UCSF Education Showcase 2018

Welcome ...... 1 Showcase Schedule ...... 2 Speaker Biographies ...... 7 Cooke Award ...... 8 Plenary Abstracts ...... 9 Workshops April 29 ...... 15 Workshops April 30-May 1 ...... 22 Mini Oral Presentation Abstracts ...... 28

Education Showcase 2018

Welcome to UCSF Education Showcase 2018

Dear Friends,

On behalf of the Center for Faculty Educators, we are proud to present the 17th annual Education Showcase, an event that highlights the scholarly work in education of UCSF faculty, learners and staff. The showcase includes a pre-event day of workshops at Mission Bay for Teach for UCSF Certificate scholars on April 29 and events at Mission Bay on April 30 and Parnassus on May 1.

Scholarly presentations address important questions and innovations in health professions education. Following a blinded peer review of all submissions, the Academy of Medical Educators (AME) Scholarship Committee selected six plenary presentations based upon their quality and collective relevance to the audience of educators. This year we have an incredible 59 mini-oral presentations which also offer opportunities for engagement and dialogue. Additionally, we will host nine faculty development workshops chosen to address current topics in our teaching landscape.

Catherine Lucey, MD and Vice Dean for Education will deliver a keynote address reprising her talk at the Association for Medical Education in Europe “Addressing Health Disparities: Can Equity Pedagogy Help?” and will lead a seminar on Monday afternoon, “Achieving the Ideal Ecosystem for Learning and Healthcare: What would you do?” Seminar attendees will hear about important developments from the recent School of Medicine Education Retreat and discuss how we might redesign the way we work, learn, care and discover to optimize our learning ecosystem.

For the 12th year, AME will present the Cooke Award for the Scholarship of Teaching and Learning. The AME Scholarship Committee selects award recipients whose work represents outstanding quality and innovation in educational research and/or curriculum development. Please join us for the awards presentation at the conclusion of Monday’s plenary session.

We extend thanks to our community of educators for contributions that highlight the depth and breadth of educational scholarship at UCSF. In the current climate of significant changes in both clinical care and the education of future clinicians, we are privileged to be amongst so many passionate health professions educators sharing our creative and innovative scholarly work.

Warmly,

Jason Satterfield, PhD Ann Poncelet, MD Patricia O’Sullivan, EdD Professor of Clinical Medicine Professor of Neurology Professor, Department of Medicine Director, Haile T. Debas Academy of William G. Irwin Endowed Chair Director, Research and Development Medical Educators Scholarship Director, Haile T. Debas in Medical Education Committee Academy of Medical Educators Endowed Chair of Surgical Education

1 Education Showcase 2018 Schedule – April 30-May 1

Online directory of sessions for links to evaluations, Teach for UCSF skills assessments, Livestream recordings and learning materials: http://tiny.ucsf.edu/EdShowcase2018

Monday, April 30: Mission Hall, 1599 4th Street at 16th Street, UCSF Mission Bay

8:15am-9:45am UCSF Education Showcase Plenary Session Presentations MH-1400 Evaluation of a Novel Performance Dashboard for Medical Students at UCSF: Nicholas Iverson, MD and team

What makes “difficult patients” difficult for medical students?: Jody Steinauer, MD and team Capturing the Teachable Moment: Using video re-enactments of interprofessional groups to support faculty development for interprofessional teaching and debriefing: Bridget O’Brien, PhD and team

Characterizing Diagnostic Reasoning in the UCSF Pre-Clerkship Curriculum: Jason

Parad, MPH, MBE and team

Trainees' Rating of Code Team Leader Based on Professional Background & Gender: Mindy Ju, MD and team Effect of cost exposure on medical students’ preferred mammography screening strategies: how should we teach high value care?: Clarice Nguyen, BA and team 9:15-10:15 Break 10:15-11:30 Keynote Address by Catherine Lucey, MD 11:30-11:45 Presentation of the Cooke Award for the Scholarship of Teaching and Learning 11:45-12:30pm Lunch MH Lobby 12:30-2:30pm Achieving the Ideal Ecosystem for Learning and Healthcare: What would you do? MH-1402 Seminar led by Catherine Lucey, MD 12:30-2:30pm Designing Instructional Activities in the Workplace: How Cognitive Load Theory Helps MH-1401 2:30-3:00pm Break 2:30-4:30pm Mini-oral Presentations (see mini-oral schedule for details) MH-1401, 1402

2 Tuesday, May 1: UCSF Library Teaching and Learning Center: 530 Parnassus Ave., 2nd Floor

8:00am-noon Workshop: Using Technology for Effective Teaching CL-221/222 8:00am-10:00am Workshop: Faculty Developer Tips and Tricks CL-215-216 10:00am-noon Workshop: Optimizing Group Decision Making for Summative Assessment of Competence CL-220/223 11:30am-12:30pm Lunch CL-213/214 Noon-1:00pm Keynote Address by Larissa Thomas et al Design Thinking for Equity and Well-Being in Medical Education 1:00-3:00pm Workshop: Teaching Learners to Use and Find Data for Quality Improvement and Patient CL-220/223 Safety (QIPS) 1:00-3:00pm Workshop: Helping Trainees Navigate Professional Identity Tensions in the Age of Social CL-221/222 Media 2:30-3:00pm Break 3:00-5:00pm Workshop: Learning Environments at UCSF: Creating Actionable Plans for Optimization CL-222 3:00-5:00pm Workshop: Harnessing Who’s in the Room: Creating and Facilitating Productive Meetings CL-220/223 (breakout, CL-216) 3:00-5:00pm Mini-oral Presentations (see mini-oral schedule for details) CL-221, CL-213, 3-A, B, C CL-214 4-A, B, C

3 Education Showcase 2018 Mini-oral presentation schedule

Monday, April 30 at Mission Bay

Session 1-A: 2:30-3:30, MH-1401 Title Author 04-Interprofessional Curriculum for Early Health Professions Students on Communication to Promote Patient Adherence Mills 36-Cultivating Teamwork: An Interprofessional Collaboration Skills Curriculum for Early Medical Students in Clinical Microsystems Wamsley 17-Quality of Written Interprofessional Feedback for First-Year Medical Students: A Content Analysis McGinness 20-'Getting out of that siloed mentality early': opportunities for interprofessional learning in a longitudinal placement for first year medical students Rivera 30-Patient-centeredness? Exploring students’ representation of the patient in an interprofessional standardized patient exercise O'Brien 43-Improving Trainee Communication Skills with Direct Observation and Feedback Gager

Session 1-B: 2:30-3:30, MH-1402 Title Author 05-Perceptual Expertise in Robotic Surgeons: Developing a Novel Measurement Tool Green 06-Integrated Ophthalmology-General Surgery Internship Educational Impact Everett 12-The Impact of a Regional Anesthesia Ultrasound and Anatomy Workshop on Resident Education Harmon 16-How do I cope? Emotional distress and the role of peer support during internship Moore 25-Developing and Piloting An Airway Curriculum in Emergency Medicine Residency Shochat

Session 2-A: 3:30-4:30, MH-1401 Title Author 19-Diversity and Inclusion Competencies for Residents Rothstein 23-Impact of an Interprofessional (IP) Learning Community in Geriatric Primary Care Chen 44-Training Healthcare Professionals To Identify and Respond to Victims of Human Trafficking Morgan 66-Development of "Five Keys to Older Adult Health" Curriculum in Primary Care and Community Services Chodos 68-Two Fellowships are Better than One: Combining Geriatrics and Palliative Care Flint

Session 2-B: 3:30-4:30, MH-1402 Title Author 09-Supporting Learners to Learn from “Difficult Patients” Steinauer 34-Walk the Walk: Evaluating the Impact of a National Workshop on Program Evaluation Seritan 39-Preparing the 21st Century Physician: A New Foundational Social and Behavioral Sciences Course Garg 42-“A friendly place where you can grow as an educator”: Exploring communities of practice among medical student coaches Schreiner 57-FS-in-F2 Program of Assessment: Assessment For Learning Mills

4 Education Showcase 2018 Mini-oral presentation schedule

Tuesday, May 1 at Parnassus

Session 3-A: 3:00-4:00pm, CL-221 Title Author 70-Structural expectations: Characterizing structural competency for medical students Dobbins 07-Common Threads of Care: Integrating Geriatrics and Specialty Practice for Medical Students Byerly 08-Broadening Definitions of “Home”: A Models of Residential Geriatric Care Curriculum for Pre- clerkship Students Byerly 48-Gender-Inclusive Care: A Pilot Workshop to Improve Medical Student Competency During Third-Year Clerkships Benesch 58-What Can Physicians Do?: Building An Advocacy Curriculum for First Year Medical Students Griffiths 50-Emotional Awareness and Mindfulness in Diagnosis – Preparing Second Year Medical Students for Clerkships Cook

Session 3-B: 3:00-4:00pm, CL-213 Title Author 27-A Multicenter Qualitative Study of Interprofessional Simulation-Based Education Ju 31-E-ASSESS: Creating an EPA-Based Assessment Tool for Use in Simulated Emergency Scenarios Andler 45-“Will you be my Facebook friend?” Professional Identity Tensions and Boundary Issues in the Age of Social Media: A Workshop for Psychiatry Residents Zhou 47-Providing trainees with feedback about practice habits – who, what, why, and how? Rosenbluth 55-IGNITE: Lighting A Fire For Interprofessional Error Disclosure Curriculum Saxena 60-Earth Health: A Novel Elective Shaping Student Perceptions of Sustainable Healthcare Aguilar

Session 3-C: 3:00-4:00pm, CL-214 Title Author 46-Back to the basics: observing foundational science on internal medicine rounds Pai 01-Trial and Improvement of Clinical Instruction Between Medical Students at the UCSF Family Medicine Center at Lakeshore MacKenzie 51-UCSF CMC Clinical Immersion Week McNamara 54-A Novel Curriculum of Pediatric Emergency Medicine for Emergency Medicine Physician Assistants Wallin 59-Building an Emergency Medicine Boot Camp for Graduating Undergraduate Medical Seniors Daniel 67-Standardizing Learning for Fourth-Year Medical Student Medical Specialty Rotations: Prioritizing Content Abdoler 21-California’s Virtual Emergency Medical Services (EMS) Fellowship Consortium: One State’s Innovative Approach to Fellow Education Mercer

See next page for Sessions 4-A, 4-B and 4-C, 4:00-5:00pm

5 Education Showcase 2018 Mini-oral presentation schedule

Session 4-A: 4:00-5:00, CL-221 Title Author 13-Enhancing Pediatric Trainees’ Skills in Providing Gender-Affirming Care for Transgender Adolescents Using Standardized Patient Encounters Vance 33-Enhancing Operative Feedback: A Descriptive Trajectory of Surgical Development in Otolaryngology Zhao 35-National Trends in Internal Medicine Resident Applications to Subspecialty Fellowships Santhosh 52-Narrative Practices Among Global Health Fellows: A Needs Assessment for Future Curriculum Development Jacobs 53-Development and Implementation of Milestone-based Post-Shift Assessment Cards for Real- Time Feedback to Pediatric Emergency Medicine Fellows Wallin 65-A needs assessment: Pediatric residents are expected to be competent in neonatal intubations, how are we facilitating this in the face of dwindling clinical opportunities for them to intubate? Briscoe

Session 4-B: 4:00-5:00, CL-213 Title Author 03-An Online Spaced Education Curriculum for Obstetrics and Gynecology Third-year Clerkships Nelson 14-Getting outside the box: Exploring role fluidity in interprofessional student teams using activity theory Byerly 28-Mapping Interprofessional Communication during Intensive Care Unit to Ward Transitions Beach 38-The Impact of Perspective-Taking on Moral Distress in the Pediatric Intensive Care Unit Kowalek 56-Editing Wikipedia for Medical School Credit – Analysis Across 4 US Medical Schools Joshi 62-A Novel Half-Day Serious Illness Communication Workshop for UCSF Medical and Nursing Students Calton 69-Using Virtual Reality to Improve Care of the Critically Injured Brown

Session 4-C: 4:00-5:00, CL-214 Title Author 15-Clerkship Grading Committees: What is the Value Added? Frank 18-Breaking the curve: moving from normative to criterion-based grading on neurology clerkship Brown 37-Test-Enhanced Learning in a Therapeutics Course Shin 40-Aha! Moments: Breakthroughs in learning lumbar punctures and implications for instruction Kant 61-Re-imagining clinical skills: longitudinal integration of first year medical students in interprofessional teams for meaningful systems improvement Rennke 71- The Development of an EPA-Based Simulation Curriculum for Sub-Interns Daya

6 UCSF Education Showcase 2018

Keynote Addresses

Addressing Health Disparities: Can Equity Pedagogy Help?

Catherine Reinis Lucey, MD

Dr. Lucey is vice dean for education at UCSF School of Medicine. She directs the undergraduate, graduate and continuing medical education programs of the School of Medicine and the Office of Medical Education. Dr. Lucey comes to UCSF from Ohio State University where she was vice dean for education for the College of Medicine and associate vice president for health sciences education for the Office of Health Sciences. She is a member of the AAMC MR5 committee, charged with overseeing the revision of the Medical College Admission Test process. Dr. Lucey completed her residency in internal medicine, including service as chief resident, at the UCSF- affiliated San Francisco General Hospital, after earning her medical degree from the Northwestern University School of Medicine.

In addition to giving the Keynote Address on April 30, Dr. Lucey will also lead a seminar, Achieving the Ideal Ecosystem for Learning and Healthcare: What would you do?

Design Thinking for Equity and Well-Being in Medical Education

Jyothi Marbin, MD, is an Associate Clinical Professor in the Department of Pediatrics at UCSF. She is the director of the Pediatrics Leadership for the Underserved Residency program, and is an Associate Program Director of the Pediatrics Residency Program at UCSF.

Larissa Thomas, MD is an Associate Clinical Professor of Medicine and a faculty hospitalist at Zuckerberg Francisco General Hospital (ZSFG). She is the Interim Associate Program Director for Inpatient Affairs, the ZSFG Site Director for the UCSF Internal Medicine Residency Program, and a coach for the UCSF Bridges Curriculum.

Rita Nguyen, MD is an Assistant Clinical Professor of Medicine at UCSF and Medical Director of Healthy Food Initiatives at ZSFG. As an Assistant Health Officer and Chronic Disease Physician Specialist for the San Francisco Department of Public Health, she supports chronic disease and cancer prevention efforts for the City and County of San Francisco.

7 Education Showcase 2018 Cooke Award

The Cooke Award for the Scholarship of Teaching and Learning

Presented by Pat O’Sullivan Director, Research and Development in Medical Education

The Academy is pleased to continue the Cooke Award for the Scholarship of Teaching and Learning, established in 2007 to recognize outstanding scholarly works presented at Education Showcase. All submissions to Education Showcase are eligible for these awards, which are accompanied by an honorarium. Top-scoring projects were nominated for the award following a blinded peer review of all abstract submissions. Award winners were determined by a ballot in which Scholarship Committee members ranked the blinded abstracts, excluding those in which they were involved.

Please join us in congratulating the 2018 recipients:

Clarice Nguyen, Dr. George Sawaya and Dr. Ari Hoffman for their work:

Effect of cost exposure on medical students’ preferred mammography screening strategies: how should we teach high value care?

Jason Parad and Dr. Denise Connor for their work:

Characterizing Diagnostic Reasoning in the UCSF Pre-Clerkship Curriculum

8 Education Showcase 2018 Plenary Abstracts – April 30

Abstract # 22

Evaluation of a Novel Performance Dashboard for Medical Students at UCSF

Nicholas Iverson, MD, UCSF School of Medicine; Alekist Quach, MD, UCSF School of Medicine; Christy Boscardin, PhD, UCSF School of Medicine; Patrick Yuan, BA, UCSF School of Medicine; Stephanie Kaner, MEd, UCSF School of Medicine; Karen Hauer, MD, PhD, UCSF School of Medicine

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Computers and Technology, Curricular Innovation, Evaluation of Programs, Feedback Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To study early experience with the Bridges electronic performance dashboard, longitudinal coaching, and structured time for goal setting. Background To develop lifelong learning skills, students need feedback, access to performance data, and coaching. Informed by self-regulated learning theory and the master adaptive learner framework, the Bridges curriculum provides these infrastructural supports to engage students in reflection and learning planning.(1) Methods We conducted 3 focus groups with 21 first-year medical students to explore performance dashboard usage and analyzed findings using content analysis. Results informed survey development to investigate experience with the new dashboard and coaching program. Results 114 of 152 (75%) students completed the survey. Exploratory factor analysis yielded 5 factors characterizing self- regulated learning behaviors explaining 57% of the variance: 1) learning goals development (α=.88), 2) dashboard usage (α=.82), 3) coaching (α=.71), 4) employment of learning strategies (α=.81), and 5) reflection (α=.63). Highest correlation among the factors was between dashboard usage and employment of learning strategies (r=.31). We identified that students perceive themselves as skilled lifelong learners, but are not optimally using the Bridges infrastructure to support their learning strategies, and are often unsure how to engage meaningfully in performance review with coaches. Discussion The student performance dashboard creates opportunities for efficient and centralized feedback. These results can guide further improvements by targeting students' needs and goals, and can inform other programs seeking to foster lifelong learning skills. Reflective Critique UCSF Education Pathway leaders provided feedback on survey design, including targeting goals of the survey and items, which we incorporated in the final survey. Reference 1. Cutrer WB, Miller B, Pusic MV, et al. Fostering the development of master adaptive learners: A conceptual model to guide skill acquisition in medical education. Acad Med. 2017;92(1):70-75.

9 Education Showcase 2018 Plenary Abstracts – April 30

Abstract # 10

What makes “difficult patients” difficult for medical students?

Jody Steinauer, MD, UCSF; Patricia O'Sullivan, PhD, UCSF; Felisa Preskill, MPP, UCSF; Olle ten Cate, PhD, UCSF / Utrecht; Arianne Teherani, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Communication, Patient Care, Professionalism Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To gain a deeper understanding of medical students’ experiences of interactions with patients toward whom they felt negative emotions, often called “difficult patients.” Background Clinicians can find it challenging to provide high-quality care when interacting with patients whom they consider “difficult.” While medical students also find some patients “difficult,” little is known about why they do or how being a student affects their perceptions. Several theories may explain the way students experience these patients. Methods We interviewed fourth-year medical students who described patient interactions in which they felt negative emotions toward the patient. Interviews were completed when theoretical sufficiency was achieved. Using the approach of constructivist grounded theory, the authors reviewed transcripts, coded data and grouped codes into themes. Results We interviewed 26 4th-year medical students (44 volunteered/180 invited). Patients toward whom they felt negative feelings (most commonly annoyance or frustration) included those who had “unfixable problems, were angry or mean, declined recommendations, were thought to have caused their health problems, and were perceived to be drug-seeking. They often had psychiatric or substance use disorders. Patient behaviors were exacerbated by three situations related to students’ roles and hopes as learners: 1) when the patients were perceived to decrease their chances of a positive evaluation; 2) when the patients challenged their desires for patient behavior and the ideal physician-patient interaction; and 3) when the students lacked authority or skills to independently meet patients’ needs. Discussion Students’ experiences of challenging patients interacted with their learner roles. This can be understood through goal orientation theory and professional identity formation. Clinical educators should consider these complexities as they teach students to provide high-quality care for patients whom might be considered “difficult.” Reflective Critique This study is under revision at Academic Medicine.

