Pediatric Medicine Residents Research Articles

Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design.

(1) Background/Objective: California has one of the highest rates of pediatric dental caries in the nation. One way to combat this problem is through non-dental provider training programs that focus on prevention. However, there are limited data on healthcare provider training program integration and evaluation of oral health curricula focused on prevention of early childhood caries. This study will assess the change in healthcare providers' attitudes, knowledge, and skills by implementing an interprofessional educational (IPE) oral health curriculum in medicine and nurse practitioner programs at one university in Southern California. (2) Methods: A mixed method design was employed using a pre- and post-educational survey, and end-of-program focus group interviews. Descriptive statistics and paired t-tests were used to assess group differences and thematic analyses for the focus groups. (3) Results: A total of 81 students (14 pediatric medicine residents, 18 pediatric, and 49 family nurse practitioners) completed the curriculum and surveys. Attitudes related to oral hygiene remained unchanged, with the nurse practitioner group showing improved clinical skills (all questions; p < 0.021). Knowledge scores significantly improved across all groups (paired t-test; p < 0.001). All focus groups expressed the helpfulness of the educational modules, the usefulness of the skills learned, and the benefits of IPE activities. (4) Conclusion: Healthcare providers showed improved oral health knowledge and clinical skills acquired through the oral health program and can serve as a model to educate across disciplines on the prevention of early childhood caries.

A shared point of care ultrasound curriculum for graduate medical education

BackgroundPoint of care ultrasound (POCUS) education has grown significantly over the past two decades. Like most curricular items, POCUS education is siloed within individual graduate medical education (GME) programs. The purpose of this study was to evaluate the effectiveness of a shared GME POCUS curriculum between five GME programs at a single institution.MethodsPost-graduate-year-1 (PGY-1) residents from emergency medicine (EM), family medicine (FM), internal medicine (IM), combined internal medicine-pediatrics (IM-Peds) and combined emergency medicine-pediatrics (EM-Peds) residency programs were enrolled in a core POCUS curriculum. The curriculum included eleven asynchronous online learning modules and ten hands-on training sessions proctored by sonographers and faculty physicians with POCUS expertise. Data was gathered about the curriculum’s effectiveness including participation, pre- and post-curricular surveys, pre- and post-knowledge assessments, and an objective skills assessment.ResultsOf the 85 residents enrolled, 61 (72%) participated in the curriculum. Engagement varied between programs, with attendance at hands-on sessions varying the most (EM 100%, EM-Peds 100%, FM 40%, IM 22%, Med-Peds 11%). Pre- and post-knowledge assessment scores improved for all components of the curriculum. Participants felt significantly more confident with image acquisition, anatomy recognition, interpreting images and incorporating POCUS findings into clinical practice (p < 0.001) after completing the curriculum.ConclusionIn this shared GME POCUS curriculum, we found significant improvement in POCUS knowledge, attitudes, and psychomotor skills. This shared approach may be a viable way for other institutions to provide POCUS education broadly to their GME programs.

Internal Medicine and Internal Medicine-Pediatrics Residency Program Website Traffic Patterns Across Two Institutions and Five Electronic Residency Application Service (ERAS) Cycles.

Background Since the start of the COVID-19 pandemic in Spring 2020, medical residency program recruitment has become increasingly web-based due to the transition to virtual interviews. Although social media use by residency programs has soared during this time, applicant surveys show that official program websites remain the most used online resource. According to survey-based studies, the content that applicants favor on program websites tends to mirror their priorities in choosing programs. However, it is unclear whether applicant-reported priorities in program choice and website content truly drive program website traffic. In this analysis, we will elucidate website traffic patterns from two Internal Medicine residency programs and two Internal Medicine-Pediatrics programs, both in terms of the thematic content of high-traffic pages and changes in traffic patterns throughout the Electronic Residency Application Service (ERAS) application cycle. We will provide novel, data-driven guidance to residency program leadership regarding website content. Methodology For each of the four programs included in the analysis, total pageviews on a monthly basis were obtained for the annual ERAS application cycles taking place from 2017 through 2022. For one Internal Medicine program, data was only available for its current website from 2020 to 2022. The mean monthly pageviews were calculated for each page within each website. The total site traffic trends across each year and within high-traffic months were totaled as well. Results As expected, the highest traffic period for all programs in all years was the days before the application deadline, with a secondary, smaller spike in traffic around Match Day. In general, the most popular pages for all four programs were thematically in line with the top five applicant priorities in the 2022 National Resident Matching Program applicant survey, namely, geographic location, goodness of fit, program reputation, work/life balance, and current program residents. Three of the websites featured unique content that unexpectedly proved to be as popular as the top survey-reported topics, such as pages related to a new major clinical site, a new integrated subspecialty pathway, and, most profoundly, a pipeline program for certain applicants from groups that are underrepresented in medicine. Alumni career content was also heavily trafficked across all four programs. Conclusions Program directors should plan twice-yearly updates to residency program websites, timed to be finished by the start of the ERAS cycle in the fall, and again just before Match Day in March. Program directors should include specific, up-to-date information about unique program features. Future research should incorporate a more diverse variety of programs, software-based page content analysis, and traffic source data.

