high-quality feedback in our fellowship program and to create a curriculum aimed at teaching fellows and faculty how to engage in more effective feedback conversations. Methods: This pilot study aimed at determining and addressing perceived barriers to high-quality feedback in the hematology-oncology fellowship program. A pre-intervention questionnaire, consisting of Likert scale and open-ended questions, was administered to identify barriers to giving feedback and to assess satisfaction with the quality of feedback received in our fellowship program. The results of the baseline questionnaire were utilized to build a virtual interactive three-session workshop provided by the ASCO Quality Training Program in which the importance of feedback and methods of providing effective feedback were taught. Topics included feedback set-up, low-inference observation, and a structured approach to reinforcing and modifying feedback. One month after the intervention the participants completed a follow up questionnaire. This project was developed through the ASH Medical Educators Institute. Results: Each questionnaire was completed by 11 participants. The two main barriers to high-quality feedback identified were the discomfort with both giving and receiving feedback, and the lack of protected time. At baseline only 54% of the participants reported they were comfortable giving feedback, increasing to 81% post- intervention. Pre-intervention, 81% of participants reported they did not have protected time for feedback, decreasing to 64% after the intervention and institution of weekly protected time for feedback. Half of the participants reported that the feedback was not actionable in the initial questionnaire, decreasing to 10% post-intervention. Overall, fellows reported that their feedback was mostly focused on notes, followed by presentations and interpersonal skills. Faculty reported that most of the feedback they received was about time management and patient care. Conclusions: This pilot study helped address a major barrier to improvement and growth within our training program and confirmed that feedback skills must be taught and practiced. A 6-hour virtual workshop showed tangible results in the satisfaction with and quality of feedback given to both fellows and faculty. Our findings are salient as we completed the intervention during the COVID pandemic. Limitations of the study include its single-institutional design and sample size. A major challenge anticipated is sustainability, which will be addressed by maintaining periodic lectures and assigning protected time for feedback.

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being...

Success and limiting factors in health service innovation: a theory-generating mixed methods evaluation of UK projects

ObjectivesTo explore and explain success and limiting factors in UK health service innovation.DesignMixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis.SettingThe...

How Can More Women be Elected to Leadership Positions in Medical Specialty Societies?

To the Editor: We read with interest Jagsi and colleagues’ study titled “Women’s Representation Among Members and Leaders of National Medical Specialty Societies,”1 which found that in 30 major medical specialties, the percentages of women who were among the highest-ranking elected society leaders between 2000 and 2015 ranged from 0% to 37.5%. A low proportion of women serving on governing boards (0%–47.6%) likely contributed to this finding. Although representation in some societies has improved, in others, it has stayed the same or regressed. Those findings complement prior research2 that showed that women are underrepresented, frequently at zero or near-zero levels, in presidential leadership positions within influential physician-focused medical societies. Over a 10-year span (2008–2017), 10 societies had no women presidential leaders. For all of the societies studied, men served as presidents for 82.6% of the cumulative years across all societies (322 of 390 years) and women for only 17.4% of those years (68 of 390 years). To our knowledge, data surrounding challenges for women from groups underrepresented in medicine in elected leadership positions have not been evaluated, but we presume that the underrepresentation issues would be intensified in these groups. One question follows naturally: “Why are women underrepresented in high-ranking elected leadership positions?” A survey study3 of more than 1,200 women physicians found that they are less likely to run for elected positions after graduating from medical school, despite the fact that a majority of women surveyed believed there should be more women in leadership.3 Although 43.2% of women considered running for office, only 16.7% actually ran. Barriers cited were lack of protected time, work support, experience, and mentorship. Fewer than 1 out of 3 respondents were previously encouraged to run for elected office by someone else, and only 8.3% of respondents were encouraged to run by a supervisor. This study highlights an opportunity to provide additional resources to encourage and support women physicians in their pursuit of leadership positions. As Jagsi and colleagues1 suggest, women in medicine face significant disparities regarding leadership. It is now time to focus on how more highly talented and qualified women physicians and scientists can be elected to top leadership positions, especially in professional medical societies. These societies significantly impact every aspect of academic medicine, and it has never been more crucial to close gender-related leadership gaps.

Building the capacity for psycho-Oncology research: a survey of the research barriers and training needs within the International Psycho-Oncology Society.

The International Psycho-Oncology Society (IPOS) is a multidisciplinary professional network that aims to improve psychosocial care for individuals impacted by cancer. IPOS encourages research activity, recognizing that a high-quality evidence base is essential to provide best-practice, data-driven clinical care. This study aimed to determine the barriers to research involvement and the training needs and priorities of IPOS members, with the goal of facilitating the development of training resources tailored to the needs of IPOS members. A link to an online, cross-sectional survey was disseminated to all registered members of IPOS via email. The online survey platform SimpleSurvey was used, and questions included demographic characteristics and items related to research interests, involvement, and training needs. High priority research training needs were identified as research tasks respondents rated as highly important, yet possessed a low perceived skill level in. Thirty-two percent of IPOS members (n = 142) completed the survey. Participants represented 49 countries and were at a variety of career stages. Overall, participants reported spending an average of 17.3 hours per week on research (range 0-80 hours per week), with 69% of respondents wanting to increase their research involvement. The main barriers to research participation included lack of research funding (80%) and lack of protected time (63%). IPOS members identified 5 high-priority training needs: preparing successful grant applications; preparing research budgets; community-based participatory research; working with decision makers; and finding collaborators or expert consultants. Participants suggested funding access, statistical advisors, and networking and mentorship opportunities as ways to enhance research involvement. Members preferred online training modules (39%) and mentorship programs (19%) as methods by which IPOS could provide research support. IPOS was viewed as being able to contribute to many aspects of research capacity building such as networking, training, and dissemination of research findings. IPOS has an important role in encouraging research capacity building among members. This survey provides an agenda for workshops and training opportunities. Mainly, for respondents it was less about training in research methods and more about training in how to prepare successful grant applications, including budgets, and receiving mentorship on this as well as having opportunities to collaborate with other researchers.

