Physician Education Research Articles

US medical school curriculum on opioid use disorder—a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition

The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.

Clerkship Chiefs: Introducing Students to the Role of Physician Educator.

As a Clerkship Chief, senior medical students prepare for futureroles as physician leaders and future medical educators. The Clerkship Chief elective offers senior students an opportunity to work with junior students on their core clerkships. Chiefs assume an educational leadership role as they mentor and provide supplemental formative feedback to junior students in real time. As educators, Chiefs answer questions, prepare study materials and didactics, and assist clerkship students with time management. This early experience and behind-the-scenes view of medical education may influence attitudes and decisions of senior students in pursuit of education leadership.

Approach of Female Patients to Screening Tests in the Prevention of HPV-Related Cervical Cancer and the Effect of Physician's Recommendation

The aim of our study was to evaluate the cervical cancer screening test status of female patients between the ages of 30-65 who applied to the family medicine outpatient clinic for any reason. If they have not had the screening test, it is aimed to provide information and relevant education to the patients about the test, and then to include the patient in the national cervical cancer screening program by improving the patient's knowledge and awareness and also to contribute to preventive health care, which is our principle of family medicine specialty. Our study was prospective observational research in which evaluating the status of having a cervical cancer screening test after appropriate information. Patients were asked about their cervical cancer screening test status, and all participants were informed about this issue, and the patients who did not get tested were contacted again by phone one month later to evaluate the status of taking the test. A unique structured questionnaire form was used for the study. A total of 146 women who agree to participate voluntarily were included in the study. The mean age of the patients was 44.39±9.26 years and 64.4% had not gone through menopause. Of the patients, 87% were married, 48.6% were university graduates, and 49.3% were not employed. 66.4% of patients had had a cervical cancer screening test at least once, while 28.9% of them had been tested more than five years ago, 2.1% did not remember when they had the test. Of those who had the screening test, 57.7% had the test for health check-up, 73.5% of those who did not get tested they did not have a test because they did not need or had any complaints. 73.3% of the patients had not received training on the screening tests. 51.3% of those receiving training stated that they received training from the hospital and 28.2% from the family health center. After being informed about the cervical cancer screening test, 58.9% (n=86) of the patients considered having the test. It was determined that 26.6% of the patients (n=79) who did not have the screening test in accordance with the screening program and who never tested, had the screening test done after being informed. Consider the average age of the patients, it was determined that their participation in the cervical cancer screening program was quite low. The fact that more than half of the participants considered having a screening test after the physician's recommendation and training, and the fact that one quarter of the participants who were due to have the screening test after one month had the screening test, shows the importance of the physician's recommendation and education.

Factors Affecting Learning Essential Procedural Skills in Pediatric Residents: A Cross-sectional Study

Background: Clinical education is a vital component of physician education, where medical students learn by attending to patients and applying their knowledge and reasoning to solve their problems. However, many medical students struggle to acquire procedural skills, the ultimate goal of clinical education. Procedural skills are expected to be learned by the residents according to their academic year and are essential for providing better health services to children and families. Objectives: This study evaluates the status of the training provided and the level of learning the necessary procedural skills in pediatric residents based on standards. Methods: This research was a descriptive cross-sectional method from 1998 to 99. In the first part of the researcher-made questionnaire, the implementation of the educational program on all pediatric residents (115) of Mofid Children's Hospital was evaluated. In the second part, the residents' views on the current state of their learning of essential procedural skills were determined. Results: All residents from years one to four participated in the study. After assessing the status of skills acquired by residents with a questionnaire and comparing the average of each skill acquisition procedure with the desired standards, the average of all skills in all three methods was under the standards approved by the Ministry of Health, except for independent subcutaneous, intramuscular and intravenous injection skills and the skill of working with a ventilator. Also, according to the Friedman test, the lowest score for gaining skills in performing procedures was related to NG tube placement skills and subcutaneous, intramuscular, and intravenous injection skills. According to the statistical results obtained from the Spearman coefficient in all procedures, the level of subcutaneous, intramuscular, and intravenous injection skills had a significant correlation with independent skills. Conclusions: According to the specialized assistants of children participating in this study, the current training program of essential procedural skills implemented at Shahid Beheshti University of Medical Sciences was generally useful and effective. But there were also obstacles and limitations. Therefore, it is recommended to review the implementation of the training programs and implement effective measures, including providing more exposure conditions for independent procedures.