10 Education Showcase 2018 Plenary Abstracts – April 30

Abstract # 32

Capturing the Teachable Moment: Using video re-enactments of interprofessional groups to support faculty development for interprofessional teaching and debriefing

Bridget OBrien, PhD, UCSF; Joe Cook, MA, UCSF; Patrick Yuan, BA, UCSF; Maria Wamsley, MD, UCSF; Josette Rivera, MD, UCSF

Area(s) abstract covers: CME, IPE Domain(s) addressed: Faculty Development, Interprofessional Education, Simulation Category: Curriculum Development

Abstract: Purpose: To create a set of video re-enactments of “teachable moments” during interprofessional (IP) interactions for use in IP faculty development. Background: Educators witness multiple opportunities to teach and give feedback when observing students during IP activities, but often lack the confidence and teaching scripts to address group dynamics, hierarchy, and mutual respect. Faculty may also feel less comfortable with norms and expectations when working with professions other than their own. Methods: We reviewed videos from 10 groups of dental, medical, nurse practitioner, pharmacy, and physical therapy students participating in the IP Standardized Patient Exercise to identify common interactions related to core IP competency domains that warrant improvement. We selected a set of 27 clips illustrating these interactions, then reviewed them with faculty from each profession for input on the potential value of the clip for IP faculty development. Based on this feedback, we scripted re-enactments of brief scenes from 3 groups and hired a videographer to produce high quality videos. The scenes depicted issues around leadership, role misunderstandings, and negotiation. We sought feedback from the same faculty members for final editing. Evaluation: Feedback from faculty confirmed the high quality and authenticity of the videos. They identified ‘teachable moments’ consistent with those we intended to portray and attested that many of these would be challenging for them to address with students and thus would be beneficial to discuss in a workshop. We will use the videos in multiple IP faculty development workshops this spring and further evaluate the authenticity, utility, and impact of the videos on faculty confidence and preparation to enact these teachable moments based on teaching scripts developed during the workshop. Reflective Critique: Our efforts to replicate real IP student interactions benefited tremendously from IP community members’ feedback and we anticipate the videos will prompt similarly beneficial conversations among IP faculty during workshops.

11 Education Showcase 2018 Plenary Abstracts – April 30

Abstract # 29

Characterizing Diagnostic Reasoning in the UCSF Pre-Clerkship Curriculum

Jason Parad, MPH, MBE, Medical Student; Denise Connor, MD, Associate Professor

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Basic Science Education, Clinical Instruction and Performance, Evaluation of Programs, Other (please describe) Mapping & Integration Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To assess the representation of diagnostic reasoning (DR) concepts in the UCSF pre-clerkship curriculum. Background: UCSF seeks to teach and integrate DR concepts throughout the pre-clerkship curriculum. Formal DR instruction is currently housed in the Clinical Microsystem Clerkship (CMC) and the DR Block. The extent to which DR concepts are incorporated into other Foundational Sciences (FS) blocks is unknown. Methods: All FS small groups in the ABC, REGN, PHD, LS, and BMB blocks were analyzed for DR concepts. Small groups were chosen given their consistent format across blocks and frequent inclusion of clinical content. Qualitative template analysis was performed with DR concept codes selected a priori and modified according to themes identified in the data. Clinical questions not directly linked to DR concepts were coded as Medical Knowledge. Results: Of the more than 1,600 small group questions coded, just over half involved DR concepts. Processed Terminology was most highly represented, seen in about one-quarter of all questions. REGN had the highest percentages of DR questions (62%) and questions coded as Diagnostic Schema (6%). LS had the highest percentage coded as Illness Script (7%). Discussion: DR concepts were highly represented across FS blocks yet embedded in variable frameworks; explicit naming and consistent ordering of concepts may improve students’ early application of DR skills. As Medical Knowledge represented a large share of questions, ample opportunity exists to further integrate DR concepts. Sharing our findings with FS block directors, discussing interest in and barriers to integration, and showcasing best practices across blocks will be key to maximizing spiral learning. Future work may consider how DR is taught and assessed in other curricular elements; involving the UCSF Mapping and Integration Committee will be a natural next step. Reflective Critique: This work was completed as part of the UCSF Education Science & Curriculum Design Summer Fellowship. Input from education experts during this time informed the selection of DR concept codes.

12 Education Showcase 2018 Plenary Abstracts – April 30

Abstract # 26

Trainees' Rating of Code Team Leader Based on Professional Background & Gender

Mindy Ju, MD, UCSF; Sandrijn van Schaik, MD PhD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Assessment and Testing, Interprofessional Education, Other (please describe) Gender Category: Curriculum Evaluation/Educational Research

Abstract: Purpose Examine impact of team leader’s profession and gender on perceptions of leadership skills. Background Interprofessional collaboration in healthcare remains challenging, in part due to power dynamics and gender differentials. Such professional and gender biases may affect perceptions of team leadership and how we assess and teach leadership skills. Methods We video-recorded a scripted simulated resuscitation scenario twice, once with a male and once with a female team leader. We copied each video and labeled the leader as a physician or nurse practitioner, leading to four study conditions. We recruited residents from 5 specialties at 4 institutions to the study and stopped recruitment when we reached our a priori determined sample size. We randomly assigned residents to view 1 version of the video and asked them to rate the team leader’s performance using the Ottawa Crisis Resource Management (CRM) Scale in an on-line survey. We conducted two-way ANOVA to examine interactions between team leader gender and profession on CRM ratings. Results 160 residents responded (89 female, 71 male). We found a statistically significant main effect of team leader gender on residents’ ratings in 2 CRM domains: leadership (F1,156=6.97, p=.009) and communication skills (F1,156=8.53, p=.004), due to lower ratings for female leaders than male leaders (5.29±.13 vs 5.74±.11; 5.05±.13 vs 5.57±.12). We did not find a significant effect of team leader gender in other domains. There was no effect of profession on ratings and no significant interaction between gender and profession for any domain. Discussion Our findings indicate bias among residents against female team leaders. Thus, differences in ratings on standard assessment tools may not reflect differences in actual performance. We therefore need to reevaluate how we assess and teach leadership skills in medical education. The lack of evidence for bias based on professional background is of interest and deserves further study. Reflective Critique Study proposal was presented HPE WIP sessions and results will be presented at the WGEA.

13 Education Showcase 2018 Plenary Abstracts

Abstract # 11

Effect of cost exposure on medical students’ preferred mammography screening strategies: how should we teach high value care?

Clarice Nguyen, BA, UCSF School of Medicine; George F. Sawaya, MD, UCSF Depts of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology and Biostatistics; Ari Hoffman, MD, UCSF Dept of Medicine, Division of Hospital Medicine

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Health Care, Health Systems, Quality Improvement Category: Curriculum Development

Abstract: Purpose: To examine the independent role of exposure to cost information on medical students’ selection of a breast cancer screening strategy from population and individual perspectives. Background: Many high value care educational interventions have focused on shaping clinical decision-making for individual patients (Stammen, 2015). Few interventions have investigated how students integrate cost information into clinical recommendations for populations. Methods: In 2017, third-year medical students at UCSF participated in a small group on expected benefits and harms of mammography (Mandelblatt, 2016). Those in even-numbered groups viewed estimated total costs of different breast cancer screening strategies (Stout, 2014). All students completed an online survey in which they selected a screening strategy from different perspectives: from a publicly funded program and an individual patient. The intervention was conducted for two cohorts of third-year students, one early and one advanced group. We used the chi-square tests for independence and for trend to compare percentages. Results: In total, 322 students were randomized, and 267 completed the online survey (87% response rate). Those in the cost exposure group selected significantly less intensive and less costly screening strategies for publicly funded programs compared with those in the control group; strategies they would choose for an individual patient were not affected by cost exposure. Discussion/Dissemination: Students tend to weigh cost considerations more heavily when making decisions about populations, rather than individual patients. We suggest that it may be easier for students to relate cost considerations to populations, and initial high value care curricular activities be framed from this perspective. We will present at WGEA and submit a research letter to JGIM. Reflective Critique: This project has been reviewed by co-directors of Intersessions and the Health Professions Education Pathway. Our findings may be used to inform and modify high value care activities in the Bridges curriculum.

14 Education Showcase 2018 Workshops-April 29

Large Group Teaching

Led by:

Zane Amenhotep, MD Associate Clinical Professor, Department of Laboratory Medicine

Elizabeth Joyce, PhD Associate Professor, Department of Microbiology and Immunology

When speaking to a large group, have you ever caught members of your audience, or even yourself, starting to nod off? Large group teaching (a.k.a. lecturing) does not have to be so sedating. This workshop provides faculty with the techniques and skills needed to prepare and deliver stimulating and effective presentations.

Advance Preparation: Participants must come prepared with a ten-minute presentation, either new or old, to deliver in front of a small group during the workshop.

The first half of the workshop will focus on practical tips for improving professional presentations, including:

 Introducing the topic and gaining audience attention.  Organizing the presentation effectively.  Discuss options for using new and old technology in the large group setting.  Actively involving participants and motivating learning.  Concluding the presentation in a powerful manner.

During the second half of the workshop, participants will implement workshop suggestions in a micro- teaching situation that involves giving and receiving feedback.

At the end of this session, participants will be able to:

 Outline approaches to the planning and delivery of dynamic presentations.  Describe 3-4 techniques for engaging learners.  Provide constructive feedback to a colleague about their presentation.  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

15 Education Showcase 2018 Workshops-April 29

Educational Strategies to Promote Clinical Reasoning

Led by:

Descartes Li, MD

Clinical reasoning is central to student and resident physicians’ professional development. We know it when we see it and we know when it is missing, yet it is hard to describe the elements of successful clinical reasoning. It is even more challenging to devise educational strategies that specifically focus on promoting reasoning for both struggling and successful learners.

During the workshop, participants will:

 Learn the basic components of diagnostic reasoning.  Analyze challenging cases of learners with clinical reasoning difficulties.  Review educational techniques that promote diagnostic reasoning.

At the end of the session, participants will be able to:

 Describe the current knowledge and vocabulary pertaining to diagnostic reasoning.  Determine a learner’s clinical reasoning deficit and propose an educational strategy.  Employ teaching methods that promote the development of clinical reasoning.  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

Introduction to Simulation: Why, When, What? Led by: Sandrijn van Schaik, MD This session provides faculty and trainees with an overview of the use of simulation in medical education, to set the stage for continued learning through the Teach for UCSF Certificate in Simulation Teaching, or as a refresher for those experienced in simulation at other institutions. Included are the rationale for use in learning and assessment, benefits to patient safety, as well as advantages to learning and patient care from the point of view of the institution. Along with an introduction to characteristics of effective simulations, this session addresses the importance of applying principles of curriculum development and learning theories to designing, planning, conducting, and debriefing simulations. The session is meant as an introduction to subsequent workshops that delve into applying learning theories to these different elements of simulation with opportunities to actively practice the associated skills. At the end of this session, participants will be able to:

 Define and describe simulation  Explain the rationale for using simulation in health professional education  List best practices for the use of simulation as an educational strategy  Find your way to various simulation resources at UCSF and beyond

16 Education Showcase 2018 Workshops-April 29

Planning and Designing Mannequin-Based Simulation Scenarios Led by: Mindy Ju, MD Department of Pediatrics

Are you ready to move forward with designing a simulation session? Do you know how the Kanbar Center can assist you in creating a simulation session? This workshop will cover how to plan and design a mannequin-based simulation session, with an emphasis on effective scenario design.

During this workshop, participants will:

 Review the resources available at the Kanbar Center;  Discuss features that characterize effective simulation-based education;  Practice writing appropriate learning objectives and using a simple template for scenario design.

At the end of the workshop, participants will be able to:

 Plan a simulation session utilizing high-fidelity mannequins;  Create clear objectives for a simulation session;  Design a simulation scenario appropriate for your learners.

Using SOAP for Learner Professionalism Led by: Andrea Marmor, MD, MSEd Clinical Professor, Department of Pediatrics, ZSFG UCSF School of Medicine Vanessa Thompson, MD Assistant Clinical Professor, Department of Medicine, ZSFG Academic Development Director, Internal Medicine Residency UCSF School of Medicine Professionalism is a required competency for medical trainees. However, faculty may need a framework for thinking about the components of professionalism, tools to identify learners with challenges in this area, and strategies to help these learners succeed. In this workshop, we discuss the components of professionalism that we expect in medical trainees, as well as a framework for understanding and describing professionalism problems that we may encounter with our learners. Participants will practice an approach to identifying and assessing the struggling learner, share ideas for dealing with professionalism problems, and leave with a practical list of tips and references. During this workshop, participants will:

 Generate and discuss definitions of medical professionalism, and categories of unprofessional behavior

17 Education Showcase 2018 Workshops-April 29

 Learn an adaptation of the SOAP model for identifying, approaching and assessing learners with professionalism challenges  Practice these skills in a breakout session, using realistic educational scenarios.  Discuss available techniques, tools and resources for helping a learner struggling with professionalism.

At the conclusion of this workshop, participants will be able to:

 Recognize categories of professionalism challenges in learners.  Apply the SOAP model to help further understand and assist learners in difficulty.  Demonstrate strategies for communicating about professionalism concerns with a learner.  Develop an initial approach to addressing professionalism issues in trainees.

Small Group Teaching

Led by: Marieke Kruidering, PhD Dept of Cellular and Molecular Pharmacology Pinelopi Xenoudi, DDS, MS Dept. of Orofacial Sciences

Much of clinical and classroom teaching takes place in small groups. A faculty member can use the skills for leading an effective discussion and encouraging active student participation in a variety of instructional formats including case studies, problem-based learning, and small group discussions. The session will begin with an introduction by the facilitator, who will describe the roles and expectations just as we would with learners in real life. A handout derived from Tools for Teaching will serve as the basis for the discussion.

During this session scholars will:

 Participate in three groups and subsequent debriefings.  Interact with expert small group facilitators to address personal facilitation challenges.  Discuss and formulate successful strategies for creating, leading and guiding discussions, and for asking and responding to questions.  Practice leading a small group session during a hands-on group exercise.

At the end of this session, participants will be able to:

 Discuss the characteristics of different kinds of small groups.  List two factors for success and two pitfalls to avoid in development of new small group sessions.  Create guidelines for asking and responding to questions.

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 Apply small group techniques to effectively teach content currently taught in lecture format in a small group setting.  Describe solutions to challenges of small group learning both in design and group dynamics.  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

Conducting Scenario-Based Simulations Led by: Meshell Johnson, MD Assistant Professor, Department of Medicine

So you have your scenario and you have planned out your session, but how do you ensure that your simulation session is effective? In this workshop, we will review the concept of fidelity, or how a scenario can be made realistic. We will address the roles that equipment, environment, and psychology play in fidelity.

During this session, participants will:

 Learn how to optimize fidelity;  Discuss the pros and cons of the use of confederates;  Review various approaches to the instructor role;  Discuss common challenges and practice dealing with unexpected developments.

At the end of this workshop, participants will be able to:

 Explain the concept of fidelity and its different components;  Create an effective learning experience by enhancing fidelity;  Anticipate common pitfalls in conducting simulation sessions;  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

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Is it Hot in Here? Learning Climate in Medical Education Led by: Patricia O'Sullivan, EdD Professor, Department of Medicine Director, Research and Development in Medical Education UCSF School of Medicine Ednann Naz, MD, MPH Director, Physician Engagement and Clinical Optimization UCSF Fresno Teaching in the clinical setting is challenging. Creating a positive and effective learning climate can be essential to maximizing the experience and education for learners (and the enjoyment for the teacher!). This workshop will give teachers the skills to create a positive learning climate – to make the clinical teaching setting a place where learners want to be. These skills can transfer to other learning experiences including large and small groups.

During this workshop, participants will:

 Engage in a discussion of the key behaviors which can enhance the learning climate  Practice applications of the key behaviors pertinent to the learning climate  Develop scripts to create a positive learning climate for learners.

By the end of this session, participants will be able to:

 Establish a positive learning climate  List key behaviors to create a positive learning climate

Debriefing a Scenario-Based Simulation Session Led by: Shruti Kant, MD Assistant Professor, Department of Emergency Medicine Mindy Ju, MD Department of Pediatrics

Debriefing is often considered to be the most important aspect of a simulation session, and facilitating effective debriefing is an essential skill that requires practice. In this workshop, participants review the goals of debriefing, learn debriefing techniques, and have an opportunity to practice debriefing skills. The instructors and the participants consider common challenges and potential solutions.

At the end of the workshop, the participants will be able to:

 List the different models for debriefing.  Apply common debriefing skills.

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 Manage pitfalls frequently encountered in debriefing.  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

Writing Effective Narrative Evaluations Led by: Elizabeth Joyce, PhD Sara Buckelew, MD

Teachers are regularly called upon to provide learner evaluations. It is difficult to write evaluation comments that are appropriately supportive of all our learners while also accurately describing performance and competency in transparent language. This is an opportunity to talk about common challenges and best practices of writing evaluations.

During this workshop, participants will:

 Identify and discuss common challenges in writing evaluations  Review and critique examples of evaluations  Apply a set of guidelines or “tips” to improve a sample evaluation  Practice composing a summary evaluation from multiple individual evaluations

At the conclusion of this workshop, participants will be able to:

 Describe common challenges in writing learner evaluations  List several systematic approaches to gathering data and using the data to compose learner evaluations  Differentiate between summative and formative evaluation/comments  Write summative and formative evaluations that are performance-based, specific, and focused  List common pitfalls in summary evaluations  Set personal goals for applying the skills learned in this workshop to one's own practice setting, and review a tool designed to assess performance of new teaching skills.

