Medicine Rotation Research Articles

A prospective cohort study evaluating enhanced addiction medicine curriculum graduate medical education on bias, clinical readiness and future practice

Background Studies demonstrate gaps in graduate medical education (GME) in treatment of opioid-use disorders (OUD). There is lack of consensus on best practices to address gaps between clinical readiness and community need despite action to improve education. Through enhanced OUD curriculum, we evaluated the impact in bias, clinical readiness, and intent for future practice OUD compared to usual training in a multi-specialty community-based GME Institution between 2018 and 2020. Objective Evaluate impact of enhanced OUD training during residency to usual training in GME. Methods Residents and faculty members were voluntarily surveyed at baseline and after 2 years in years 2018 and 2020. Interventions included SAHMSA buprenorphine-waiver training, treatment of OUD with medication-assisted treatment (MAT) in the primary care office, and two required addiction medicine rotations. The survey included questions related to bias, self- perceived clinical readiness, faculty teaching self- perceived readiness, and intent for future practice. Results Participation in the survey was 29%, 45%, and 48% for the baseline, control group and intervention group, respectively. The enhanced training group demonstrated statistically significant improvements in four out of seven bias questions, six out of eight clinical-readiness questions and intention to utilize MAT in future practice. Additional findings include a decrease in intent to prescribe MAT from the baseline group to the control group over the two-year period. Conclusions Data from this single-institution survey demonstrate that intentional enhanced OUD education can impact resident physician bias, self-perceived clinical readiness, and intent to treat patients with OUD in future practice.

A Qualitative Analysis of Clinical Year Veterinary Student Journal Entries for a Shelter Medicine Rotation.

Veterinary medical schools are tasked with not only providing experiences necessary to graduate veterinarians proficient in the skills and knowledge used most frequently in private practice, but also develop expertise in animal behavior, welfare, ethics, veterinary forensics, and cultural competency. Integrating all these knowledge areas into the curriculum can be challenging. Shelter medicine is increasingly identified by educators as an optimal learning environment to offer exposure to these topics. It can not only meet learning objectives in veterinary medical curriculum, but also provide students with authentic learning experiences to engage in and gain a deeper understanding of cultural humility, implicit bias, diversity, and inclusion. This includes documentation of international learning outcomes for shelter medicine in veterinary medical curriculum. There have been no studies evaluating authentic learning experiences specific to shelter medicine programs and their impacts on students. The aim of this study was to determine the individual activities and thematic categories on which veterinary students chose to reflect on and their potential impacts during a clinical rotation in shelter medicine at Penn Vet through qualitative content analysis of their journal entries. In our study, students found experiences on the shelter medicine rotation to be beneficial to their growth as a future veterinarian, provided them with takeaways that they found applicable and practical, helped them self-identify knowledge gaps, and changed their perspectives on several important topics related to collective human and animal welfare. These results speak to the value perceived by students of the rotation and suggest an authentic learning experience through a shelter medicine program can help cultivate more practice-ready and culturally competent veterinary graduates.

Emergency Ambulance Utilization in Harlem, New York (July 1985)

Emergency ambulance service in Harlem, New York was studied to determine the degree to which misuse exists. Data were collected prospectively from a paramedic (ALS) ambulance and a basic life support (BLS) ambulance dispatched from Harlem Hospital. The results show that only 29.5% of the 136 calls dispatched to the ALS unit had congruent dispatch and actual priorities (r = 0.05), and only 59.6% of the 255 calls handled by both units were recommended for the unit with the proper level of the skill. 69.9% of calls assigned to the ALS unit were found not to need emergency transport (ET), the most common reason being the “unfounded” call, which represented 35.3% of the sample. ALS intervention was needed on only 20.6% of calls dispatched to the ALS unit. Paramedics were able to correctly access the need for ET 95.6% of the time, but were only willing to refuse transport 35.2% of times in which they felt it was unnecessary. Within the population studied, there exists a significant subset of nonemergency calls which could be more efficiently triaged, both at the level of dispatch and by EMS personnel on the scene. Author Perspective: This research was performed from July 1 to July 26, 1985 to fulfill the requirements of a Community Medicine rotation when the investigator was a student at the Mount Sinai School of Medicine in New York City (presently the Ican School of Medicine at Mount Sinai). Dr. Alexander E. Kuehl was the Vice President of New York City Health and Hospitals Corporation, Emergency Medical Service at the time (prior to New York City EMS moving under the Fire Department) and served as preceptor for the project. This work has not been previously published; however, the investigator was an invited presenter at the “Third International Urban Emergency Medical Service System Symposium” in September 1985 at the World Trade Center in New York City. The oral presentations at the symposium were entitled: “Paramedic Attitudes Concerning On-The-Scene Triage” and “Emergency Ambulance Utilization in Harlem.” To complete the work for this 30-day rotation, the investigator performed daily ambulance ride-alongs in Harlem, New York for 15 consecutive days and collected data prospectively from paramedics. EMTs staffing an ambulance during the same time frame provided concurrent information by survey. Some EMS terminology is now outdated; however, the terms have not been updated in order to preserve the historical perspective of the article. While the data are now historical, having been collected nearly 40 years ago, this research provides useful insights into current EMS initiatives, notably: (1) accuracy of assigned dispatch priority, (2) need for emergency transport to an emergency department, and (3) willingness of paramedics to refuse transport in cases where it is deemed unnecessary. The research questions represent many of the challenges that persist in today’s EMS world with some being particularly relevant with the advent of Community Paramedicine. Emergency Ambulance Utilization in Harlem truly illustrates “what’s old is new again!”