Preparing Future Pediatric Care Providers with a Clinical Informatics Elective.

Clinical informatics (CI) has reshaped how medical information is shared, evaluated, and utilized in health care delivery. The widespread integration of electronic health records (EHRs) mandates proficiency among physicians and practitioners, yet medical trainees face a scarcity of opportunities for CI education. We developed a CI rotation at a tertiary pediatric care center to teach categorical pediatric, pediatric-neurology, and medicine-pediatric residents foundational CI knowledge and applicable EHR skills. Created in 2017 and redesigned in 2020, a CI rotation aimed to provide foundational CI knowledge, promote longitudinal learning, and encourage real-world application of CI skills/tools. Led by a team of five physician informaticist faculty, the curriculum offers personalized rotation schedules and individual sessions with faculty for each trainee. Trainees were tasked with completing an informatics project, knowledge assessment, and self-efficacy perception survey before and after rotation. Paired t-test analyses were used to compare pre- and postcurriculum perception survey. Thirty-one residents have completed the elective with their projects contributing to diverse areas such as medical education, division-specific initiatives, documentation improvement, regulatory compliance, and operating plan goals. The mean knowledge assessment percentage score increased from 77% (11.6) to 92% (10.6; p ≤ 0.05). Residents' perception surveys demonstrated improved understanding and confidence across various informatics concepts and tools (p ≤ 0.05). Medical trainees are increasingly interested in CI education and find it valuable. Our medical education curriculum was successful at increasing residents' understanding, self-efficacy, and confidence in utilizing CI concepts and EHR tools. Future data are needed to assess the impact such curricula have on graduates' proficiency and efficiency in the use of CI tools in the clinical workplace.

Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation.

The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups. Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. Onefocus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included open-ended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds. Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including(1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules. X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees.

Using Natural Language Processing to Identify Key Values in Internal Medicine-Pediatrics Residency Applications.

Using Natural Language Processing to Identify Key Values in Internal Medicine-Pediatrics Residency Applications.

Infant oral health education curriculum for medical, nursing, and social work trainees

Tooth decay is the most common chronic disease in children, and children often see their primary care practitioners more frequently than dentists (Adjaye-Gbewonyo and Black 2019-2020; National Center for Health Statistics 2019-2020). This Infant Oral Health Education Program included two online training sessions for trainees in social work, nursing, medicine, and dentistry. Trainees were assessed on anticipated changes to their practice related to children's oral health. During the first training session, trainees received a lecture on infant oral health, and then discussed a case study in interprofessional groups to reinforce the content. Trainees in medicine and nursing completed training to receive Medicaid reimbursement for performing preventive oral health services. The second training session was profession specific with tailored instructions in the form of videos, as well as a demonstration on fluoride varnish application. Of the 78 trainees (22 social work, 4 pediatric nurse practitioner, 38 pediatric medicine residents, and 14 pediatric dentistry residents), 91 % (n = 70) reported that they were introduced to at least one new health information resource or tool. Four-fifths of the eligible trainees (n = 16/20, 80 %) who completed the evaluation had fulfilled the State's requirements to receive Medicaid reimbursement for performing preventive oral health services. Three-fourths of trainees (n = 22/29, 75 %) reported that they are likely to promote children's oral health in future clinical practice. Trainees from all four professions provided positive feedback about the content.

Piloting a Transition of Care Curriculum at Two Bi-coastal Medicine-Pediatrics Residency Programs.

