Resident Confidence Research Articles

Development of a Departmental Resident Educational Program to Increase Knowledge and Confidence Related to Obstetric Anal Sphincter Injuries [ID: 1375536

INTRODUCTION: Obstetric anal sphincter injuries (OASIS) have been reported in up to 35% of vaginal deliveries; thus, understanding these injuries is a critical part of obstetrics and gynecology training. Formal educational programs with incorporated simulation training can have an advantageous effect, particularly when provided as part of residency education. This project seeks to evaluate the positive effect of departmental resident education related to OASIS, on confidence and knowledge of obstetrics and gynecology residents at Wake Forest University. METHODS: A structured OASIS curriculum was developed by the urogynecology program, including 2 hours of didactic lecture followed by stepwise simulation with swine models to demonstrate and practice anatomic repair techniques. Participants completed pre- and post-class surveys including skill confidence assessments via Likert scale (range 1–10), and standardized knowledge assessments adapted from ACOG Obstetric Laceration Repair Module, along with educational experience reports. These items were scored and analyzed. RESULTS: In August 2022, 16 residents (4 per residency year) participated. Prior to education, mean confidence level with techniques was 4.2 among all areas (range 1.6–7.4), with mean knowledge assessment score 64% (range 33–100%). Post-education, confidence improved across several domains including effectively applying perineal support (7.3–7.9), identifying lacerations and performing rectal examinations (6.1–8.0), and OASIS repair (1.9–5.4) (P<.05). Knowledge assessment scores remained similar, at 70% (P>.05). In qualitative analysis, all individuals reported beneficial aspects of the program. CONCLUSION: Introduction of an OASIS curriculum including repair simulation utilizing an animal model, increased resident skill confidence. Future research will investigate longitudinal data to improve outcomes.

Blue-Blood Pig Thorax Model Increases Residents' Confidence in Internal Mammary Dissection.

Preparation of the recipient vessels is a crucial step in autologous breast reconstruction, with limited opportunity for resident training intraoperatively. The Blue-Blood-infused porcine chest wall-a cadaveric pig thorax embedded in a mannequin shell, connected to a saline perfusion system-is a novel, cost-effective ($55) simulator of internal mammary artery (IMA) dissection and anastomosis intended to improve resident's comfort, safety, and expertise with all steps of this procedure. The purpose of this study was to assess the effect of the use of this chest wall model on resident's confidence in performing dissection and anastomosis of the IMA, as well as obtain resident's and faculty's perspectives on model realism and utility. Plastic surgery residents and microsurgery faculty at the University of Wisconsin were invited to participate. One expert microsurgeon led individual training sessions and performed as the microsurgical assistant. Participants anonymously completed surveys prior to and immediately following their training session to assess their change in confidence performing the procedure, as well as their perception of model realism and utility as a formal microsurgical training tool on a five-point scale. Every participant saw improvement in confidence after their training session in a minimum of one of seven key procedural steps identified. Of participants who had experience with this procedure in humans, the majority rated model anatomy and performance of key procedural steps as "very" or "extremely" realistic as compared with humans. 100% of participants believed practice with this model would improve residents' ability to perform this operation in the operating room and 100% of participants would recommend this model be incorporated into the microsurgical training curriculum. The Blue-Blood porcine chest wall simulator increases trainee confidence in performing key steps of IMA dissection and anastomosis and is perceived as valuable to residents and faculty alike.

Assessing the Impact of a Multi-Modal Neuro-Ophthalmology Educational Workshop on Resident Confidence in the Neuro-Ophthalmology Examination (P1-2.005)

