Resident Teams Research Articles

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks.

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Mitigating Risks in Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy: A Preventative Reference Planning Review Approach

PurposeOnline adaptive radiotherapy (oART) treatment planning requires evaluating the temporal robustness of reference plans, anticipating the potential changes during treatment courses that may even lead to risks unique to the adaptive workflow. This study conducted a risk analysis of the CBCT-guided adaptive workflow and is the first to assess an adaptive specific reference planning review that mitigates risk in the planning process to prevent events and treatment deficiencies during adaptation. Methods and MaterialsA quality management team of medical physicists, residents, physicians, and radiation therapists performed a fault tree analysis, and failure mode and effects analysis (FMEA). Fault trees were created for under/overdosing targets, treatment deficiencies, as well as assisted in identifying failure modes for the FMEA. Treatment deficiency was defined to include a non-ideal oART plan resulting in treatment with a lower quality plan (either oART or scheduled plan), treatment delay, or cancelling treatment for the day. A reference planning checklist was created to catch failure modes before reaching the patient. Risk priority numbers (RPN=Severity*Detectability*Occurrence) were scored with and without the reference planning checklist to quantify risk mitigation. A root cause analysis was conducted for an event where an adaptive plan failed to generate. ResultsThe reference planning checklist (with items covering patient background, contouring/planning robustness for anatomy variability, and machine limitations) reduced the RPN for all failure modes. Only 1 failure mode with a risk priority number >150 occurred with the reference planning checklist compared to 29 failure modes without, including 14 adaptive specific failure modes. Contouring, planning, setup, scheduling, and documentation errors were identified during the fault tree analysis. 29/70 errors were adaptive specific. The reference planning checklist could address 23/33 for over/under dosing and 28/37 errors for treatment deficiency. The root cause analysis highlighted the need for checking setup prior to adaptive plan delivery, and time-out checklist. ConclusionsThe reference planning checklist improved detection of the failure modes and improves the quality and robustness of the plans produced for oART. It is ideally performed before physician plan review to prevent last minute re-plan (before or after first adaptive treatment) and delay of patient start. The checklist presented can be modified based on failures specific to individual clinics and utilized at various planning steps based on available resources.

Human-in-the-Loop-A Deep Learning Strategy in Combination with a Patient-Specific Gaussian Mixture Model Leads to the Fast Characterization of Volumetric Ground-Glass Opacity and Consolidation in the Computed Tomography Scans of COVID-19 Patients.

Background/Objectives: The accurate quantification of ground-glass opacities (GGOs) and consolidation volumes has prognostic value in COVID-19 patients. Nevertheless, the accurate manual quantification of the corresponding volumes remains a time-consuming task. Deep learning (DL) has demonstrated good performance in the segmentation of normal lung parenchyma and COVID-19 pneumonia. We introduce a Human-in-the-Loop (HITL) strategy for the segmentation of normal lung parenchyma and COVID-19 pneumonia that is both time efficient and quality effective. Furthermore, we propose a Gaussian Mixture Model (GMM) to classify GGO and consolidation based on a probabilistic characterization and case-sensitive thresholds. Methods: A total of 65 Computed Tomography (CT) scans from 64 patients, acquired between March 2020 and June 2021, were randomly selected. We pretrained a 3D-UNet with an international dataset and implemented a HITL strategy to refine the local dataset with delineations by teams of medical interns, radiology residents, and radiologists. Following each HITL cycle, 3D-UNet was re-trained until the Dice Similarity Coefficients (DSCs) reached the quality criteria set by radiologists (DSC = 0.95/0.8 for the normal lung parenchyma/COVID-19 pneumonia). For the probabilistic characterization, a Gaussian Mixture Model (GMM) was fitted to the Hounsfield Units (HUs) of voxels from the CT scans of patients with COVID-19 pneumonia on the assumption that two distinct populations were superimposed: one for GGO and one for consolidation. Results: Manual delineation of the normal lung parenchyma and COVID-19 pneumonia was performed by seven teams on 65 CT scans from 64 patients (56 ± 16 years old (μ ± σ), 46 males, 62 with reported symptoms). Automated lung/COVID-19 pneumonia segmentation with a DSC > 0.96/0.81 was achieved after three HITL cycles. The HITL strategy improved the DSC by 0.2 and 0.5 for the normal lung parenchyma and COVID-19 pneumonia segmentation, respectively. The distribution of the patient-specific thresholds derived from the GMM yielded a mean of -528.4 ± 99.5 HU (μ ± σ), which is below most of the reported fixed HU thresholds. Conclusions: The HITL strategy allowed for fast and effective annotations, thereby enhancing the quality of segmentation for a local CT dataset. Probabilistic characterization of COVID-19 pneumonia by the GMM enabled patient-specific segmentation of GGO and consolidation. The combination of both approaches is essential to gain confidence in DL approaches in our local environment. The patient-specific probabilistic approach, when combined with the automatic quantification of COVID-19 imaging findings, enhances the understanding of GGO and consolidation during the course of the disease, with the potential to improve the accuracy of clinical predictions.