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education.

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube. A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria. Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality. YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

Motivations and Experiences of Teaching Assistants in a First-Year Integrated Medical Course.

Peer teaching is used in many medical schools and is recognized as beneficial to the student teacher and learner. We surveyed a cohort of teaching assistants (TAs) in a first-year course to determine their motivations to serve as TAs and the perceived benefits. TAs served because they wanted to help, solidify their knowledge, and have an opportunity to teach. They perceived that their experience helped them develop their communication skills and encouraged them to pursue future teaching opportunities. This information will help in recruiting students into teaching and also in developing a standardized student-as-teacher program to foster the next generation of physician educators.

Misdiagnosis of amyotrophic lateral sclerosis in clinical practice in Europe and the USA: a patient chart review and physician survey

Objective Delays in amyotrophic lateral sclerosis (ALS) diagnosis can result in compromised disease management and unnecessary costs. We examined the extent of ALS misdiagnosis in the US and Europe. Methods Data were collected via the Adelphi ALS Disease Specific Programme™, a cross-sectional survey of physicians and a medical chart review of their consulting patients with ALS in France, Germany, Italy, Spain, the UK (EU5), and the US. Between July 2020 and March 2021, eligible physicians (primary speciality neurology, active involvement in managing patients with ALS) abstracted data from patients (≥18 years old) with confirmed ALS. Results Overall, 138 physicians completed the survey (EU5 107, US 31), with data reviewed from 795 patient medical charts (EU5 568, US 227); 278 (35.0%) patients (EU5 183 [32.2%], US 95 [41.9%]) had received ≥1 initial misdiagnosis based on symptoms later attributed to ALS. Mean (SD) time from symptom onset to first healthcare professional consultation was 3.8 (5.2) months (EU5 4.3 [4.8] months, US 2.6 [5.8] months). Mean (SD) time from symptom onset to ALS diagnosis was 8.2 (12.5) months (EU5 9.6 [14.0] months, US 5.0 [6.8] months) and increased to 10.4 (17.9) for patients with a misdiagnosis (compared with 6.9 [7.2] for patients with no misdiagnosis). Physician-identified barriers to timely ALS diagnosis included the similarity of symptoms to other conditions and delayed referral to neurologists. Conclusions Misdiagnosis of ALS is frequent, with a protracted diagnostic pathway. Targeted education of patients and physicians about signs and symptoms and benefits of prompt referral to multidisciplinary care are needed.

SAT349 Participant Experiences of a Web-based Lifestyle Intervention for Postpartum Women With Recent Preeclampsia

Abstract Disclosure: C.E. Horn: None. J.M. Dias: None. G. Skurnik: None. A. Roche: None. J.J. Stuart: None. E. Tsigas: None. J.W. Rich-Edwards: None. E.W. Seely: None. Title Participant Experiences of a Web-based Lifestyle Intervention for Postpartum Women with Recent Preeclampsia. Introduction Patients with a history of preeclampsia have increased risk of developing cardiovascular disease (CVD) postpartum compared to their normotensive counterparts. The postpartum period following a preeclamptic pregnancy is a unique window of opportunity to implement lifestyle changes targeted at reducing future maternal CVD. Mobile, web-based health interventions can be leveraged to overcome many challenges of the postpartum period in this high-risk population. Here, we describe key findings of qualitative interviews conducted to gather feedback regarding a web-based lifestyle intervention to reduce cardiovascular risk in women with recent preeclampsia. Study Design A qualitative study was conducted with 21 women from the Heart Health for Moms (HH4M) study, a prospective, 9-month randomized controlled trial conducted nationwide to test the effectiveness of an online intervention to improve lifestyle for 151 women with recent preeclampsia (Clinical Trail Registration #NCT02147626). Within two months of completing HH4M, women were invited to participate in structured, phone-based interviews regarding their experiences in the study. Interviews were conducted until saturation was reached (n=21). Two investigators independently analyzed and coded interview transcripts for repeated concepts and themes. Results Four prominent themes emerged including: 1) the motivation for participating in research; 2) inadequate continuity of care postpartum and physician education regarding future risks; 3) importance of social support; and 4) the motivation provided by accountability. Overall, women chose to participate in the study to learn about preeclampsia risk and help themselves and others affected by preeclampsia. Many women were unaware of the link between preeclampsia and CVD prior to study participation and attributed this to inadequate clinical provider education or counseling as well as gaps in continuity of care from the pregnancy to the postpartum period. Participants reported positive impacts on their social support networks, including increased confidence to build community, the involvement of family and friends in healthy lifestyle behaviors, and a sense of connection to other participants. Women emphasized that interactions with the lifestyle coach made them feel accountable which was an important motivator. Conclusion HH4M provided accountability, motivation, and social support for women with recent preeclampsia to adopt healthy lifestyle habits in the postpartum period. Study participant feedback may inform the creation and dissemination of web or app-based interventions to educate, support, and empower women with recent preeclampsia. Presentation Date: Saturday, June 17, 2023

