Retrospective Pre-post Survey Research Articles

Paediatric resident identification of cardiac emergencies.

Critical CHD is associated with morbidity and mortality, worsened by delayed diagnosis. Paediatric residents are front-line clinicians, yet identification of congenital CHD remains challenging. Current exposure to cardiology is limited in paediatric resident education. We evaluated the impact of rapid cycle deliberate practice simulation on paediatric residents' skills, knowledge, and perceived competence to recognise and manage infants with congenital CHD. We conducted a 6-month pilot study. Interns rotating in paediatric cardiology completed a case scenario assessment during weeks 1 and 4 and participated in paired simulations (traditional debrief and rapid cycle deliberate practice) in weeks 2-4. We assessed interns' skills during the simulation using a checklist of "cannot miss" tasks. In week 4, they completed a retrospective pre-post knowledge-based survey. We analysed the data using summary statistics and mixed effect linear regression. A total of 26 interns participated. There was a significant increase in case scenario assessment scores between weeks 1 and 4 (4, interquartile range 3-6 versus 8, interquartile range 6-10; p-value < 0.0001). The percentage of "cannot miss" tasks on the simulation checklist increased from weeks 2 to 3 (73% versus 83%, p-value 0.0263) and from weeks 2-4 (73% versus 92%, p-value 0.0025). The retrospective pre-post survey scores also increased (1.67, interquartile range 1.33-2.17 versus 3.83, interquartile range 3.17-4; p-value < 0.0001). Rapid cycle deliberate practice simulations resulted in improved recognition and initiation of treatment of simulated infants with congenital CHD among paediatric interns. Future studies will include full implementation of the curriculum and knowledge retention work.

How to Teach Cross-Cultural Communication: A Workshop Using the Experiential Learning Model.

The United States population is diversifying, leading to higher rates of cultural, ethnic, and racial discordance between medical teams and patients. Studies show that pediatric residents lack training in cross-cultural communication (CCC). We based learning objectives on the AAMC's Tool for Assessing Cultural Competency Training. The workshop design was based on Kolb's experiential learning model. In 2020-2021, we delivered this 2-hour workshop to trainees at two large, urban sites. We administered two surveys to evaluate our workshop: a retrospective pre-post survey following the workshop and a 3-month follow-up survey. Using 5-point Likert scales, participants rated their awareness of the effect of their own cultural identity on CCC and familiarity with and confidence using CCC models. We analyzed responses using Wilcoxon signed rank tests. Sixty-two trainees participated in the workshop; 44 completed the retrospective pre-post survey (71%). After the workshop, 36% were extremely aware of the effect of their own cultural identity on CCC compared to 4% before the workshop (p < .001). Confidence managing cross-cultural misunderstandings when conveying a diagnosis and explaining disease management increased after the workshop (70% vs. 25%, p < .001; 70% vs. 20%, p < .001, respectively). Twelve participants completed a 3-month follow-up survey (27%). A workshop using the experiential learning model to teach CCC increased participants' awareness of how their cultural identity impacted CCC and familiarity with and confidence in using two CCC models. This workshop offers pediatric program directors a tool to enhance their CCC curricula and meet ACGME requirements.

Primary Palliative Care for Pediatric Residents: A Curricular Framework and Pilot.

Palliative care (PC) is high-value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges the quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or ..úPrimary..Ñ PC. We completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory. After 1 year of implementation, we assessed resident comfort with primary PC skills via a retrospective pre-post survey. We found a statistically significant (P.ß<.ß.05) increase in residents... comfort with pain management, delivering serious news, and discussing goals of care. An increase in comfort with the management of other symptoms was not statistically significant. After 1 year of implementation, residents describe an increase in comfort with primary PC skills. The next steps include more rigorous evaluation and expansion to include more education in medical ethics. While the educational need is universal, resident needs are constantly evolving and each institution should tailor this curriculum to fit their specific trainee needs and institutional expertise.