Preparing Residents to Navigate Neurosurgical Careers in the 21st Century: Implementation of a Yearlong Enhanced Didactics Curriculum

Background and ObjectiveNeurosurgery residency, known for its rigorous training, must adapt to evolving healthcare demands. Formal education should now encompass areas like quality improvement and patient safety (QIPS), machine learning, career planning, research infrastructure, grant funding, and socioeconomics. We share our institution's experience with a yearlong enhanced didactics curriculum, complementing our traditional teaching. MethodsOur resident and faculty team evaluated essential skills for trainee success and leadership, identified knowledge gaps, and addressed them with 31 lectures. We conducted pre- and 6-month surveys using a Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree) to assess resident education. Survey results were analyzed using Student t-tests, with p < 0.05 indicating statistical significance. ResultsEleven out of twelve residents completed the pre- and 6-month surveys. The surveys revealed improved scores in areas such as research career preparation (3.0/5 to 4.33/5, p=0.002), building research skills (3.18/5 to 4.33/5, p=0.002), and comfort with quality and patient safety (4.09/5 to 4.75, p=0.04). Residents found the lectures highly effective in supplementing their residency training (4.58/5). Qualitative feedback from faculty was highly positive as well. ConclusionsOrganized neurosurgery excels in clinical and technical training for residents but lacks formalized training in crucial nonclinical areas, such as QIPS, machine learning/artificial intelligence, research infrastructure, and socioeconomics. Our formal curriculum focused on these topics, with positive resident engagement and feedback over the first six months. However, continuous longitudinal monitoring is needed to confirm the curriculum’s efficacy. This program may guide other neurosurgery departments in enhancing resident education in these areas.

Internal Medicine Acting Internship Trends in Rotation Structure and Student Responsibilities: Results from a 2023 National Survey.

The acting internship (AI) in internal medicine plays a key role in the transition from medical school to residency. While there have been recent changes in medical education including a pass/fail USMLE Step 1 and increasing use of competency-based assessment, there has not been a large survey of the state of the AI in many years. To assess the current landscape of the internal medicine AI and identify areas in need of standardization. This was a voluntary online survey of medical schools in the United States (U.S.). Course directors of the AI rotation at U.S. medical schools. Number of AI rotations required for graduation, length of AI rotation, types of services allowed for AI, clinical responsibilities of students, curricular components. Response rate was 50.7% (71/140 LCME accredited schools). All responding institutions require at least one AI for graduation, with nearly all schools integrating students into resident teaching teams, and almost half also allowing AI students to work on hospitalist services. Students carry 3-4 patients per day on average with a maximum of 5-6 in most institutions. Students are responsible for most aspects of patient care including notes, orders, interprofessional communication, and transitions of care. Night call or night float responsibilities are infrequently required. The structured curriculum published by AAIM is used by only 41% of schools. The internal medicine AI continues to be a staple in the medical school experience, but there is variation in the structure, curriculum, and expectations on the rotation. Opportunities exist to improve standardization of the AI experience and expectations to better prepare medical students for the transition from medical school to residency.

Leaving Against Medical Advice: Current Problems and Plausible Solutions.