Use of Focal Radiotherapy Boost for Prostate Cancer and Perceived Barriers toward its Implementation: A Survey.

In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practices worldwide as well as physicians' perceived barriers toward its implementation. An online survey assessing the use of intraprostatic focal boost was conducted in December 2022 and February 2023. The survey link was distributed to radiation oncologists worldwide via email list, group text platform, and social media. Survey questions included how many prostate cancer cases participants treat in a typical month; how often they use focal boost, if at all; the degree to which their practice is genitourinary (GU)-subspecialized; main barriers to implementing focal boost more often in their practice; and demographic information. Subgroup analyses were also conducted for participants from high-income or low-to-middle-income countries, as defined by the World Bank. The survey initially collected 205 responses from various countries over a two-week period in December 2022. The survey was then reopened for one week in February 2023 to allow for more participation, leading to a total of 263 responses. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of respondents worked at an academic medical center (52%) and considered their practice to be at least partially GU-subspecialized (74%). 57% of participants overall reported not routinely using intraprostatic focal boost. Even among complete subspecialists, a substantial proportion (39%) do not routinely use focal boost. Less than half of participants in both high-income and low-to-middle-income countries were shown to routinely use focal boost. Perceived barriers to implementation are shown in Table 1. Despite the promising level 1 results of the FLAME trial, many radiation oncologists worldwide are not routinely offering focal RT boost. Adoption of this technique might be accelerated by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, automated planning algorithms, and physician training on contouring prostate lesions on MRI.

Outcomes of resident physician-performed cataract surgery in a diverse veterans affairs health system population.

To evaluate visual acuity (VA) outcomes and complications from resident physician-performed cataract surgery in a diverse Veterans Affairs Hospital population. A retrospective chart review was conducted for patients who underwent cataract surgery performed by resident physicians from 01/01/2013 to 12/31/2015 at the Veterans Affairs Medical Center. Intraoperative and postoperative clinical information, best-corrected VA (BCVA) (1 day, months 1, 2-3, and 6), and surgery complications were extracted. Univariable and multivariable linear regression models were performed for risk factors of BCVA change. This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years. 1154 (97.5%) were males, 493 (41.7%) African-American, and 681 (57.6%) Caucasian. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months, and 0.14 (0.36) at 6 months. 1080 (91.3%) patients experienced VA improvement from baseline and 1023 (86.5%) patients achieved at least 20/40 BCVA at 1 month. There were 86 (7.3%) complications, most commonly including 47 (4.0%) posterior capsular tears and 64 (5.4%) vitreous loss. In multivariable analysis, younger age (P < 0.0001), worse baseline VA (P < 0.0001), and absence of iris prolapse (P < 0.001) were significantly associated with greater improvement in VA at 1 month. In a diverse VAMC, resident-performed cataract surgeries achieved significant improvement in VA with a cumulative complication rate lower than previously reported. Resident physician education may benefit from specific focus on prevention of iris prolapse and better incision construction during surgery as these intraoperative events often led to delayed stabilization of visual outcome beyond 1 month.

Factors Associated with Korean American Women's Health-Related Internet Use: Findings from Andersen's Behavioral Model.

Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model.Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women.Predisposing factors of being aged 60 or older (β = - 0.329, SE = 0.694, p = 0.004) and employment status (β = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (β = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use.The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.

Optimizing Antihypertensive Management for Hypertensive Patients With Secondary Complications: A Systematic Review and Meta-Analysis in PrimaryCareSettings.

Despite significant pharmacological advancements, hypertension management remains challenging, with varying quality of primary care. Digital tools and other non-pharmacological interventions hold promise in addressing this challenge. Consequently, a thorough examination of these interventions is recommended. This meta-analysis focuses on clinician-oriented strategies aimed at improving hypertension management, to assess the most effective approaches for improving antihypertensive prescribing and blood pressure control for secondary prevention. This was done through a systematic review of randomized controlled trials published in PubMed and Embase since the beginning of 2010 that aimed to enhance antihypertensive medication prescription in primary care settings for hypertensive patients with secondary complicationswhile reporting changes in blood pressure or target achievement. We screened6305 records. Four studies met the inclusion criteria, with reported interventions including physician education and the implementation of electronic decision support systems. All studies showed that the control group had a statistically significant lower systolic blood pressure, but the effect on diastolic blood pressure was not statistically significant. The overall mean difference was 2.12 mmHg (95% CI = 0.98; 3.26, P-value = 0.0003) for systolic blood pressure in favor of the control group and 1.22 mmHg (95% CI = -0.48; 3.26, P-value = 0.16) for diastolic blood pressure, which was not statistically significant. Despite considerable efforts to control hypertension, it remains a significant obstacle to optimal cardiovascular risk reduction.This review is also limited by a scarcity of studies.

The Relationship Between Spiritual Needs, Adherence to Refills, and Medications in Patients With Coronary Artery Disease

Background and Aim: Coronary artery disease is recognized as a major cause of mortality and an important health priority worldwide. The patient's adherence to the treatment regimen is one of the important factors in disease control. Many patients do not adhere to the treatment and ignore the physician's instructions. Spiritual needs can affect adherence to a patient's treatment. This study was conducted to determine the spiritual needs and their relationship with adherence to refill and medication in patients with coronary artery disease. Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2017 in Qom, Iran. In this study, 100 patients with coronary artery disease hospitalized in Qom educational hospitals were selected by convenience sampling method. The required information was collected via interview using four questionnaires of demographic characteristics, spiritual needs questionnaire, hospital anxiety and depression scale, and adherence to treatment regimen questionnaire. Finally, the data were analyzed using SPSS software version 22. Results: The Mean±SD spiritual needs in the elderly was 44.65±12.18 and 30% of patients had adherence to refill the average. The results of multiple regression analysis showed that two variables of depression (P=0.012; β=-0.37) and active/productive forgiveness (P=0.007; β=0.41) were significantly associated with adherence to the treatment regimen among the variables included in the model. Conclusion: The results of this study showed that spiritual needs have a significant relationship with adherence to refill. Also, depression is an important predictor of adherence to refill and healthcare providers need to pay attention to the role of these factors in improving adherence to patients› treatment regimens.

Biobank Education for Future Physicians: Training Medical Students Through Student Research Association Networks.

Research biobanks have become crucial collaborators in a variety of basic and clinical research projects with comprehensive biological sample collection and associated data storage. Medical students, who are the most important stakeholders of biobanks as future physicians, need to be trained in biobanking; however, there is no consensus on how to include it in formal education. This study aimed to determine and increase awareness among medical students regarding biobanks through peer training organized online by medical student research association networks. Volunteer medical or graduate students were trained by biobank professionals at the Izmir Biomedicine and Genome Center (IBG) biobank for 6-9 months. Then, a biobank event was planned by these trainees, the Ege Scientific Research Team (ESRT), and IBG-Biobank with the support of The Biobanking and BioMolecular Resources Research Infrastructure (BBMRI) Turkey. The study reached students of 46 different medical faculties. Before the event, students' level of knowledge about biobanks was identified using a pre-event questionnaire (n = 239). Following 2 days (4 main sessions) of online events, a post-event questionnaire was administered to event participants (n = 110) and 80.9% of them answered (n = 89). The pre-event survey revealed that only 34.3% of the medical students had heard of the term "Biobank" in Turkey. After the event, medical students were significantly more enthusiastic about putting effort into biobanking and using and sharing stored biobank samples of their patients compared with the pre-event (p < 0.0001). Moreover, 92% of the students stated that they would consider attending an advanced course in biobanking. In conclusion, the current study demonstrates that extracurricular courses with peer learning methods coordinated with medical student associations can be valuable in increasing future physicians' awareness and knowledge of biobanking.