(172) TrueNorth Sexual Health and Rehabilitation eTraining (SHAReTraining) in Prostate Cancer: Evaluation of an Online Course for Practitioners

Abstract Introduction Sexual dysfunction (SD) is a prevalent and distressing side effect for survivors of prostate cancer (PCa). Unfortunately, many health care practitioners (HCPs) report a lack of training and confidence in addressing the sexual health needs of PCa patients. Consequently, many PCa patients do not receive the comprehensive sexual healthcare needed to manage their SD. Objective To address the gap in HCP training, the Movember Foundation funded the development and evaluation of a 12-week, faculty-facilitated, online course designed to train HCPs in the delivery of PCa specific sexual health counselling: the TrueNorth Sexual Health And Rehabilitation eTraining (SHAReTraining). Course content includes, SD assessment and intervention, professional ethics, unique needs of sexual and gender minority populations, and approaches to implementing sexual health programming in a healthcare setting. Methods Participants completed a pre-course survey (n=23), a retrospective pre-post survey (n=19), and a 3-month follow-up survey (n=19) to assess retention of relevant outcomes. Outcomes included HCP perceived knowledge and self-efficacy to conduct assessments and provide interventions across a number of relevant physical, functional, psychological, and relational domains of SD in PCa survivors and their partners. Additionally, completed a course satisfaction survey at the conclusion of the course. Results Descriptive analysis of the pre-post survey revealed that graduates perceived knowledge of sexual health counselling improved from a mean of 51.12% pre-course to 75.18% post-course across all measured domains. Similarly, graduate ratings of self-efficacy in providing comprehensive care increased from a mean of 56.63% pre-course to 79.73% post-course. The follow-up survey demonstrated participants’ self-efficacy remained high 3-months post-course at 79.75%. Graduate experience taking the course was uniformly positive with a vast majority (94.7%) agreeing that they were satisfied with the course. Conclusions For HCPs seeking specialized sexual health care training for PCa patients, the TrueNorth SHAReTraining course is an accessible and effective resource. Graduates of the course have the potential to improve the quality of SD care they provide to their patients. Disclosure No

Supporting DACA recipients and international students pursuing careers in medicine: A pilot program for advisors.

The United States (U.S.) health professions are becoming more invested in diversity. Information on students who are undocumented or recipients of Deferred Action for Childhood Arrivals (DACA), and international students on student visas entering U.S. medical education is sparse. Few programs offer targeted training for educators on advising students who are undocumented, DACA recipients, or on a visa. We piloted a virtual program for pre-health advisors and educators on supporting students who are undocumented or recipients of DACA and international students transitioning to medical school. Program evaluation consisted of an anonymous retrospective pre-post survey. Of 117 registrants, 40% completed the survey. Prior to the program, most participants indicated that they were unsure or thought students were ineligible for financial aid during medical school if they were DACA recipients (40% unsure, 26.6% ineligible) or on a student visa (30% unsure, 30% ineligible). After the program, most respondents reported students were eligible for merit scholarship or private loans with DACA (66.6% eligible) or an international student visa (60% eligible). Perceptions of students with DACA being able to lawfully practice medicine in the U.S. changed from pre-program (43.3% unsure or not eligible) to post-program (90% eligible). Participants indicated they were more confident advising DACA recipients and international students post program. This virtual program was an effective step in providing support for advisors who are assisting non-citizen or permanent resident students start their careers in healthcare. Our findings show the need for more information on advising students who are DACA recipients, undocumented, or on student visas prior to matriculating to medical school and throughout training.

A Case for Case Reports: How to Write One and Promote Mentorship, Scholarship and Faculty Development.

Introduction Case reports form the base layer of the evidence pyramid, describing new or emerging diseases, side effects to treatments, common presentations of rare diseases, or rare presentations of common diseases. An important scholarly pursuit, writing case reports can be hindered by lack of time, training, and mentorship. Here, we describe a workshop incorporating case writing skills with mentorship opportunities to engage faculty and learners. Methods We designed and implemented a virtual, synchronous workshop addressing knowledge and attitudes on case reports for trainees and academic faculty at distributed sites. Participants discussed the contributions of case reports to the medical literature, key features of successful cases, approaches to writing learning objectives, and how to develop interesting cases into dynamic case reports. Case reports were discussed as a way to mentor learners to disseminate interesting cases as a source of clinical experience and academic productivity. A retrospective pre-post survey was collected two months after the workshop to evaluate its utility. Results Fifteen out of 42 participants responded to the survey. As a result of the workshop, respondents noted improvement in confidence in identifying and writing case reports and identifying and working with mentors or mentees, regardless of level of training or specialty. At the follow-up, seven (47%) respondents had identified a case and 10 (67%) had identified a mentor/mentee to write a case report with. Discussion This workshop, successfully delivered virtually, demonstrates the utility of a brief educational intervention in improving participant confidence in identifying and writing case reports with mentorship.