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Achieving the Ideal Ecosystem for Learning and Healthcare: What would you do? Led by: Catherine Lucey, MD Achieving the ideal ecosystem for learning and healthcare requires educators and clinicians to work collaboratively to support our students, residents, faculty and interprofessional colleagues to learn, grow and thrive while providing the highest quality health care to all of our patients. Forces that threaten our ability to learn, grow and thrive while caring for patients include time pressures, complex and stressful work, dynamic team schedules and competition for grades and prominence. Forces that nurture our ideal ecosystem include collaboration, teamwork, relationship building and co-ownership of all important tasks. Changes in the ways in which we work, learn, care and discover are needed to ensure that our ecosystems are thriving. This seminar will ask the question of attendees: how might we redesign the way we work, learn, care and discover to optimize our ecosystem. Prerequisites for attendees: a willingness to engage in creativity and disruption. The SOM Education Retreat's theme this year was Achieving the Ideal Clinical Learning Environment. Catherine Lucey reports back on important developments from that retreat. At the end of this presentation, participants will be able to:

 Define "Clinical Learing Environment"  Discuss faculty strategies to enhance the clinical learning environment

Designing Instructional Activities in the Workplace: How Cognitive Load Theory Helps Led by: Justin Sewell, MD Associate Professor, Dept. of Medicine Cognitive Load Theory (CLT) identifies working memory limitations as a primary bottleneck for learning. When the task demands exceed working memory capacity, learning and performance suffer. CLT further identifies three types of cognitive load that contribute to a learner’s working memory: intrinsic, extraneous, and germane. In order to support learning and performance, educators can apply CLT to minimize extraneous load and match intrinsic and germane load to the learner’s developmental stage. Since the 1970s, CLT’s focus on managing the cognitive load of the learner has led to numerous, empirically tested instructional techniques. These techniques have most often been applied to classroom settings. More recently, researchers and educators have recognized the relevance of CLT to medical education, with specific applications to classroom-based, workplace-based, and self-directed learning. We will draw on the results of a recent systematic review of CLT applications in workplace settings as well as CLT-informed approaches such as the 4 Components Instructional Design. This workshop is relevant to individuals involved in workplace education. Participants will leave the workshop with CLT design principles and a plan to design an activity that they can use in their own workplace. During this workshop, participants will:

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 Design or improve an activity for their workplace  Share with group insights gained from the workshop  Consider next steps to implement the designed activity.

At the end of this workshop, participants will be able to:

 Describe CLT and its associated design principles  Apply these principles to design a new or optimize an existing workplace learning activity.

Learners in Crisis: See Something, Do Something Led by: John A. Davis, PhD, MD Associate Dean for Curriculum Associate Professor, Infectious Diseases Susan Whitlow Learning Specialist Learning Resource Services, Student Academic Affairs Howard Rubin, MD Director, Medical Student Well-Being Program Medical students are great achievers who face numerous stressors. Students arrive on our campus with rich histories, including great distances travelled, family needs, and medical / mental health treatment. Once here, there are multiple additional stressors: micro-aggressions, bias, minority tax, curricular pressures, professional development, imposter syndrome, time management, etc. Students in crisis will present in many ways and to different people. Recognizing a student in crisis and using a team approach is key; crisis response often includes a range of interventions, from curricular to clinical to financial. Advance Preparation: Please think of a time when you experienced a learner in distress. This could have been when you were the educator, or when you had a different role. Think about things that went well, and things that could have gone better. What were resources or infrastructure elements that worked for or against the learner in that situation? We ask that you think in advance about how you will de- identify cases (guarding student privacy) before sharing. At the end of this workshop, participants will be able to:

 Identify the learner’s perception of crisis/distress and the triggering events.  Identify new resources that they could use to facilitate a learner who is in crisis  Referral for learner whose insight is not aligning with reports.

During this workshop, participants will:

 Share cases and insights in small group settings.  Apply concepts from the workshop to their own cases.

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Using Technology for Effective Teaching Led by: Christian Burke and Greg Gadwood Technology-Enhanced Education UCSF School of Medicine Christy K. Boscardin, PhD Associate Professor, Department of Medicine Research Faculty, Center for Faculty Educators Brian Schwartz, MD Associate Professor, Department of Medicine Note: Advance preparation is required. Please see below.

Educational technology is the use of technology to improve teaching and learning. The use of modern technologies to enhance learning should never get in the way of teaching and learning, but should be used effectively and appropriately to improve the teaching and learning environment. Technology can be used to promote active learning, facilitate course evaluations, teach through simulation, enhance presentations, provide deeper exploration of content, connect faculty and learners across locations, and promote student collaboration.

During the session, participants will:

 Discuss typical challenges facing educators and specific instructional media tools and strategies to address these challenges  Examine ways that technology can be used to promote active learning  Explore different types of instructional methods using technology and discuss how each might be used to teach in different settings.

At the end of the session, participants will be able to:

 Describe how technology can enhance teaching and learning and address teaching challenges  Describe instructional media and technology resources available at UCSF  Discuss specific areas where technology can improve teaching and learning.

In preparation for the session please: 1. Bring your laptop computer to the session 2. Brainstorm how you plan to incorporate technology into your own teaching.

 Identify your current challenges in teaching? What do you want to do that you can't currently do? AND/OR  Identify a technology that you have observed that you may want to try out in one of your teaching sessions

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Note: for the last hour of the workshop we will discuss Virtual Reality in Education and showcase how UCSF uses VR in Anatomy education (with Dr. Derek Harmon coming 11-12). For those that are interested, you will also get to try out VR for Anatomy.

Tips and Tricks for Faculty Developers (by invitation only) Led by: Calvin Chou, MD, PhD Faculty development is critical in establishing standardized content, norms, and culture of teaching our trainees. However, structuring and teaching these sessions for faculty learners can present problems and difficulties that surmount those we encounter with full-time trainees. This session will allow participants to learn from each other in enhancing skills in faculty development. And experience an innovative approach they might like to incorporate in their future offerings. At the end of this session, participants will be able to:

 Develop strategies to manage personal challenges in faculty development.  Implement an innovative faculty development strategy  Consider how this approach can be used in integrated workplace faculty development.

Optimizing Group Decision Making for Summative Assessment of Competence Led by: Karen Hauer, MD, PhD Professor, Dept of Medicine Associate Dean, Assessment UCSF School of Medicine Group decision making is increasingly common for summative assessment of learners’ competence in medical education. Clinical competency committees and grading committees are two examples of groups that review performance information and make judgments about learners’ competence and readiness to advance in training or practice. During this workshop, Dr. Hauer introduces concepts in group decision making and their relevance to the vital work of clinical competence committees and other groups. Participants will have the chance to discuss the concepts and implications, and contribute their experiences and ideas to the group. During this session, participants will:

 identify common pitfalls in group decision making  practice strategies to mitigate such pitfalls, to increase trustworthiness of decisions by clinical competency committees and other groups

At the end of this session, participants will be able to:

 Describe implications of programmatic assessment for group decisions  Apply group decision making concepts to the work of clinical competence committees

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Helping Trainees Navigate Professional Identity Tensions in the Age of Social Media Led by: Erick Hung, MD and Ning Zhou, MD Generational differences influence how learners and faculty use social media. As students become health professionals, guidance is needed to help them navigate the personal and professional tensions on social media. Faculty can benefit from understanding current AMA and UCSF policies and best practices related to social media use and professionalism, appreciate boundary crossings and violations related to social media use, and apply privacy settings to online profiles. The leaders of this workshop will use case vignettes and video clips to illustrate the issue, and ask participants to share experiences and strategies for helping trainees navigate professionalism issues in the social media age. By the end of this workshop, participants will be able to:

 Discuss frameworks for understanding professional identity tensions in the age of social media.  Define professional policies, best practices, and principles related to social media use.  Discuss professional boundary issues relevant to social media use  Reflect on one’s online presence, describe privacy features, and adjust privacy settings on Facebook and Instagram.

Teaching Learners to Use and Find Data for QIPS Led by: Glenn Rosenbluth, MD Catherine Lau, MD We understand the power and influence of data, but some of us don’t feel confident in our ability to find and use quality improvement and patient safety (QIPS) data to the best advantage for improving health systems and patient health. It can be a further challenge to convey these skills effectively to our learners. In the CMC setting, students may interact with a variety of staff, faculty and other learners around QIPS data. All are welcome to attend this workshop. By the end of this workshop, participants will be able to:

 Describe the elements of impactful data (timely, actionable, attributable, measurable)  Devise strategies to use existing institutional reports to engage learners to design improvement projects o Using data to identify where there is a problem; an opportunity to address a gap o Using data to measure improvement due to an intervention o To analyze the benefits and limitations of data to guide improvement projects  Describe how providers are rewarded by health systems based off of performance on quality metrics  Create an accurate EHR data request

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Harnessing Who’s in the Room: Creating and Facilitating Productive Meetings Led by: the Meeting Optimization Team (Anda Kuo, Christian Burke, Raquel Rodriquez) The Meeting Optimization Program (MOP) developed from the 2014 School of Medicine’s Dean’s Retreat by a group of SOM faculty and staff who identified a need to develop a culture of leadership at UCSF. The goal of MOP is to tackle one of the most common leadership challenges we face – running and facilitating meetings. This workshop briefly discusses key components of an effective meeting and takes a more in-depth look at facilitating a productive meeting, with time to practice. After this workshop, participants will be able to:

 Describe key components of effectively setting up and running a meeting  Clarify the role that a facilitator has in a meeting  Describe and implement approaches to facilitating participation during a meeting including managing common behavior challenges

Learning Environments at UCSF: Creating Actionable Plans for Optimization Led by: David Irby, PhD Sandrijn Van Schaik, MD, PhD Research has shown that we can influence the effectiveness of an educational experience for everyone involved by designing and maintaining the learning environment according to a set of principles. In this workshop, the leaders will share their research and lead participants through activities to develop strategies to create an optimal learning environment. By the end of this workshop, participants will be able to:

 List the key elements of the learning environment.  Identify strategies that influence the learning environment.  Select a strategy and develop a plan for implementation to enhance learning for everyone in your setting.

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Abstract # 04

Interprofessional Curriculum for Early Health Professions Students on Communication to Promote Patient Adherence

Lynnea Mills, MD, UCSF; Elizabeth Imbert, MD, MPH, UCSF; Jennifer Cocohoba, PharmD, UCSF; George Saba, PhD, UCSF; Amin Azzam, MD, MA, UCSF; Anna Chang, MD, UCSF; Calvin Chou, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Communication, Curricular Innovation, Interprofessional Education, Patient Care Category: Curriculum Development

Abstract: Purpose: Develop an interdisciplinary curriculum to train early health professions students on evidence-based communication methods to inquire about and improve patient adherence. Background: Non-adherence with medical plans has significant consequences for patients’ health outcomes and systems metrics. Utilization of effective patient-centered communication techniques by healthcare providers can successfully address adherence issues, but many health professions trainees may not receive education on communication to promote adherence. Methods: First year pharmacy and medical students worked in small groups through a facilitated interactive case demonstrating multiple causes of and approaches to nonadherence to develop “best practices” for talking with the “patient” about her adherence. Medical students entered clinical settings to test out these skills with real patients, then returned to small groups to do a facilitated debrief. Results/Evaluation Plan: Based on pre- and post-intervention surveys, medical students demonstrated improved confidence discussing adherence, and improved knowledge of evidence-based approaches to discussing adherence, at 3-months post-intervention. (We lack adequate post-intervention data for pharmacy students because of logistical challenges obtaining their data.) Discussion/Dissemination: The challenges include the logistical difficulties of coordinating schedules of students from different schools and enabling students to interview real patients. We developed a comprehensive facilitator guide to enable non-expert small group facilitators to guide students, making this sustainable and transferable to other institutions. We are presenting our work at WGEA, have submitted it to SGIM and plan to publish the curriculum in MedEdPORTAL. Reflective Critique: Based on feedback from the UCSF School of Pharmacy faculty, we made changes to enable pharmacy and medical students to be integrated into the same small groups as often as possible, and to have Pharmacy and Medical School faculty co-facilitate all sessions.

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Abstract # 36

Cultivating Teamwork: An Interprofessional Collaboration Skills Curriculum for Early Medical Students in Clinical Microsystems

Maria Wamsley, MD, UCSF; Susannah Cornes, MD, UCSF; Allison Ishizaki, MPH, UCSF; Anna Chang, MD, UCSF; Josette Rivera, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Interprofessional Education, Longitudinal Educational Activities Category: Curriculum Development

Abstract: Purpose To teach and assess interprofessional (IP) collaboration skills of first-year medical students participating in a longitudinal clinical skills curriculum. Background While IP education traditionally focuses on interactions of students of different professions, embedding students in IP teams in clinical settings may also provide rich opportunities for IP learning. In the Clinical Microsystems Clerkship (CMC), 6 first-year medical students are assigned to a faculty coach and clinical microsystem for 15 months, where they participate one day per week to learn patient care skills, IP teamwork, and systems improvement. Methods We created a longitudinal IP curriculum embedded in CMC to 1) increase student knowledge of roles/responsibilities of health professionals and 2) foster IP collaboration skills. Activities include team member interviews/shadowing, an IP communication small group, IP team observation, and communication with a team member about a patient care issue. We developed and piloted two assessments: a written assessment testing student application of an IP communication tool (ISBAR) in month 4, and a case in which each student negotiates a patient's care plan with a standardized social worker in month 8. Results On the written assessment emphasizing handoff communication, students received an average score of 60% (SD=2. 8%). On the standardized social worker skills assessment, students demonstrated a mean score of 88% (SD=8. 9%) with a rubric that emphasized rapport-building skills. Discussion/Dissemination While all students were incorporated into IP clinical settings, the robustness of student IP learning varied depending on the composition of the IP team and prior experiences of the faculty coach. Student performance improved as they gained collaborative experiences over time. This work has been accepted for presentation at WGEA. Reflective Critique We solicited input from CMC site directors on the curriculum and made adjustments based on their feedback. We worked closely with Ms. Anita Richards, standardized patient expert, in developing the assessments.

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30 Education Showcase 2018 Mini-oral Abstracts – April 30, 1-A

Abstract # 17

Quality of Written Interprofessional Feedback for First-Year Medical Students: A Content Analysis

Anelah McGinness, B.S., University of California, San Francisco School of Medicine; Maria Wamsley, MD, University of California, San Francisco School of Medicine; Josette Rivera, MD, University of California, San Francisco School of Medicine

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Feedback, Interprofessional Education, Professionalism, Research Category: Curriculum Evaluation/Educational Research

Abstract: Purpose We performed a content analysis to assess the feasibility and quality of interprofessional (IP) feedback for first- year medical students in the Clinical Microsystems Clerkship (CMC), a 14-month longitudinal clinical placement focused on systems improvement, IP collaboration, and clinical skills. Background There is an increasing national focus on ensuring that medical students achieve IP collaboration competencies. Yet, most medical students graduate without receiving feedback from non-physicians - a missed opportunity. Methods 152 first-year medical students were required to request feedback on collaboration skills from IP providers at two time points during the CMC via an online survey with 2 open-ended items. Feedback comments were coded for specificity (global personality vs behavior vs specific instance of behavior), valence (reinforcing vs constructive), and IP competency domains established by the national IP Education Collaborative. Results 89% of students received IP feedback at least once, mainly (54%) from providers who worked with students one to four times. The majority of comments (84%) were behavior-oriented and 31% referred to specific instances of behavior. 34% (73/220) of feedback was constructive, of which 43% (32/73) contained a specific strategy for improvement. 10% of comments cited insufficient contact to provide constructive feedback. Comments spanned the entire range of IP competency domains: communication (74%), values/ethics (65%), teams/teamwork (42%) and roles/responsibilities (19%). Discussion It is feasible for IP team members to provide specific, behavior-oriented feedback on collaboration skills for medical students without training. However, feedback quality was hampered by lack of substantive, constructive feedback. Students may benefit from more workplace interactions with IP team members to increase opportunities for quality constructive feedback. Reflective Critique We modified our analysis and data interpretation based on expert feedback at project proposal meetings and works in progress meetings.

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Abstract # 20

Getting out of that siloed mentality early': opportunities for interprofessional learning in a longitudinal placement for first year medical students

Josette Rivera, MD, UCSF; Maria Wamsley, MD, UCSF; Bridget O'Brien, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Interprofessional Education Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To examine how medical students interact with and learn from various professionals in longitudinal clinical placements. Background Many interprofessional (IP) curricula bring early learners together in classroom or simulated settings. While these experiences can be easier to orchestrate, they miss opportunities for interprofessional learning (IPL) afforded by clinical settings. Situated learning theory posits that learning occurs through co-participation with practitioners. However, the quality of IP relationships varies among clinical settings, thus raising questions about quality situated IPL opportunities for students. Methods We invited 30 ending first-year medical students to participate in a semi-structured interview about their IP interactions and IPL in the Clinical Microsystems Clerkship, a 15 month, weekly half-day clinical placement focused on systems improvements (SI) and clinical skills. We purposively sampled students placed in diverse settings. Three authors analyzed interview transcripts using conventional qualitative content analysis. Results We interviewed 14 students in 12 sites (6 outpatient, 5 inpatient, 1 ED). Students’ IP co-participation varied considerably; some students reported ongoing interactions, others reported infrequent interactions driven by curricular assignments or patient care. Factors influencing the depth of IP interactions included the nature of the SI project, clinical workflow, student/staff schedules, workplace culture, student agency, and faculty coach facilitation of IP interactions. All students recognized the value of learning about and from diverse professionals in their clinical microsystem. Discussion There are significant IPL opportunities for early learners in the workplace. We identified factors that need to be addressed when designing these experiences to enrich IPL. Coach support is essential in enabling students to meaningfully engage with various healthcare professionals. Reflective Critique We will incorporate WGEA reviewers’ suggestions to include specific details on the analysis in the full presentation.