Leave against medical advice (LAMA) is defined as 'a decision to leave the hospital before the treating physician recommends discharge', and is associated with higher rates of readmission, longer subsequent hospitalization, and worse health outcomes. In addition to this, they also contribute to poor healthcare resource utilization. We conducted a single-center audit to establishpatient demographics and contributing factors of patients leaving against medical advice from our emergency department (ED). We benchmarked our data against locally available clinical policy guidelines.We interrogated our electronic health record system (known as Salamtak®), which is a Cerner-based platform (Cerner Corporation, Kansas City, MO 64138)for patients who signed LAMA from ED from 2018 to 2023. We selected a convenience pilot sample of 120 subjects. Based on a literature review, we identified patient demographics (age, gender, nationality, socioeconomic status, marital status, religion), possible contributing factors (time of attendance, insurance status, length of ED stay), and patient outcomes (reattendances within 1 week and mortality) to evaluate. Based on locally available guidance, we formulated six criteria to audit with a standard set at 100% for each. A team of emergency medicine residents collected data that was anonymized on an Excel spreadsheet (Microsoft Excel,Microsoft Corporation. (2018). Basic descriptive statistics were used to collate results. About 93 patients (77.5%) were 16 years and above, and 27 patients (22.5%) were below 16 years. There was a slight preponderance of males (64 patients, 53.3%) than females (56 patients, 46.6%). The majority of LAMA cases presented in the evening and night (97 patients, 80.8%). About 57 (47.5%) patients had an ED length of stay of 3 hours or more. The average ED length of stay for these patients was 3.4 hours. About 73 patients (60.3%) were insured. Out of 120 patients, only 12 (10%) had a mental capacity assessment documented. The commonest reason for signing LAMA was a social reason in 45 (37.5%) cases. In the remaining cases, the causes were a combination of family, financial, waiting, or other/undocumented reasons). When faced with a decision to LAMA, the involvement of a Public Relationship Officer (PRO) was only documented to be consulted in seven (5.8%) cases. About 14 cases were re-attended within 1 week (11.6%) and no mortalities were reported in any of the reattendances. LAMA is a not-so-rare phenomenon often occurring in EDs, and often a cause of trepidation for healthcare workers. Treating this as an aberrant behavior on the part of the patient, or laying the responsibility for this action on the healthcare provider is primitive, counter-productive, and not patient-centric. Familiarity with local guidelines around this contentious area is essential. Revised nomenclature like 'premature discharge' may be less stigmatizing for the patient.Where possible, a harm reduction approach should be used and frontline healthcare workers must be prepared with an escalation plan.In the United Arab Emirates, familiarity with Wadeema's Law as a child protection measure is essential.

Improving Early Sepsis &amp; Severe Sepsis Identification and Management on Internal Medicine service at the Detroit John D. Dingell VA Medical Center

Background: Sepsis is a life-threatening organ dysfunction due to infection, with an incidence of nearly 50 million people each year, causing about 11 million in mortality worldwide. Adhering to Sepsis protocols is a quality metric monitored by both the Centers for Medicare &amp; Medicaid Services (CMS) via the SEP 1 measure and the VA Healthcare System through SEP 90, which consists of an all-or-nothing score comprised of individual metrics. These metrics include specific actions such as early management bundle utilization, lactate monitoring, timely fluid resuscitation, and vasopressor administration, all within defined timeframes. Based on FY 2023 Data, the John D. Dingell VAMC performed nationally in the last quintile with &gt; 72% fallouts. Given that the vast majority of our Sepsis patients are treated and managed by the inpatient Internal Medicine resident service, we initiated a Quality Improvement project to educate them and thereby decrease our number of fallouts. We aim to improve Sepsis, severe Sepsis, &amp; Septic shock Identification and Management by 50% over the course of 8 months on the internal medicine service. Methods: Internal medicine residents are central to the identification and management of early Sepsis and Severe Sepsis at the Detroit VA. Given the monthly turnover of resident teams, we focused on our model for improvement on interventions at the start of each month with targeted educational sessions to define Sepsis, severe Sepsis, and septic shock (and their management). We have also implemented targeted EMR training on utilizing a recently developed “Sepsis Bundle order set” for patients who have been identified as Sepsis. Sepsis Menu data usage was collected based on health factor tags on patients with Sepsis as their ICD-10 code on discharge from the internal medicine service. Results: Internal Medicine Resident educational sessions and EMR training commenced on July 1st, 2024. Sepsis Bundle was implemented in the EMR late 2022 due to rising fallouts of Sepsis and severe sepsis cases. However, its usage remained minimal, as depicted in Figure One, when compared to the number of discharged patients. Following the educational sessions and EMR training, both the identification and management of Sepsis have increased. Prior to intervention, from October 2022 to June 2023, a mean sepsis bundle usage rate of 10% was observed for identified sepsis patients, whereas post-intervention, from July 2023 to March 2024, the mean has increased to 30%. Conclusion/Discussion: Based on the early data, we can confidently note that our monthly education sessions, paired with our process measure (Sepsis bundle use), have been effective. Ongoing opportunities for improvement are improved coordination and handoff between ER and IM/MICU. We continue to see the need for ongoing resident education on identification and appropriate documentation of Sepsis severity along with obtaining labs within a certain time frame.