EXPERIENTIAL ASSESSMENT OF AN INNOVATIVE DEMENTIA CARE TRAINING SEQUENCE FOR HEALTH AND HUMAN SERVICES WORKERS

Abstract This poster presents results of an assessment of an interdisciplinary dementia care training titled Dementia Reconsidered (DR). In contrast to disease and deficit-focused training curricula, DR incorporates and emphasizes the strengths and humanity of people living with dementia and focuses on person-directed support for, and care of, persons living with dementia. For example, DR makes the case for an approach to shared and supported decision-making that optimizes the individual’s— and significant others’—abilities. The on-line lectures were chunked to accommodate cognitive load and active learning; 20-30 second stretch breaks were interspersed to facilitate attention. This may account for the higher retention and utilization rates of DR than are often found in one-off trainings. A retrospective pre-post survey administered at the conclusion of DR sessions measured participant learning outcomes. Participants in DR sessions were representative of the fields of social work (42%), nursing (21%), and a significant “other” category (28%), mostly long-term care administrators. Among post-training survey respondents (N=36), 77% improved their knowledge of the key principles of person-directed dementia care; 73% (N=37) showed improved comfort in supporting residents with dementia during the CoVID-19 pandemic; 83% (N=24) showed improvement in ability to distinguish capacity and competency; and 83% (N=23) reported increased comfort in supporting people with dementia in making decisions in the face of diminished capacity. At six month follow-up, 63% (N=33) had used a skill gained from their training (17% no, 20% not sure). Implications for training in dementia care practices will be discussed.

Forum Theatre to Address Peer-to-Peer Mistreatment in General Surgery Residency

Mistreatment is widespread in graduate medical education, and much attention has been generated on this topic and its relationship to burnout in general surgery residency. In particular, peer-to-peer mistreatment poses a developmental dilemma - as junior residents find themselves mistreated and some turn around and perpetuate that mistreatment. There is a paucity of effective interventions. Forum Theatre (FT) is a novel educational tool to engage participants in solving difficult situations. We present the use of FT as a tool to explore solutions to address peer-to-peer mistreatment in a surgery residency. FT starts with the performance of a culture-specific conflict scenario and then invites the audience to participate in renditions of the situation ending in a collective solution. Stakeholder support was obtained from the general surgery program leadership. Time was protected during two 1-hour scheduled wellness didactic sessions. First, focus groups with each PG year identified the residents' experience of mistreatment. Themes regarding peer-to peer mistreatment were identified and presented to a group of 3 volunteer actor residents who chose to focus on the unintended consequences of public, corrective feedback with the understanding this would be presented to the residency at large. Following this, they developed a scenario for enactment which was implemented during the second didactic session. The enacted scenario posed a problem with public feedback ending unsatisfactorily. The audience was then invited to engage the actors and participate in replays of the situation until a collective solution was identified. Retrospective pre-post survey and a 6-month post survey were administered. General surgery residency at University of Texas Health San Antonio. General surgery residents. 32 of 66 (48.5%) residents participated. Participants noted an improved understanding of mistreatment, felt more confident in recognizing mistreatment, reported improved confidence in their ability to intervene when witnessing mistreatment and to recognize when they themselves were involved in mistreatment (p < 0.001 for all). In fact, of the residents who reported participating in mistreatment, 100% reported directing it towards peers. After the FT, 89% of residents said they "definitely" or "most likely" recommended participating in a FT to address mistreatment. 85.7% reported that the intervention was moderately to extremely effective for teaching topics in professionalism. These trends remained steady in the survey 6 months after the intervention as well. We found FT was feasible to implement in a busy general surgery residency and well received with sustained, self- reported behavior change. FT is a novel tool to engage residents to self-evaluate and participate in methods to address mistreatment. FT interventions can be tailored to the local culture to address conflicts specific to that setting.