Training and education of young physicians and engineers in the field of endoscopy and laparoscopy – a review of Germany-wide joint cooperation and training possibilities

Abstract Introduction: Application-related (hands-on) training and instruction is an essential component in the advanced education of physicians in residency. To teach and train required endoscopic examinations and interventions in a standardized manner, courses are offered by various societies. Within these courses the assistant endoscopists learn and train how to use the technical equipment and how to perform the examinations and related interventions. Similarly, for graduate biomedical engineering students with a job- or research-related interest in the field of endoand laparoscopy, an early involvement and practical introduction to the instrumentation and techniques - if possible already during their studies - can generate a fundamental understanding of the technical requirements as well needs of the physicians. Objective: As various such (hands-on) training-courses for flexible and rigid endoscopy specifically addressing young physicians, surgeons as well as engineers are offered by numerous institutes, this contribution tries do provide a structured overview on/over these possibilities. Material: Known cross-institutional courses in the field of endo- and laparoscopy currently offered in Germany in cooperation of physicians and engineers are listed and briefly described. Results: A total of n = 4 crossinstitutional courses for the introduction and training in flexible and rigid endoscopy have been identified. Discussion: The cross-institutional courses for physicians and technicians in the field of endo- and laparoscopy presented serve to provide a better understanding of the subject matter and the field of either discipline. Questions that arise in the field of endoscopy from physicians can be addressed at an early stage and, if necessary, worked on with little effort. Ideas for new instruments and even new interventions can arise and be pursued through an intensive exchange between technicians and physicians. Collaborations are established on a local basis which will foster national activities in this field and which allow to develop competencies relevant for the industrial sector of medical engineering.

Exploring barriers and facilitators of primary care physicians towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group: a qualitative study in Singapore

ObjectivesTo explore the perspectives of primary care physicians with regard to the barriers and facilitators towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group.DesignQualitative descriptive study.SettingFour...

Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation: A Proposal for Standardization in Fellowship and Training Programs.

The need to be competent in neuromodulation is and should be a prerequisite prior to completing a fellowship in interventional pain medicine. Unfortunately, many programs lack acceptable candidates for these advanced therapies, and fellows may not receive adequate exposure to neuromodulation procedures. The American Society of Pain and Neuroscience (ASPN) desires to create a consensus of experts to set a minimum standard of competence for neurostimulation procedures, including spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG-S), and peripheral nerve stimulation (PNS). The executive board of ASPN accepted nominations for colleagues with excellence in the subject matter of neuromodulation and physician education. This diverse group used peer-reviewed literature and, based on grading of evidence and expert opinion, developed critical consensus guides for training that all accredited fellowship programs should adopt. For each consensus point, transparency and recusal were used to eliminate bias, and an author was nominated for evidence grading oversight and bias control. Pain Education and Knowledge (PEAK) Consensus Guidelines for Neuromodulation sets a standard for neuromodulation training in pain fellowship training programs. The consensus panel has determined several recommendations to improve care in the United States for patients undergoing neuromodulation. As neuromodulation training in the United States has evolved dramatically, these therapies have become ubiquitous in pain medicine. Unfortunately, fellowship programs and the Accreditation Council for Graduate Medical Education (ACGME) pain program requirements have not progressed training to match the demands of modern advancements. PEAK sets a new standard for fellowship training and presents thirteen practice areas vital for physician competence in neuromodulation.

