Medical Education Activity Research Articles

Медична допомога дітям у навчальних закладах: стан, проблеми та перспективи розвитку

В статті проведено аналіз систем медичного забезпечення дітей шкільного віку, особливостей організації. Міжнародний досвід свідчить, що існують різні моделі медичного забезпечення дітей у навчальних закладах: відмінності щодо підпорядкування шкільної служби (структурам охорони здоров’я або освіти), фінансування, підготовки кадрів та найбільш — щодо профілактичної спрямованості: обсягу та терміну проведення профілактичних медичних оглядів. Всесвітня організація охорони здоров’я наголошує, що поки оптимальної моделі шкільної охорони здоров’я в світі не визначено. Загальними проблемами шкільної охорони здоров’я є недостатнє фінансування, нерівномірний доступ дітей до медичних послуг. Наведено стан медичного забезпечення школярів у країнах пострадянського простору, результати змін у галузі охорони здоров’я дітей, що стосувалися реформування системи санітарно-епідеміологічних закладів, модернізації їх функцій, створення нових вертикальних структур, функціями яких є розробка національних і регіональних програм щодо пропаганди здорового способу життя, медичної освіти та комунікаційна діяльність. Проаналізовано розвиток системи шкільної медицини в Україні з позиції «Концепції стандартів якості шкільних медичних послуг і компетенцій» Європейського союзу шкільної та університетської медицини. Окреслено перспективи шкільної медицини в Україні, а саме: потреба у розробці і запровадженні нової української моделі шкільної медицини, адаптованої до європейських стандартів, та інтегрування її у систему громадського здоров’я, що затверджено в Україні; оновлення нормативно-правової бази; розвиток кадрового потенціалу; формування нових професійних компетентностей медичних працівників шкільної медицини в Україні; посилення міжвідомчої взаємодії в питаннях допомоги збереження здоров’я дітям і підліткам, які навчаються.

PERCEPTIONS OF CONTINUING MEDICAL EDUCATION PARTICIPANTS REGARDING IMPROVEMENT OF PATIENT CARE THROUGH CONTINUING MEDICAL EDUCATION ACTIVITIES IN LAHORE DISTRICT

Objective: To explore the perceptions of Continuing Medical Education participants about the improvement of patient care through Continuing Medical Education activities and to explore the factors hampering or favouring improvement of patient care through Continuing Medical Education activities.
 Study Design: Qualitative phenomenological study.
 Place and Duration of Study: University of Health Sciences, Lahore, from Dec 2016 to May 2017.
 Methodology: In qualitative phenomenological study conducted at University of Health Sciences, Lahore from Dec 2016 to May 2017, semi structured in-depth interviews were conducted individually from 10 General Practitioners which were audiorecorded and transcribed. Code labels were assigned manually and grouped together into broader themes. Interpretation ofthemes was done after thematic analysis.
 Results: Two participants were female and ten were male with experience ranging between 20-38 years. Three main themes with sub-themes were identified: (1) positive talk (Affirming the link between Continuing Medical Education and improved patient care), (2) negative talk (perceived hindrances in gaining full benefit from Continuing Medical Education activities), (3) concerns regarding current Continuing Medical Education activities.
 Conclusion: Participants were found inclined towards Continuing Medical Education activities and felt more confident and comfortable in managing their patients. However, they felt that physicians working in rural areas were dealing directly with all sorts of patients and were more in need of targeted and tailored Continuing Medical Education activities.

Evaluation of the effectiveness of handwashing training given to paramedic students remotely

Background and objectives: The COVID-19 pandemic has affected face to face medical education and training activities around the world. The aim of this study was to provide remote practical handwashing training to health sciences students and to measure the effectiveness of the training provided and to create a feedback model.
 Methods: Students of the Paramedic department were included in the study. Two virtual classrooms were created via Zoom Video Communication system. An 11-step handwashing algorithm was developed. Two hours of remote handwashing training was given. Participants were asked to apply the handwashing application they learned at their own location and to record videos. Application videos were evaluated and scored.
 Results: A total of 135 Term-1 and Term 2 students of the Paramedic department participated in the study. The duration of the evaluated videos was on average 57.67 ± 12.69 (34-95) seconds. Fifty-five (40.7%) of the participants successfully completed all the steps and their average success score was 10.3 ± 0.67 (8-11). The most failure (33.3%) in the process steps was the 9th step in which the wrists are rubbed with soap.
 Conclusion: Suitable teaching and feedback methods are required for medical and health science students who receive education and practical training remotely from home.
 Ibrahim Med. Coll. J. 2021; 15(2): 18-25