Outcomes of a Peer Mentoring Circle: An Innovation to Improve Academic Physician Career Advancement in a Community Hospital Setting.

Faculty retention is a prominent topic in academic medicine. Investment in faculty career development supports faculty vitality, advancement, and retention. Academic physicians in community-based settings far from their academic affiliate may find identifying local career advancement mentorship challenging. In June 2018, a career advancement in-service day at The Children's Hospital of San Antonio and Baylor College of Medicine in Houston was convened to design a peer mentoring circle (PMC). Using self-determination theory, this program aimed to help PMC members develop goals; schedule and attend regular meetings; format, review, and critique member curricula vitae and portfolios; and hold one another accountable to submitting award and promotion applications. Eleven inaugural PMC cohort members attended regular monthly meetings from July 2018 to June 2019 (median, 6 members per meeting). All members were competent in accessing the PMC repository of materials. Statistically significant improvement ( P < .01) was seen in self-reported knowledge and skills relevant to award or academic promotion support and resources. Compared with no patient care or teaching awards and 1 academic promotion among non-PMC faculty, 5 PMC members (45.5%) earned a patient care award, 4 (36.4%) earned a teaching award, and 5 of 10 faculty members (50.0%) achieved academic promotion ( P < .001 for all). On the retrospective pre-post survey, members endorsed several PMC strengths, including personal and emotional support, professional support, and accountability. Next steps include establishing a local faculty development office, convening a second cohort, revising evaluation methods, expanding membership, and offering 1-on-1 career counseling. Community-based academicians who aim to replicate this program should organize a career advancement and faculty development in-service day, identify local faculty members to manage meetings, retain a repository of resources, set deadlines and hold one another accountable to them, and celebrate achievements and support one another in failure.

Synthesizing the Evidence: Best Practices for Trauma-Informed Care Education Across the Health Professions Workforce.

Purpose: Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but TIC education for clinicians has not been well examined. To remedy this, the authors conducted a multidisciplinary, scoping literature review to discern best practices for design, implementation, and evaluation of TIC curricula for health care professionals. Method: The research team searched Ovid Medline, Cochrane Library, Elsevier’s Scopus, Elsevier’s Embase, Web of Science, and the Published International Literature on Traumatic Stress database. Two independent reviewers screened 1,824 abstracts and excluded 1,697. After assessing 127 full-text articles, they excluded 76 based on predefined exclusion criteria; subsequently, they identified 4 additional articles through hand searching. Results: Fifty-five studies met inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma, responding to disclosures, defining trauma, and understanding trauma’s impact on health. Forty-seven of the studies included curricular evaluations, most commonly pre- and postsurveys. A minority used only postsurveys or a retrospective pre–post survey. The most common survey items included confidence in TIC skills, training content knowledge, participant demographics, and attitudes regarding the importance of TIC. Discussion: Future curricula should include applying a foundational lens of cultural humility, understanding the impacts of marginalization and oppression on individual and collective experiences of trauma, interprofessional collaboration, and incorporating survivors’ voices in education. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care providers. Significance: Although medical school curricula are increasingly including TIC education, best practices in TIC curricula have not been developed. This scoping review lays the groundwork for evidence-based strategies for the design, implementation, and evaluation of TIC curricula in the health professions.