Do acting interns need residents? A comparison of acting intern experience on hospital medicine resident versus nonresident teams.

The clinical demands for hospitalist groups have grown at academic medical centers, without similar growth of teaching opportunities for faculty. Traditional resident teaching teams are often crowded with learners which can limit acting intern (or subintern) patient encounters. Medical students are often placed on nonresident teaching teams, although there are few studies on learner experience on a nonresident teaching team model. To address these concerns, we created two nonresident teaching teams composed of one attending and two acting interns. We compared acting intern experience on the nonresident teaching teams to the traditional resident teams to determine if there were significant differences in student experience by reviewing course evaluation data on the two team models. Of the 276 students who completed the Internal Medicine Acting Internship from 2019 to 2023, 224 students (81%) completed the course evaluation. The course was highly rated, and the ratings were similar in both models demonstrating that the nonresident teaching team model is an effective option for acting interns. The nonresident teaching team model can offload crowded teaching teams, add additional acting intern experiences, and add teaching opportunities for hospital medicine attendings.

Implementation of a vascular acute care surgery service model is associated with decreased surgeon burnout

ObjectiveVascular surgeons have one of the highest rates of burnout among surgical specialties, often attributed to high patient acuity and clinical workload. Acute Care Surgery models are a potential solution used among general and trauma surgeons. MethodsThis is a retrospective analysis of prospectively collected Accreditation Council for Graduate Medical Education survey results from faculty and residents before and after implementation of a vascular Acute Care Surgery (VACS) model. The VACS model assigns a weekly rotation of an attending surgeon with no elective cases or clinic responsibilities and a monthly rotating resident team. Residents and attendings are in-house to cover all urgent and emergent vascular daytime consultations and procedures, whereas nights and weekend coverage remain a typical rotating schedule. Survey question results were binned into domains consistent with the Maslach Burnout Inventory. ResultsBoth residents and faculty reported an increase in median scores in Maslach Burnout Inventory domains of emotional exhaustion (Faculty: 2.9 vs 3.4; P < .001; Residents: 3.1 vs 3.6; P < .001) and faculty reported higher personal accomplishment scores (Faculty: 3.3 vs 3.8; P = .005) after the VACS model implementation. ConclusionsA VACS model is a tangible practice change that can address a major problem for current vascular surgeons, as it is associated with decreased burnout for faculty and residents through improvement in both emotional exhaustion and personal accomplishment. Improved longitudinal assessment of resident and faculty burnout is needed and future work should identify specific practice patterns related to decreased burnout.

Using exome analysis as a tool for genetics acquaintance in a psychiatry residence program

Objective: In this paper, a residency program at a Brazilian University Hospital shares its experience with a genetic screening test during the investigation of an inpatient with schizophrenia features. Method: A whole exome sequencing study investigation of a clozapine-refractory patient with schizophrenia served as a facilitator for mastering skills in genetics. Results: During the hospitalization of a 26-year-old patient with clozapine-refractory schizophrenia, the medical residency team noted syndromic features, such as retrognathia, large ear pinnae, pectus excavatum, and a longer wingspan relative to height. These findings led to an interest in genetic evaluation using exome sequencing. The exam showed variations in TMEM106B, IRF2BPL, and ALKBH8, leading to the hypothesis of polygenic heritage. The variations found are previously linked to a wide variety of neuropsychiatric syndromes. Conclusions: Clinical practice in modern psychiatry demands deep knowledge in genetics as genetic and pharmacogenetic tests become more accessible. Genetic training is imperative for the 21st-century psychiatric resident so that one can critically assess this field of knowledge. In this paper, a residency program at a Brazilian University Hospital shares its experience in genetics learning.

Resident-Driven Clinical Decision Support Governance to Improve the Utility of Clinical Decision Support.