Service Learning Model Development in Medical Education

Many medical schools provide curricular or extra-curricular courses focused on service activities for social responsibility. Research on service learning varies from theory to teaching model, but research on service learning in medical education is difficult to find. Therefore, this study aims at developing a program that combines a medical educational curriculum and service activities. For the development of a service learning model in medical education, this study adopted Design Based Research method as a research method and developed a service learning model in medical education by analyzing problems in educational settings (2014-2017), reviewing literature, and going through a total of three formative cycles. As a result of applying the first Service Learning Model in Medical Education developed through literature analysis to the school field three cycles and revising it, we developed a final Service Learning Model in Medical Education with preparation, orientation, implementation, reflection, celebration, and evaluation s stages. The feelings of reward, interest, and satisfaction levels of the student’s analysis results showed continuously increased. In particular, the students showed higher levels of feelings of reward, interest and satisfaction in the final SL-ME model applied in 2017 than in the first SL-ME model applied in 2014. This study is significant in that it outlines the concepts, necessity, and instructional model of service learning necessary for the operation of service-related programs in medical education.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

To the Editor: Incorporating New Technologies Into Graduate Medical Education Practices.

Technological advances, such as simulation training, have transformed medical education and training in the modern era and have improved the training of residents and fellows. Residents now learn how to perform complex procedures using simulation and develop competencies before live patient attempts. Despite these improvements, performing other trainee duties, such as logging procedures, cases, and work hours, have failed to leverage such technologies. Using technology to perform these duties may reduce the burden on trainees to accomplish these tasks and may improve trainee satisfaction and well-being.In a recent issue of the Journal of Graduate Medical Education, Anyanwu and colleagues1 report using automated procedure logs for first-year and second-year cardiology fellows during their cardiac catheterization laboratory rotations. A clinical educational report template (CERT), with automated procedure log generation from the electronic medical record, documented procedures performed by trainees over 1 year. The investigators discovered that the CERT procedure logs were associated with a statistically significant increase in weekly procedure documentation over manual entry of procedure logs. CERT procedure logs also eliminated the 1 to 5 hours weekly that trainees spent documenting these procedures manually. We commend Anyanwu et al1 for publishing this critical study that may transform graduate medical education (GME) activities such as work hours and procedure logging by trainees.Traditionally, trainees assume responsibility for documenting tasks manually. Manual data entry is a time-consuming process that can be fraught with inaccuracies.2 Further, program directors have difficulty verifying these logs. As a result, sponsoring institutions and programs may lose accreditation for violations. Equally important, trainees may not show procedural competency for independent practice if they make errors in logging procedures. Leveraging technology to document these tasks would be beneficial for sponsoring institutions and trainees.Automated data collection can facilitate accurate data assembly and assist with the fair assignment of cases to learners. It can also assist program directors in understanding their learners' clinical experiences better and cater to their educational needs. Principally, work hour violations would be avoided, clinical competency would be achieved, and trainee well-being could increase.It may be time to develop technological applications that facilitate automated procedure and work hours logging. Doing so will enable timely and accurate logging of trainee activities, streamline monitoring by program directors and GME offices, and improve trainees' well-being. Considering that 27% of the trainees in the study by Anyanwu et al1 spent 3 to 5 hours weekly manually logging their procedures, trainees may instead spend this time on personal well-being and educational activities. Anyanwu et al1 provide a framework for all of us to follow regarding leveraging technology for GME processes. GME offices should collaborate with technology companies to develop applications that enable automated trainee procedure and work hours documentation.

Continuous medical education activities; Case No. 6. Train to apply principles of prudent antimicrobial use

Antimicrobial stewardship entails every provider selects “The right antibiotic, for the right indication (right diagnosis), the right patient, at the right time, with the right dose and route, causing the least harm to the patient and future patients.” If followed strictly, these principles ensure that providers only prescribe antibiotics for non-self-limiting bacterial infections. Depending on the clinical setting antimicrobial stewardship programs will target their goals and outcomes based on available resources and opportunities. Those goals fall under the following categories: 1) Improve patient care and outcomes. 2) Reduce collateral damage and 3) Impact costs. We will present two cases to discuss how to apply principles of prudent antimicrobial prescribing.