A novel simulation-based approach to training for recruitment of older adults to clinical trials

BackgroundThe need to engage adults, age 65 and older, in clinical trials of conditions typical in older populations, (e.g. hypertension, diabetes mellitus, Alzheimer’s disease and related dementia) is exponentially increasing. Older adults have been markedly underrepresented in clinical trials, often exacerbated by exclusionary study criteria as well as functional dependencies that preclude participation. Such dependencies may further exacerbate communication challenges. Consequently, the evidence of what works in subject recruitment is less generalizable to older populations, even more so for those from racial and ethnic minority and low-income communities.MethodsTo support capacity of research staff, we developed a virtual, three station simulation (Group Objective Structured Clinical Experience—GOSCE) to teach research staff communication skills. This 2-h course included a discussion of challenges in recruiting older adults; skills practice with Standardized Participants (SPs) and faculty observer who provided immediate feedback; and debrief to highlight best practices. Each learner had opportunities for active learning and observational learning. Learners completed a retrospective pre-post survey about the experience. SP completed an 11-item communication checklist evaluating the learner on a series of established behaviorally anchored communication skills (29).ResultsIn the research staff survey, 92% reported the overall activity taught them something new; 98% reported it provided valuable feedback; 100% said they would like to participate again. In the SP evaluation there was significant variation: the percent well-done of items by case ranged from 25–85%.ConclusionsResults from this pilot suggest that GOSCEs are a (1) acceptable; (2) low cost; and (3) differentiating mechanism for training and assessing research staff in communication skills and structural competency necessary for participant research recruitment.

Pediatric Emergency Physicians' Comfort Level Providing Urgent Care for Adults on Telemedicine During the COVID-19 Pandemic: Experience at an Academic Medical Center.

Objective: Our objectives were to assess the comfort level of pediatric emergency physicians (PEPs) providing urgent care to adult patients on telemedicine (APOTM) when redeployed during the coronavirus disease 2019 (COVID-19) pandemic, how it changed over time, and what resources were helpful. Materials and methods: We conducted a retrospective pre-post cross-sectional survey of PEPs providing urgent care to APOTM with COVID-19 symptoms during the COVID-19 surge from March 12, 2020, to June 12, 2020 (the "care period") at two academic pediatric emergency departments in New York City. A retrospective chart review was also conducted. We include data on demographics of PEPs and adult patients; comfort level of PEPs providing urgent care to APOTM with COVID-19 symptoms pre- and post-three-month care period and effective resources.Results: Sixty-five PEPs provided urgent care to 1515 APOTM with COVID-19 symptoms during the care period. Pre-pandemic, 22/43 (51%) of responders feared caring for APOTM; 6/43 (14%) were comfortable. At the end of the care period, 25/42 (58%) of the responders stated they were comfortable caring for these patients. Factors associated with increased comfort level were: increased volume of patients over time, treatment algorithms, group support via electronic communication, and real-time back-up by a general emergency medicine (GEM) physician. Reduced medicolegal liability was also cited.Conclusion: With minimal additional training and resources, PEPs can increase their comfort to provide urgent care to APOTM with COVID-19 symptoms. As future pandemics may disproportionately affect certain patient populations (adults versus pediatrics), interventions such as treatment algorithms, group support via emails and texts, and sub-specialty backup should be incorporated into redeployment plans for urgent care telemedicine programs. Future research is needed to determine the adaptability of other medical specialties to cross-cover a different specialty from their own if needed.

"Patient's Family Wants an Update": A Curriculum for Senior Medical Students to Deliver Telephone Updates for Hospitalized Patients.

IntroductionResidents have the important task of updating family members of hospitalized patients, often by telephone. There are limited curricula dedicated to preparing medical students for this task, which will become their responsibility as residents.MethodsWe created a virtual workshop, including four patient cases, to facilitate teaching senior medical students enrolled in an internal medicine residency preparation course. Students alternated role-playing either physician or family member. We assessed performance using a self-assessment rubric before (preworkshop) and after (postworkshop) a didactic session. We compared pre- and postworkshop scores using t tests. We also used a retrospective pre-post survey with a 5-point Likert scale to assess each participant's comfort level, knowledge, and perceived ability.ResultsThirty-nine students completed the pre- and postworkshop evaluation (response rate: 70%). The mean score on the preworkshop self-assessment was 83% (SD = 9%) and on the postworkshop self-assessment was 94% (SD = 8%; p < .01), with a large effect size of 1.22. Among the 31 students (62%) who completed the survey, there was improvement in comfort level (2.9 vs. 3.7, p < .001), knowledge (2.7 vs. 3.8, p < .001), and perceived ability (2.9 vs. 3.7, p < .001).DiscussionOur workshop was effective in teaching medical students a structured format for providing telephone updates and was well received. The workshop was also effective when delivered virtually (with videos off) to mimic the non-face-to-face communication that occurs when delivering family updates by telephone. The curriculum could be expanded to other learner groups.