Lack of consistency in primary care residency training exists in transitions of care (TOC) of adolescents from pediatric to adult medicine, which can lead to conflicting or incomplete training. To fill this gap, we developed a curriculum based on the Got Transition Six Core Elements and piloted it at two bicoastal, academic Medicine-Pediatrics (Med-Peds) residency programs. The goals of this project are to increase resident TOC knowledge, increase transition discussion comfort and skills, and obtain feedback for curriculum improvement. Two educational sessions were held at both institutions between 2020-2021. Of 32 potential resident participants, 26 participated in session one and 22 participated in session two. Sessions included a didactic presentation, small group activities, and a guest speaker discussing transitional experience. Electronic pre-session, post-session, and retention surveys evaluated resident knowledge, comfort, and self-reported skills of TOC. A Hybrid Type II design was used with mixed methods to evaluate curriculum effectiveness and implementation. The first and second sessions had 81% and 68% attendance, respectively. Eighty-four percent completed the pre-session survey, 65% completed the post-session survey, and 68% completed the retention survey. TOC knowledge increased by 19% overall (p<0.001). First-year residents gained the most knowledge and implementation skills. Residents participating in alternating medicine and pediatric clinics gained more knowledge than those in a combined Med-Peds clinic (p=0.001). Comfort increased for both initiating and continuing TOC discussions after the first session. Knowledge retention was not statistically significant. A standardized TOC curriculum can improve resident knowledge and is easily implemented at multiple institutions. Early-in-training residents and those in alternating medicine and pediatric clinics particularly benefit.

Upholding Our PROMISE: Underrepresented in Medicine Pediatric Residents' Perspectives on Interventions to Promote Belonging.

Underrepresented in medicine (UIM) residents experience challenges during training that threaten their sense of belonging in medicine; therefore, residency programs should intentionally implement interventions to promote belonging. This study explored UIM pediatric residents' perspectives on current residency program measures designed to achieve this goal. The authors conducted a secondary qualitative analysis as part of a national cross-sectional study, PROmoting Med-ed Insight into Supportive Environments (PROMISE), which explored pediatric residents' experiences and perspectives during training in relation to their self-identities. A 23-item web-based survey was distributed through the Association of Pediatric Program Directors Longitudinal Educational Research Assessment Network from October 2020 to January 2021. Participants provided free-text responses to the question "What are current measures that promote a sense of belonging for the UIM community in your training program?" The authors used conventional content analysis to code and identify themes in responses from UIM participants. Of the 1,748 residents invited to participate, 931 (53%) residents from 29 programs completed the survey, with 167 (18%) identifying as UIM. Of the 167 UIM residents, 74 (44%) residents from 22 programs responded to the free-text question. The authors coded more than 140 unique free-text responses and identified 7 major themes: (1) critical mass of UIM residents; (2) focused recruitment of UIM residents; (3) social support, including opportunities to build community among UIM residents; (4) mentorship; (5) caring and responsive leadership; (6) education on health disparities, diversity, equity, inclusion, and antiracism; and (7) opportunities to serve, including giving back to the local community and near-peer mentorship of UIM premedical and medical students. This is the first national study to describe UIM pediatric residents' perspectives on interventions that promote a sense of belonging. Programs should consider implementing these interventions to foster inclusion and belonging among UIM trainees.

To Worry or to Believe

In this narrative medicine essay, a current associate program director who entered medicine-pediatrics residency the year work-hours were capped and heard worried remarks about the quality of training residents would receive now hears the same worries expressed after residents voted to unionize at her hospital.

Using Natural Language Processing and Machine Learning to Identify Internal Medicine-Pediatrics Residency Values in Applications.

Although holistic review has been used successfully in some residency programs to decrease bias, such review is time-consuming and unsustainable for many programs without initial prescreening. The unstructured qualitative data in residency applications, including notable experiences, letters of recommendation, personal statement, and medical student performance evaluations, require extensive time, resources, and metrics to evaluate; therefore, previous applicant screening relied heavily on quantitative metrics, which can be socioeconomically and racially biased. Using residency applications to the University of Utah internal medicine-pediatrics program from 2015 to 2019, the authors extracted relevant snippets of text from the narrative sections of applications. Expert reviewers annotated these snippets into specific values (academic strength; intellectual curiosity; compassion; communication; work ethic; teamwork; leadership; self-awareness; diversity, equity, and inclusion; professionalism; and adaptability) previously identified as associated with resident success. The authors prospectively applied a machine learning model (MLM) to snippets from applications from 2023, and output was compared with a manual holistic review performed without knowledge of MLM results. Overall, the MLM had a sensitivity of 0.64, specificity of 0.97, positive predictive value of 0.62, negative predictive value of 0.97, and F1 score of 0.63. The mean (SD) total number of annotations per application was significantly correlated with invited for interview status (invited: 208.6 [59.1]; not invited: 145.2 [57.2]; P < .001). In addition, 8 of the 10 individual values were significantly predictive of an applicant's invited for interview status. The authors created an MLM that can identify several values important for resident success in internal medicine-pediatrics programs with moderate sensitivity and high specificity. The authors will continue to refine the MLM by increasing the number of annotations, exploring parameter tuning and feature engineering options, and identifying which application sections have the highest correlation with invited for interview status.