<h3>Objective:</h3> To identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Background:</h3> The Neuro-Ophthalmology examination is essential for neurological localization. However, increased workloads and limited exposure make it challenging for residents to become proficient. This study aims to identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Design/Methods:</h3> This is a single-center, mixed methods, quantitative-qualitative (convergent parallel design) survey-based study evaluating resident confidence in neuro-ophthalmological examination. The utility of a didactic-based and hands-on Neuro-Ophthalmology workshop covering evaluation of visual fields, extraocular movements (EOM), and fundoscopic exam was assessed. A survey composed of Likert scales (1=strongly agree, 5=strongly disagree) and open-ended questions for qualitative feedback was administered before and after the workshop. Descriptive data and paired comparisons (Wilcoxon signed-rank test) are reported. <h3>Results:</h3> 16 adult and pediatric neurology residents (81% adult, median post-graduate training-year 3, [range 1–4]) participated in the 2-hour workshop. Pre-workshop surveys revealed that residents were least confident in disc edema assessment (median rating 4 [range 2–5]) and reported an unmet need for teaching and feedback about examination techniques (median rating 4 [range 2–5]). Post-workshop surveys demonstrated a significant improvement (p&lt;0.05) in overall confidence in exam skills, specifically when identifying relative-afferent pupillary defects and pathognomonic characteristics of ophthalmological disorders. Fundoscopic exam confidence did not improve significantly, but results were limited given early termination of breakout sessions. Videos of EOM abnormalities and immediate feedback from instructors were reported as most helpful. Residents suggested increasing workshop length for future sessions. <h3>Conclusions:</h3> A combined didactic-based and hands-on Neuro-Ophthalmology workshop is helpful in identifying gaps in Neuro-Ophthalmology training and increasing resident confidence. Additional instruction in visual acuity and fundoscopic assessments may be beneficial in future workshops. We aim to utilize our findings to create an optimized Neuro-Ophthalmology curriculum with future application to other aspects of resident training. <b>Disclosure:</b> Dr. Kang has nothing to disclose. Dr. Flowers has received intellectual property interests from a discovery or technology relating to health care. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Lavin has nothing to disclose. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Shah has received publishing royalties from a publication relating to health care.

Can Self-Reported Confidence be used as an Indicator for Performance? A Multi-Center Study of Simulation Training for Acute Ischemic Stroke (P9-2.002)

<h3>Objective:</h3> To assess changes in neurology residents’ confidence in managing acute ischemic stroke after a simulated case and explore if confidence scores correlate with knowledge and performance. <h3>Background:</h3> Prior studies have shown improvement in trainee confidence after simulation interventions. Few studies have assessed the effect of simulation training on neurology resident confidence in acute stroke management. <h3>Design/Methods:</h3> We conducted a multicenter, simulation-based study of neurology residents’ confidence managing a case of acute ischemic stroke complicated by alteplase-related hemorrhage and cerebral herniation. Participants rated their confidence in managing acute ischemic stroke on a 7-point Likert scale before and after the simulation. Neurology resident knowledge was assessed before the simulation on a multiple-choice test. Performance in the simulation was assessed using a checklist of 22 critical action items, supported by previously published validity evidence. The primary outcome was confidence before and after the simulation, assessed by paired samples t-test. The secondary outcome was correlation of confidence with knowledge assessed by multiple-choice test and performance assessed by simulation checklist score. <h3>Results:</h3> Thirty-six neurology residents (26 post-graduate year 2 [PGY-2], 7 PGY-3, 3 PGY-4) participated in the scenario. Residents performed a mean sum of 13.1 (standard deviation [SD] 2.3) out of 22 (60%) critical action items. Resident confidence increased after the simulation (post-simulation mean = 5.6 (1.1) vs. pre-simulation mean 4.0 (1.7)), <i>p</i> &lt; .001). Neither pre- nor post-simulation confidence correlated with scores on the multiple-choice test (r = 0.02, <i>p = .927</i> and r = −.09, <i>p</i> = .610, respectively). Similarly, neither pre-simulation confidence nor post-simulation confidence was correlated with performance in the simulation (r = 0.123, <i>p</i> = .502 and r = −0.015, <i>p</i> = .936, respectively). <h3>Conclusions:</h3> Simulation training increases neurology residents’ confidence in managing acute ischemic stroke. Confidence should not be used as a surrogate for knowledge and performance. <b>Disclosure:</b> Dr. Pergakis has nothing to disclose. Dr. Albin has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum: Life Long Learning in Neurology. Dr. Albin has received research support from American Academy of Neurology. Dr. Albin has received publishing royalties from a publication relating to health care. Dr. Albin has received personal compensation in the range of $500-$4,999 for serving as a Instructor with Resuscitation Leadership Academy. Mr. Neustein has nothing to disclose. The institution of Dr. Morris has received research support from American Board of Psychiatry and Neurology. The institution of Dr. Morris has received research support from UMB ICTR through NIH NCATS&amp;CTSA grant 1UL1TR003098. The institution of Dr. Morris has received research support from University of Maryland Medical Center.