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Abstract # 30

Patient-centeredness? Exploring students’ representation of the patient in an interprofessional standardized patient exercise

Bridget O'Brien, PhD, UCSF; Judith Little, PhD, UC Berkeley; Joe Cook, MA, UCSF

Area(s) abstract covers: Medical Student Education (UME), IPE Domain(s) addressed: Interprofessional Education, Simulation, Standardized Patients Category: Curriculum Evaluation/Educational Research

Abstract: Purpose Our study explores how students from multiple professions represent and attend to the patient in an interprofessional standardized patient exercise (ISPE). Background “Patient-centeredness” appears frequently in the interprofessional (IP) education and practice literature as a key factor in collaboration. Students participating in IP education are expected to demonstrate patient- centeredness, but how this manifests during discussions of patients is unclear. Methods We conducted a qualitative interaction analysis of videos from 10 groups of students engaged in a pre-visit huddle and post-visit care planning session focused on Elsie, a 75 year old woman who has multiple chronic conditions and recently fell. Each group had 4 students from different professions (dentistry, medicine, nursing, pharmacy, physical therapy). Results We identified three primary representations of the patient that included patient as: • a case comprised of conditions and problems that warrant attention or fixing • an informant who supplies medical, psychosocial, and contextual information needed to prioritize concerns and construct a plan • a person with goals, preferences, emotions, and agency who contributes to decisions and plans. Groups primarily represented Elsie as a case or informant, with limited consideration of her as a person. We identified ways in which instructions, tasks, materials, individuals, and group dynamics appeared to influence patient representation. Discussion While the concept of patient-centeredness suggests full attention to personhood, our findings reflect the complexity of attending efficiently to familiar problems that require professional expertise to ‘fix’ while also appreciating the unique goals, circumstances, and agency of the patient. In a simulated environment, modifications to the activity may facilitate more explicit attention to personhood. Reflective Critique

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Discussing our findings with faculty who run the ISPE provided insights into tensions among various ISPE objectives and prompted reflection on affordances and constraints of a simulated environment.

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Abstract # 43

Improving Trainee Communication Skills with Direct Observation and Feedback

Krista Gager, MS, NP, San Francisco VA Medical Center; Calvin Chou, MD, PhD, FACH, SFVA, UCSF; Bridget O'Brien, PhD, UCSF; Gillian Earnest, MS, SFVA; Christopher Shamasunder, MD, SFVA, UCSF; Anna Strewler, MS, NP, SFVA, UCSF; Jennifer Manuel, PhD, SFVA, UCSF; Rebecca Shunk, MD, SFVA, UCSF; Denise Davis, MD, FAACH, SFVA, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Communication, Curricular Innovation, Feedback, Patient Care Category: Curriculum Development

Abstract: Purpose To improve the learner-centeredness of our communication curriculum by implementing direct observation with formative feedback (DOF) for primary care trainees. Background Competence in patient-centered communication (PCC) is required by both AGCME and NONPF, yet trainees report insufficient DOF on PCC during patient visits. They have identified DOF as a more effective way to develop PCC skills than didactics or role play. Methods We paired NP and MD faculty with 1-3 trainees for a half day of observation; we aimed for 3 observations per trainee, per year. Trainees included 2nd year NP students, NP residents and 2nd year IM residents. The observation process included: (1) Brief Set-up Meeting: patient identification, elicit trainee communication skill/goal; (2) Direct observation: 5-15 minutes; (3) Feedback: debrief the observation, provide reinforcing and constructive feedback; (4) Data Collection: post-observation questionnaire. for observer and trainee Evaluation In the first 6 months of this year-long initiative, 27 trainees were observed 1-2 times by 9 faculty. Trainees’ rated satisfaction with the observation and the feedback highly (n=20; mean 4.6 and 4.8 out of 5). Faculty observers strongly agreed (4.9 of 5) with the statement “I would recommend this experience to others.” Trainees’ written comments indicated specific skills to work on such as “find a natural-feeling way to elicit patient understanding of plan” and “change body language.” Faculty also valued the experience stating, “It really allows me to more effectively precept & support learning goals of this trainee.” At yearend, we will review all data and identify curricular areas that need improvement with the aim to expand. Dissemination Plans for dissemination include posters and workshops at regional and national meetings and development of an online toolkit. Reflective Critique

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We are working to create a culture change to incorporate unscheduled DOF which will require attending to knowledge/comfort of faculty, time constraints and adequate staffing.

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Abstract # 05

Perceptual Expertise in Robotic Surgeons: Developing a Novel Measurement Tool

Courtney A Green, MD, UCSF; John R. Porterfield, MD, UAB; Patricia O'Sullivan, PhD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Assessment and Testing, Clinical Instruction and Performance, Computers and Technology Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: As an initial attempt to develop a tool to measure perceptual expertise (PE), surgeons were surveyed to determine which behaviors reflected this skill in robotic assisted surgery. Background: An essential component of surgical expertise is perceptual; through experience, surgeons’ abilities to extract patterns and relationships evolve leading to improved intraoperative decision making and mastery of surgical performance. PE is the logical endpoint of the normal trajectory of learning in a domain-specific environment such as surgery. Robotic technology, lacking haptic feedback, heightens the importance of PE to ensure safe surgical performance Methods: Using Goldstone’s (1998) theory of perceptual learning, on screen surgical actions were separated into three categories: attentional weighting, unitization and differentiation. Survey participation was solicited from robotic surgical education experts. Participants rated each of sixty behaviors as unimportant, somewhat, important and very important. To be considered further, items had to receive at least 80% of respondents rating important/very important. Participants also offered edits, indicated missing behaviors and provided additional feedback. Results: Eleven robotic surgeons completed the assessment. Respondents represented junior faculty (27%, n = 3) and senior faculty (73%, n = 8) from four surgical specialties. Most respondents (64%, n =7) had performed more than 300 robotic cases with over 90% completing more than 100 cases. The following summarizes behaviors surpassing the 80% standard: 21/25 behaviors of attentional weighting, 16/19 behaviors of unitization, 16/16 behaviors of differentiation. Discussion: Experts endorsed 53 items reflecting PE in robotic surgery. We will need to determine the feasibility of an instrument this length and collect additional evidence of validity. Reflection: Using visual input to guide operative decisionmaking is critical for mastery of robotic surgery. This is a first step in designing an assessment to measure progression of learners in robotic surgery.

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Abstract # 06

Integrated Ophthalmology-General Surgery Internship Educational Impact

Lesley Everett, MD, PhD, MPhil, UCSF Department of Ophthalmology; Saras Ramanathan, MD, UCSF Department of Ophthalmology

Area(s) abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance, Competencies, Curricular Innovation, Residency Category: Curriculum Development

Abstract: Purpose This study tests the hypothesis that participation in an integrated ophthalmology internship (IOI) better prepares residents for the PGY2 year and provides a stronger foundation in ophthalmology, as compared to traditional non-IOIs. UCSF outcomes will be compared to other IOIs. Background IOIs provide more focused and relevant training than non-IOIs. UCSF recently developed an Ophthalmology- Surgery IOI, allowing for additional ophthalmology training for interns, earlier research opportunities, and exposure to periocular subspecialties. Methods Clinical faculty evaluated the IOI’s impact on resident preparation for the PGY2 year through an anonymous qualitative survey, as well as the program’s strengths, weaknesses, and areas for improvement. Twelve relevant qualities of PGY2 residents who completed the IOI were compared to previous PGY2 residents who did not complete the IOI (preparedness for primary call, independence, surgical and exam skills, clinical knowledge, etc.). Likert scale data were analyzed by t-test with multiple comparison correction. Results PGY2 residents who completed the IOI had statistically significantly higher scores than PGY2s who did not complete the IOI in every category except for IM knowledge, which was equivalent. Fifty percent of respondents considered the educational value of a surgical IOI to be higher than the value of an IM IOI, while 38% felt these would be equal. Disadvantages of the IOI were considered to be difficulty of the surgical rotations, potential lack of investment by surgery attendings, and less focus on IM. Discussion The UCSF Surgery IOI more successfully prepares residents for the PGY2 year and provides valuable clinical and procedural training, as compared to non-IOIs, without sacrificing IM knowledge. Outcomes will be compared to other IOIs. Results will be presented at the 2018 ARVO meeting and submitted for publication. Critique Residency Program Directors provided guidance for this project. Clinical Fellows completed a pilot survey, which informed survey revision prior to faculty participation.

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Abstract # 12

The Impact of a Regional Anesthesia Ultrasound and Anatomy Workshop on Resident Education

Derek Harmon, PhD, MS, University of California, San Francisco; Candace Shavit, MD, University of California, San Francisco; Elizabeth Whitlock, MD, MSc, University of California, San Francisco; Dana Rohde, PhD, University of California, San Francisco; Matthias Braehler, MD, PhD, University of California, San Francisco

Area(s) abstract covers: GME Domain(s) addressed: Curricular Innovation, Patient Care, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To test the hypothesis that an interdisciplinary structured workshop will improve anesthesia residents’ knowledge of ultrasonography and anatomy, as demonstrated by a pretest, posttest, and a six-month follow-up test. Background: Anesthesia residents must demonstrate competence in ultrasound-guided regional anesthesia, and formal guidelines for education and training were recently published by the American Society of Regional Anesthesia. We used these recommendations to design a workshop to present to CA-2 anesthesia residents. Methods: The workshop lasted five hours, with a 10-minute lecture on ultrasonography, two 15-minute lectures on upper and lower extremity blocks, and two 15-minute lectures on upper and lower extremity anatomy. The lab component consisted of a 45-minute cadaver upper extremity anatomy review and a 45-minute upper extremity ultrasound scanning session on standardized patients. The schedule was then repeated for the lower extremity. A 30-question exam tested residents’ understanding of ultrasound terminology, identification of structures on ultrasound images, anatomy and peripheral nerve innervation. The same exam was administered prior to the workshop, immediately following the course, and again 6 months after the workshop. Results: Twenty-two residents participated in the workshop. Test scores (number correct out of 30; mean ± standard deviation) were 20.6±3.3 for the pretest, 27.4±1.9 in the post•test(paired t•test p<0.001). The mean score improvement after the course was 6.8±3.2 points. Test scores significantly declined after six months but remained higher than the pretest by an average of 2.1 points (p=0.002). Discussion: An integrated learning program of regional anesthesia utilizing lecture series and anatomy review reinforced through the use of cadaver dissection and parallel sessions of ultrasound scanning on live models is a useful method for resident education. Reflection: In addition to the 30 item content exam, residents were asked to provide qualitative feedback, which will be used to improve this now annual workshop.

39 Education Showcase 2018 Mini-oral Abstracts – April 30, 1-B

Abstract # 16

How do I cope? Emotional distress and the role of peer support during internship

Kendra Moore, MD, MBE, UCSF; Larissa Thomas, MD, MPH, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Leadership , Mentoring, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose The goal of this study is to describe how residents perceive that their senior residents helped them to cope with emotionally challenging experiences during intern year, and whether peer learning affects coping skills. Background Physicians-in-training are at high risk for burnout, and interns are particularly vulnerable to emotional distress and empathy erosion. During residency, junior trainees rely heavily on the guidance and example of supervisory near-peers, with a significant portion of their development driven by peer learning, yet, little is known about the extent to which interns' emotional well-being can be influenced by peer learning. Given the integral role of peer learning for other aspects of residency training, we aimed to identify techniques interns use to cope with emotional distress and the role peer learning plays in the development of these techniques. Methods This study uses a constructivist grounded theory approach sensitized by peer learning theory. We conducted 10 semi-structured interviews with internal medicine residents. The initial code book was developed using blind open coding by two investigators, with subsequent thematic content analysis. Results Early themes confirm contributors to emotional distress in interns include fatigue, social isolation and a personal sense of inadequacy. Coping strategies and perceived impact of peer teaching and support are wide-ranging and variable. Forthcoming thematic analysis will be presented. Discussion Early themes suggest variability in the extent to which peer-to-peer learning affects interns’ response to emotional distress. Results may inform curriculum development to train senior residents in effective strategies to promoting coping skills. Reflective Critique: The purpose and methodology of the initial project were refined based on feedback from the Health Professions Education Pathway faculty.

40 Education Showcase 2018 Mini-oral Abstracts – April 30, 1-B

Abstract # 25

Developing and Piloting An Airway Curriculum in Emergency Medicine Residency

Guy Shochat, MD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Curricular Innovation, Residency, Simulation Category: Curriculum Development

Abstract: Purpose: To address a cognitive gap in complex airway management in Emergency Medicine (EM) resident training. Background: Airway management is a core competency in EM. At UCSF, a year long targeted needs assessment of resident airway management knowledge and skills showed a lack of knowledge of new devices and a cognitive gap in strategizing approaches to difficult airways. Practice opportunities for rare procedures were also limited. A review of MedEd Portal and PubMed revealed only one airway curriculum. A curriculum design needs to reflect new technical skills and address gaps in clinical reasoning skills in complex airway management. Methods: Using Kern’s curricular model and initial needs assessments results, a curriculum was developed and implemented. Needs assessment teaching labs had found small group think aloud learning best facilitated acquisition of clinical strategy. A curriculum of 8 multimodal labs combines simulation for procedures with small group workshops for developing difficult airway planning. Simulation with difficult anatomy airway models highlights the use and unique advantages of new devices. Supplemental cadaver labs provide rare procedure review and realistic device practice. Clinical reasoning skills are reinforced during device training by verbalizing clinical scenarios pertaining to the device. Support has been obtained from residency leadership and simulation/cadaver lab resources secured. The course is taught by established trained faculty airway instructors and implemented into scheduled simulation and cadaver lab days. Evaluation Plan: Developmental evaluation will be used to evaluate and guide the evolution of our curriculum. This approach will allow us to: 1) determine resident satisfaction; identify clinical reasoning gaps; 3) assess individual learners on procedural skills and retention; and 4) modify our curriculum throughout the evaluation process. Dissemination: A successful program can be disseminated to other residencies. Reflective Critique: Feedback from ESCape guided evaluation and assessment.

41 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Abstract # 19

Diversity and Inclusion Competencies for Residents

Edward Cruz, MD, MPH, UCSF; Nicole Rosendale, MD, UCSF; Joanie Rothstein, MPP, MPH, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Competencies, Cultural Competence, Diversity, Patient Care Category: Curriculum Development

Abstract: Purpose: The aim was to create resident competencies promoting diversity, equity and inclusion (DEI) within multicultural communities based on the Multicontextual Model for Diverse Learning Environments (MMDLE) framework, and then to align them with ACGME Milestones for resident assessment. Background: As the U.S. population diversifies, we must ensure residents are taught the skills necessary to provide equitable care for all, while also promoting a climate of inclusion at their institutions, and practicing culturally responsive teaching methods. The Differences Matter Initiative at UCSF was created with this goal in mind. While integration of DEI milestones has begun within undergraduate medical education, no uniform effort has occurred within graduate medical education. We therefore used the MMDLE model as a framework for elucidating the organizational, curricular, and individual level factors that influence trainees and the campus climate. Methods: We first performed a literature search on designing competency standards for residents centered on DEI. We then utilized a modified Delphi method to design the competencies and map them to the ACGME milestones. Results/Evaluation Plan: We plan to share our process and outcomes widely through the Difference Matter initiative, as well as in GME professional settings such as the AAMC 2018 Western Group on Educational Affairs (WGEA) Regional Meeting, where this work has been accepted for an oral presntation. Reflective Critique: We presented our work to educational leaders at UCSF, including the Educational Scholarship Conference (ESCape), the GME Curriculum Committee, and to individual faculty and at departmental meetings. We have used feedback to continue to refine the competencies.

42 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Abstract # 23

Impact of an Interprofessional (IP) Learning Community in Geriatric Primary Care

Pei Chen, MD, UCSF School of Medicine; Mackenzie Clark, PharmD, UCSF School of Pharmacy; Michele Sharma, MSW, UCSF Medical Center; Yvonne Troya, JD, UC Hastings College of the Law

Area(s) abstract covers: GME, interprofessional education Domain(s) addressed: Competencies, Interprofessional Education, Longitudinal Educational Activities, Primary Care Category: Curriculum Development

Abstract: Purpose: Evaluate an IP learning environment and the impact of an IP learning community on achieving IP collaboration (IPC) competencies and patient care in geriatric primary care. Background: We piloted a year-long weekly IP learning community in a geriatric primary care clinic to provide an interface between education and a health system for IP learners to practice IPC and manage a panel of complex older adults. IP learners (geriatrics fellows, pharmacy resident and students, social work intern, and law students) work with clinic staff, see patients synchronously and asynchronously, and participate in weekly team meetings. Methods: IP learners used the Assessment for Collaborative Environment (ACE 15) to evaluate the IP learning environment and the IP Collaborative Competencies Attainment Survey (ICCAS) to evaluate their IPC over time at team meetings. IP learners and clinic staff completed open-ended feedback surveys on each learner and the learning community at the end of the semester. Data were analyzed using descriptive statistics, paired t-test, and thematic analysis. Results: 26 IP learners participated in team meetings and completed surveys; 7 of 9 clinic staff completed surveys. During the first semester, IP learners perceived improvement in the IP learning environment using ACE 15 (p < 0.05) and all 5 domains of IP collaborative competencies (communication, collaboration, roles and responsibility, patient-centered care, and conflict management and team functioning) using ICCAS (p < 0.05). Thematic analysis from IP learners’ and clinic staff’s surveys showed perceived positive impact of IPC on patient care. Discussion: This pilot showed a constructive environment where learners can develop IPC competencies over time in the workplace. Preliminary feedback suggested perceived positive impact of the pilot on the care of older adults; however, feedback from patients and families will provide additional insight to the impact of IPC on patient care. Reflective Critique: We will reduce survey length for patients and families to reduce survey burden.