A Visiting Rotation for Underrepresented in Medicine Pediatric Residents Is Valuable for Recruitment Into Pediatric Fellowships

To truly build an equitable health care system, we need a diverse physician workforce that reflects the demographics of the general population. Diversity improves clinical care outcomes, improves patient satisfaction, and is associated with improved treatment adherence when patients are treated by race-concordant physicians. Additionally, Black, Indigenous, and Hispanic/Latinx physicians are more likely to focus their care efforts on the most vulnerable patient populations in the United States.1 A sense of urgency has developed as recent trends show a decreasing proportion of underrepresented in medicine (UIM) pediatric subspecialty fellows.2,3 The drivers causing this workforce issue have not been fully identified, with limited exposure to subspecialty experiences as a potential contributor. Increasing the numbers of UIM physicians requires deliberate action by academic institutions to recruit and support UIM applicants across various medical subspecialties.The Promoting Resident Experiences in the Subspecialties at Stanford (PRESS) program is a 4-week funded and mentored pediatric subspecialty rotation for UIM residents who will be applying for subspecialty fellowship in the next year. PRESS was created with the following goals: (1) to increase recruitment of UIM trainees into pediatric subspecialty fellowships and academic medicine; (2) to improve inclusion, belonging, and career development of the next generation of UIM subspecialists through coaching and mentoring; and (3) to enhance our learning community by increasing the diversity among our trainees and institution, both during the rotation and afterward. Visiting residents self-select a subspecialty experience, are assigned a faculty mentor and a fellow mentor within the division, and are invited to events within the division, the department, and the larger graduate medical education community. They receive individualized mentorship and coaching on creating a CV and personal statement as well as strategies to increase success in the fellowship application process. Each resident receives funding to cover travel and living expenses during the rotation.Our inaugural cohort consisted of 5 residents. Our residents identified as African American/Black, Hispanic/Latinx, Asian, and North African, and hailed from 4 different states. Our second cohort will include 7 residents (37% acceptance rate), identifying as African American/Black, Hispanic/Latinx, and Southeast Asian, coming from 4 different states.A survey of the first cohort determined that all residents (100%) found the program to be valuable, offering a unique experience and a network of colleagues in and out of their chosen subspecialty. All residents stated that participation in the PRESS program encouraged them to apply to our institution when they would not have otherwise. All residents found the mentorship and individualized coaching helpful. One resident remarked: “It was an absolutely invaluable experience and nothing I probably would have gotten to experience on my own. The support and mentorship was great and I loved the desire for change. I would love for other UIM to experience medicine at an elite center…and I've already recommended that several people I know apply for next year.”Program leadership and residents cited the program as an effective recruiting tool, and leaders felt the PRESS program allowed them to consider applicants that they might not have otherwise. As one fellowship leader highlighted, there is the benefit of “participating in developing opportunities for exposure/recruitment of UIM trainees, [and the] ability to gain new perspectives.” Excitedly, one resident from our inaugural cohort matched into the pediatric cardiology fellowship at our institution. All other residents matched into their desired specialties.The PRESS program represents a feasible and effective program to expose and recruit UIM trainees into programs they would not have otherwise considered and to help them develop a sense of belonging in their subspecialty. It may also help fellowship programs and institutions expand their recruitment base, encouraging a more diverse applicant pool.

Enhancing Resident Education by Embedding Improvement Specialists Into a Quality and Safety Curriculum.