3rd-Degree Atrioventricular Block.

3rd-Degree Atrioventricular Block.

An Intervention to Promote Healthcare Transition Planning Among Pediatric Residents

PurposePoorly planned healthcare transition (HCT) from pediatric to adult-based care for adolescents and young adults with special healthcare needs (AYASHCN) is associated with increased morbidity and mortality. Most pediatricians and pediatric residents are not trained to assist AYASHCN with HCT planning. An electronic medical record-based Transition Planning Tool (TPT) was developed at a large children’s hospital to guide provider-patient interactions around HCT planning. The purpose of this study was to evaluate an educational intervention to promote residents’ use of the TPT. MethodsA multimodal (TPT training, demonstrations, use prompts, and case discussions) curriculum promoting the use of the TPT was developed and implemented within a one-month Adolescent Medicine Rotation. A prospective, nonrandomized, quasi-experimental design with Intervention and Historical Control groups was used. Forty-two residents received the intervention. Twenty-three Historical Control residents received minimal formal training in the TPT. Intervention Group residents completed prerotation/postrotation assessments measuring perceived importance of/comfort with HCT planning and self-reported HCT planning activities. TPT use was compared between the two groups. ResultsCompared to the Historical Control Group, Intervention Group residents were significantly more likely to use the TPT (98% vs. 37%, p < .001) and had a higher mean number of uses (5.5 ± 3.0 vs. 2.6 ± 1.2, p < .001). Residents reported greater perceived importance of (p < .001) and engagement in (p < .001) transition planning activities after completing the intervention. Nearly all (91%) reported that their training increased their comfort in HCT planning. ConclusionsA targeted intervention improved pediatric residents’ use of the TPT and HCT planning activities.

Perception of medical interns about simulation-integrated curriculum of their emergency medicine rotation.

To evaluate the perception of interns about their experience during one-month rotation in the emergency department, and the impact of adding simulation-based training. The retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised feedback surveys filled by interns at the end of their rotation in the emergency department between December 2017 and July 2020. The feedback questionnaire in use is aimed at evaluating interns' experience with the emergency department rotation and the common academic activities during the rotation period. A comparison was done between those who had received simulation-based training and those who had not. Data was analysed using SPSS 24. Of the 971 interns having done rotation in the emergency department, 718(74%) had completed the survey. Simulation-based training had been received by 208(29%) interns, while 510(71%) had not received it. Mean points given on a scale of 1-10 by the interns was 8.2+/-1.8. Overall, 684(95%) interns believed the rotation had met or exceeded their expectations (p>0.001). There was no significant difference between those who had received simulation-based training and those who had not (p>0.05). Interns had a positive perception towards the learning experience during their emergency department rotation, but there was no difference between those who had received simulation-based training and those who had not.

Understanding medical students' interests in family medicine in Vietnam: A qualitative study.

Family medicine has recently been introduced into undergraduate training programs after more than 10years of only being available for postgraduate doctors in Vietnam. The aim of this study was to explore the perceptions of sixth-year medical students towards family medicine and the factors that influence their career choice for - or against - family medicine. The authors used a qualitative approach with a criterion sampling technique, including 36 participants in eight interviews and four focus group discussions, with thematical analysis. Most students could explain well what they had learned about family medicine but showed little interest in it. Only a few of the interviewees indicated they would choose a career in family medicine. The following factors influenced their career choice: valuing continuing care, the doctor-patient relationship and work-life balance; family medicine clinical rotation and teachers' roles; and related health policies offering a clear practice pathway and patient allocation to capable family doctors. The students' perceptions of family medicine were positive, but their interests in and intention to pursue a career in family medicine were still low after a clinical rotation. The authors concluded that the family medicine rotation should be maintained, family medicine should become more prominent in more components of the medical curriculum, and health policies to support and encourage becoming a family doctor are necessary.

Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students

BackgroundMedical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance.MethodsAll third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student’s manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation.Results119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p’s < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students’ confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training.ConclusionsGuided abdominal simulator practice increased medical students’ capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.

Caring for caregivers: encouraging intervention activities as a learning strategy in medical internship

Abstract: Introduction: This work describes the experience of structuring a therapeutic group with informal caregivers who showed signs of overload and who worked providing care to bedridden people followed through home visits by the health team of the Family Health Strategy (FHS). Experience Report: The group was structured and developed by two students of the Internship period of the medical course during the rotation in Family and Community Medicine (FCM) together with the second-year resident physician of the Specialization Program in FCM, the preceptor of the Program, and the team nurse at the Josefa de Souza Silva school unit, Pedra Linda neighborhood, in Petrolina, state of Pernambuco, based on the identification of a problem in the community and as part of the intervention project. Discussion: Seven weekly meetings were held with twelve caregivers, from May to July 2019. Each meeting was divided into welcoming activities, presentation of the day’s proposal with the experience of a self-care practice and ended with the suggestion of a home activity, to be developed until the next meeting. For the development of activities, the community approach and resources such as Popular Education and Integrative and Complementary Practices in Health were used. Conclusion: The reduction of stress and overload on caregivers was observed, from the practice of self-care and the strengthening of support networks in the community. At the same time, the potential of the intervention project was perceived as a learning strategy in the process of medical training in the FHS: the students were able to experience the establishment of the doctor-patient relationship, the use of light technologies for care, the coordination of a therapeutic group, understanding the meaning of equity, integrality and longitudinality in the practice of FCM, recognizing themselves as caregivers and the importance of taking care of themselves to take care of others.

Preparing for the future of medical education: A case series of traditional and virtual clinical rotations in addiction medicine spanning the COVID pandemic

Background: Substance use accounts for more than 400,000 deaths annually in the United States and overdose rates surged during the COVID pandemic. While the pandemic created increased pressure for better prepared providers, it simultaneously placed restrictions on medical training programs. The purpose of this educational case series is to assess the feasibility of a virtual addiction medicine training program and conduct a qualitative evaluation of medical student attitudes toward caring for people with substance use disorders, both before and after their addiction medicine training experience. Methods : We conducted a qualitative analysis related to course content focused on strengths and limitations of in-person and virtual training modalities. Individual quotes were evaluated and content themes were developed after a thorough review of all codes and detailed examination of interviewee quotes. Results: The primary themes that emerged were (1) Addiction medicine content is important to improve care of patients with substance disorders and is not fully addressed in undergraduate medical education (2) In-person and virtual training contain unique strengths and weaknesses and (3) Students perceived that both experiences provided positive and needed training in addiction medicine that shifted perspective and enhanced confidence to practice. Conclusions: Remote training via virtual lectures and patient visits may enhance training opportunities for students with limited exposure to addiction medicine patients and faculty with addiction medicine expertise. There is a need to further refine virtual care for patients with SUDs and virtual training to meet the needs of patients and learners across the country.

Caring for caregivers: encouraging intervention activities as a learning strategy in medical internship

Abstract: Introduction: This work describes the experience of structuring a therapeutic group with informal caregivers who showed signs of overload and who worked providing care to bedridden people followed through home visits by the health team of the Family Health Strategy (FHS). Experience Report: The group was structured and developed by two students of the Internship period of the medical course during the rotation in Family and Community Medicine (FCM) together with the second-year resident physician of the Specialization Program in FCM, the preceptor of the Program, and the team nurse at the Josefa de Souza Silva school unit, Pedra Linda neighborhood, in Petrolina, state of Pernambuco, based on the identification of a problem in the community and as part of the intervention project. Discussion: Seven weekly meetings were held with twelve caregivers, from May to July 2019. Each meeting was divided into welcoming activities, presentation of the day’s proposal with the experience of a self-care practice and ended with the suggestion of a home activity, to be developed until the next meeting. For the development of activities, the community approach and resources such as Popular Education and Integrative and Complementary Practices in Health were used. Conclusion: The reduction of stress and overload on caregivers was observed, from the practice of self-care and the strengthening of support networks in the community. At the same time, the potential of the intervention project was perceived as a learning strategy in the process of medical training in the FHS: the students were able to experience the establishment of the doctor-patient relationship, the use of light technologies for care, the coordination of a therapeutic group, understanding the meaning of equity, integrality and longitudinality in the practice of FCM, recognizing themselves as caregivers and the importance of taking care of themselves to take care of others.