Evaluation of Physician Assistants' Self-Reported Attitudes and Behaviors After Completion of a Hospital-Wide Multidisciplinary Communication Skills Training Workshop.

Physician's assistants (PA) are an integral part of hospital teams. To the best of our knowledge, this is the first study to examine the effects of a multidisciplinary hospital-wide communication skills training (CST) workshop on PAs. From November 2017 to November 2019, all participants in the CST workshop were sent a web-based retrospective pre-post survey to measure self-reported attitudes and behaviors related to communicating with patients, CST, and specific skills taught. PA responses were analyzed alone and were compared to non-PAs. Non-PAs were physicians and 1 nurse practitioner. In total, 258 PA and 333 non-PA participants were surveyed for an overall response rate of 25%. Among PAs, in 9 out of 10 domains measured, there was a significant change in self-reported attitudes and behaviors toward communicating with patients, CST, and skills taught (P < .05). Similar to other providers, PAs experienced positive changes in these self-reported attitudes and behaviors after CST, however, there were some significant differences found when comparing PAs and non-PAs in the covariate analysis.

Promising Interventions to Prevent Liver Cancer in Idaho.

The Idaho Comprehensive Cancer Control Program (ICCCP) collaborated with the Idaho Immunization Program (IIP) to plan and implement activities to increase knowledge and awareness of liver cancer prevention through tailored hepatitis B immunization messaging to the Idaho community and health care providers. In this article, we report findings from an evaluation of these activities. The two programs implemented liver cancer prevention activities between May 2017 and December 2017; strategies included a social media vaccination awareness campaign and health care provider education. Facebook Insights was used to report, and descriptive statistics were used to analyze, data from the social media campaign. Descriptive statistics were used to analyze data collected from a retrospective pre-post survey for the health care provider presentations and paired t-tests were conducted to detect differences between pre- and postexposure. For the social media campaign, ICCCP and IIP posted a total of 32 liver cancer and hepatitis B vaccination posts on their respective Facebook pages, which reached 42,804 unique users. For the health care provider presentations, there was a statistically significant increase in awareness, knowledge, ability, and intention among health care providers. Our evaluation serves as an example of how public health social media can reach consumers and how educating providers can raise awareness on the importance of hepatitis B vaccination as a means of preventing liver cancer.

Using simulation to increase resident comfort discussing social determinants of health

BackgroundSocial determinants of health (SDoH) play an important role in pediatric health outcomes. Trainees receive little to no training on how to identify, discuss and counsel families in a clinical setting. The aim of this study was to determine if a simulation-based SDoH training activity would improve pediatric resident comfort with these skills.Methods We performed a prospective study of a curricular intervention involving simulation cases utilizing standardized patients focused on four social determinants (food insecurity, housing insecurity, barriers to accessing care, and adverse childhood experiences [ACEs]). Residents reported confidence levels with discussing each SDoH and satisfaction with the activity in a retrospective pre-post survey with five-point Likert style questions. Select residents were surveyed again 9–12 months after participation.Results85% (33/39) of residents expressed satisfaction with the simulation activity. More residents expressed comfort discussing each SDoH after the activity (Δ% 38–47%; all p < .05), with the greatest effect noted in post-graduate-year-1 (PGY-1) participants. Improvements in comfort were sustained longitudinally during the academic year. More PGY-1 participants reported engaging in ≥ 2 conversations in a clinical setting related to food insecurity (43% vs. 5%; p = .04) and ACEs (71% vs. 20%; p = .02).DiscussionSimulation led to an increased resident comfort with discussing SDoH in a clinical setting. The greatest benefit from such a curriculum is likely realized early in training. Future efforts should investigate if exposure to the simulations and increased comfort level with each topic correlate with increased likelihood to engage in these conversations in the clinical setting.