Quality improvement and patient safety (QIPS) curricula are critical in graduate medical education, yet barriers limit the educational experience and project outcomes. To explore the impact of QIPS curricular enhancements and integration of continuous improvement specialists (CIS) by examining the A3 document, the primary project product and surrogate for project quality. Since 2009, University of Michigan internal medicine and medicine-pediatric residents participate in a QIPS curriculum, which includes a 4-week group project. In 2016, residency leaders collaborated with CIS staff, non-clinical experts in QIPS with backgrounds in engineering and business, to improve the curriculum. Informed by a needs assessment, the intervention was implemented in 2017 and consisted of a set of enhancements including integration of CIS staff into groups as co-facilitators. In this retrospective cohort study, a blinded reviewer evaluated all available A3 documents before and after the intervention using a quantitative analysis tool. All residents participated in the curriculum during the pre-intervention (July 2009 to June 2016, n=351) and post-intervention (July 2017 to June 2020, n=148) periods. A total of 23 of 84 (27%) pre-intervention and 31 of 34 (91%) post-intervention A3 documents were available for review. Scores improved significantly for 17 of 23 (74%) A3 items and for 7 of 8 (88%) sections. Mean A3 total scores increased from 29.0 to 47.0 (95% CI 12.6-23.4; P<.001) out of a possible 69.0. Embedding CIS experts into residency QIPS curricula is associated with improved A3 document quality.

Caring for Each Other: A Resident-Led Peer Debriefing Skills Workshop.

Inadequate time and space to process critical incidents contribute to burnout. Residents do not regularly participate in emotional debriefs. An institutional needs assessment revealed only 11% of surveyed pediatrics and combined medicine-pediatrics residents had participated in a debrief. The primary objective was to increase resident comfort in participation in peer debriefs after critical incidents from 30% to 50% with implementation of a resident-led peer debriefing skills workshop. Secondary objectives included increasing resident likelihood of leading debriefs and comfort in identifying symptoms of emotional distress. Internal medicine, pediatrics, and medicine-pediatrics residents were surveyed for baseline participation in debriefs and comfort in leading peer debriefs. Two senior residents became trained debrief facilitators and led a 50-minute peer debriefing skills workshop for co-residents. Pre- and post-workshop surveys assessed participant comfort in and likelihood of leading peer debriefs. Surveys distributed 6 months post-workshop assessed resident debrief participation. We implemented the Model for Improvement from 2019 to 2022. Forty-six (77%) and 44 (73%) of the 60 participants completed the pre- and post-workshop surveys. Post-workshop, residents' reported comfort in leading debriefs increased from 30% to 91%. The likelihood of leading a debrief increased from 51% to 91%. Ninety-five percent (42 of 44) agreed that formal training in debriefing is beneficial. Almost 50% (24 of 52) of surveyed residents preferred to debrief with a peer. Six months post-workshop, 22% (15 of 68) of surveyed residents had led a peer debrief. Many residents prefer to debrief with a peer after critical incidents that cause emotional distress. Resident-led workshops can improve resident comfort in peer debriefing.

573. AIMS-trained Residents Exhibit Specific Communication Skills During Virtual Encounters with Standardized Vaccine-Hesitant Parents Following an Online Training Program

Abstract Background There are no accepted best practices for counseling vaccine-hesitant parents, and training in this area is not required in residency. In a prior study (J Pediatr 2022;241:203-11), we demonstrated that in-person training in a structured communication strategy called AIMS (Announce, Inquire, Mirror, Secure) resulted in behaviors of interest during live encounters with standardized patients (SPs) portraying vaccine-hesitant parents. We investigated whether similar effects would be seen if training and SP encounters occurred in a virtual environment. Methods Pediatrics and Medicine-Pediatrics residents were randomized to receive either AIMS or control training. Subjects underwent pre- and post-training SP encounters simulating an immunization visit for a 4-month-old. SP case materials were modified to more closely approximate well-intentioned reluctance to vaccinate and allow for more authentic interaction. Encounters were video-recorded and assessed by 3 raters using the Vaccine Hesitancy Communication Assessment (VHCA), developed and characterized in the initial study but modified based on factor analysis to improve reliability and validity. Subject confidence and SP evaluations of the encounter were assessed pre- and post-training. Investigators, subjects, SPs, and video raters were blinded to treatment allocation. Results Fifty-three subjects completed the protocol and 47 had complete video files. Subject confidence improved in both groups (Panel A). No differences in SP evaluations were detected between groups (B). Preliminary analysis demonstrated that AIMS behaviors were more commonly detected among AIMS-trained subjects than control, as evidenced by an increase in VHCA score (C). Conclusion Communication training and assessment using SPs were both successfully transitioned to a virtual environment; this opens the possibility of efficient training and assessment of residents who are not located on site. Training increased confidence non-specifically. Encounters with SPs can serve as a model to detect learned vaccine-specific communication behaviors among resident providers, but post-encounter assessments by SPs remained insensitive to differences in those behaviors despite modification of the case materials. Disclosures Shanna M. Barton, MD, M.Sc., Sanofi Pasteur: Grant/Research Support Aaron W. Calhoun, MD, FSSH, Sanofi-Pasteur: Grant/Research Support|Society for Simulation in Healthcare: Board Member|Society for Simulation in Healthcare: Honoraria Victoria A. Statler, M.D., M.Sc., Astellas: University Research Support|Gilead: University Research Support|Pfizer: Advisor/Consultant|Sanofi: University Research Support|Seqirus: Advisor/Consultant Gary S. Marshall, MD, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|GlaxoSmithKline: Honoraria|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Sanofi: Advisor/Consultant|Sanofi: Grant/Research Support|Sanofi: Honoraria|Seqirus: Advisor/Consultant|Seqirus: Grant/Research Support|Seqirus: Honoraria.