Continuous medical education activities; Answers to Case No. 5: Infection control for MRSA transmission

Methicillin-resistant Staphylococcus aureus (MRSA) is still recognized as one of the most important nosocomial pathogens. These isolates are usually resistant to all currently available β-lactam antibiotics (penicillins, cephalosporins and carbapenems). Vancomycin has historically been the drug of choice and sometimes the last resort for the treatment of serious MRSA infections, providing empirical coverage and definitive therapy. However, its increased use has now become questionable. Moreover, its increased use has already led to emergence of vancomycin-intermediate S. aureus (VISA) as well as vancomycin-resistant S. aureus (VRSA) in certain parts of the world. In the early 1990s, MRSA was reported to account for 20 – 25 % of S. aureus isolates in hospitalized, worldwide. By the middle of the current decade, many hospitals experienced MRSA percentages in the range of 50-70% of total S. aureus isolates from clinical cultures. Recent studies have found that an increasing proportion of hospital-onset invasive MRSA infections are caused by community strains. The clinical scenario has been more dramatic by MRSA colonization which increases the risk of infection, and infecting strains match colonizing strains in as many as 50–80% of cases. Methicillin-resistant Staphylococcus aureus may persist within the hospital environment for a long time, complicating attempts of eradication. Besides, colonization is not static, as strains have been found to evolve and even to be replaced within the same host. Poor infection control measures as well as continues and indiscriminate use of antibiotics have resulted in this huge problem of acquisition and dissemination of MRSA.

Anti-Racism and Anti-Colonialism Praxis in Global Health-Reflection and Action for Practitioners in US Academic Medical Centers.

ABSTRACT.The movement to decolonize global health and address power inequities among its actors is not new. Founded on the work of colonized and marginalized people themselves, initiatives at universities, schools of public health, and international development organizations have emerged to call for anti-racism and anti-colonialism within the field. US Academic Medical Centers (AMCs) have been less vocal in this wider discussion, despite their large engagement in the field through clinical, research, and medical education activities. As global health practitioners currently based at an AMC, we believe that it is important to critically evaluate our practices. We therefore propose three starting questions for our colleagues and students to consider and act upon as they adopt and navigate a praxis in anti-racism and anti-colonialism as foundational principles in global health. These questions call on us to closely examine the legacies of racism and colonialism in global health, the value placed on different ways of knowing in this field, and our motivations for engaging in this work. They are presented as a tool to reexamine global health, challenging the constructed binary of the “global South” and “global North,” and the perceived ideas of poverty and resource scarcity as the natural immutable reality of the global South.

Increase your Confidence in Opioid Prescribing: Marketing Messages in Continuing Medical Education Activities on ER/LA Opioids

Overprescription of opioids has fueled an epidemic of addiction and overdose deaths. The FDA required manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing medical education (CME) on opioids as part of a Risk Evaluation and Mitigation Strategy (REMS). We sought to determine whether industry-funded REMS on long-acting opioids were consistent with the FDA's goal to reduce serious, adverse outcomes resulting from inappropriate prescribing, misuse, and abuse. In 2018, we analyzed all internet-based REMS CME activities funded by the REMS Program Companies (RPC), a consortium of ER/LA opioid manufacturers. We utilized systematic narrative thematic analysis, an inductive approach that allows for mapping of concepts and meanings across a body of data by identifying, recording, analyzing, and refining key narrative points, called "themes". Authors viewed all REMS activities multiple times. Ten themes were identified, all of which were at least somewhat incongruent with federal guidelines and their goals: 1. Chronic pain is a common, under-treated problem. 2.Chronic pain is a chronic disease.3.Opioids are an appropriate treatment for chronic pain. 4.LAs are more appropriate than immediate-release (IR) opioids for chronic pain. 5.Tolerance is normal, expected, and beneficial. 6. Opioid rotation" can maximize analgesia and minimize adverse effects.7. There is no population for whom opioids are absolutely contraindicated or inappropriate. 8. Screening and monitoring tools are effective for preventing opioid-related problems. 9. Opioid related adverse effects, such as respiratory depression and addiction, are due only to misuse and abuse. Addiction, overdose, and death are due to street drugs such as heroin and fentanyl, not prescription opioids.Themes and statements repeated in these activities were inconsistent with current medical knowledge, evidence-based federal guidelines, and FDA goals. We evaluated only online, not live, CME. We also did not evaluate individual conflicts of interest of faculty. Industry-funded REMS-compliant CME on opioids contain messages that misrepresent scientific evidence and may foster overprescribing of opioids.