A Telehealth Training Program for Neurology Residents (P8-2.005)

<h3>Objective:</h3> Neurologists in-training will become proficient in skills needed for an effective teleneurology visit. <h3>Background:</h3> Telehealth has improved patient access to clinicians and reduced time/cost burden on patients. Video appointment are now offered in most practices. The AAMC has outlined telehealth domains whereby clinicians must demonstrate proficiency. The Neurology RRC has endorsed support for resident telehealth encounters. We developed a no-cost reproducible telehealth training program to improve resident skills. <h3>Design/Methods:</h3> Thirteen residents recorded a telehealth counseling session pre-intervention for a patient considering botulinum toxin injections for migraines. (Time 1) Feedback was provided. Residents received a one-hour lesson outlining tele-etiquette, communication and exam skills. Trainees then underwent two 20-minute encounters with faculty trained as standardized patients. (Time 2) A second reviewer also scored the session on video review. Each resident received feedback then completed a third 20-minute clinical encounter at one-year follow-up. (Time 3) Resident confidence in skillset was also measured prior to Time 1 and upon training completion. Statistical analysis was conducted via Wilcoxin Paired t-test <h3>Results:</h3> Comparison of pre and post-course resident surveys revealed significant improvement in telehealth comfort in all categories (3.2 ± 0.8 to 4.3 ± SD 0.5 (p &lt;0.005)). Comparison of initial recording and post-course encounter revealed improvement in tele-communication and “webside” manner ((2.4 ± 0.3, 2.7 ± 0.3), (1.9 ± 0.3, 2.4 ± 0.5) (p &lt;0.05)). Comparison of initial visit and one-year follow up revealed improvement in communication, professionalism and “web-side” manner ((2.4 ± 0.3, 3 ± 0), (2.4 ± 0.7, 3 ± 0), (2.4 ± 0.7, 3 ± 0) (p &lt;0.05)). Additionally, improvement was observed in professionalism between post-course encounter and one year follow up (2.4 ± 0.7, 3 ± 0, (p &lt;0.05)). <h3>Conclusions:</h3> A low resource, no cost, telehealth training program can be effectively integrated into resident curriculum and improve tele-related interpersonal skills, communication skills, and professionalism. <b>Disclosure:</b> Dr. Davitz has nothing to disclose. Dr. Leaver has nothing to disclose. Dr. Skliut has nothing to disclose. Dr. Katsnelson has nothing to disclose. Dr. Swan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NACME. The institution of Dr. Swan has received research support from Sanofi Genzyme. The institution of Dr. Swan has received research support from Abbvie. The institution of Dr. Swan has received research support from Biogen. The institution of Dr. Swan has received research support from Sage . Dr. Shanker has nothing to disclose.

Effect Evaluation and Development Countermeasures of Family Doctor Contract Service from the Perspective of Demand Side

Objective: To study the implementation effect of family doctor contract service in Zhenjiang City with community residents as the main body, analyze the problems existing in the contract service of family doctor in Zhenjiang City, and then explore the optimization strategy of family doctor contract service. Method: Through studying relevant literature and Zhenjiang government documents and reports, we learned about the signing measures of the signing system of family doctors in Zhenjiang in recent years. With the guidance of experts, we designed the questionnaire of the current situation of signing family doctors of residents in Zhenjiang. By random sampling method, we randomly selected three communities in Zhenjiang, randomly selected several households in each community, distributed 120 questionnaires, and recovered 112 questionnaires. There were 8 invalid questionnaires, and the effective rate was 93.33%. Results: At present, the construction of the talented team of family doctors in Zhenjiang City is insufficient. Residents' concept of medical treatment is solidified; Not enough in-depth publicity. Conclusion: Increase the number of talents, improve the quality of service, and enhance the confidence and compliance of residents to community health service; Gradually change the residents concept of medical treatment, promote hierarchical diagnosis and treatment; Carry out in-depth publicity, improve the breadth and depth of the general population's cognition, and improve the utilization rate of residents.