1296. Customized Learning About Bettering Sterile Insertion (CLABSI): A Look at Reducing Hospital Acquired Line Infections

Abstract Background Central line associated bloodstream infections (CLABSIs) are associated with significant clinical and economic impacts. A large portion of central venous lines (CVLs) placed at the University of Arkansas for Medical Sciences are done so by resident physicians. A formal education session focusing specifically on aseptic technique for residents has not been utilized so far. Methods Literature review and expert opinion was used to guide development of a multi-modal resident education session. The session consisted of a PowerPoint presentation, a video tutorial, and a CVL insertion checklist. More than 50% of the time was allotted to a hands-on session led by residents demonstrating how to aseptically place a CVL under the supervision of an Infection Preventionist. A Likert scale was utilized to assess the level of confidence residents had regarding eight CLABSI prevention metrics both before and after attending the session. Additionally, residents were polled to assess their preferred teaching modality. 66 internal medicine residents and 18 internal medicine-pediatrics residents participated in the study over a five-week period. The results were assessed for statistical significance with a two-tailed Mann-Whitney U-test. Results Responses were received from 54 residents prior to the simulation lab session, and from 56 residents after the simulation lab session. The total resident response rate was 66.67%. A statistically significant improvement in resident confidence was found in all eight surveyed CLABSI prevention metrics. The majority of responding residents found workshop style sessions, peer-to-peer teaching and educational videos to be the most useful modalities to deliver information. Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention Resident Responses to Preferred Methods of Learning about CLABSI's Pre- and Post-Intervention Conclusion Attendance of a two-hour multimodal resident-driven educational session improved the confidence of residents in their knowledge and implementation of CLABSI prevention metrics. Participants preferred learning via workshop style sessions and educational videos. We recommend a multi-modal approach to resident education, and the consistent involvement of an Infection Preventionist. We hope to expand our curriculum to involve residents in other departments and explore the variation in preferred learning modalities and its overall impact on hospital CLABSI rates Disclosures Hazel K. Liverett, MD, Merck: Stocks/Bonds.

Implementing and Assessing a Resident Diversity Council to Address the Need for a Diverse Clinical Workforce

Minoritized racial and ethnic groups remain underrepresented in medicine (UIM) compared with the general population. Although many residency programs want to train a diverse group of individuals, methods for implementation are not fully established. To describe the implementation and restructuring of the Boston Combined Residency Program (BCRP) Diversity Council and evaluate the association between restructuring the BCRP Diversity Council and the number of UIM interns. A retrospective cohort study was conducted on a large academic pediatric residency program at Boston Children's Hospital and Boston Medical Center. Interns who matched in the BCRP from March 17, 2011, to March 18, 2021, were included. Interns who matched in an affiliated medicine-pediatrics residency were excluded because they are not universally exposed to the same recruitment efforts as individuals in the other BCRP tracks. Because the BCRP Diversity Council was restructured in 2016, 2011-2016 was defined as the prerestructuring era and 2017-2021 as the postrestructuring era. The primary outcome was the proportion of interns who self-identified as UIM. A total of 516 BCRP interns from 2011 to 2021 were included. A total of 62 individuals (12.0%) identified as racial and ethnic identities UIM (ie, American Indian/Alaska Native, Black/African American, Hispanic/Latino, and Native Hawaiian/Pacific Islander). During the 6-year prerestructuring Diversity Council era, 27 of the 275 BCRP interns (9.8%) were UIM; 35 of 241 BCRP interns (14.5%) were UIM during the 5-year restructured Diversity Council era (χ2 P = .10). In this cohort study, the number of UIM interns was higher after the BCRP Diversity Council was restructured, although the difference was not statistically significant. As the magnitude of the Diversity Council's influence is multidimensional, perhaps studying additional aspects would have better captured its impact. The BCRP Diversity Council has expanded innovative recruitment initiatives, supported efforts to improve the resident experience, and collaborated with the residency and institutional leadership to promote an inclusive and antiracist learning environment.