Addressing Challenges in Chronic Phase Chronic Myeloid Leukemia: Impact of Education on Practice Behaviors and Knowledge

Background: Optimal outcomes for patients with chronic-phase chronic myeloid leukemia (CML) require both rigorous patient adherence to oral tyrosine kinase inhibitor (TKI) therapy and regular monitoring of treatment response by clinicians. Clinicians caring for patients with CML face a number of challenges with respect to management including selecting initial therapy, monitoring for treatment resistance and failure, and determining when to switch therapy. As a result of barriers including lack of time to search guidelines and lack of experience with CML, analyses have demonstrated that adherence to management guidelines, such as those of the European LeukemiaNet and National Comprehensive Cancer Network, is poor (Goldberg SL, et al. J Oncol Pract. 2015;11:e398-e404; Guérin A, et al. Curr Med Res Opin . 2014;30:1345-1352). To address these challenges, we created an education activity focused on molecular profiling, treatment selection, and management of treatment outcomes. Learner responses were evaluated to assess the influence of education.Methods: A live-online 1-hour video continuing medical education activity with slides, polling and live questions was launched on October 27, 2016 and made available on-demand at www.OMedLive.com through October 27, 2017. CME test questions were administered at 3 time points (pre-activity, immediate post-activity, and after 8-weeks). Data from these test questions, live polling responses, and questions that learners posed during live Q&A were analyzed to determine engagement, lessons learned, and continuing education gaps. Tests of statistical significance were conducted using the McNemar test for matched pairs (learners who completed both pre/post & pre/survey, respectively). Effect size was computed using Cohen's d (for all significant findings).Results: Forty-five of 149 (30%) registered learners completed all pre-, post-, and 8-week follow-up surveys, of whom, 71% reported the educational activity positively influenced patient experience or outcome, and 76% reported it positively altered their clinical practice. Learners reported improvements in their ability to assess the relative safety, efficacy and tolerability profiles of TKIs used to treat CML (69%), manage potential adverse events that may be associated with TKI therapies in patients with CML (67%), educate patients on the recent improvements and benefits of existing therapies with respect to survival outcomes (60%), and follow recommendations from clinical practice guidelines on CML (64%). As the result of education, 95 of 149 (64%) of learners reported commitments to change in regards to: medical/practice knowledge (88%), care attitudes (84%), practice behavior (84%) and patient clinical outcomes (79%). Learners demonstrated improved competence via a case scenario which required identifying the optimal next step for a 61-year old patient with CML who was not meeting treatment milestones. They also showed improved knowledge on the efficacy of specific TKIs in newly diagnosed CML patients, the definition of a complete cytogenetic response, and use of molecular profiling and influence of molecular response on prognosis. Although this study is limited by lack of access to practice data, outcomes results and participant questions indicate clinicians may benefit from continuing education on CML.Conclusions: Ongoing education on CML can yield immediate and sustained gains in knowledge, competence, and performance, which may improve adherence to guidelines and outcomes for patients. DisclosuresSteensma:Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; H3 Biosciences: Consultancy; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Celgene: Consultancy; Takeda: Consultancy; Janssen: Consultancy, Research Funding; Incyte: Equity Ownership; Onconova: Consultancy.

Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference.

BackgroundThe COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative.ObjectiveThe unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic.MethodsThe program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference.ResultsWe used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session—“Dialysis access management under the impact of viral epidemics”—was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively.ConclusionsSwitching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic.