Library instruction and Wikipedia: investigating students' perceived information literacy, lifelong learning, and social responsibility through Wikipedia editing.

Objectives:This article presents a multiyear pilot study delineating practical challenges, solutions, and lessons learned from Wikipedia editing experiences with first-year medical students at the John A. Burns School of Medicine at the University of Hawai‘i at Mānoa. The purpose of our project was to determine the feasibility and effectiveness of Wikipedia editing to improve information literacy and lifelong learning skills and to investigate aspects of social responsibility in first-year medical students.Methods:Lessons were provided through a combination of in-person and online instruction via the WikiEdu learning management system (LMS). Students next selected a health-related Wikipedia article to edit. After the editing experience, structural completeness data were collected from the WikiEdu LMS. Feedback was collected via an anonymous retrospective pre-post survey to assess the students' attitudes toward their perceived information literacy skills and the social responsibility of improving Wikipedia articles. Nonparametric tests were conducted to compare pre versus post outcomes.Results:Fifty-seven (79%) participants in the 2018 cohort and forty-nine (64%) participants in the 2019 cohort completed the retrospective pre-post survey. In both cohorts, respondents showed statistically significant increases (p<.05) in self-rating of all ten domains of information literacy and social responsibility after completing the program.Conclusions:This study showed that medical students are competent editors of Wikipedia and that their contributions improve both the quality of the articles and their own perceived information literacy. Additionally, editing medicine-related articles provides an opportunity to build students' social responsibility by improving content on an open platform that reaches millions each day.

Renaissance in the Nursing Home During the COVID-19 Pandemic: Telemedicine Blooms in a Time of Crisis

Prior to the pandemic, telemedicine was not well adopted in nursing facilities in the United States and was nearly non-existent in Hawaii. Many nursing facilities have since acknowledged its value due to the need for stricter infection control measures and reduction of exposure risk from face-to-face visits during the COVID-19 pandemic. To develop, implement, and assess a quality improvement project for a safe and effective telemedicine protocol in a high-volume, post-acute nursing home during the COVID-19 pandemic. Hale Nani Rehabilitation and Nursing Center (HNRC, an Avalon Health Care Group facility) is Hawaii’s largest skilled nursing facility with 288 beds and approximately 100 post-acute admissions and discharges per month. Five major medical groups (about 15-20 medical providers) and a wide array of consultants provide care here, with different and complex demands on facility staff. The COVID-19 pandemic spurred the rapid development and implementation of an innovative telemedicine protocol as a quality improvement project to sustain patient satisfaction, quality and access to care, and infection control. A needs assessment survey and internal focus groups directed process improvement. Project impact was measured by a retrospective pre-post survey of 7 questions to evaluate process improvement, attitudes, skills and perceptions with a 5-point Likert scale (5=strongly agree, 1=strongly disagree). Three additional qualitative questions assessed respondents’ views on the post-pandemic sustainability of telemedicine in the facility. The survey was completed by 22 respondents (8 medical providers and 14 HNRC staff). Scores from before and after implementation of the telemedicine protocol were compared using paired T-tests. Respondents expressed improvement in the perceived value of telemedicine (3.23 vs. 4.82, p < 0.0001); personal skill/efficiency with telemedicine visits (2.29 vs. 4.24, p < 0.0001); comfort level with telemedicine (2.29 vs. 4.45, p < 0.0001); and the scheduling process for telemedicine visits (2.27 vs. 3.91, p=0.0001). They expressed increased awareness of barriers and benefits of telemedicine (2.84 vs. 4.66, p < 0.0001) and improved leadership commitment (2.64 vs. 4.43, p < 0.0001). The weekly average number of telemedicine visits per respondent increased significantly after protocol implementation (6.48 vs. 25.61, p=0.002). Although not statistically significant, medical providers were more likely to wish to continue telemedicine post-pandemic compared to facility staff (75 % vs 43%, p=0.204), who expressed concerns about time commitment and workflow. With support of facility leadership, interdisciplinary team members and engagement of key stakeholders, we successfully implemented a complex telemedicine protocol in a high-volume, post-acute care skilled nursing facility during the COVID-19 pandemic, allowing patients to receive the care they needed.