S1561 Food Is Medicine: A Novel Educational Intervention to Improve Nutritional Competency in Graduate Medical Education

Introduction: Nutrition plays a critical role in the pathogenesis of many chronic conditions, and thus it is essential that physicians and trainees possess a strong knowledge base of key nutritional concepts. This is especially relevant to gastroenterologists, who care for patients at high risk for developing nutritional abnormalities due to complications of their gastrointestinal diseases. However, physicians receive minimal nutritional instruction throughout their medical training due to curricular and time constraints and often feel unprepared to effectively counsel patients on key aspects of nutrition. This study aimed to evaluate resident physicians’ attitudes toward nutrition and to improve competency in nutritional counseling using a novel educational intervention. Methods: We implemented a novel nutrition training intervention, aimed at senior internal medicine and internal medicine-pediatrics residents. A scripted presentation was developed on fundamental nutritional concepts and evidence-based nutritional considerations on topics deemed highest priority by the American Society for Clinical Nutrition Committee on Medical/Dental School and Residency Nutrition Education. Resident physicians were surveyed using an abbreviated version of a validated nutrition survey and questionnaire evaluating attitudes on nutrition and objective nutritional competence before and after receiving the presentation. Comparison of pre- and post-intervention scores was made by 2-sample t-test. Results: Among the 39 resident physicians who completed the survey, 85% believed physicians are not adequately trained to counsel patients on nutrition, and 95% expressed the desire to improve their competency in nutrition. Mean scores of objective nutritional competence were significantly improved after administration of the nutritional intervention (63.6% ±11.8 vs 72.2% ±11.5; P=0.017, CI -3.29 to -0.34), as was subjective confidence in counseling patients on all surveyed nutritional concepts (Table). Conclusion: Our study suggests that resident physicians value nutritional education and desire to improve their knowledge of nutrition, but the majority are not satisfied with the current quality of nutrition training. Our novel educational intervention is a simple, efficient method of improving objective nutritional competency among resident physicians that can be easily implemented while respecting time constraints associated with graduate medical training. Table 1. - Basic participant demographics as well as observed measures of subjective confidence and objective competence in nutritional counseling Baseline Participant Demographics Pre-Intervention Survey Completion Post-intervention Survey Completion PGY2 22 12 PGY3 14 4 PGY4 2 1 Male 29 12 Female 10 6 Objective Competence Scores Pre-Intervention (n=39) Post-intervention (n=18) P-Value 63.60% 72.20% 0.0169 Measurement of Subjective Confidence in Nutritional Counseling Nutritional Topic Pre-Intervention (n=39) Post-Intervention (n=18) P-Value Food constituents 2.85 4.12 < 0.0001 Body mass index 3.08 4.06 0.0055 Basic metabolism 3.46 4.67 0.0007 Vitamins 3.00 4.17 0.0003 Omega-3/6 fats 3.11 3.72 0.0409 Dietary cholesterol 3.55 4.28 0.0103 Type 2 diabetes 3.90 4.50 0.0033 Osteoporosis 3.26 4.00 0.0032 HIV 2.08 3.89 < 0.0001 Objective competence was determined utilizing 22 questions from a validated nutrition assessment survey, and scores are reflected as percentage correct. Subjective confidence was determined using a validated questionnaire assessing comfort level and knowledge of nutritional interventions in commonly-encountered diseases in primary care, and was scored on a scale of 1-5 from least to most comforTable, respectively. HIV - human immunodeficiency virus. PGY – post-graduate year.