614-P: Success of CME at Improving Knowledge of Clinical Use of Real-Time CGM

We sought to determine if an online continuing medical education (CME) activity could improve knowledge and competence of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) related to clinical use of rtCGM. The effect of an online, 15-minute, CME-certified summary of a satellite symposium was analyzed to determine efficacy. A repeated pairs pre-/post-assessment study design was used and chi-squared test (5% significance level, P <.05) assessed educational effect. Cramer's V was used to calculate the effect size (0.06-0.15 is a noticeable effect, 0.16-0.26 considerable, and >0.26 extensive). The activity posted June 22, 2020, and data were collected through October 14, 2020. Matched learner data indicate that overall, 19% of D/E learners' (N=234) and 26% of PCP learners' (N=241) responses improved from pre-to-post (both P<.001) with a considerable effect size of 0.164 and 0.205, respectively On a question-level: 15% of D/Es and 17% of PCPs improved at recognizing recent clinical trial data on the use of rtCGM in pregnant patients with T1D 24% of D/Es and 34% of PCPs improved at identifying appropriate TIR levels in patients with gestational diabetes Overall, 33% of D/Es and 46% of PCPs reported increased confidence in interpreting glucometric data from CGM device, for a total confidence shift of +11.4% and +23.3, respectively. Continued educational gaps: • 29% of both D/Es and PCPs did not recognize data on the use of rtCGM in pregnant T1D patients • 41% of D/Es and 49% of PCPs did not recognize appropriate TIR levels in gestational diabetes This study demonstrates the success of an online summary from a satellite symposium on improving knowledge and confidence of clinical use of rtCGM, with gaps identified for future education. Disclosure A. Larkin: None. J. Schrand: None. A. Le: None. Funding Dexcom, Inc.

408-P: Improving Knowledge and Confidence of Diabetologists and Endocrinologists Related to MRAs for CKD in T2D with Curriculum-Based Online Education

The goal of continuing medical education (CME) is professional growth and improved patient care. We sought to determine if a curriculum of online continuing medical education (CME) activities could improve the clinical knowledge and confidence of diabetologists and endocrinologists (D/Es) related to use of mineralocorticoid receptor antagonists (MRAs) in the management of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D). The online CME curriculum consisted of 5 online activities. Of these, 4 used repeated pairs pre-/post-assessment study design was used and McNemar’s test (P <.05 is considered significant) to assess educational effect. The activities launched in 2020 and data were collected for up to 12 weeks. The education reached over 19,000 physicians, including 6,000 D/Es. Overall, knowledge improved by 9% among D/Es (N=1,111, P<.001) Specific improvements: • 8% relative increase in knowledge related to the role of MRAs in treatment of CKD in T2D (P<.01) • 16% relative increase in knowledge related to the mechanism of action (MOA) of MRAs for CKD in T2D (P<.01) • 9% relative increase in knowledge related to identifying CKD in patients with T2D (P<.01) Of the D/Es who were included, 34% had a measurable increase in confidence, and among those the average level of confidence increased 50%. While this curriculum demonstrated success in educating on this topic, some gaps still remain after education. On average, 22% of the questions assessing knowledge on the MOA of MRAs in managing CKD in T2D and 29% of the questions assessing knowledge related to the role of MRAs in the management of CKD in T2D were still incorrectly answered after education, demonstrating a need for more education in these areas. Disclosure A. Larkin: None. K. L. Hanley: None. A. Le: None. Funding Bayer AG

Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses.

Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes? In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4. Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey.

Objectives This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. Materials and methods Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. Results For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. Conclusion Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

Online CME closes gaps in CSCC management revealed in a virtual patient simulation.

e23013 Background: Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer type. Although highly curable in its early stages, advanced or metastatic CSCC has been associated with mortality rates as high as 70%. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of oncologists on the assessment and management of CSCC. Methods: The educational series consisted of 4 online, CME-certified activities in multiple delivery formats, including an initial virtual patient simulation, followed by a clinical practice assessment (CPA) and 2 video discussions with synchronized slides. For the video discussions, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test ( P <.05) assessed educational effect. The first activity launched June 2019 and the last launched August 2020; data were collected until December 2020. Results: Following education oncologists had significant improvements in knowledge and competence compared with responses from the CPA. Improvement in knowledge and competence measured as relative % change in correct responses pre/post education across the learning themes identified in the virtual patient simulation are reported: Identifying patients who are not candidates for surgical intervention: 9% increase (56% CPA/ 77% pre/ 84% post; n=123-314; P <.05). Tailoring treatment: 30% increase (41% CPA/ 56% pre/ 73% post; n=119-314; P <.05). Tailoring treatment–cemiplimab: 22% increase (32% CPA/ 55% pre/ 67% post; n=123-314; P <.05). Tailoring treatment–cetuximab: 16% increase (15% CPA/ 37% pre/ 43% post; n=123-314; P <.05). New and emerging immunotherapies for CSCC: 47% increase (28% CPA/ 30% pre/ 44% post; n=119-314; P <.05). Conclusions: These results demonstrate the effectiveness of curriculum-based education for oncologists to address specific gaps in care as identified in a virtual patient simulation. This series of CME-certified online educational activities resulted in significant improvements in knowledge and competence in the assessment and treatment of patients with CSCC.