43 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Abstract # 44

Training Healthcare Professionals To Identify and Respond to Victims of Human Trafficking

Stefana Morgan, MD, UCSF Department of Psychiatry; Antonia Lavine, JD, LLM, NCJW, SFCAHT; Jo Ellen Brainin- Rodriguez, MD, UCSF; Susan Voglmaier, MD, PhD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Competencies, Computers and Technology, Curricular Innovation, Interprofessional Education Category: Curriculum Development

Abstract: Purpose: We are developing an online module to train UCSF health professionals in evidence-based approaches to identify and provide medical and mental health care to human trafficking (HT) victims. We will evaluate HT knowledge of providers and assess the efficacy of the module. Background: HT victims are domestic or immigrant minors or adults, forced or coerced into labor, including sex work. They frequently experience severe physical, psychological and sexual abuse and health sequeale (Dovydaitis, 2010) which require comprehensive patient-centered, sensitive and informed treatment. Evidence exists of the value of HT training at the local level among a small group of ED providers (Grace, 2014), but no evaluation of larger scale training is known to these authors. Methods: The online module will be developed during January-March 2018 by a multi-disciplinary team including various medical specialties, legal experts, service providers and technological leads. Over April-June 2018, providers from the UCSF department of psychiatry (residents, RNs, ED social workers, attending physicians) will watch the module and evaluate it via Qualtrics before and after the intervention. Evaluation Plan: We will assess provider knowledge regarding HT, victim needs and resources, plus interface user friendliness. Dissemination: The project was described in a Senior Talk at the UCSF Department of Psychiatry in January 2018. We will present at the Annual Meeting of the Association for Academic Psychiatry and submit a manuscript to Academic Psychiatry. The module will also be disseminated throughout the UCSF community. Reflective Critique: Based on Open Proposal feedback, content will be organized in short, parsed, play-listed format, including closed captions. Changes will be made based on feedback by the interdisciplinary team at the end of March 2018. References: Dovydaitis T. Human trafficking: the role of the health care provider. J Midwifery Womens Health. 2010 Sep- Oct;55(5):462-7

44 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Grace, et al. Educating health care professionals on human trafficking. Pediatr Emerg Care. 2014 Dec;30(12):856- 61

45 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Abstract # 66

Development of "Five Keys to Older Adult Health" Curriculum in Primary Care and Community Services

Anna Chodos, MD, UCSF; Alicia Neumann, PhD, UCSF; Kate Radcliffe, BA, UCSF; Jack Anderson, BA, UCSF; Remi Frazier, MS, UCSF; Louise Aronson, MD, UCSF; Louise Walter, MD, UCSF; Janet Myers, PhD, UCSF; Josette Rivera, MD, UCSF

Area(s) abstract covers: GME, CME Community Domain(s) addressed: Competencies, Curricular Innovation, Primary Care, Other (please describe) Community Category: Curriculum Development

Abstract: PURPOSE: To "geriatricize" our city through education for medical and social service providers in San Francisco. BACKGROUND: In San Francisco, 20% will be 65 and older by 2030, and there is a need for education in the care of older adults across health care, community services and social services. To address this, we developed a broad curriculum through a partnership between the UCSF Division of Geriatrics, primary care, and social service providers called the Optimizing Aging Collaborative (OAC). METHODS: Following Kern’s framework, a needs assessment identified educational needs in geriatrics topics from stakeholders and integrated the recommendations of San Francisco governmental committees. Further needs assessment was performed with target trainees. Stakeholders met to agree on key topics and objectives based on needs assessments. Goals, objectives and educational materials were developed by core Geriatrics faculty for each trainee group (e.g. SW, RN, MD). We developed a strategy to teach target trainees, e.g. course length, outreach strategy. RESULTS/EVALUATION PLAN: Through our needs assessment, we developed the “Five Key” topics in older adult health: cognition, mental health, safety, independence, and decision making. We also focused on the needs of underserved groups, such as those with dementia, who live alone, and who identify as LGBTQ. From 2015 to 2018, the OAC delivered 129 trainings to laypersons, social service providers, and primary care teams (n=2720), and 261 trainings to health professionals in training (MD, RN, NP, n=156). The trainings varied in scope (one/more topic per training) and was tailored by learner group. DISCUSSION/DISSEMINATION: Through a broad collaboration, we developed a training program for diverse learners to integrate geriatrics into the community and primary health care. With post-session surveys, we plan to evaluate the impact on trainees’ knowledge and improve content and delivery. REFLECTIVE CRITIQUE: It will be important to evaluate the impact of our trainings on knowledge, practice change, and health outcomes.

46 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-A

Abstract # 68

Two Fellowships are Better than One: Combining Geriatrics and Palliative Care

Lynn Flint, MD, UCSF; Thomas Reid, MD, UCSF; Eric Widera, MD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Competencies, Curricular Innovation, Leadership Category: Curriculum Development

Abstract: Purpose: Design a physician fellowship to develop leaders in the care of older adults with serious illness. Background: Geriatrics and palliative care share many clinical competencies. Both fields face workforce shortages and, thus, share a focus on amplifying their impact through leadership in education, research, quality improvement and program development. The Integrated Geriatrics and Palliative Care ("geri-pal") fellowship is an American Board of Internal Medicine (ABIM) pilot project in competency-based medical education that leverages overlapping clinical competencies to allow time for professional development and leadership training. Methods: Geriatrics and palliative care fellowship leaders designed a 24-month curriculum including 16 months of clinical rotations and eight months of professional development, including mentorship, leadership training, and a scholarly project. Approval from the ABIM was obtained. Funding was obtained from the VA and philanthropy. The first fellow is presently in his first year; a second fellow will begin in July 2018. Evaluation plan: A multi-institution collaborative is conducting an evaluation of the programs, including analysis of milestone achievement, board pass rates, and positions taken after graduation. Locally, we surveyed the applicants who interviewed for the geriatrics and geri-pal fellowships to identify ways to increase awareness of our program. Dissemination: The leadership curriculum will be submitted for presentation at the American Geriatrics Society national meeting in 2018. A qualitative study of the barriers and facilitators to creating novel graduate medical education programs using this fellowship as a case study is in development. Reflective critique: Integrating two distinct fellowships with separate leadership creates both administrative and clinical challenges. We regularly obtain program feedback from the geri-pal fellow and the clinical teams and faculty at all fellowship sites. In response to this feedback, we plan to further integrate curricula for all the geriatrics and palliative care fellows.

47 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-B

Abstract # 09

Supporting Learners to Learn from “Difficult Patients”

Jody Steinauer, MD, UCSF; Arianne Teherani, PhD, UCSF; Felisa Preskill, MPP, UCSF; Olle ten Cate, PhD, UCSF - Utrecht; Patricia O'Sullivan, EdD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Communication, Patient Care, Professionalism Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To understand students’ strategies when feeling negative emotions toward “difficult patients” and to explore relevant curricular support. Background Medical students experience negative emotions in interaction with some patients, often occurring for the first time in clinical clerkships. Students receive pre-clinical training in the social and behavioral sciences, often including learning about “difficult patient” interactions, yet little is known about their desire for training during clinical education. Methods We interviewed 4th-year students about interactions with “difficult patients,” and sought to identify strategies and supports needed in these interactions. Interviews ended when theoretical sufficiency was achieved. We used qualitative content analysis to organize strategies into themes about areas benefiting from curricular supports. We mapped students’ desired curricular support examples to cognitive apprenticeship teaching methods – modeling, coaching, reflection, scaffolding, exploration, and articulation - and aligned them with traditional pedagogical techniques. Results We interviewed 26 medical students (44 volunteered/180 invited). Their strategies formed 6 themes: anticipating challenging interactions, finding empathy, modulating time with patients, using learned communication approaches, seeking team support, and considering the interaction an opportunity for more responsibility. Students described ideal clinical teaching, including post-interaction debriefs with an emphasis on validating their emotional reactions and challenges. Students mentioned all cognitive apprenticeship teaching methods, most prominently modeling (observing supervisors in such interactions) and supported reflection. They also identified a need for faculty and resident development to enact these teaching methods. Discussion Students use learned strategies in “difficult patient” interactions but desire more clinical teaching, especially supervisor modeling, team debriefs and reflection. Reflective Critique We will present at the 2018 AERA meeting after input.

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Abstract # 34

Walk the Walk: Evaluating the Impact of a National Workshop on Program Evaluation

Andreea Seritan, MD, UCSF; Sanjeev Sockalingam, MD, MHPE, Univ Toronto

Area(s) abstract covers: Faculty development Domain(s) addressed: Evaluation of Programs, Faculty Development, Longitudinal Educational Activities, Quality Improvement Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To assess the impact of a workshop on program evaluation held at the Association for Academic Psychiatry (AAP) 2017 Annual Meeting. Background: The AAP Master Educator Program offers 2 3-hour long workshops each year at the AAP Annual Meeting. One of the 2017 workshops focused on program evaluation. 4 months after the workshop, a survey was sent to participants to evaluate the impact of the workshop by collecting data on their program evaluation activities at their home institutions. In doing this, workshop presenters exemplified Kirkpatrick level 4 of program evaluation. Methods: Participants were 25 faculty members and residents from psychiatry departments in the US and Canada. An 11-question anonymous survey was developed and emailed to participants. Data collected included participant demographics, educational leadership role, type of educational project evaluated, Kirkpatrick level, barriers encountered, and creative solutions. Data were analyzed using descriptive statistics. This study was deemed exempt by UCSF IRB. Results: 15 completed surveys were received. Survey respondents were: 6 (40%) men, 9 (60%) women; 9 (60%) assistant professors, 3 (20%) associate professors, 1 (6.7%) professor, 1 (6.7%) resident, and 1 (6.7%) psychiatrist affiliated with a community program. 12 (80%) had formal educational leadership roles, including program director (3), assistant/associate program director (6), intern education director (2), and clerkship director (1). Respondents evaluated a variety of programs: resident/fellow clinical rotation (4), resident/fellow didactic curriculum (2), faculty development program (2), medical student clinical rotation (1), or a combination of the above. With regard to Kirkpatrick level, 6 (40%) targeted learning, 5 (33.3%) assessed learner behavior, 2 (13.3%) explored learner reaction, and 2 (13.3%) evaluated program impact. Discussion/Dissemination: Academic psychiatrists use skills learned in the AAP Master Educator workshop on program evaluation, exemplifying Kirkpatrick level 4. Reflective Critique: The survey used was developed with peer input.

49 Education Showcase 2018 Mini-oral Abstracts – April 30, 2-B

Abstract # 39

Preparing the 21st Century Physician: A New Foundational Social and Behavioral Sciences Course

Megha Garg, MD, MPH, UCSF, San Francisco VA Medical Center; Archna Eniasivam, MD, UCSF; Dan Dohan, PhD, UCSF; Jason Satterfield, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Cultural Competence, Curricular Innovation, Health Policy, Health Systems Category: Curriculum Development

Abstract: Purpose: Develop a social and behavioral sciences (SBS) course for first year students in the UCSF Medical School Bridges curriculum. Background: Over 50% of premature morbidity and mortality are attributable to social and behavioral causes; traditional medical curricula do not prepare students for these challenges. The UCSF Bridges curriculum addressed this gap by creating a new Foundations 1 SBS course. Methods: The Kerns 6-step model for curriculum development was used to define the problem, assess learner needs, collect resources, select pedagogy and design evaluations. Previous work by the National Academy of Medicine, AAMC, and published literature informed content areas and themes, including patient/provider identity, behavior change, health disparities, structural competence and health policy. Expert and student reviews shaped sessions maximizing learner engagement and scientific rigor. Results/Evaluation Plan: An 8-week course (two 4-week segments: Health & the Individual and Health & Society) ran successfully in 2016-2017. Teaching innovations included a longitudinally followed “standardized family”, integrated cases for chronic pain and addiction, a social science book club and patient panels. Quantitative student evaluations rated small group facilitator effectiveness 4.3/5 (H&I) and 4.4/5 (H&S). Qualitative comments suggest that students valued patient discussions on addiction and palliative care yet desired improved reading materials. Discussion/Dissemination: Students appreciated in-depth coverage of SBS, noting its relevance to high quality care. Challenges included limited hours and need for facilitators with topic expertise and abilities to guide discussions of topics such as race and bias. UCSF faculty are involved with NIH and AMA curriculum consortia to share and adapt SBS program materials. Reflective Critique: Our curricular approach continues to evolve. Ongoing evaluations will shape content and highlight opportunities for integration with other Bridges elements. External block critiques will be obtained via sister programs at UNC and UCLA.

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Abstract # 42

“A friendly place where you can grow as an educator”: Exploring communities of practice among medical student coaches

Katherine Schreiner, BA, Department of Medicine, University of California, San Francisco; Bridget O'Brien, PhD, Department of Medicine, University of California, San Francisco; Karen Hauer, MD, PhD, Department of Medicine, University of California, San Francisco; Sandrijn van Schaik, MD, PhD, Department of Pediatrics, University of California, San Francisco; Anna Chang, MD, Department of Medicine, University of California, San Francisco; Leslie Sheu, MD, Department of Medicine, University of California, San Francisco

Area(s) abstract covers: Medical Student Education (UME), CME Domain(s) addressed: Curricular Innovation, Faculty Development, Research, Other (please describe) Coaching Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To explore how UCSF’s medical student coaching program (MSCP) facilitates coach interactions, whether these interactions suggest formation of coaching communities of practice (CoPs), and what value coaches attribute to CoPs. Background Increasingly, medical schools are developing MSCPs that bring together medical educators dedicated to supporting students’ professional growth. As coaches participate in faculty development and collaborate to develop coaching skills, CoPs may form and enhance the effectiveness of coaching and coaches’ job satisfaction (Wenger, 1998). Methods One year after initiation of UCSF’s MSCP, coaches participated in interviews focused on interactions with one another, extent to which they felt part of a community, and value of community. We analyzed interview transcripts for themes related to CoPs. Results We invited a purposive sample of 17 (out of 25) coaches to interview; 14 participated. Coaches described belonging to CoPs of varied size and cohesion based on site and faculty development cohorts. They defined CoPs as collaborative groups of coach peers and leaders, with a “connection on the grounds of shared experience.” Faculty development offered opportunities to build interdepartmental relationships, exchange advice, and share common challenges. These communities enriched coaches’ work with students, and enhanced their career satisfaction and professional identities. Geography and time constraints presented barriers to CoP formation. Discussion Though CoP formation was not an explicit MSCP goal, belonging to CoPs benefitted coaches’ confidence, job satisfaction, and identity. Our findings highlight factors influencing CoP formation and support future efforts to develop CoPs among physician-educators. We will present our findings at the WGEA Conference in March 2018. Reflective critique

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WGEA reviewers expressed an interest in formal structures to facilitate CoPs, which we will address in our presentation. References Wenger, E. (1998). Communities of Practice: Learning, Meaning, and Identity. New York, NY: Cambridge University Press.

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Abstract # 57

FS-in-F2 Program of Assessment: Assessment For Learning

Lynnea Mills, MD, UCSF; Heidi Kirsch, MD, MS, UCSF; Jonathan Pai, , UCSF; Amy Yun, , UCSF; Sara Clemons, , UCSF; Patricia Cornett, MD, UCSF; Christy Boscardin, PhD, UCSF; Karen Hauer, MD, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Assessment and Testing, Basic Science Education Category: Curriculum Development

Abstract: Purpose: To develop assessment methods that facilitate learning in the School of Medicine’s Foundational Sciences in Foundations 2 (FS-in-F2) course. Background: FS-in-F2 sessions enable students to revisit foundational science topics during the core clerkship year to build on content and enhance application to clinical practice. Goals were to develop formative assessments that would maximize utility to students (assessment FOR learning); emphasize application of foundational science to clinical work; and provide accurate, just-in-time feedback on progress toward milestones, including licensing exams. Methods: For the 23 sessions, we developed four assessment options, customizable to the session objectives, and rooted in well-described educational assessment techniques: 1) Boards-style multiple-choice questions, enhancing retention and transfer via retrieval of information and feedback via correct answers/explanations afterward; 2) writing exercises on reflection or application prompts, promoting learning via generative retrieval, with model answers to further learning; 3) presentations of students’ inquiry (i.e., research) mini-projects pertaining to the day’s topic, with peer rubric-based assessment; and 4) presentations of educational materials for patients or colleagues, with peer rubric-based assessment. Evaluation Plan: The evaluation plan includes student feedback via surveys and focus groups, and faculty feedback via survey. Feedback will demonstrate how assessment techniques guide learning and solidification of foundational science content, and how students apply this knowledge in the clinical workplace. Dissemination: We will present this work at national education meetings and in a peer-reviewed journal. Reflective critique: Feedback from FS-in-F2 core faculty and Design Leads, as well as the SOM Student Assessment Advisory Board, led to modification of rubrics, alteration of methods to emphasize peer assessment, and expansion of writing prompts to include more application questions.

53 Education Showcase 2018 Mini-oral Abstracts – April 30, 3-A

Abstract # 70

Structural expectations: Characterizing structural competency for medical students

Emma Dobbins, MS, UCSF; Joshua Neff, MS, UCSF; Kelly Knight, PhD, USCF; Arianne Teherani, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Competencies, Cultural Competence, Curricular Innovation, Diversity Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: This project aims to characterize structural competence for medical students at various levels of training. Background: There is a growing priority in the medical field to intervene upon the social determinants of health and health disparities. To address this need, some medical schools have introduced a new framework into their curricula called structural competency. Structural competency (SC) shifts medical education away from individual/behavioral explanations of disease and focuses instead on the upstream structures that impact health outcomes. To date, no studies have defined what is core SC for medical students. As such, it is important to clearly characterize SC for medical students in order to ensure a systematic and rigorously-defined education in this area. Methods: One step of curriculum and assessment development involves establishing content validity. To do this, we first conducted a literature review to develop a working definition of SC. Next, we conducted semi- structured interviews with 26 experts to verify and further characterize the definition and to outline reasonable expectations for medical students. Results: In the initial results, we found that SC was characterized as a complex framework for clinical practice that requires students to be able to think beyond biomedical explanations for disease to identify structural factors impacting health. Humility and interprofessional collaboration were described as necessary early steps for enacting structural interventions. Experts also emphasized that the current system of medical education itself poses structural barriers to teaching SC. Discussion: Analysis is ongoing, but preliminary conclusions are twofold: First, training in SC will require iterative instruction over multiple years that is responsive to community needs and student feedback. Next, medical schools may need to examine and potentially adjust their pedagogical systems to allow students to fully explore SC. Critique: This work will be modified based on feedback from students, content experts, as well as experts in medical education.

54 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 07

Common Threads of Care: Integrating Geriatrics and Specialty Practice for Medical Students

Laura Byerly, MD, UCSF Division of Geriatrics; Kathryn Eubank, MD, UCSF Division of Geriatrics; Josette Rivera, MD, UCSF Division of Geriatrics

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Patient Care Category: Curriculum Development

Abstract: Purpose: To implement a small-group curriculum co-created and taught by geriatricians and specialists for 2nd year medical students illustrating practical application of geriatric principles for clerkships and practice regardless of career choice. Background: While most medical students will not pursue a career in geriatrics, all will work with older adults. Early introduction to the relevance of geriatrics in diverse specialties may improve students’ application of geriatrics principles. Methods: UCSF geriatricians and faculty from surgery, psychiatry, OBGYN, and pediatrics jointly developed case scenarios and discussion questions focused on key geriatric concepts commonly seen in each specialty’s practice. The 2-hour small-group utilized a ‘speed dating’ format in which geriatrician/specialist pairs rotated through 4 student groups to discuss the case related to the specialist’s field. Students discussed all 4 specialty cases and then completed a 5-point Likert-scale evaluation on session structure and effectiveness. Comments were thematically analyzed. Results: Students (n=116) rated the overall session 4.37/5.0, SD 0.75. They positively rated provider co- facilitation (4.60/5.0, SD 0.63); student comments indicated this approach was “relevant,” “appreciated,” and “valuable.” Students also highly rated the effectiveness of the 4 cases in highlighting the relevance of geriatrics to specialty care (average 4.41/5.0) and commented that the cases provided concrete take home points for future practice. Facilitators highly enjoyed co-facilitating and commented they also learned from each other. Discussion: Partnering with specialists to develop and teach this small group session provided an innovative and practical method of teaching high-yield real-world geriatric pearls. This replicable curriculum demonstrates a promising approach to role modeling collaboration and introducing widely applicable geriatric concepts. Reflective Critique: Based on student and facilitator feedback, future iterations will have shortened case scenarios to foster increased discussion time.