Role Reversal Between Trainees and Surgeons: Improving Autonomy and Confidence in Surgical Residents

IntroductionThere are increasing concerns regarding resident autonomy in the context of efficiency, legal ramifications, patient expectations and patient safety. However, autonomy is necessary to develop competent, independent surgeons. Therefore, educational paradigms that maximize opportunities for entrustability without sacrificing patient safety are necessary to ensure adequate training for surgeons. MethodsThis is a prospective, qualitative study of intraoperative role reversal between surgeons and residents. Using Likert scales and binary questions, preintervention and postintervention surveys were collected, evaluating variables including intraoperative learning, decision making, communication, confidence, autonomy and opportunity for safe struggle. The Mann-Whitney U test was used to analyze results and compare responses between training years. ResultsThirty-six general surgery residents comprising post-graduate year 1, 2, 4, and 5 acted as primary surgeon in a total of 36 cases. Preoperative knowledge scores were significantly higher in more senior residents (P < 0.001), but all residents had significant improvement in knowledge scores postoperatively (P < 0.001). The knowledge improvement was quantitatively larger for junior versus senior residents. Intraoperative decision making significantly improved after the intervention for all training levels (P < 0.001). 25 intraoperative “rescues” were performed by faculty for failure to progress or unsafe conditions (23 for junior residents, 2 for senior residents). Residents indicated that this intraoperative role reversal improved preparation, confidence, autonomy, and intraoperative communication. ConclusionsIntraoperative role reversal between residents and surgeons provides a safe opportunity for maximizing learning and increasing entrustability under direct supervision.

Latex-Infused Porcine Abdominal Model: A Novel Microsurgery Simulator for Deep Inferior Epigastric Perforator Dissection.

Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as a microsurgical training model, there are significant drawbacks that limit their use, including cost, limited ability for repetition, and obstacles associated with animal care. Here we describe the creation of a novel perforator dissection model using latex augmented non-living porcine abdominal walls. We provide anatomic measurements that demonstrate valuable similarities and differences to human anatomy to maximize microsurgical trainee practice. Six latex-infused porcine abdomens were dissected based on the deep cranial epigastric artery (DCEA). Dissection was centered over the abdominal wall mid-segment between the second and fourth nipple line. Dissection steps included exposure of lateral and medial row perforators, incision of anterior rectus sheath with perforator dissection, and dissection of DCEA pedicle. DCEA pedicle and perforator measurements were compared with deep inferior epigastric artery (DIEA) data in the literature. An average of seven perforators were consistently identified within each flap. Assembly of the model was performed quickly and allowed for two training sessions per specimen. Porcine abdominal walls demonstrate similar DCEA pedicle (2.6 ± 0.21 mm) and perforator (1.0 ± 0.18 mm) size compared with a human's DIEA (2.7 ± 0.27 mm, 1.1 ± 0.85 mm). The latex-infused porcine abdominal model is a novel, realistic simulation for perforator dissection practice for microsurgical trainees. Impact on resident comfort and confidence within a microsurgical training course is forthcoming.

Implementing an Educational Module for Orthopaedic Residents Placing Skeletal Traction