CME curriculum improves clinician knowledge, competence, and confidence in managing patients with NF1-related tumors.

e23009 Background: Neurofibromatosis type 1 (NF1) is an uncommon complex autosomal dominant disorder caused by germline mutations in the NF1 tumor suppressor gene. Therapeutic options have historically been limited with surgical debulking being the preferred treatment modality. However, recent clinical data have shown improved outcomes with the use of MEK inhibitors. The objective of this study was to assess the educational impact of a series of continuing medical education (CME) activities on the knowledge, competence, and confidence of physician learners with respect to the treatment of NF1-related tumors. Methods: The educational series consisted of four online, CME-certified activities. For each activity, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities, stratified by learning theme, and evaluated by target specialty. A repeated pairs pre-/post-assessment study design was used and McNemar’s test or paired samples t-test (P < .05) assessed educational effect. The first activity in the series launched Dec. 2019 and the last launched June 2020; data were collected until Dec. 2020. Results: Overall significant improvements were seen after education for oncologists (N = 258, P < .001), neurologists (N = 474, P < .001), surgeons (N = 427, P < .001), neurosurgeons (N = 93, P < .05), and pediatricians (N = 56, P < .001), regardless of practice setting. A sub-analysis of community specialists also showed significant improvements after education: oncologists (N = 117, P < .01), neurologists (N = 188, P < .001), and surgeons (N = 206, P < .001). Outcomes assessed by learning themes and specialty showed relative percent increases, with the majority being statistically significant. Conclusions: This analysis demonstrates that oncologists’ and other specialists’ knowledge, competence, and confidence regarding the treatment of NF1-related tumors improved after education, as measured through a comprehensive analysis of CME outcomes data from a variety of activities designed to achieve these ends. These results have the ability to translate to improvements in clinical care. Despite the improvements, additional educational activities are needed to address residual gaps and further increase clinicians’ ability in this clinical setting.

The brain metastasis journey: Experience from patient, caregiver, and physician surveys on diagnosis and treatment of brain metastases.

e14004 Background: Brain metastases (BM) is one of the most feared complications of cancer due to substantial neurologic sequalae, neuro-cognitive morbidity and grim prognosis. In the past decade, targeted therapies and checkpoint inhibitors have resulted in meaningfully improved overall survival for a minority of these patients. Accordingly, there is a growing need to identify issues surrounding patient survivorship and to standardize physician practice patterns for these patients. To date, there has not been a well-conducted formal study to specifically explore these questions of survivorship and practice standardization for BM patients. Methods: Here, we present results from a cross-sectional survey in which we analyzed responses from 237 BM patients, 209 caregivers, and 239 physicians. Surveys contained questions about BM symptoms, discussion of BM diagnosis by the clinician, psychosocial concerns, available treatment options for BM, BM patient advocacy resources, and BM-specific clinical trials. Results: Our survey revealed compelling findings about current care of BM patients. There were discrepancies in the perceived discussion of the implications of the diagnosis of BM, from the patient/caregiver and physician perspective. Important topics, such as prognosis and worrisome symptoms, were felt to have been discussed more frequently by physicians than by patients or caregivers. In our physician survey, private practice physicians, compared to academic physicians, were significantly more likely to recommend whole brain radiotherapy (61.1 vs 39.7%; p = 0.009). Participation in a clinical trial was one of the least recommended treatment options. Many physicians (59.1% private; 71.9% academic) stated that BM patients in their care are denied participation in a clinical trial, specifically due to the presence of BM. The consensus among physicians, patients and caregivers was that the highest yield area for federal assistance is increased treatment and research funding for BM. Conclusions: Our hope is that these findings will serve as a basis for future quality improvement measures to enhance patient-physician communication and patient well-being, continuing medical education activities detailing latest advances in BM for oncologists, and lobbying efforts to the federal government in prioritizing BM research, clinical trials, and patient survivorship.

Pediatric Radiology Continuing Medical Education Activity

Pediatric Radiology Continuing Medical Education Activity