This resident-driven quality improvement project aimed to better understand the known problem of a misaligned clinical decision support (CDS) strategy and improve CDS utilization. An internal survey was sent to all internal medicine (IM) residents to identify the most bothersome CDS alerts. Survey results were supported by electronic health record (EHR) data of CDS firing rates and response rates which were collected for each of the three most bothersome CDS tools. Changes to firing criteria were created to increase utilization and to better align with the five rights of CDS. Findings and proposed changes were presented to our institution's CDS Governance Committee. Changes were approved and implemented. Postintervention firing rates were then collected for 1 week. Twenty nine residents participated in the CDS survey and identified sepsis alerts, lipid profile reminders, and telemetry renewals to be the most bothersome alerts. EHR data showed action rates for these CDS as low as 1%. We implemented changes to focus emergency department (ED)-based sepsis alerts to the right provider, better address the right information for lipid profile reminders, and select the right time in workflow for telemetry renewals to be most effective. With these changes we successfully eliminated ED-based sepsis CDS reminders for IM providers, saw a 97% reduction in firing rates for the lipid profile CDS, and noted a 55% reduction in firing rates for telemetry CDS. This project highlighted that alert improvements spearheaded by resident teams can be completed successfully using robust CDS governance strategies and can effectively optimize interruptive alerts.

AMU patient list generation: from junior scribe to junior doctor

This quality improvement project (QIP) aimed to assess the impact of automating patient list generation on the acute medical unit (AMU) at Sandwell and West Birmingham Hospitals NHS Trust. The...

Family Doctors Calling in Transcarpathian Region in the Wartime

After the russian invasion, 60,000 refugees from the eastern and southern parts of Ukraine, who had many problems with physical and mental health, arrived in Uzhgorod. A team of family doctors, residents and students with the support of volunteers and various medical, educational, charity and religious organizations started a volunteer project, which later grew into the “InterFamily” clinic. Starting as a charity center where internally displaced persons could receive free and high quality primary care and medicines purchased through donations from international partners, today it has become a licensed clinic that provides many different medical services (some of which are unique in our region), and as well as primary (i.e. psychological) and secondary care not only to refugees, but also to city residents. The “InterFamily” clinic is a training center for students and residents who gain hands-on skills and experience, and have the opportunity to become staff members as clinic assistants, providing greater autonomy and the opportunity to gain clinical and management skills. Thanks to the European-Ukrainian Support In Teaching (later EUSIT-Exchange) project, the European experts have been conducting practical lectures for Ukrainian doctors and nurses and students since the beginning of the war. The clinic’s innovative medical and educational experience is valuable not only for Ukrainian, but also for foreign specialists. The international recognition of the “InterFamily” clinic was confirmed by the WONCA Europe 5 Star Doctor Award to the director of the “InterFamily” clinic Pavlo Kolesnyk.

A faculty-led resident strike team as a force expander during disaster.

The emergence of the coronavirus disease 2019 (COVID-19) pandemic produced an unprecedented strain on the United States medical system. Prior to the pandemic, there was an estimated 20,000 physician shortage. This has been further stressed by physicians falling ill and the increased acuity of the COVID-19 patients. Federal medical team availability was stretched to its capabilities with the large numbers of deployments. With such severe staffing shortages, creative ways of force expansion were undertaken. New Orleans, Louisiana, was one of the hardest hit areas early in the pandemic. As the case counts built, a call was put out for help. The Louisiana State University (LSU) system responded with a faculty-led resident strike team out of the LSU Health Shreveport Academic Medical Center. Residents and faculty alike volunteered, forming a multispecialty, attending-led medical strike team of approximately 10 physicians. Administrative aspects such as institution-specific credentialing, malpractice coverage, resident distribution, attending physician oversight, among other aspects were addressed, managed, and agreed upon between the LSU Health Shreveport and the New Orleans hospital institutions and leadership prior to deployment in April 2020. In New Orleans, the residents managed patients within the departments of emergency medicine, medical floor, and intensive care unit (ICU). The residents assigned to the medical floor became a new hospitalist service team. The diversity of specialties allowed the team to address patient care in a multidisciplinary manner, leading to comprehensive patient care plans and unhindered team dynamic and workflow. During the first week alone, the team admitted and cared for over 100 patients combined from the medical floor and ICU. In a disaster situation compounded by staff shortages, a resident strike team is a beneficial solution for force expansion. This article qualitatively reviews the first published incidence of a faculty-led multispecialty resident strike team being used as a force expander in a disaster.