Although placement of a distal femoral traction (DFT) pin is a relatively simple procedure used to stabilize femoral and pelvic fractures, it places patients at risk of iatrogenic vascular, muscular, or bony injury. We designed and implemented an educational module combining theory and practical experience to standardize and improve resident teaching on the placement of DFT pins. We introduced a DFT pin teaching module into our second-year resident "boot camp," which is used to help prepare residents for taking primary call in the emergency department at our level I trauma center. Nine residents participated. The teaching module included a written pretest, an oral lecture, a video demonstration of the procedure, and a practice simulation on 3D printed models. After completing the teaching, each resident underwent a written examination and proctored live simulation involving 3D models using the same equipment available in our emergency department. Pre-teaching and post-teaching surveys were used to assess resident experience and confidence with placing traction in the emergency department. Before the teaching session, the rising postgraduate year 2 residents scored an average of 62.2% (range, 50% to 77.8%) on the DFT pin knowledge quiz. This improved to an average of 86.6% (range, 68.1% to 100%) (P = 0.0001) after the teaching session. After completing the educational module, they also demonstrated an improvement in confidence with the procedure, from 6.7 (range, 5 to 9) to 8.8 (range, 8 to 10) (P = 0.04). Despite reporting high levels of confidence in their ability to place traction pins before starting the postgraduate year 2 consult year, many residents also reported anxiety around the accurate placement of traction pins. Early results of our training program showed improved resident knowledge of safe placement of traction pins and improved confidence with the procedure.

Case Cards: A Novel Learner-Centered Initiative to Improve Resident Education in the Pediatric Emergency Room.

The pediatric emergency department (PED) provides a wealth of learning opportunities for residents. However,delivering dedicated educationcan be a significant challenge due to considerable variability inday-to-dayschedules, volume, cases, time, and resource availability. Case-based and learner-centered teaching models are well suited for ambulatory settings like the emergency department. Using the Kern model, we designed an educational intervention titled "Case Cards" to facilitate active learning conversations in pediatric emergency medicine (PEM). Our goal was to improve clinical teaching in the PED to demonstrate self-reported satisfaction, knowledge acquisition, confidence, and commitment among residents rotating in this fast-paced, challenging clinical environment. After general and targeted needs assessments, we developed a compendium of 30high-yield case cards to facilitate case-based learning conversations between learners and preceptors. Case topicsmirror the American Board of Pediatrics Content Outline of Emergent Conditions. The "Learner Card" presents a PEM case for the learner to read and hold, while the "Teacher Card" contains evidence-based teaching prompts following established learner-centered clinical teaching models to guide and facilitate the case.Post-implementation surveys queried Kirkpatrick New World educational outcomes in a retrospectiveformat. We collected data from 24 pediatric and emergency medicine residents between July 2021 and January 2022. All respondentsagreed or strongly agreed that case cards are enjoyable, educational, applicable to clinical practice, enhanced confidence, and would be recommended to others. Case cards for learner-centered teaching in the pediatric emergency setting are well-received and demonstrate resident self-reported satisfaction, knowledge, and confidence in core PEM conditions. Having established and readily available teaching topics, such as case cards, can enhance the clinical experience in the PED and other challenging settings and augment clinical exposure to core content. Educators may wish to expand and explore evolving technologies to facilitate learner-centered clinical teaching.

RSSA conference: Radiology Residents Experience with CT Brain Perfusion: Regional Cross-sectional Study in Saudi Arabia

Background: &#x0D; CT brain perfusion (CTP) is the gold standard for ischemic penumbra detection. Residents should be confident to report CTP by the end of their training. Our informal observation led us to question whether residents are encountering enough cases to become confident in reporting them.&#x0D; &#x0D; Objectives: &#x0D; To determine the level of confidence of radiology residents in a regional study and to identify the factors affecting their confidence.&#x0D; &#x0D; Materials and methods:&#x0D; Direct communication with radiology residents at the western region of Saudi Arabia to complete an online survey describing their experience with CTP and their level of confidence in reporting these cases.&#x0D; &#x0D; Results: &#x0D; One hundred and nine out of 224 residents participated in the study within the study period. 49 (45%) residents did not encounter CTP during their neuroradiology rotation (45%) nor their on-calls (53%). Sixty (55%) residents encountered at least one CTP during their neuroradiology rotation (55%) and during on-calls (47%), only half of them (55%) reported the cases while the rest only observed. Overall, 60% of residents were not confident in reporting CTP independently and majority (93%) believe they would benefit from a dedicated teaching on stroke imaging. Confidence to independently report CTP during on-calls was significantly higher among residents who received their primary training in Jeddah (51.4%) compared to other regions. This self-reported confidence increased significantly with the increased average number of CTPs reported per one rotation and per on-call.&#x0D; &#x0D; Conclusion: &#x0D; Half of the residents do not feel confident reporting CTPs when less than 10 CTPs are encountered during their neuroradiology rotation or on-calls.&#x0D;

Creating Teams of Family Medicine Residents and High School Culinary Students Reduces Some Barriers to Implementing a Culinary Medicine Hands-On Workshop.