Transition-to-residency: pilot innovative, online case-based curriculum for medical students preparing for pediatric internships

ABSTRACT Background: There is increasing recognition in medical education that greater emphasis must be placed on preparing graduating medical students for their new roles as interns. Few publications in the literature have described transition-to-residency curricula specifically for students interested in pediatrics or pediatric-related fields Approach: We developed novel online pediatric cases, embedded within an innovative, hybrid transition-to-residency course, to address high yield, multi-disciplinary topics within the context of several of the AAMC’s identified Entrustable Professional Activities Evaluation: The pilot cases were evaluated over two academic years (2018, 2019) at a single academic medical center as part of routine student course evaluation (N = 18/35) with the 2019 evaluation containing additional retrospective pre-post survey questions (N = 9/18) assessing self-reported changes in knowledge. Almost all students were very satisfied or satisfied with the modules overall (94%), the quality of the resources provided (100%), and the structure and clarity of the presentation of the material (100%). Among the students who completed the retrospective pre-post survey after participation in the online modules, significant self-reported improvements were noted in writing orders to the pediatrics floor (Z = −2.07, p = 0.04), providing anticipatory guidance (Z = −2.0,p = 0.046), formulating a differential diagnosis for common pediatric conditions (Z = −2.24, P = 0.03), and preparedness for managing common pediatric floor emergencies (Z = −2.33, P = 0.02). Reflection: We demonstrated feasibility of implementation of an interactive, online case-based curriculum, medical student satisfaction with content and delivery, and increased self-reported knowledge after completion of the pilot pediatric cases on the online, asynchronous learning platform.

A Retrospective Pre-Post Survey to Analyze Course Revisions, Perceived Learning, and Learning Outcomes in an Agricultural Structures Course

HighlightsThe RASE pedagogical model for integrating technology into an upper-division structures course proved effective.A retrospective pre-test/post-test was used to measure changes in students’ perceived competencies.Students indicated increases in perceived knowledge, skills, and attitudes following several course modifications.Students felt technology, experiential learning, and formative and summative assessment improved their learning.Abstract. In early 2019, instructors in the Agricultural Operations Management (AOM) program in the Department of Agricultural and Biological Engineering at the University of Florida developed a retrospective pre-test/post-test survey instrument to measure changes in perceived knowledge, skills, and attitudes (KSA) for students enrolled in AOM4642: Environmental Systems for Agricultural Structures during the fall 2019 semester. The course trains students to understand the components of the environment, the impact of those components on building usage, and how to control the environmental variables of buildings used to house agricultural products (e.g., livestock and horticultural) for more efficient production, processing, and storage. The course stresses a hands-on approach through experiential learning opportunities, and it challenges students to solve problems using critical thinking and application of conceptual principles. The course recently underwent significant revisions following the RASE pedagogical model to create student-centered curricular experiences and link learning objectives with assessments, outcomes, and evaluation. Thirty-one AOM students enrolled in the 16-week course completed the survey. After the course, the students retroactively (i.e., “before and after” instruction) rated their perceived learning. Changes in pre- and post-instruction responses were compared using measures of central tendency and correlations, and statistical significance (p-values) was reported. Constructs measuring KSA items were created using collapsed variables and tested for internal consistency and scale reliability against a threshold reliability coefficient of 0.70. The goal of this study was to assess the effectiveness of the RASE pedagogical model on student-perceived learning with respect to changes in knowledge, skills, and attitudes in an agricultural structures course. The specific objectives of this study were to: (1) measure changes in students’ perceived knowledge, skills, and attitudes, (2) evaluate student sentiment toward the course materials and activities, and (3) solicit feedback from the students on ways to improve the course. Results of the survey indicated significant increases in students’ perceived learning with respect to KSA. In addition, students commented on the effectiveness of several instructional activities (e.g., labs, field trips), indicating that those activities enhanced their experiences, but they also noted that shorter, more frequent homework would help with retention. Keywords: Assessment and evaluation, Construct reliability analysis, Instructional improvement, Perceived learning, RASE pedagogical model, Retrospective pre-test and post-test design, Student perceptions.