55 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 08

Broadening Definitions of “Home”: A Models of Residential Geriatric Care Curriculum for Pre- clerkship Students

Laura Byerly, MD, UCSF Division of Geriatrics; Jessica Eng, MD, MS, UCSF Division of Geriatrics; Josette Rivera, MD, UCSF Division of Geriatrics

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Health Systems, Patient Care Category: Curriculum Development

Abstract: Purpose: To immerse pre-clerkship medical students in diverse models of residential geriatric care and guide analysis of both their defining characteristics and impact on patient care. Background: Most older adults spend some time living in a community-based model of residential geriatric care. While there are published curricula focused on patient transitions out of inpatient settings, no known curricula focus explicitly on the characteristics and capabilities of long-term residential care models in which many older adults live. Methods: Twenty local models of care (e.g., assisted living, senior apartments) were recruited to participate in site visits for this 2-day session. On day 1, all UCSF MS2s were divided into teams that spent a half-day at a model of care interviewing site administrators and touring facilities. On day 2, MS2s debriefed in small groups with peers who visited different models and peer-taught each model’s capabilities, financing, and target populations. They discussed how providers might partner with sites in delivering quality care. MS2s completed retrospective pre/post Likert-scale self-assessments on site characteristics; MS2s and sites both provided open- ended feedback. A vignette-based summative exam question assessed content application. Results: MS2s (n=144) rated overall site visit experiences as 4.49/5.0, SD 0.88. Self-assessments showed significant improvement in confidence describing models’ admission criteria and payment structures (p<0.001 for all). On the summative exam question, 81% ‘passed.’ MS2 comments indicated this was a unique and effective learning approach though they were surprised by the high costs of residential care. Participating sites indicated interest in ongoing participation. Discussion: Community models of care visits were high-yield for students and sites alike. Curricular materials are novel, adaptable for diverse health professions trainees, and will be presented at the 2018 American Geriatrics Society Annual Meeting. Reflective Critique: Based on feedback, we plan to incorporate more low-income care sites.

56 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 48

Gender-Inclusive Care: A Pilot Workshop to Improve Medical Student Competency During Third-Year Clerkships

Tara Benesch, M.S. in Public Health, UCSF SOM; Joanna Jacobs, , UCSF SOM; Lager Jeannette, M.D., UCSF SOM

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Cultural Competence, Diversity, Patient Care, Simulation Category: Curriculum Development

Abstract: Abstract Purpose: Transgender and gender-nonconforming (gender minority or GM) Americans face significant barriers to inclusive, quality healthcare. UCSF piloted a one-hour workshop with third-year medical students on inclusive obstetric and gynecologic care for GM patients, with the goal of identifying and filling gaps in medical student knowledge and competency. Background: Previous interventions have used focused case studies and patient panels to improve medical students’ comfort with LGBT health topics . Peer-led workshops and exposure to LGBT individuals increases comfort in providing services to the LGBT community . Methods: Workshop participants were asked to fill out anonymous pre- and post-workshop surveys to assess knowledge of and comfort with transgender health issues. Qualitative and quantitative responses were compiled and analyzed using Qualtrics and Excel. Results: Of 19 trainees, 16 completed the pre-test and 10 completed the post-test. Participants averaged 107 minutes of prior LGBT training, and expressed need for additional time to practice gender-inclusive history and physical exams. The surveys demonstrated that the one-hour workshop was an effective way to introduce vocabulary and increase comfort using inclusive terminology in reproductive health settings. Students expressed need for additional trainings—particularly interactive workshops—in preparation for the care of GM populations. Discussion/Dissemination: Interactive workshops on gender-inclusive care are an effective way to help medical students feel comfortable using appropriate language, and should be included in medical school curricula. This model may improve medical student competence and thus health outcomes for gender minority populations. Reflective Critique: Findings were presented at the Educational Scholarship Conference and feedback solicited regarding curriculum design, further evaluation, and partnerships. Survey responses and suggestions from the Educational Scholarship Conference will inform the next iteration of the workshop.

57 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 58

What Can Physicians Do?: Building An Advocacy Curriculum for First Year Medical Students

Elizabeth Griffiths, MD, MPH, UCSF Department of Medicine; Arianne Teherani, PhD, UCSF School of Medicine; Megha Garg, MD, MPH, UCSF Department of Medicine

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Community Medicine, Curricular Innovation, Health Policy, Leadership Category: Curriculum Development

Abstract: Purpose: To develop a novel curriculum to teach first year medical students how to reflect on physicians’ roles as advocates and develop advocacy skills. Background: Professional societies have increasingly recognized the role of physicians as advocates. However, most medical students still receive no training in advocacy. Prior surveys of medical students exiting UCSF indicate that students feel unprepared to engage in advocacy activities. Methods: A new small group on physician advocacy was created for the Bridges Health and Society course, modeled after portions of an established resident advocacy curriculum developed at Brown University. The session comprised an advocacy debate, opinion writing critique, and writing exercise. Results/Evaluation Plan: The session ran successfully in the 2016-2017 academic year as part of the Health and Society course. Students rated overall effectiveness of small group instructors as 4.41 out of 5, and in qualitative comments noted the small group as a “must keep” session. Students felt the session’s advocacy debate needed improvement. In 2018, quantitative data will be collected via a matched pre- and post-curriculum survey to assess students’ perception of the importance of advocacy, their likelihood of being involved in advocacy, and their confidence in their ability to engage in advocacy. Qualitative data will be collected via thematic analysis of medical students’ written reflections on physicians’ roles as advocates. This information will be used to guide future curriculum development. Discussion/Dissemination: Students valued a physician advocacy component in the curriculum. 2017-2018 survey and qualitative data will be presented, and findings will be distributed via local and national conferences and manuscript publication. Reflective Critique: Based 2016-2017 evaluations, the session was revised to include a pre-work written reflection exercise and the debate structure was modified. Legislative advocacy skills training was added.

58 Education Showcase 2018 Mini-oral Abstracts – Date, Session

59 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 50

Emotional Awareness and Mindfulness in Diagnosis – Preparing Second Year Medical Students for Clerkships

Joe Cook, MA, Medical Education, UCSF; Larissa Thomas, MD, Department of Medicine, UCSF; Eve Ekman, PhD, MSW, Osher Center, UCSF; Denise Connor, MD, Department of Medicine, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Communication, Curricular Innovation, Other (please describe) Emotional Awareness Category: Curriculum Development

Abstract: Purpose: To create a workshop for the Diagnostic Reasoning (DR) Block that addresses the role of emotional awareness (EA) in diagnosis. Background: The Bridges Curriculum includes a 3-week DR Block for pre-clerkship medical students that aims to build students’ reasoning skills and develop awareness of factors that impact diagnostic accuracy. Studies suggest EA is an important skill that may reduce the risk for diagnostic mistakes by promoting rapport and communication, protecting against burn-out, and increasing awareness of potential bias. However, education in EA is rare in medical school curricula. Research suggests EA can be taught through experiential learning modalities such as mindfulness. Methods: Educators with expertise in diagnostic reasoning, emotion, wellness, and mindfulness developed a 2 hour workshop to provide experiential EA learning opportunities for 2nd year medical students. We used a “trigger, experience, response” conceptual framework to construct case vignettes based on emotional events that commonly occur during clerkships, and paired mindfulness practices with each vignette to promote EA skills development. We recruited and trained 13 faculty facilitators to deliver the workshop to groups of 12-15 students. Evaluation: We evaluated acceptability and feasibility using a student survey and faculty debrief. Faculty reported high interest and receptivity. Several faculty ran out of time and adapted the content to the needs of their group. 97 (N=140) students responded to the survey. 70% of respondents endorsed the likeliness of attending to emotion in future clinical encounters as a result of the session. Comments noted some redundancy with ARCH week content. Dissemination: We will engage facilitators to refine and improve the session, meet with leaders of CMC and ARCH week to enhance integration and optimize sequencing of the session, and will explore integrating EA skills throughout the DR block. Reflective Critique: Facilitator training raised many pedagogical advantages and challenges of incorporating EA and mindfulness into curricula.

60 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-A

Abstract # 27

A Multicenter Qualitative Study of Interprofessional Simulation-Based Education

Mindy Ju, MD, UCSF; Naike Bochatay, MSc, Centre Medical Universitaire; James Frank, MD, UCSF; Bridget O'Brien, PhD, UCSF; Sandrijn van Schaik, MD PhD, UCSF

Area(s) abstract covers: GME, CME Domain(s) addressed: Interprofessional Education, Simulation Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To examine interprofessional simulation-based education (IPSE) across settings. Background Despite the growing use of IPSE, there is limited evidence to support best practices and existing guidelines. As a first step towards creating a stronger evidence-base for IPSE, we explored to what extent IPSE programs apply these guidelines. Methods We distilled 10 IPSE principles from published recommendations for IPSE, interprofessional education, and simulation-based education, to create a framework for a qualitative case study of 7 IPSE programs at 5 different hospitals affiliated with 2 institutions. Of the 10 ISPE principles, 8 were included in an observation guide, to create field notes based on 3 observations per program. Two investigators coded field notes followed by comparison and reconciliation through discussion. We used the framework method to compare observations with pre-determined IPSE principles and identify candidates for additional best practices. Results Over a 9-month period, we observed 21 simulations (30 hours total). Four IPSE principles were consistently applied across programs (active learning, psychological safety, sociological fidelity and feedback/debriefing). Application of the remaining 4 principles was variable (equitable distribution of tasks, collaborative practice/teamwork competency based learning, repetitive and distributive practice and attention to difference and hierarchy). Additional themes related to debriefing format and content may inform future guidelines. Discussion IPSE programs vary significantly in how they apply principles derived from published guidelines. Our ongoing investigations will examine whether the differences between programs are intentional, based on each program’s specific needs, or result from unique affordances or barriers within each program’s environment. Ultimately, we aim to evaluate evidence for these principles by exploring how their application translates into program outcomes. Reflective Critique Study proposal was discussed at UCSF Simulation WIP sessions. Data will be presented at WGEA.

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Abstract # 31

E-ASSESS: Creating an EPA-Based Assessment Tool for Use in Simulated Emergency Scenarios

Caroline Andler, MD, UCSF; Sandrijn VanSchaik, MD, PhD, UCSF; Katie Kowalek, MD, UCSF; Sneha Daya, MD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Assessment and Testing, Competencies, Residency, Simulation Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To examine whether entrustment based on performance in simulation correlates with entrustment based on clinical performance using a novel Entrustable Professional Activity (EPA)-based tool. Background: The EPA framework for assessment of medical trainees requires supervisors to decide how much they trust trainees to complete activities and the level of supervision needed. This implies direct observation of trainees, which is not always possible in the clinical setting. Simulation-based education allows for direct observation, but it is unclear whether trainee performance during simulation translates to performance in clinical settings. Methods: We adapted an existing EPA-based tool used by supervisors in the clinical setting for use in simulation through an iterative process eliciting feedback from various experts and working groups. Three independent raters are using the tool to assign entrustment levels to pediatric residents after observing their performance during simulated scenarios. We will examine interrater reliability and compare entrustment levels between residents of different training levels. We will also compare these ratings with clinical supervisor ratings provided during residency training. Evaluation Plan: We hope to find concordance between entrustment ratings based on performance in the simulation setting and those based on performance in clinical settings. Dissemination: If such concordance exists, this will open up opportunities for similar assessment approaches using simulation as a substitute for direct observation in the clinical setting. If no concordance exists, this should inform adjustments in the simulation curriculum to ensure better alignment between simulation learning and clinical performance needs. Reflective Critique: We used input from experts in the Health Professions Education Pathway and Simulation and Scholarship working groups to help inform project design and make adaptations to our tool. We will continue this iterative process throughout data collection and analysis.

62 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-B

Abstract # 45

“Will you be my Facebook friend?” Professional Identity Tensions and Boundary Issues in the Age of Social Media: A Workshop for Psychiatry Residents

A. Ning Zhou, MD, UCSF; Erick Hung, MD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Computers and Technology, Evaluation of Programs, Professionalism, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: We designed, implemented, and evaluated a 90-minute workshop for psychiatry residents to explore professional identity tensions and boundary issues that arise with social media use. Background: Social media use causes unique tensions for medical professionals as it can blur the boundary between personal and professional lives. Currently, UCSF psychiatry residents receive no formal teaching on how to navigate social media. Methods: We used Kern’s 6-step framework to develop a workshop on social media considerations in the professional setting. A needs assessment from focus groups with residents and faculty revealed a dearth of discussion about social media and desire for formalized curricula. Based on learning objectives for the session, we designed a 90-minute mixed-strategy workshop in November 2017 that included a didactic component, think-pair-shares, personal reflection, case-based small group discussions, and audience-response interaction. Results: Twenty-nine residents (PGY1-4) attended the session. Thirteen (45%) residents completed the pre- and post-surveys. Before the session, 46% of residents reported feeling comfortable or somewhat comfortable discussing the challenges social media may create in their professional careers, which increased to 92% after the session. Fifty-four percent of residents somewhat agreed or strongly agreed that they will change their social media use after this workshop. Discussion: A mixed-strategy workshop on social media increases psychiatry residents’ comfort in considering professionalism and boundary issues that arise online and helps residents navigate the complexities of social media in their professional careers. Reflective Critique: We sought consultation from the UCSF Health Professions Education Pathway and the Educational Scholars Conference, removing sections and making the workshop more aligned with the learning objectives. Per written evaluations from residents, the case vignettes were useful; future versions of this workshop may include more case vignettes and a personalized section on how to manage privacy settings.

63 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-B

Abstract # 47

Providing trainees with feedback about practice habits – who, what, why, and how?

Glenn Rosenbluth, MD, UCSF; Michelle Tong, , UCSF; Shivany Condor Montes, , UCSF; Christy Boscardin, PhD, UCSF

Area(s) abstract covers: GME Domain(s) addressed: Feedback, Patient Care, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To describe the types of data residents and fellows desire to improve their clinical practice. Background: ACGME CLER program has an expectation that trainees receive data on quality metrics, with emphasis on data specific to residents’/fellows’ patient populations. We have limited information about how residents and fellows define their patient population for the purpose of using data to improve practice. Methods: We conducted focus groups with trainees from a variety of specialties. Participants were asked a series of questions in four broad categories: (1) How do they define the patients with whom they have meaningfully participated in care? (2) What data would they find helpful to improve practice? (3) How do they envision using these data to improve practice? (4) How would they like data presented? Transcripts were analyzed for common themes using content analysis. Results: 20 residents and fellows, representing 6 clinical departments and 12 training programs participated in 3 focus groups. We identified 4 key themes: Trainees vary in their criteria for which patients/encounters they would like to have data about, and are most interested in data from unusual or unexpected diagnoses or from encounters in which they perceived autonomy (e.g. decision to take to OR, initial consult). Trainees are interested in comparison data for peers within and outside their programs. Trainees feel that it would be important to review data with a faculty member with whom they work with clinically. Trainees have limited interest in institution-level data. Discussion: Trainees were interested in receiving data about their clinical practice, but had varying criteria for what data would be most useful and how they prefer to receive and use these data. Our results will be compared to data on the same topic currently being collected from program directors. Data to improve clinical practice will likely need to be customized to programs based on individual needs. Reflective critique: Our results will be reviewed with program directors as well as clinical leadership to validate appropriateness of data, as well as to align with the format of clinical data currently presented to faculty.

64 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-B

Abstract # 55

IGNITE: Lighting A Fire For Interprofessional Error Disclosure Curriculum

Sanskriti Saxena, University of California, Berkeley; Bryant Ho; Anthony Sanabria; Mihir Joshi; Aparna Manocha; Amin Azzam, MD, MA, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Interprofessional Education, Patient Care, Quality Improvement Category: Curriculum Development

Abstract: Background: A lack of adequate communication and collaboration amongst interprofessional health care team members results in both increased medical errors and ineffective disclosures of those errors. These issues have significant, negative impacts on healthcare safety and quality and must be addressed through increased interprofessional collaboration to ensure ethical and patient-centered care. Methods: The Interprofessional Group Near-peer Integrated Team Education (IGNITE) curriculum is an interprofessional (IPE) elective class taught at Samuel Merritt University (SMU) that facilitates team based decision making during instances of error disclosure. Combining both Simulation-Based Learning (SBL) and Problem-Based Learning (PBL), the main goals are to consider contributing factors and prevention of error disclosure, and practice- opportunities to address clinical errors effectively as a healthcare team. Results/Evaluation Plan: We evaluated how students’ perception of their behavior and skills in regards to interprofessional teamwork changed before and after participation in IGNITE using the Inter-professional Collaboration Competency Attainment Survey (ICCAS) before and after each of 4 course sessions. Analysis of the data found that all 68 students enrolled demonstrated significant positive behavior changes in all aspects. Discussion/Dissemination: Through active engagement and authentic learning activities, students and faculty continue their evolution into highly competent, empathetic healthcare professionals engaged in collaborative practice. Reflective Critique: Other schools can adapt the IGNITE curriculum by adopting specific PBL cases or SBL stations.

65 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-B

Abstract # 60

Earth Health: A Novel Elective Shaping Student Perceptions of Sustainable Healthcare

Hugo Aguilar, BS, UCSF School of Pharmacy; Yaser Khoshal, BS, UCSF School of Pharmacy; Katherine Gruenberg, PharmD, UCSF Department of Clinical Pharmacy; Conan MacDougall, PharmD, MAS, UCSF Department of Clinical Pharmacy

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Global Health, Interprofessional Education, Other (please describe) Sustainable Healthcare Category: Curriculum Development

Abstract: Purpose: To implement an inter-professional elective course at UCSF designed to enhance foundational knowledge, shape attitudes, and promote activism supporting sustainable healthcare. Background: Climate change is considered one of the greatest threats to public health. Healthcare professionals would benefit from education on sustainability and climate change to anticipate and mitigate the effects of climate-related disease. Few U.S. health professional schools provide sustainable healthcare education within their curricula. As future healthcare providers, UCSF students must be prepared to engage patients and stakeholders about the effects of climate change on public health. Methods: In April 2017, UCSF students enrolled in this elective course were invited to complete an electronic pre-course and post-course survey. Survey items used a 5-point Likert-type scale to measure respondents' level of agreement with statements regarding knowledge, attitudes, and behaviors towards climate change and health. Responses were dichotomized and McNemar's test was used to analyze paired responses. Results: A total of 80-students enrolled in the elective and 76-students (95%) completed both pre-course and post-course surveys. Paired responses demonstrated a significant increase in agreement with statements in the domains of knowledge (36%), attitudes (18%), and behavior (18%) post-course. Discussion: Overall positive changes in self-perceived knowledge, attitude, and behavior highlights the benefit of a sustainable healthcare elective. Agreement in the knowledge domain was greater than attitude and behavior domains possibly due to lectures emphasizing foundational knowledge. This course will be offered again in Spring 2018 and speakers will be encouraged to focus on solutions to mitigate the effects of climate change on health. Outcomes will be shared with the UCSF Carbon Neutrality Initiative. Reflective Critique: Post-course student feedback and results from this study will be used to modify topic selection, speaker lineup, and course objectives for the spring 2018 iteration.