Barriers to implementation of culinary medicine in resident training include lack of facilities, administrative support, and community engagement. Twenty-five family medicine residents were teamed with 17 high school culinary arts students to prepare recipes aligned with the Mediterranean diet (MED) and the USDA low, moderate, and liberal cost food plans. The workshop took place in the high school teaching kitchens. A pre-survey informed the planning committee's design of a 4-h hands-on workshop that was considered a success. Post-surveys documented improved resident confidence and skills in recommending MED to their patients and interaction with their own peers and high school students, as well as enjoyment by all participants of this hands-on approach.

12. Needs Assessment: Knowledge and Confidence of ObGyn Residents in the Evaluation and Management of Heavy Menstrual Bleeding due to Bleeding Disorders

12. Needs Assessment: Knowledge and Confidence of ObGyn Residents in the Evaluation and Management of Heavy Menstrual Bleeding due to Bleeding Disorders

Simulation in Surgical Resident Education: A Porcine Hemostasis and Laparoscopic Model.

The steep learning curve associated with learning laparoscopic techniques and limited training opportunities represents a challenge to general surgery resident training. The objective of this study was to use a live porcine model to improve surgical training in laparoscopic technique and management of bleeding. Nineteen general surgery residents (ranging from PGY 3 to 5) completed the porcine simulation and completed pre-lab and post-lab questionnaires. The institution's industry partner served as sponsors and educators on hemostatic agents and energy devices. Residents had a significant increase in confidence with laparoscopic techniques and the management of hemostasis (P = .01 and P = .008, respectively). Residents agreed and then strongly agreed that a porcine model was suitable to simulate laparoscopic and hemostatic techniques, but there was no significant change between pre- and post-lab opinions. This study demonstrates that a porcine lab is an effective model for surgical resident education and increases resident confidence.

Applying the Surgical Checklist Approach for Psychiatric Trainees to a Busy, Time Sensitive Psychiatric Crisis Environment

IntroductionThe Jackson Hospital Crisis (Psychiatric ED) Center serves the entirety of Miami-Dade County in Florida and is considered one of the top three busiest and per capita of clinical staff likely the busiest nationally across the United States. Simultaneously, the management of mental health emergencies has ascended near the top of international priorities driven by multiple trends (e.g., growing social isolation associated with the pandemic, de-stigmatization). The crisis environment presents a uniquely difficult challenge in applying high quality medical care: frequent suicidal gestures, impulsive often intoxicated or psychotic patients, unprecedented demand, diminishing staff capacity, and requirements to consistently apply specific medical and psychiatric protocols. These challenges are specifically difficult for new trainees who are not yet accustoms to the high acuity situations found in psychiatry. Moreover, academic, institutional, and governmental policies change on a monthly, or even weekly basis, often with the objective of improving care. Nevertheless, such constant shifts in workflow result in opportunities for errors that impact patient trajectories.ObjectivesAs such we endeavored to apply an evidence-based approach to improving the likelihood of success. One such vetted approach, the use of checklists, benefits from 10+ years of peer-reviewed research in “operational” medical specialties (e.g., surgery, ED, ICU) where work is segmented around interventions or time-shifts which share commonalities with the Psychiatric ED model. Yet the difficulty in implementing such models is typically not in the “hard” aspects of defining the checklist, but in the “soft” implementation dimensions of syndication, distribution, and enablement in the context of the individual unique settings.MethodsWe developed a checklist that will be implemented on the Jackson Crisis emergency department, with the aim of having first year trainees complete the check list on each individual patient. Surveys were administered before implementation of checklist and will be distributed on a quarterly basis to trainees to evaluate for changes in resident confidence and clinical care.ResultsOver six months, we launched this initiative with drivers of adoption focused on accelerating and easing new resident training, safety incident targeting, and in the balancing of “push” top/down and “pull” bottom/up dynamics. Initial learnings include rapidly improving resident satisfaction as well as various other impacts currently being observed throughout the institution.ConclusionsOverall reception to the checklist has been positive from attendings and new trainees alike, further evidence will be analyzed and presented as the checklist is utilized throughout the psychiatric ED.Disclosure of InterestNone Declared