Abstract TP70: EHR Based System Improves Stroke Alerting Process in the Emergency Department

Background and Issues: Treatment decisions for patients experiencing acute ischemic stroke require complex imaging and evaluation. Specialized teams including Neurologists, pharmacists and CT technicians are alerted to the ED when a patient presents with signs or symptoms of acute ischemic stroke (AIS) to carry out these evaluations. At our facility, these alerts were delivered via a de-identified text message, preventing the collection of data needed for clinical effectiveness and quality improvement work. Purpose: This project's purpose was to improve the Stroke Alert process using Computerized Physician Order Entry (CPOE) to initiate the alert via a HIPAA Compliant Group Messaging (HCGM) application called Haiku. Methods: Haiku is an application available in the hospital’s electronic health record, which allows for retrieval of data unavailable when utilizing the de-identified alerting method. Data on 70 consecutive Stroke Alerts from 6 weeks prior to implementation of the Haiku Stroke Alert were compared to 80 consecutive Stroke Alerts 6 weeks after implementation. A comparison of Door to CT and Door to Needle times in those periods were also compared to ensure the new process did not cause any delays in these metrics. Results: Results showed the CPOE based Haiku Stroke Alert process was easily adopted and allowed for access to data necessary for clinical effectiveness and quality improvement work without causing delays in Door to CT (DTCT) or Door to Needle (DTN) times. Conclusions: In conclusion, this quality improvement project addressed the lack of data available to assess the Stroke Alert process. A new CPOE based alert process utilizing the HCGM app Haiku proved feasible, received positive feed-back from ED team who initiates the alert and the Neurology resident team who receives the alert. The Haiku alert did not appreciably add time to the DTCT or DTN times. This process allows access to comprehensive data that can be used to explore other avenues to improve the hyperacute phase of AIS triage and treatment. The availability of robust Stroke Alert data was the missing foundational element allowing for clinical effectiveness and quality improvement work.

STRENGTHENING OF PROFESSIONAL NURSING CARE METHODS (MAKP) TEAM NURSING METHOD IN RSUD DR. R. KOESMA TUBAN

Hospitals is health service organization unit by providing comprehensive health services that include promotive, preventive, curative and rehabilitative for all levels of society, often experience problems related to community dissatisfaction with the quality of hospital services which are considered unsatisfactory. Nursing service is one of the factors that determines the good and bad quality and image of the hospital. In addition to the form of service which has special characteristics, namely the implementation of continuous 24-hour service, it is also one of the most numerous health professional workers in hospital. The Professional Nursing Care Model (MAKP) which is currently becoming a trend in Indonesian nursing is the MAKP with comprehensive method of providing nursing care. MAKP is method of providing nursing care in which a professional nurse leads group of nursing staff in providing nursing care to patients through cooperative and collaborative efforts. According to an interview conducted by the residency team to one of the Heads of Room at RSUD Dr. R. Koesma, Tuban Regency, the application of MAKP uses the team method. However, in practice it is still more likely to use functional methods. After the implementation was carried out in the form of providing Socialization of MAKP Strengthening Team Methods to nurses in the Lily Room at RSUD, found the following evaluation results: The Room Nurse will apply the Team MAKP method continuously and consistently. Then, supervision will be carried out periodically so there are no more findings that result in MAKP Team's method not running optimally

A framework to integrate artificial intelligence training into radiology residency programs: preparing the future radiologist

ObjectivesTo present a framework to develop and implement a fast-track artificial intelligence (AI) curriculum into an existing radiology residency program, with the potential to prepare a new generation of AI conscious radiologists.MethodsThe AI-curriculum framework comprises five sequential steps: (1) forming a team of AI experts, (2) assessing the residents’ knowledge level and needs, (3) defining learning objectives, (4) matching these objectives with effective teaching strategies, and finally (5) implementing and evaluating the pilot. Following these steps, a multidisciplinary team of AI engineers, radiologists, and radiology residents designed a 3-day program, including didactic lectures, hands-on laboratory sessions, and group discussions with experts to enhance AI understanding. Pre- and post-curriculum surveys were conducted to assess participants’ expectations and progress and were analyzed using a Wilcoxon rank-sum test.ResultsThere was 100% response rate to the pre- and post-curriculum survey (17 and 12 respondents, respectively). Participants’ confidence in their knowledge and understanding of AI in radiology significantly increased after completing the program (pre-curriculum means 3.25 ± 1.48 (SD), post-curriculum means 6.5 ± 0.90 (SD), p-value = 0.002). A total of 75% confirmed that the course addressed topics that were applicable to their work in radiology. Lectures on the fundamentals of AI and group discussions with experts were deemed most useful.ConclusionDesigning an AI curriculum for radiology residents and implementing it into a radiology residency program is feasible using the framework presented. The 3-day AI curriculum effectively increased participants’ perception of knowledge and skills about AI in radiology and can serve as a starting point for further customization.Critical relevance statementThe framework provides guidance for developing and implementing an AI curriculum in radiology residency programs, educating residents on the application of AI in radiology and ultimately contributing to future high-quality, safe, and effective patient care.Key points• AI education is necessary to prepare a new generation of AI-conscious radiologists.• The AI curriculum increased participants’ perception of AI knowledge and skills in radiology.• This five-step framework can assist integrating AI education into radiology residency programs.Graphical