66 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 46

Back to the basics: observing foundational science on internal medicine rounds

Jonathan Pai, BA, University of California, San Francisco; Heidi Kirsch, MD, University of California, San Francisco; Patricia O'Sullivan, EdD, University of California, San Francisco; Patricia Cornett, MD, University of California, San Francisco

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Basic Science Education, Clinical Instruction and Performance, Research Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To explore foundational science (FS) discussion during internal medicine (IM) rounds with third year medical students (MS3s). Background: Educators have called for an integrated FS and clinical curriculum that promotes application of FS knowledge. Yet, teaching on clinical clerkships appears to have shifted away from FS. Limited studies suggest competing demands restrict teaching FS. Methods: We performed a qualitative exploratory study using constructivist grounded theory. Participants included IM teams at UCSF Medical Center. We observed MS3 patient presentations on IM rounds and tracked FS discussion content. Following observation, we conducted individual interviews with team members. Three investigators read transcripts independently, developed codes and a codebook. Codes were synthesized into themes after discussion. Results: We observed three different IM teams. Each team had an attending, resident, two interns, and an MS3. FS domains of clinical, biomedical, and social/behavioral science were included. FS was a small fraction of total teaching. Interviews (11 out of 14 observed team members) evoked three themes: 1) reasons to discuss FS, 2) goals of teaching and 3) barriers to FS discussions. Reasons to discuss FS included personal curiosity, unusual patient presentations, and importance for management. Goals of teaching FS included improvement of understanding and learner engagement. Barriers included time constraints, lack of attending comfort with FS knowledge, and lack of MS3 comfort with setting. Discussion/Dissemination: This pilot study provides insight to improving FS discussion. Like others we found a time tension between clinical management and FS limiting discussion. We found this true despite professed interest in the FS topics. We could promote FS discussions with brief teaching of FS by the MS3 during the patient presentation. We are submitting our findings to AMEE 2018. Reflective Critique: We presented this study at HPE WIP meeting and ESCape meeting and feedback was incorporated into study design.

67 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 01

Trial and Improvement of Clinical Instruction Between Medical Students at the UCSF Family Medicine Center at Lakeshore

Tenessa MacKenzie, MD, UCSF; Gabriel Goldfien, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Mentoring, Patient Care, Primary Care Category: Curriculum Development

Abstract: Purpose: While new curricula often seek to expose early medical students to patient care, shortage of instructors and space are frequent limiting factors. We aimed to determine if pairing early and late medical students in clinical preceptorships addressed these challenges and contributed to education./Background: Senior medical students have few opportunities for clinical instruction, yet may benefit from exposure before residency. An analysis of peer mentorship in student-run free clinics found that MS4s enhanced the educational experiences of MS1s (Choudhury et al., 2014)./Methods: In Spring 2017, five MS1s, three MS3s, and four physicians participated in a trial of medical student pairing at our clinic. MS1-MS3 pairs saw patients together, then presented to and saw patients with the attending. Students were encouraged to provide feedback to one another./Results: We evaluated our pilot program qualitatively with interviews for all participants, providing specific questions. Results were analyzed for key themes. All participants responded to this trial favorably and reported they would participate again./Discussion: Pairing of MS1s and MS3s was mutually beneficial, providing low stakes learning and feedback for MS1s, teaching practice for MS3s, and without compromising clinic efficiency or flow. This may be an effective, efficient model for engaging more learners in patient care and allowing them to learn from each other. We plan to offer these sessions again at our site, as well as encourage other faculty to try similar sessions./Reflective Critique: Feedback was solicited from student and faculty participants. Participants felt that pairing was most effective with more experienced MS3s, though this emphasis may decrease as the curriculum shifts toward earlier clinical involvement. For future pairing we plan to provide teaching guidelines for MS3s and suggestions for structuring clinical encounters with multiple learners./References:Choudhury N, et al. Peer mentorship in student-run free clinics: the impact on preclinical education.Fam Med.2014 Mar;46(3):204-8.

68 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 51

UCSF CMC Clinical Immersion Week

Margaret McNamara, MD, UCSF Department of Pediatrics and ZSFG; Allison Ishizaki, MPH, UCSF Office of Undergraduate Medical Education; Shannon Fogh, MD, UCSF Department of Radiation Oncology; Daphne Lo, MD, UCSF Department of Medicine, Division of Geriatric Medicine & SFVAHCS; Stephanie Rennke, MD, UCSF Department of Medicine, Division of Hospital Medicine; Kristin Casey, MA, UCSF Office of Undergraduate Medical Education; Patricia Ramirez, MPA, UCSF Office of Undergraduate Medical Education; Anna Chang, MD, UCSF Department of Medicine, Division of Geriatric Medicine & SFVAHCS

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Health Systems, Patient Care, Professionalism Category: Curriculum Development

Abstract: Purpose: Immersion Week is a curricular innovation to prepare early medical students to engage in the clinical workplace in defined roles on inter-professional teams to make authentic contributions to advance institutional systems improvement priorities. Background: Calls for reform of traditional medical education and a growing recognition that learners need different knowledge and skills to address the complex systems and clinical environments they face prompted the development of the UCSF SOM Bridges Curriculum. Methods: The Bridges Clinical Microsystems Clerkship (CMC) is the longitudinal, introductory clinical skills course for pre- clerkship medical students at UCSF. After lectures and small group workshops focused on quality improvement and patient safety topics, Immersion Week introduces first year students to clinical microsystems. Under the guidance of faculty coaches, students are oriented to inter-professional teams, the community served by the health system, and systems improvement needs of the clinical workplace. Local clinical and quality leaders present their institutional values and priorities. Students participate in curriculum related to the care experience, inter-professional communication, quality improvement, professionalism and professional identity formation. The curriculum helps prepare students to effect meaningful systems change before they are ready to do so through direct patient care. Student contributions to 76 projects across three health systems resulted in quality, safety, value, or care experience improvements and demonstrate the effectiveness of an intensive immersion week for early learners prior to health system improvement work. Discussion/Dissemination: Immersion Week will be presented as a Small Group Discussion at the 2018 WGEA meeting. Reflective Critique: Immersion Week is revised annually. Coaches asked for specific guidance for how to introduce first year students to health system clinical teams; students requested more opportunity to observe patients in their microsystem. Both changes were incorporated the next year.

69 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

70 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 54

A Novel Curriculum of Pediatric Emergency Medicine for Emergency Medicine Physician Assistants

Dina Wallin, MD, UCSF Department of Emergency Medicine, Division of Pediatric Emergency Medicine

Area(s) abstract covers: CME, Continuing education for Physician Assistants Domain(s) addressed: Curricular Innovation, Interprofessional Education, Patient Care Category: Curriculum Development

Abstract: Background: Physician assistant (PA) use in the emergency department (ED) is increasing, and a significant proportion of the patients PAs treat are children. However, currently no standardized curriculum in pediatric emergency medicine (PEM) exists for PAs. Purpose: I hypothesized that this two hour PA-specific session, consisting of rapid-fire visual diagnosis review, didactics, and case-based small group work, would increase learners’ understanding of PEM, not only immediately after the session, but also at six months. Methods: I e-mailed workshop registrants a 20 question Qualtrics pre-test 3 days prior to the session. I then sent the same quiz, with the question and response orders shuffled, the day after the session and again at six months. I recorded responses and analyzed them utilizing a rank sum test. Results: Fifteen PAs attended the session. Six completed the pre-test, 7 completed the immediate post-test, and 4 completed the 6 month post-test. The mean score on the pre-test was 74.2%, 97% on the immediate post-test, and 93.4% on the 6 month post-test, with mean improvements of 20 percentage points immediately after the session and 15 percentage points at 6 months; these improvements were statistically significant immediately after (p=0.04) but not at 6 months (p=0.11). Discussion: This novel PEM curriculum designed specifically for PAs significantly improved PEM knowledge, with sustained retention. I will submit the curriculum to MedEdPortal for dissemination. Reflective Critique: A low response rate sharply limits analysis of this project’s effectiveness. A monetary incentive, which I did not offer, may have increased response rate and data quality. Qualitatively, attendees enjoyed the session and emphasized a significant increase in perceived comfort in caring for pediatric patients in the ED. No questions were missed by a majority of respondents in either post-test, suggesting that the curriculum adequately covered all learning objectives.

71 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 59

Building an Emergency Medicine Boot Camp for Graduating Undergraduate Medical Seniors

Rosny Daniel, MD, UCSF; David Duong, MD, Highland Hospital; Esther Chen, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Curricular Innovation, Simulation Category: Curriculum Development

Abstract: Purpose: The Emergency Medicine (EM) Boot Camp is designed for 4th year med students in their final month of undergraduate education with the goal of preparing students for internship. Background: Boot camps, are short intensive training courses which have been proven to be an effective educational strategy in improving learners’ clinical skills and confidence prior to starting internship. We describe our experience designing an EM boot camp. Methods: We use the Kern framework for curriculum development to design and refine a boot camp that includes lectures, panels, low/high fidelity simulation and hands on procedures practice to teach approaches to common chief complaints, communication and procedural skills. We identified a gap in medical students’ readiness for intern year, surveyed our intended audience, developed educational goals and implemented innovative instructional strategies to achieve our goals. Results: More than 30 students have taken the EM boot camp over 3 years. They evaluated each individual session with surveys using a global rating scale as well as subjective feedback on their experience of the course as a whole. Using this feedback we've enhanced skills labs and changed formats of other sessions. This year learners will complete pre and post test questionnaires based on ACGME milestones to assess perceived abilities and confidence before entering intern year. We define a successful curriculum by improvement in learner’s self assessment regarding milestone achievement and level of confidence for beginning intern year in medical knowledge, communication, procedural skills and practice based performance improvement. Discussion: We plan to evaluate questionnaire responses to determine learners perceived abilities and confidence. We will communicate our results with a poster presentation mapping our design process and share curriculum on MedEd Portal. Reflective Critique: Through course feedback from learners and faculty, we have iteratively made enhancements and hope to continue to refine the curriculum to best serve our students.

72 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 67

Standardizing Learning for Fourth-Year Medical Student Medical Specialty Rotations: Prioritizing Content

Emily Abdoler, MD, UCSF; Karen Hauer, MD, PhD, UCSF; Brian Schwartz, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Other (please describe) Elective Education Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To determine priority Infectious Diseases (ID) topics for advanced medical students, which will be used to create an ID consult elective curriculum. Background Student learning during clinical electives is idiosyncratic and often defined by the cases students see. We aim to standardize learning during the ID elective by creating a supplemental curriculum that reinforces ID concepts important for all medical students, regardless of career choice. As no such list has been published, the first step is to identify these topics. Methods We conducted a modified, two-round Delphi process to develop consensus on ID topics all graduating medical students should know. The initial list included 16 topics generated via literature review for common diagnoses and High Value Care, and from the UCSF 49. Eighty-four expert educators from Internal Medicine, Family Medicine, Emergency Medicine, and Surgery rated topics' importance using a 5-point Likert scale. Items rated 3 (important) by at least 80% of participants reached consensus. Results Sixty of 84 (71%) educators completed round 1, and 48/60 (80%) completed round 2. Nine additional topics were proposed by first-round participants. After the second round, 14 topics met consensus. Many common conditions, several dangerous infections, and illnesses overrepresented in the local population met consensus. While many of the topics failing to meet consensus addressed rare conditions or those managed by subspecialists, some represented common illnesses. Discussion Standardizing medical student learning during elective rotations begins with identifying key topics. Our process included a diverse group of educators and achieved consensus. We will use this list to develop an ID elective curriculum, and we will describe our process as part of a curriculum toolkit for rotation directors. Reflective Critique We solicited feedback on our survey from experienced UCSF educators, which helped hone our research question. The survey itself serves as feedback, as three topics suggested by participants in round one ultimately met consensus.

73 Education Showcase 2018 Mini-oral Abstracts – May 1, 3-C

Abstract # 21

California’s Virtual Emergency Medical Services (EMS) Fellowship Consortium: One State’s Innovative Approach to Fellow Education

Mary Mercer, MD, MPH, UCSF; Katherine Staats, MD, Stanford University; Nichole Bosson, MD, MPH, UCLA; Joelle Donofrio, DO, UCSD; Shira Schlesinger, MD, UCLA; Clayton Kazan, MD, USC; John Brown, MD, MPA, UCSF; Alicia Loza-Gomez, MD, USC; Mark Eckstein, MD, USC; Marianne Gausche-Hill, MD, UCLA

Area(s) abstract covers: GME Domain(s) addressed: Curricular Innovation, Longitudinal Educational Activities, Mentoring Category: Curriculum Development

Abstract: Purpose: California EMS fellowships sought to develop an innovative method for expanding fellows’ exposure to protocols and educators outside their immediate programs. Background: Emergency medical services (EMS) Fellowships are growing in significance within the United States prehospital health care system, training physicians in evidence-based methods of EMS medical direction. While fellowships represent a cornerstone of EMS subspecialty education, an individual learner’s experiences are limited to the local EMS system’s practices. Methods: Each month, fellows, fellowship directors, and local EMS medical directors from throughout the state participate in a video conference. This four-hour meeting is divided into four distinct components: book chapter presentation, board-style question review, call review, and an EMS literature review. Each fellow, with oversight from his or her EMS faculty, is responsible for separate portions of the educational meeting, on a rotating basis. Fellows and affiliated medical directors are exposed to different protocol and system approaches in an interactive and accessible format. This partnership expands educational opportunities for fellows and promotes collaboration across EMS systems. Evaluation Plan: Fellowship directors will continue to track the rate of EMS subspecialty board exam passage by graduates of their programs. Additionally, they will elicit feedback from fellows, graduates and faculty to modify future curriculum content. Dissemination: A manuscript describing this novel curricular program has been submitted to a scholarly journal reaching emergency medicine educators. Additionally, program design has been shared as an abstract at the National Association of EMS Physicians national conference in January 2017.

74 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-A

Abstract # 13

Enhancing Pediatric Trainees’ Skills in Providing Gender-Affirming Care for Transgender Adolescents Using Standardized Patient Encounters

Stanley Vance, Jr., MD, UCSF; Brian Lasofsky, MSN, MSW, UCSF; Elizabeth Ozer, PhD, UCSF; Sara Buckelew, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME), GME Domain(s) addressed: Communication, Curricular Innovation, Standardized Patients Category: Curriculum Development

Abstract: Purpose: To augment a Trans Youth Curriculum by integrating standardized patient (SP) encounters targeting learners’ skills in caring for transgender youth. Background: Previously, our Trans Youth Curriculum, consisting of online modules and a clinic observation, improved knowledge (Vance et al, JAH 2017) and self-efficacy (Vance et al, Clin Teach in press). As our ultimate goal is aiding learners in attaining a higher level of proficiency in communication and skills in caring for transgender youth, we expanded the curriculum to include SP encounters. Methods: Target learners are 4th year med students, pediatric and psychiatry interns, and nurse practitioner trainees on an adolescent medicine block. After completing online modules, learners participate in 2, 20-minute formative SP encounters featuring transgender teens. Cases were developed with the Kanbar Center and feedback from transgender SP actors. Learners complete cases while observed by faculty. After each case, learners complete self-assessments and receive feedback from faculty and SP who both complete skills checklists. The SP encounter assessments are embedded within our broader curriculum evaluation plan. Learners have 4 assessments with measures evaluated: 1. pre-curriculum (demographics, knowledge, and self-efficacy), 2. post- modules (knowledge and self-efficacy), 3. during SP encounters (skills via self-assessments and checklists completed by faculty and SP actors), and 4. post-curriculum (self-efficacy and satisfaction). Results/Evaluation Plan: To date, 6 learners have participated in the expanded curriculum. After further data collection, changes in skills, knowledge, and self-efficacy will be measured. Improvement in each educational domain will suggest curriculum efficacy. Discussion/Dissemination: After evaluation, the expanded curriculum will be disseminated via manuscript submission for publication and submission to MedEd portal. Reflective Critique: This project has been informed by feedback from the Innovations Grant proposal process and journal manuscript review.

75 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-A

Abstract # 33

Enhancing Operative Feedback: A Descriptive Trajectory of Surgical Development in Otolaryngology

Nina Zhao, MD, University of California, San Francisco; Patricia O'Sullivan, EdD, University of California, San Francisco; Emily Huang, MD, MAEd, University of Chicago

Area(s) abstract covers: GME Domain(s) addressed: Feedback, Metacognition, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To determine how otolaryngology faculty describe surgical learning and to compare this model with a trajectory in general surgery. Background: Operative feedback is essential for surgical trainees, but current assessments provide little actionable information to learners. Recently, our group developed TAASE (Technician, Anatomist, Anticipator, Strategist, Executive), a descriptive model of surgical development to help educators provide more useful feedback. As TAASE was initially based in general surgery, its relevance to other specialties was unclear. Methods: Ten otolaryngology educators participated in semi-structured, recorded interviews. Using constructivist grounded theory, we coded the transcripts and identified themes within the data. Co-occurrences of codes were examined to determine alignment of skills and developmental stages. We then compared the results to a developmental model in general surgery. Results: Otolaryngology faculty characterized surgical development as an integrated and continuous trajectory of technical and cognitive skills progressing from specific operative tasks to a global understanding of patients and procedures. Novices developed basic technical skills and anatomical knowledge whereas senior trainees focused on operative flow and decision-making. Compared to general surgery, otolaryngology faculty tended to emphasize expertise as a comprehensive approach to the operation and patient experience, versus a state of intuitive intraoperative flow. Discussion: Surgical development is a continuous process that can be described as a trajectory. Otolaryngology and general surgery faculty agree upon a common arc to maturity, but slight differences in characterization of expertise may reflect unique specialty cultures. Our findings corroborate the TAASE trajectory, suggesting that TAASE may be a useful tool for providing intraoperative assessment in otolaryngology. Reflective Critique: We have solicited both internal and external feedback, including a manuscript submission, all have which informed the presentation of this work.