First Author Spotlight

AnnouncementFirst Author SpotlightPublished Online:09 Sep 2022https://doi.org/10.1152/ajprenal.2022.323.3.AUMoreSectionsPDF (285 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat RAWAN ALMUTLAQCardiorenal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AlabamaFigure 1.Rawan AlmutlaqDownload figureDownload PowerPointRawan Almutlaq is a PhD student in the Department of Integrative Biology and Physiology at the University of Minnesota, mentored by Dr. Louise Evans. She earned her BS in Biochemistry from King Abdulaziz University and her MS in Biotechnology from the University of Alabama at Birmingham. Her research interest focuses on salt-sensitive hypertension. In her spare time, she likes to bake [Photo: Fig. 1].https://doi.org/10.1152/ajprenal.00055.2022DENISE C. HASSONDivision of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OhioFigure 2.Denise HassonDownload figureDownload PowerPointDenise Hasson was born and raised in a suburb of Los Angeles, CA. She graduated from Dartmouth College and then earned her medical degree at Keck School of Medicine at the University of Southern California. She completed an Internal Medicine-Pediatrics Residency at the University of Colorado Hospital/Children's Hospital Colorado. She moved to Cincinnati, OH, to pursue research mentorship from Dr. Steve Standage, Dr. Hector Wong, and Dr. Stuart Goldstein in the laboratory of Dr. Steve Standage at Cincinnati Children's Hospital Medical Center. She finished a Pediatrics Critical Care Fellowship and a Critical Care Nephrology Fellowship. Her research interests focus on the improvement of pediatric acute kidney injury outcomes with a translational approach to nutritional/metabolic optimization. She has accepted a position as a Clinical Assistant Professor in the Department of Pediatrics at NYU Langone Health/NYU Grossman School of Medicine. Denise enjoys traveling, biking, swimming, and she is a loyal Dodgers fan [Photo: Fig. 2].https://doi.org/10.1152/ajprenal.00033.2022SOPHIA M. SEARSDepartment of Pharmacology and Toxicology, University of Louisville, Louisville, KentuckyFigure 3.Sophia SearsDownload figureDownload PowerPointSophia Sears recently earned her PhD in Pharmacology and Toxicology from the University of Louisville. During her graduate studies, she was awarded an F31 predoctoral fellowship from the National Institute of Diabetes and Digestive and Kidney Diseases under the mentorship of Dr. Leah Siskind. She then became a postdoctoral associate in Dr. Siskind's laboratory. Her research interests include chronic kidney disease and inflammation. In her spare time, she enjoys exercising and playing with her dog [Photo: Fig. 3].https://doi.org/10.1152/ajprenal.00097.2022This article has no references to display. Download PDF Back to Top Next FiguresReferencesRelatedInformationRelated ArticlesAromatase inhibition increases blood pressure and markers of renal injury in female rats 23 Aug 2022American Journal of Physiology-Renal PhysiologyCholine supplementation attenuates experimental sepsis-associated acute kidney injury 17 Aug 2022American Journal of Physiology-Renal PhysiologyPharmacological inhibitors of autophagy have opposite effects in acute and chronic cisplatin-induced kidney injury 17 Aug 2022American Journal of Physiology-Renal Physiology More from this issue > Volume 323Issue 3September 2022Pages i-i Crossmark Copyright & PermissionsCopyright © 2022 the American Physiological Society.https://doi.org/10.1152/ajprenal.2022.323.3.AUHistory Published online 9 September 2022 Published in print 1 September 2022 Metrics

Thriving in Residency: a Qualitative Study.

BackgroundWhile a great deal of research has brought attention to the issue of physician burnout in recent years, and resident physician burnout in particular, the topics of physician well-being, and by extension physician thriving, have been relatively understudied. Consequently, we propose a model of resident physician thriving.ObjectiveTo understand what factors contribute to a subjective sense of thriving among resident physicians.DesignIn this study, we conducted in-depth interviews from May 2020 through February 2021 with resident physicians to determine what factors have contributed to their sense of thriving in their careers as well as in their lives more generally. We used a snowball sampling technique to recruit participants. Validated instruments were used to quantify the participant’s subjective level of job and life satisfaction as well as their level of career burnout. To derive our conclusions, we employed thematic content analysis using a grounded theory-based approach.ParticipantsResident physicians in the internal medicine, pediatrics, and combined internal medicine-pediatrics residency programs at a single university-affiliated institution.ApproachWe interviewed those residents with high life, career, and residency satisfaction who did not meet criteria for burnout to explore those factors that contribute to their sense of thriving.Key ResultsThirty-seven screening interviews were conducted. Twenty-four participants met criteria for life, career, and residency satisfaction while also not meeting criteria for burnout. The six key themes contributing to resident thriving that we identified during the course of our analysis included program leadership, learning climate, connectedness, joy in medicine, life balance, and intrinsic factors.ConclusionsThis project proposes a model of resident thriving that can potentially inform program structure, culture, and values.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07504-6.