ADVANCED-COMFORT: TESTING A CARE PLANNING INTERVENTION FOR NURSING HOME RESIDENTS WITH ADVANCED DEMENTIA

Abstract Many nursing home (NH) residents with advanced dementia receive burdensome interventions rather than interventions that promote comfort or quality of life. The purpose of this study was to test the usability of a novel intervention called ADVANCED-Comfort that aims to enhance the provision of personalized, comfort focused care for residents with advanced dementia. The intervention consisted of structured care plan meetings between the NH team and proxies of residents with dementia (e.g., family members). Using the ADVANCED-Comfort workbook, proxies and staff created individualized care plans addressing 6 domains adapted from the Age Friendly Health System Framework (what Matters; Meaningful activities; Mealtime; Mobility; Medications and treatments; and Make comfortable). We evaluated the intervention using surveys, observation, and exit interviews. We found the intervention to be highly usable (acceptable, appropriate, and feasible) and exit interviews identified several promising outcomes. Both families and staff reported that the intervention improved communication and trust. Families reported that they had a newfound trust in staff to provide consistent quality care. Staff reported that the intervention helped them build better relationships with families and allowed families to articulate what they prefer rather than waiting until “something goes wrong.” Staff also reported that the intervention improved their excitement to go to work and enhanced their sense of teamwork. Finally, both staff and proxies reported exciting implications for residents such as a reduction in antipsychotic medication, decrease in distressed behaviors, weight stabilization, and initiation of hospice. Based on these preliminary findings, additional testing of the ADVANCED-Comfort intervention is warranted.

Exploring gender and thematic differences in qualitative assessments of internal medicine resident performance

IntroductionEvidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance.MethodsQualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016–2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role.ResultsData included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents’ communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership.DiscussionThere were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.

Abstract 17730: Facilitated Peer Mentoring: A Novel Model for Promoting Equitable and Inclusive Mentoring for Underrepresented Trainees in Academic Medicine

Introduction: Underrepresented minoritized(URM) cardiologists represent less than 8% of the US cardiology workforce. A positive role model, access to mentorship, and a diverse workforce influences the choice of cardiology as a subspecialty. Recognizing this, we established a novel facilitated peer-mentoring research group, the “Ogunniyi Research Group (ORG),” with the goal of creating a supportive and inclusive learning environment for trainees to develop cardiovascular research proficiencies. Methods: Our team consists of a lead mentor(cardiologist), 2 co-facilitators(cardiology fellows), and 4 resident-led teams of medical students and residents(Figure 1). Our mission is to advance cardiovascular health and equity through research, advocacy, and service; built on core pillars of mentorship, scholarship, leadership, community, and service. Mentees complete an individual development plan and meet regularly with the lead mentor to ensure milestones are met. Teams engage in research and quality improvement projects, which are reviewed at virtual monthly meetings. Quarterly academic medicine research seminars focus on building research skills. Results: 26 trainees participated during the 2021-22 and 2022-23 academic year. Most trainees (&gt;95%) self-identified as Black, with equal sex representation. Major accomplishments include &gt;16 abstracts presented at conferences, co-authorship on &gt;10 publications, and several prestigious awards, grants, honors, and scholarships. 4 team members were selected as chief medical residents. To date, we have secured 100% residency and cardiology fellowship match rate. Conclusion: Our novel, multilevel, facilitated peer mentoring group has increased access to research and professional development opportunities, especially for URM trainees interested in cardiology. The ORG can serve as a model sustainable pathway for equitable mentorship, promoting diversity and inclusion in the cardiology workforce.