Education Research: Neurology Residents Report Improved Skills After Initiation of a Lumbar Puncture Clinic

Background and Objectives Neurology residents have limited opportunities to perform lumbar punctures (LPs). We hypothesized that establishing a clinic for residents to perform LPs would increase success rates, improve resident comfort with LPs, reduce the need for assistance by attending physicians, and improve patient care. Methods The Vanderbilt University Medical Center neurology residency began a resident LP clinic and measured residents' input and clinical data to see whether the clinic affected resident LP skills. Before and after the launch of LP clinic, neurology residents were invited to complete online surveys at the end of the academic year and during their LP clinic rotation. Completion of the surveys was voluntary and considered consent. The surveys assessed LP attitudes and experience (e.g., confidence with LPs and number performed) and LP clinic procedural data (e.g., LP success rate). Attitudes were measured by assessing confidence; experience by quantifying the number of LPs performed; procedural success was measured by the number of LPs with successful CSF acquisition. Differences in resident attitude and LP outcomes were analyzed using Spearman correlations and logistic regressions. Results Prior to the launch, 15/25 (60% response) residents responded to the clinic survey. After the launch, 6/21 (29%) responded to the first-year follow-up survey and 12/21 (57%) to the second-year follow-up survey. Resident confidence and the number of LPs performed were unchanged. Success rate reported by individual residents increased 15% (p = 0.04), which did not correlate with the overall LP clinic success rate. In the first year of the clinic, 83% of postgraduate year (PGY)3s needed an attending's assistance compared with 29% of PGY4s. In the second year, 44% of PGY3s and 32% of PGY4s needed an attending's assistance. Discussion This structured clinic provided an opportunity for informal resident-to-resident teaching, which may have reduced the need for attending assistance.

Development of a New Resident-Centric Sex Trafficking Education Program for Obstetrics/Gynecology, Emergency Medicine, and Family Medicine Programs

Human sex trafficking is widespread and a nationally recognized public health crisis. Trafficked individuals and survivors often utilize the healthcare system, yet healthcare professionals cite a lack of formal training to identify and provide appropriate care. This study aims to increase obstetrics/gynecology, emergency medicine, and family medicine residents' knowledge and confidence when caring for individuals involved in sex trafficking. Obstetrics/gynecology, emergency medicine, and family medicine residents voluntarily attended an evidence-based education session and received an electronic pre-, immediate post-, and 5-month post-session survey measuring knowledge, attitudes, beliefs, and confidence. Validated survey items were adapted from previous studies. Paired t-tests (p<0.05) and descriptive analyses were used to determine differences. A concluding focus group was facilitated to further understand trainee experiences and awareness when caring for suspected sex-trafficked individuals and survivors. Thematic analysis determined reoccurring themes. Between 2019 and 2021, 48 pre-session, 28 immediate post-session, and 13 5-month post-session surveys were collected. Resident knowledge and confidence increased from the pre-session to the immediate post-session period. Session pre- and post-surveys were linked (n=14) and showed a statistically significant increase in knowledge (p<0.05) and an increase in confidence. The mean number of correct knowledge questions remained higher 5 months after the session than in the pre-session period. Focus group themes included increased resident knowledge and confidence. Improvement and retention in resident knowledge and confidence in caring for sex-trafficked individuals illustrate the utility of this education intervention and expand on current literature. This study provides an example of an education session that can be adapted for other medical trainees.

Making Headway in Surgical Education at Home and Abroad: Use of an Inexpensive Three-Dimensional Learning Model to Improve Plastic Surgery Resident Confidence in Mohs Defect Assessment and Closure Planning.