Proof-of-Concept: Conceptual design and realisation of an educational augmented reality (AR) application for anaesthesia induction

Abstract Increasing patient safety during operations is an inevitable topic in anaesthesiology. The cockpit strategy presented by Vogelsang et al. addresses this issue with elements such as closed loop communication and the use of checklists. In this paper, the use of checklists is taken up further. An AR application is presented that augments checklists for anaesthesia induction into the user’s field of view. The application is to be implemented in teaching and help prospective physicians to internalise the workflows in anaesthesiology more quickly and sustainably. A working prototype has been created and loaded onto the HoloLens 2. The prototype is being assessed and evaluated by an anaesthetist. The feedback will be included into the following development steps. The application will be further adapted to the needs and requirements of the users. In order to evaluate the usability and the user experience, students and medical professionals should test and evaluate the application repeatedly.

Abstract P117: Improving Hypertension Control In A Veterans Affairs Resident Primary Care Clinic, A Mixed-Methods Study

Introduction: Hypertension (HTN) is a critical modifiable risk factor for cardiovascular disease (CVD). In 2017, ACC/AHA guidelines recommended a blood pressure (BP) target of ≤ 130/80 mmHg for patients with high CVD risk. Prior research in the primary care clinic showed poor adherence with up-to-date guidance for BP control. The current study targets resident physician prescribing barriers to improve HTN control. Method: The study was conducted in a large Midwest VA Patient Aligned Care Team (PACT) staffed by 49 Internal Medicine resident physicians and 10 supervising physicians. Physician prescribing barriers were identified via semi-structured interviews. Interventions included physician education on BP goals and treatment, guided self-audit exercise, and revised implementation of EMR HTN order menu. Therapeutic inertia (TI) data was collected weekly from October 2022 to May 2023. Results: Major themes of prescribing barriers identified by physician interviews were patient non-adherence, lack of guideline-integrated practices, and lack of knowledge of single-pill combination agents (Table 1). Therapeutic inertia was examined for patients with high CVD risk and uncontrolled BP at a PACT visit. Baseline TI from June to October 2022 was 88.2% (128 of 145 patients had no change in antihypertensive therapy). Post-intervention TI was 88.4% (107 of 121 patients had no change in antihypertensive therapy). Conclusion: This study highlights the ongoing need to engage resident physicians with interactive tools to increase awareness of updated HTN guidelines. Identifying barriers to resident prescribing behaviors can be used to target interventions.

Trends and Patterns of Antibiotic Prescriptions in Primary Care Institutions in Southwest China, 2017-2022.

To explore the prescription patterns and usage trends of antibiotics within primary care institutions located in underdeveloped regions of China from 2017 to 2022. A retrospective analysis of antibiotic prescriptions was conducted from 25 primary care institutions in Guizhou Province during the period of 2017-2022. Antibiotic prescriptions were categorized into appropriate and inappropriate use. Appropriate use is further categorized into preferred medication, and antibiotics can be used or substituted. Inappropriate use is further categorized into unnecessary use, incorrect spectrum of antibiotics and combined use of antibiotics. Factors associated with inappropriate use were investigated using generalized estimation equations. Holt-Winters and SARIMA models were employed to predict the number of inappropriate antibiotic prescriptions as the alternative model. A total of 941,924 prescriptions were included, revealing a decreasing trend in both the number and inappropriate rates of antibiotic prescriptions from 2017 to 2022. Diseases of the respiratory system (70.66%) was the most frequent target of antibiotic use, with acute upper respiratory infections of multiple and unspecified sites representing 52.04% of these cases. The most commonly used antibiotics were penicillins (64.44%). Among all prescriptions, inappropriate antibiotic prescriptions reached 66.19%. Physicians aged over 35, holding the title of associate chief physician and possessing more than 11 years of experience were more likely to prescribe antibiotics inappropriately. The phenomenon of inappropriate antibiotic use was commoner among children aged five or younger. By comparing model parameters, it was determined that the SARIMA model outperforms the Holt-Winters model in predicting the number of inappropriate antibiotic prescriptions among primary care institutions. The number and inappropriate rates of antibiotic prescriptions in southwest China exhibited a downward trend from 2017 to 2022, but inappropriate prescription remains a serious problem in primary care institutions. Therefore, future efforts should focus on strengthening physician education, training, and clinical practice. Additionally, physicians' awareness of common misconceptions about inappropriate antibiotic use must be improved, and the prescribing behavior of physicians who fulfill patients' expectations by prescribing antibiotics needs to be modified.