30. IMPROVING THE IMPACT OF A PRIMARY CARE ASYNCHRONOUS CURRICULUM IN PEDIATRIC RESIDENCY

Background Few studies have assessed the efficacy of asynchronous curricula (AC) in GME. In 2018 we introduced the John Hopkins Physician Education & Assessment Center, a module-based pediatric primary care AC to replace in-person didactics (IPD). While residents liked the concept of AC, usage was low. This led to further investigation to optimize the impact of AC, resulting in a new blended curriculum (BC). Aim Identify barriers to AC use; compare usage and satisfaction with AC alone vs. BC; determine if poor AC use in 2018 impacted knowledge as measured on the pediatric in-training exam (ITE). Design A survey was sent to residents exposed to 1 year of AC to assess barriers and preference for IPD vs. AC. Results prompted design of a BC for 2019 with monthly resident-led conferences and faculty-led board review on assigned modules with incentives for module completion (MC). After 6 months of BC use, satisfaction and MC were assessed. ITE scores were collected from 2018 and 2019 for those exposed to a year of IPD and then a year of AC. Questions on primary care topics (PCT) were identified and a PCT subscore was computed. Results 22/32 residents (69%) exposed to 1 year of AC completed the survey. 73% preferred a blend of IPD and AC, whereas prior to AC, 65% preferred AC to IPD. 68% cited either lack of protected time (41%) or accountability (23%) as barriers to MC. After 6 months of exposure to BC, 35/57 residents (61%) responded to the next survey; there was no preference for any one BC component. MC for AC vs. BC was compared for 52 residents; median MC in 6 months increased by 3 in BC (p Conclusion A BC with in-person components and more accountability led to higher MC, underscoring the need to accommodate diverse learning styles. Resident PCT scores decreased significantly after 1 year of the underutilized AC. Further study will determine the impact of better BC participation on PCT scores.

5. DISTRESSING EVENTS: WHAT DO OUR TRAINEES WANT? A QUALITATIVE STUDY FROM A LARGE PEDIATRIC RESIDENCY PROGRAM

Background Patient care events that cause emotional distress are common during pediatric training. Research has demonstrated that ICU rotations have a significant impact on trainee burnout likely in part due to the number of distressing events that occur in that environment. Interventions have been proposed by the AAP for training on peer-debriefing as well interventions to decrease distress in the ICU. Objective: Perform a needs assessment in our training program to: examine what scenarios lead to distress, assess how they are able to process these events and, have their voices be heard on how they want to be debriefed. Methods Semi-structured interviews guided by open-ended questions were conducted with 15 trainees from our large academic pediatric training program. Demographic information was collected. Data was transcribed and analyzed using a phenomenological approach. The transcribed data was coded using an iterative approach and organized into themes. Results Interviews were conducted from Aug-Dec 2019. About half of our participants were female (8, 53%) and nearly all were senior residents PGY 2(8, 53%), PGY-3 (6, 40%). Trainees experienced distressing cases either in the NICU or PICU. Based on data analysis, these cases elicited feelings of shock, loneliness, helplessness, or fear. Currently, residents receive untrained support from their peers and families and are additionally challenged by the lack of protected time to debrief the event. A common theme revealed that the trainees expect a debrief from the service faculty to assist them in processing these events. The lack of intervention by the service faculty contributes to a higher level of distress in our trainees. When describing their ideal debrief, they all agreed that the emotional debrief should stand alone from a medical debrief. Conclusions Emotionally charged patient care events have a strong impact on trainees and lead to higher rates of burnout. We plan to use this data to support peer-training in debriefing, as well as to develop a framework for service faculty to use to debrief these events with our trainees.

Clinical Use and Barriers of Thoracic Ultrasound: A Survey of Italian Pulmonologists

Introduction: Thoracic ultrasound is accurate in the diagnosis of a wide range of respiratory diseases. Yet the extent of its use is unknown. Through a national survey, we aimed to explore the clinical use of thoracic ultrasound and the barriers to the diffusion of the technique in Italy. Methods: Accademia di Ecografia Toracica (AdET) developed a self-administered survey which was sent by email to Italian pulmonologists via national scientific societies and networks. Results: Of the 2010 physicians invited, 514 completed the survey (26% response rate). According to 99% of responders, thoracic ultrasound had a relevant clinical role. Seventy-nine percent of the responders used thoracic ultrasound at least once a month. The main settings were: 53% pulmonology ward, 15% outpatient clinic, 15% interventional pulmonology room, 10% internal medicine ward, 4% respiratory intensive care units, and 9% other. Thoracic ultrasound was primarily used: (1) with both diagnostic and interventional aims (72%), (2) as diagnostic imaging (17%), and (3) as guidance for interventional procedures (11%). The main clinical applications were: (1) diagnosis and management of pleural effusion, (2) pneumothorax, (3) pneumonia, (4) cardiac failure, and (5) acute dyspnea. Twenty-one percent of the responders do not use thoracic ultrasound. The main reported bar­riers were: (1) availability of an ultrasound system (52%), (2) lack of protected time and training (22%), and (3) use of the technique by other specialists (15%). Conclusion: Thoracic ultrasound is widely used by Italian pulmonologists and considered a clinically relevant tool. The availability of dedicated ultrasound systems seems to be a major limit of the use of the technique.