The development of simulation, particularly low-cost models, has become a focus of interest within plastic surgery education. Current simulators for Mohs reconstruction are either expensive or not reusable. The authors hypothesize that using a Styrofoam head model during an interactive teaching session will positively affect plastic surgery trainee comfort in designing Mohs reconstructive options. A cohort of integrated plastic surgery residents at a single institution performed a preactivity questionnaire to obtain baseline comfort in defect assessment and design for five Mohs defects. They subsequently underwent an interactive learning session and were instructed to design flaps on life-size Styrofoam heads with feedback from the senior author (M.L.B.). A postactivity questionnaire was completed to assess improvement in comfort in defect assessment and flap design. Three attending surgeons then compared trainee designs with the senior author's design to assess accuracy. All surveys were based on a five-point Likert scale. When analyzing all defects, average postactivity scores increased by 0.63 (SD, ±0.24) ( P = 0.008). Junior residents ( n = 8) had a greater increase in average score responses [mean, 1.07 (0.5 to 1.75)] compared with senior residents ( n = 9) [mean, 0.27 (0 to 1)] ( P < 0.001). When assessed by senior-level surgeons, senior residents had significantly greater accuracy in design for each defect ( P < 0.05) except cheek advancement flap ( P = 0.08). Participation in an interactive educational activity using a Styrofoam head model demonstrated significant improvements in trainee assessment and design of reconstructive options for Mohs defects.

Communities’ Perception of Health Risks Associated with Utilizing the Water and Fish from the River Nyong, Cameroon

Objectives: Freshwater resources are essential to livelihoods because of the ecosystem services they provide. However rivers flowing through residential and agricultural areas are susceptible to contamination, affecting these services. It is essential to ascertain the level of confidence of residents in the use of the said river resources. The aim of this study was to assess the perceptions of the communities on the health risks associated with the use of the River Nyong in Cameroon.&#x0D; Methods: 140 semi-structured questionnaires were administered to users of the river in Akonolinga, Cameroon. Data were analysed in the SPSS version 21 statistical package at α = 0.05.&#x0D; Results: Some respondents (11.4%) do laundry in the River Nyong. Few (17.6%) bathe in the river while a majority (88.1%) consumes fish from it. A majority of respondents (78.6%) get sick and are hospitalised between 1 and 3 times annually. Food poisoning and waterborne diseases occur between 20 to 30 times annually in at least 22.2% of the respondents, and symptoms include stomach ache (54.8%), diarrhoea (41.9%) and rashes (17.2%). There is a strong association between the method of preparing fish before consumption and the number of annual hospital visits (Χ2 = 18.073, p = 0.006).&#x0D; Conclusion: While respondents’ perceptions of the health risks associated with exposure to the water and fish from the river are strong, we did not find a causal association between the risk factors studied and the health risk indicators.

A Novel Hands-on Approach Towards Teaching Diagnostic Radiology Residents MRI Scanning and Physics

Traditional approaches towards teaching magnetic resonance imaging (MRI) scanning and physics have limitations that a hands-on course may help overcome. A dedicated week of MRI instruction may help improve radiology resident confidence and competence. Additional benefits may include improved physician-technologist communication and accelerated mastery of MRI safety. Surveys and tests were approved by our Program Evaluation Committee and administered at the beginning and at the end of this one-week course. The course consisted of protected reading time as well as practice scanning with a research magnet and assisting with clinical scanning under the close supervision of a licensed MRI technologist. Eighteen senior residents (nine third-year and nine fourth-year) participated in this course during its first year. Few residents had previous experience with MRI physics, scanning, or research prior to residency. After this course, mean resident confidence increased by 0.47 points (3.33 vs 2.86; p=0.01) on a five-point Likert scale. Understanding of MRI physics, as measured by pre- and post-tests, increased by 22% (0.72 vs 0.50; p<0.01), corresponding to a large effect size of 1.29 (p<0.001). Resident feedback reported that this course was efficacious (5/5), engaging (4.9/5), and had optimal faculty oversight. The most highly rated component of the course was the opportunity to experiment with the research MR scanner (5/5). A dedicated week of MRI education was highly rated by residents and associated with improvements in confidence and understanding, suggesting a positive correlation between confidence and competence. Additional metrics, such as trends in scores on the American Board of Radiology's Core Examination over the next several years, may further support the apparent benefits of this hands-on MR course.