A Brief Coaching Pilot Enhances Professional Identity Formation and Clinical Skills Acquisition During Emergency Medicine Clerkships Shortened by COVID-19.

IntroductionThe Covid-19 pandemic limited educational and career development opportunities for medical students, requiring innovative programs to accelerate professional identity formation and clinical skills acquisition.MethodsWe developed a brief coaching intervention that took place over the advanced (sub-internship) emergency medicine rotation at our institution. We trained coaches using a newly developed workshop, who met with students for an average of 4.5 hours over 3 weeks.Impact/effectivenessWe showed that this coaching program was both feasible and impactful for faculty coaches and medical students.

Assessing the Impact of a Virtual Shelter Medicine Rotation on Veterinary Students' Knowledge, Skills, and Attitudes Regarding Access to Veterinary Care.

Strong bonds commonly form between companion animals and people of all socio-demographic backgrounds, yet many pet owners face numerous barriers to accessing veterinary care for their companion animals. For example, they may have difficulties paying for care; they may lack veterinary practices in their community; and they may experience language barriers that impede their ability to utilize veterinary services. Various strategies exist that can help veterinarians address the diverse needs of pet owners in their communities, but these techniques are not commonly covered in the veterinary school curriculum. This study explored how including in-depth, purposefully curated information about access to veterinary care issues within a required shelter medicine rotation impacted fourth-year veterinary students' knowledge, skills, and attitudes regarding the problems clients commonly face when seeking access to veterinary care. Students participated either in a control group of a virtual, four-week rotation delivered via Zoom meetings and self-study, or in an experimental group that additionally completed an interactive online learning module. The online module heavily featured issues surrounding access to veterinary care. Irrespective of which version of the rotation students enrolled, their opinions grew more favorable from pretest to post-test regarding the role of not-for-profit veterinary clinics in communities, as did their expectations that veterinarians should provide affordable treatment options. Additionally, students in the experimental group demonstrated from pretest to post-test increased awareness of the potential for implicit bias toward pet owners within veterinary practice and showed a reduction in their tendency to be judgmental of veterinary clients. By the end of the study, students in the experimental group also expressed greater confidence in their ability to offer incremental care treatment options to veterinary clients. These findings suggest that providing content that focuses on increasing access to veterinary care enhances students' awareness of the need to offer a variety of treatment and payment options to clients. Findings from this study can inform curriculum design in veterinary schools and continuing education programs for veterinary professionals.

ICRE Top Research Abstracts

ICRE Top Research Abstracts

Teen Actors Teaching Communication Skills.

IntroductionTo provide high-quality care, physicians must effectively communicate with adolescents while addressing difficult and sensitive subjects. Our program aimed to (1) cost-effectively incorporate teenage actors into a pediatric simulation program and (2) increase residents' self-perceived comfort level with adolescent patients by practicing interview skills with teens.MethodsIn 2013, the authors established a Teen Acting Program, in which volunteer theater students created and simulated patient characters and provided feedback to learners. Residents on the adolescent medicine rotation participated in the program, completed a survey on self-perceived comfort level with adolescent patients, and answered open-ended questions regarding the program.ResultsA total of 70 residents participated in the program and pre-survey; 46 completed both the pre- and the post-survey. Of 46 participants, 37 (80%) reported that the program was helpful and four (9%) stated it was the best thing about the rotation; 35 (80%) described the program as “high-yield” for the time spent. Between the pre- and post-surveys, residents demonstrated statistically significant improvement in comfort interacting with adolescent patients, addressing confidentiality, and taking histories on sexuality, substance use, mental health, diet, and safety, whether they were the interviewer or observer. Residents that reported the teens taught them specific skills and concepts related to communication. A calculation of program costs demonstrated a 10-fold decrease in cost from traditional simulation patient encounters.ConclusionThe Teen Acting Program was cost-effective and improved resident comfort with interviewing adolescents about sensitive topics, while giving adolescent actors experience honing their acting skills.

A Student in My Pocket: Development of a Virtual Internal Medicine Hospital Rotation During the COVID-19 Pandemic.

Purpose: It is imperative for physician assistant (PA) students to be exposed to hospital medicine as 40% of practicing PAs identify the hospital as their principal clinical practice setting. 1 Many of these rotations were canceled due to the COVID-19 pandemic, negatively impacting the 70% of PA programs not affiliated with an academic medical center. 2 To address this need and provide a comparable experience for PA students, medical educators at the University of Chicago created a Virtual PA Rotation (VPAR). The purpose of this project was to develop a high-yield clinical rotation for private PA programs negatively impacted by COVID-19 by implementing and evaluating a 4-week-long VPAR comprising (1) direct patient care, (2) medical educator-facilitated breakout sessions, and (3) asynchronous learning. Approach: Five students worked with 3 preceptors for the VPAR and were assigned 3–6 patients daily. Direct patient experiences included virtual interviews using FaceTime, preceptor staffing via Zoom, and completion of daily progress notes. This was augmented with medical educator-facilitated breakout sessions and didactic sessions. Evaluation of the VPAR included: (1) comparison of virtual vs traditional in-person rotation patient logs, (2) postcurriculum survey of students and medical educators’ satisfaction and self-efficacy, and (3) student pass rate on the end of rotation (EOR) examination. Outcomes: Diagnoses and patient encounter logs were collected from the 5 virtual rotation students and compared with 4 students who completed traditional in-person rotations in 2019–2020. Mean diagnoses logged per virtual student was 206 (standard deviation [SD] = 155), compared with mean 414 diagnoses (SD = 130) for traditional students (t = 2.14, P = .07). Mean patient encounters logged per virtual student was 34.2 (SD = 20.7), compared with 80.8 (SD = 29.5) for traditional students (t = 2.79, P = .03). One hundred percent of students responded to a survey. Interactive patient interviews, preceptor group, case presentations, and electronic health record review were rated as the most useful educational experiences. Students felt most prepared in ability to review hospital charts, analyze results, and obtain a patient history. All 5 students felt this rotation provided an adequate experience to understand Internal Medicine in a hospital setting. Fifty-nine percent (13/22) of medical educators responded to the postrotation survey. Eighty-five percent (11/13) were moderately or extremely satisfied with their participation in teaching in the rotation, 77% (10/13) were moderately or extremely likely to recommend the rotation to other medical educators, and 100% felt it made them more open to future interprofessional education experiences. Discussion: We were able to create an innovative, high-yield hospital medicine rotation to meet the need for PA students negatively impacted by COVID-19. The VPAR overall was a success as measured by 100% EOR examination pass rate, high student ratings, and comparable patient encounters and diagnoses. The VPAR was also well received by medical educators, though most felt it was more time-consuming, proving to be the biggest limitation to this model. Lessons learned from the preceptors included limitations of technology such as decreased device battery life, need for troubleshooting, and loss of organic educational experiences for students. They also highlighted concerns regarding increased time dedicated to logistics of the rotation while managing highly complex patients. Strengths of the VPAR include its feasibility, low cost of implementation, and ease of application of this model to other practice settings, specialties, and professions. The VPAR also has the capability to adjust for different rotation lengths of time. Significance: We believe the results above showcase that this innovative model of education can meet the needs of PA students negatively impacted by COVID-19. Therefore, as COVID-19 continues and health systems respond, a VPAR is a reasonable alternative to in-person clinical rotations. Beyond COVID, this pilot rotation’s success demonstrates that VPARs or a hybrid of a virtual and in-person rotation may be an interesting addition to PA education, particularly for unaffiliated programs with a significant need for access to inpatient rotations and tertiary care centers. Furthermore, this model could easily translate to other professional disciplines similarly impacted by visiting student restrictions.

Canadian general internal medicine residents' perception of a pedagogical tool of online cases in obstetric medicine.

Sufficient exposure to rarer medical problems around pregnancy is a challenge during short rotations in obstetric medicine (OM). A Canadian research group created online clinical cases, the CanCOM cases, to overcome this. We conducted an exploratory study to document the use and perceived utility of the CanCOM cases. 77 residents doing an OM rotation participated in our study. We used a survey to document their perception of CanCOM cases (12 items, 7-point scale), clinical exposure to several conditions (pre and post rotation; 41 items, 7-point scale) and use of the educational tool (1 item, 4-option scale). CanCOM cases was perceived as an accessible and useful tool. Participants completed a median of 6/20 cases (range 1-20), and highly recommended the cases (6.48 ± 0.73 SD on a 7-point Likert scale). Despite some technical limitations, CanCOM cases was shown to contribute to clinical exposure to rare but essential medical conditions.

Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp

BackgroundIntegration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns’ patient management skills, ethical decision-making, and reflection skills.MethodsA multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group’s performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students’ performances, and common achievements and mistakes of students.Results133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill.ConclusionThe multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.

When it\u2019s needed most: a blueprint for resident creative writing workshops during inpatient rotations

BackgroundNarrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.ObjectiveTo evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.MethodsWe developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1–7; 3–4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017–2018, weeks 1 and 4), and implementation year (2018–2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.ResultsResidents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.ConclusionsInpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial.

Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.