76 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-A

Abstract # 35

National Trends in Internal Medicine Resident Applications to Subspecialty Fellowships

Lekshmi Santhosh, M.D., UCSF; Harry Hollander, M.D., UCSF; Patricia Cornett, M.D., UCSF; Jennifer Babik, M.D., Ph.D., UCSF

Area(s) abstract covers: GME Domain(s) addressed: Career Choice, Residency Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: We examined the trend in internal medicine resident applications to subspecialty fellowships over the last 10 years. Background: Since the term “hospitalist” was coined in 1996, hospital medicine has become larger than any of the internal medicine subspecialties. The impact of this new field on resident career choice, in particular the decision to pursue fellowship in a medical subspecialty, remains unclear. Methods: We examined 10 years (2009-2018) of National Resident Matching Program data for internal medicine subspecialty fellowship match applicants. To calculate the percentage of third year internal medicine residents (R3s) applying into subspecialty medicine, we used the number of applicants divided by the number of R3s graduating in that same year, which was obtained from the American Board of Internal Medicine (ABIM). Statistical analysis of trends was performed using linear regression using Prism. Results: The total number of matched fellowship applicants increased significantly over time from 2889 applicants in 2009 to 4087 applicants in 2018 (r2=0.95, p<0.0001) All subspecialties, except Nephrology & Infectious Diseases, saw a statistically significant increase in matched applicants over time. The total number of applicants remained relatively stable (r2=0.42, p=0.06). Through this same time period, the number of total positions offered showed a significant and linear increase from 3034 positions in 2009 to 3863 positions in 2017 (r2=0.99, p<0.0001). Final results are pending 2017 ABIM data. Discussion: The number of matched applicants to subspecialty fellowships within internal medicine has increased over the last decade for all subspecialties expect nephrology & infectious diseases. This increase in number of matched applicants seems to come in part from an increase in the number of positions being offered in the match, as the total number of applicants was relatively stable over time. We are preparing a manuscript for submission. Reflective Critique: This study did not examine reasons for career choice; further studies will focus on this.

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Abstract # 52

Narrative Practices Among Global Health Fellows: A Needs Assessment for Future Curriculum Development

Zachary Jacobs, MD, UCSF; Robin Tittle, MD, MS, OHSU; Joseph Scarpelli, MPH, UCSF; Karen Cortez; Sriram Shamasunder, MD, DTM&H, UCSF

Area(s) abstract covers: GME, CME, inter-professionalism Domain(s) addressed: Curricular Innovation, Global Health, Interprofessional Education, Medical Humanities Category: Curriculum Evaluation/Educational Research

Abstract: PURPOSE The goal of this study was to assess the reflective writing practices and need for narrative training among current global health fellows. BACKGROUND Delivering healthcare in resource-limited settings can be isolating and challenging. Teaching narrative skills to healthcare providers can promote resiliency, and global health is a potential niche that has not been explored. In an inter-professional global health fellowship at our institution, fellows are encouraged to blog about experiences but have limited formal narrative training. METHODS We surveyed fellows electronically on interest in narrative training, reflective practices, barriers to reflection, and attitudes toward global health (via 5-point Likert scale). We also conducted a deductive content analysis of fellows’ blog posts written from 2013-2017. Blogs were coded by a single reviewer for 1 major and ≥1 minor themes (using a codebook of 8 common healthcare themes), as well as presence/degree of emotional disclosure. RESULTS Survey response rate was 33/61 (54%). Twenty-nine (88%) reported interest in narrative training, while only 15% endorsed writing reflectively at present. Common barriers were time (64%), lack of skill (52%), and lack of topic (27%). Global health was rated as frustrating (avg. 3.3 / 5), emotionally exhausting (avg. 3.8 / 5), and isolating (avg. 3.6 / 5). Among 31 blogs, healthcare disparities was the major theme in 18 (58%). Most common minor themes were advocacy (58%) and humanism (29%). Only 33% featured emotional disclosure. DISCUSSION Here we demonstrate a need for further training in reflective practices among global health fellows, with 9 in 10 expressing interest, and less than 1 in 6 writing regularly. In a review of fellows’ blogs, disparities, advocacy, and humanism accounted for the majority of themes, and emotional disclosure was rare. Future curricula should focus on overcoming barriers, broadening thematic content, and emboldening emotional disclosure/introspection. REFLECTIVE CRITIQUE Based on feedback from colleagues, a second reviewer is now analyzing the reflections.

78 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-A

Abstract # 53

Development and Implementation of Milestone-based Post-Shift Assessment Cards for Real-Time Feedback to Pediatric Emergency Medicine Fellows

Dina Wallin, MD, UCSF Department of Emergency Medicine, Division of Pediatric Emergency Medicine; San Tat, MD, MPH, UCSF Department of Emergency Medicine, Division of Pediatric Emergency Medicine; Evelyn Porter, MD, MS, UCSF Department of Emergency Medicine, Division of Pediatric Emergency Medicine; Shruti Kant, MD, UCSF Department of Emergency Medicine, Division of Pediatric Emergency Medicine

Area(s) abstract covers: GME Domain(s) addressed: Assessment and Testing, Communication, Competencies, Feedback Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To develop and implement a structure for trainees in Pediatric Emergency Medicine (PEM) to receive real-time, useful, and Milestone-based feedback. Background: In 2014, the Accreditation Council for Graduate Medical Education introduced the PEM Milestones, a collection of 23 competencies for use as markers of progress in training. Milestone reporting and feedback delivery are programmatic requirements for trainee development and assessment. Currently there is no literature on effective use of PEM Milestones. Our PEM fellowship struggles with both meaningful use of Milestones and real-time, actionable feedback delivery to fellows. Here we address both problems by building on the concept of feedback cards, which have been successfully used in emergency departments, by developing and implementing PEM Milestone-based feedback cards. Methods: We selected 11 PEM Milestones particularly amenable to end-of-shift completion, addressing such competencies as communication and team leadership. We printed each Milestone onto notecards, with space on the opposite side for free text comments. Five fellows and 13 faculty were trained via a 10 minute didactic on the intervention. The study started in July 2017 and will conclude in June 2018. At the beginning of their shift, PEM fellows select a Milestone card on which they would like to be observed. At the end of the shift, the faculty and fellow complete the card together; the collated cards are then shared with the fellow and referenced during the fellow’s semi-annual assessment. Evaluation Plan: When the study concludes, we will survey fellows and faculty, assessing usability of the PEM Milestones as a framework for feedback, acceptability of notecards, and frequency and quality of feedback delivered. Dissemination: If successful, we will implement this process at other sites and institutions. We plan to submit results to Journal of Education & Teaching in Emergency Medicine. Reflective Critique: Members of ESCape and the EM Education Works in Progress group gave feedback that informed study design and evaluation.

79 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-A

Abstract # 65

A needs assessment: Pediatric residents are expected to be competent in neonatal intubations, how are we facilitating this in the face of dwindling clinical opportunities for them to intubate?

Heather Briscoe, MD, ZSFG; Valerie Gribben, MD, ZSFG

Area(s) abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance, Competencies, Curricular Innovation, Feedback Category: Curriculum Development

Abstract: Purpose: A needs assessment of trainee confidence and competence in the challenging skill of newborn airway management Background: ACGME requires pediatric residents to be competent to intubate newborns despite declining opportunities as cited in the literature. At ZSFG, we are implementing the use of a video laryngoscope (C-MAC) and took this occasion to evaluate resident education. Methods: We conducted a literature review on PubMed and MeEd Portal. We then surveyed all pediatric residents and chiefs. We inserviced nurses and all third year pediatric residents on C-MAC and began using C- MAC recordings in the simulation lab for debriefing. We will repeat the same survey this May to see if familiarity with C-MAC impacted resident confidence and intubation opportunities. We will also review patient records to evaluate adverse outcomes and number of intubation attempts per successful intubation. These findings will guide the new curriculum launching this fall. Results: 52 out of 80 residents (65%) responded to the survey. 88% of all responding residents were uncomfortable with their intubation skills. 82% R2/R3 residents indicated that over the past year, they performed NO intubations. 100% of R3 residents indicated they were uncomfortable allowing more junior trainees the opportunity to intubate. Once the new curriculum is implemented, we would like to evaluate it with a procedural assessment tool, and a self-efficacy index based on the work of Bandura. Discussion: The lack both confidence and competence in neonatal intubation makes it imperative we make the most of every learning opportunity. We anticipate a combination of teaching modalities in a curriculum including real- time feedback during intubations and debriefing in simulation to help address both skill and emotions related to intubation. There is much new research we can build on in this endeavor. Reflective Critique We presented our WIP at the APA conference to solicit feedback, and are similarly submitting this abstract to engage in dialogue with scholars of the region.

80 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 03

An Online Spaced Education Curriculum for Obstetrics and Gynecology Third-year Clerkships

Ashleigh Nelson, BS, UCSF; Jeannette Lager, MD, MPH, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Competencies, Computers and Technology, Curricular Innovation Category: Curriculum Evaluation/Educational Research

Abstract: PURPOSE To evaluate whether a spaced education curriculum enhanced the learning of OB/GYN core clerkship material in third-year medical students. BACKGROUND We previously piloted a spaced education curriculum with Longitudinal Integrated Clerkship students, which showed improvement in shelf scores of participants vs. non-participants. This study expands upon that program by focusing on traditional clerkship students. METHODS A 30-question spaced education curriculum based on clerkship learning objectives via the Qstream platform was offered to 90 third-year medical students during their OB/GYN clerkship. Measured outcomes included shelf scores, participation, and curriculum usefulness. Exam scores were inter-compared with Student’s T-tests and against participation using least squares linear regression. An end-point survey was used to evaluate student attitudes toward the curriculum. RESULTS Sixty-one percent of students participated in the curriculum. There was no difference between exam scores of participants vs. non-participants (p=0.97). Participation scores did not correlate linearly to participant’s exam scores (r= -0.116 p= 0.399). 100% participants who completed our survey found the curriculum to be useful to their learning. DISCUSSION Most students participated in the curriculum, and all survey respondents found it was useful to their learning. Although there was no difference between shelf scores of participants and non-participants, the use of outside study resources and small sample size likely affected those data. Our findings will be presented at the 2018 CREOG/APGO meeting. We will collect data for the remainder of the academic year. REFLECTIVE CRITIQUE Feedback was elicited at the end of each clerkship, and updates were continually made as suggestions were received. The curriculum is evaluated and edited at the end of each academic year, and we will write five additional questions. We are considering using the final clerkship grade or USMLE Step 1 score as outcomes, but confounding variables and privacy issues may affect these measures.

81 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 14

Getting outside the box: Exploring role fluidity in interprofessional student teams using activity theory

Laura Byerly, MD, UCSF Division of Geriatrics; Bridget O'Brien, PhD, UCSF Center for Faculty Educators

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Interprofessional Education, Patient Care, Research Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: Explore team and learning environment factors that shape role fluidity in interprofessional (IP) student teams. Background: IP teamwork literature portrays roles as static and clearly definable while also suggesting that role flexibility can enhance team functioning. Both likely carry some truth and providing optimal training in IP teamwork requires a better understanding of the team factors influencing the dynamic nature of professional boundaries (role fluidity). Methods: We conducted an exploratory activity theory (AT)-based case study. AT provides in-depth analysis of system components (tools, division of labor, rules and community) and how their interactions impact outcomes. We studied the fluidity of one physical therapy (PT) student’s role within 3 different IP teams of medical (MD) and pharmacy (PH) students completing patient care plans during a geriatrics elective. We collected and coded field notes from observations, group interviews, and care-plans for AT components, mapped team-specific activity systems, then compared role-influencing interactions and tensions across teams’ activity systems. Results: PT’s role boundaries varied in each team’s activity system, influenced primarily by team use of tools (e.g., computers), implicit rules (e.g., encouraging questions or focus on efficiency) and community (e.g., MD/PH actions). In teams with collaborative tool use, rules, and community, PT exhibited both positive expertise-based and broader medical/psychosocial roles; contrastingly, divisiveness or tensions in tool use/rules/communities restricted PT’s role to one of professional expertise. Interviews and care-plans suggested better team learning experiences and more comprehensive plans when PT’s role was fluid. Discussion: Facilitating modifiable team factors, such as team tool use and explicit rules, and encouraging positive learning communities could foster role fluidity allowing for improved collaborative IP learning environments. Reflective Critique: Feedback at ESCape helped us clarify the purpose of our study and the problem it addresses.

82 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 28

Mapping Interprofessional Communication during Intensive Care Unit to Ward Transitions

Shire Beach, BS, UCSF School of Medicine; Lekshmi Santhosh, MD, UCSF Department of Medicine, Division of Pulmonary and Critical Care Medicine

Area(s) abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance, Communication, Patient Care, Quality Improvement Category: Curriculum Evaluation/Educational Research

Abstract: Objective: Map communication during ICU-ward transfers across three UCSF sites. Background: Transitions of care pose a risk to patient safety. Starmer’s 2014 I-PASS study demonstrated that implementation of a handoff protocol decreased medical errors. One prior study identified broad domains of communication errors during intensive care unit to ward (ICU-ward) transfers. ICU-ward handoffs across hospital sites nationally and within the University of California-San Francisco (UCSF) system, however, are not standardized. Methods: Key stakeholders in the ICU and on the wards, including resident physicians, nurses, and administrators, were interviewed regarding the typical handoff practices during ICU-ward patient transfers. These data were visually represented using process mapping. Results: ICU-ward handoff communication is highly variable across UCSF sites. Verbal communication between ICU and ward residents, for example, is a consistent feature of transfers at sites with closed but not open ICUs. Furthermore, verbal communication at the resident level is variably conducted depending on site, with face-to- face handoffs expected at certain hospitals but phone handoffs routinely conducted at others. Nursing communication practices are more standardized with verbal handoffs between ICU and ward bedside nurses consistently conducted at all sites. Discussion: Mapping ICU-ward transfer communication demonstrates the heterogeneity of this process within our institution. While nurses have an established handoff protocol, resident physicians do not. Next steps include a needs assessment of ICU-ward transfers and evaluating ICU readmissions data. This work will facilitate development and implementation of a handoff protocol aimed at optimizing resident education and patient safety. Reflective Critique: This focused project is part of a larger effort aimed at developing a novel ICU-ward handoff protocol that will improve patient safety. It has been presented and discussed at local and national internal medicine and medical education conferences.

83 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 38

The Impact of Perspective-Taking on Moral Distress in the Pediatric Intensive Care Unit

Katie Kowalek, MD, UCSF; Sandrijn van Schaik, MD, PhD, UCSF

Area(s) abstract covers: GME, CME Domain(s) addressed: Communication, Interprofessional Education, Professionalism Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To examine moral distress among physicians and nurses and the impact of perspective-taking on moral distress. Background: When caring for patients, healthcare professionals may experience ethical dilemmas but perceive constraints that prohibit inhibit them from providing the care they feel is ethically sound. This phenomenon is called moral distress. Interprofessional disagreements about care are a root cause of moral distress and are likely in the pediatric intensive care unit. Perspective-taking can rouse empathetic concern for others and may decrease moral distress. Methods: We conducted a study among pediatric critical care physicians and nurses at two academic medical centers using a fictional patient scenario and a modified Moral Distress Scale-Revised (MDS-R) survey (scale 10- 50) in an online platform. After reading the scenario, participants completed the MDS-R, then reviewed the perspective of the other profession, and completed the MDS-R again. We used unpaired t-test to compare nurse to physician moral distress and paired t-test to compare the pre- and post-perspective MDS-R scores. Results: Of 351 people contacted, 169 accessed the survey and 139 (104 nurses and 35 physicians) completed the survey. Nurses experienced higher baseline moral distress than physicians (mean ± standard deviation 31.1±6.9 vs 29.8±7.5, P<0.007). Nurses demonstrated a small but significant decline in moral distress in response to the physician perspective. There was no change in moral distress in physicians. Discussion: Consistent with prior studies, nurses experience higher moral distress than physicians. Perspective- taking appears to mitigate moral distress, which may have implications for possible interventions. Ongoing studies will explore how this translates to real life. Reflective Critique: Feedback from Health Professions Education and Simulation and Scholarship work in progress meetings informed changes made to abstract and future portions of this study.

84 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 56

Editing Wikipedia for Medical School Credit – Analysis Across 4 US Medical Schools

Mihir Joshi, UC Berkeley Undergraduate, UCSF Research Assistant; Bryant Ho, UC Berkeley Undergraduate, UCSF Research Assistant; Aparna Manocha, UC Berkeley Undergraduate, UCSF Research Assistant; Anthony Sanabria, UC Berkeley Undergraduate, UCSF Research Assistant; Sanskriti Saxena, UC Berkeley Undergraduate, UCSF Research Assistant; Amin Azzam, MD, MA, Clinical Professor - UC San Francisco, UC Berkeley; Simulation Educator - Samuel Merritt University

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Communication, Computers and Technology, Evaluation of Programs Category: Curriculum Development

Abstract: Purpose: Four US medical schools offer credit-bearing Wikipedia editing assignments or courses. These enable students to expand open-access health information, collaborate with peers, and simplify technical information. We sought to 1) monitor the growth of such courses, 2) build tools to aid these programs, and 3) assess impact on students. Background: The UCSF School of Medicine is the first health professional school to offer a month-long elective to edit Wikipedia’s medicine-related content. We now encourage and guide the development of similar programs. In 2017, 3 additional US medical schools (Rush Medical College, University of Central Florida, and the Medical University of South Carolina) created Wikipedia editing courses or assignments. These courses use a customizable dashboard designed by the Wiki Ed Foundation to create courses, assign student work, and monitor student progress. Methods: We analyzed the dashboards across all US medical school courses to assess their impact on Wikipedia. Course dashboards include metrics such as numbers of edits, pages edited, words and images added, and pageviews during the active dates of the course. Results: In total 130 medical students completed credit-bearing Wikipedia editing assignments in the 2017-18 academic year. Students were in the summer between their MS-1 and MS-2 academic year or were MS-4’s. Ranges across the courses include the following: number of students (6 - 54), edits per student (128 - 1420), pages edited (3 - 36), words added (6,320 - 61,200), images added (0 - 14), course duration (4 - 9 weeks), and pages viewed during the course (44,300 - 1,380,000). Students’ perspectives on Wikipedia quality and the importance of improving free- access health information have universally been positive. Dissemination: Tracking metrics and instituting learning modules through the WikiEd dashboard has improved student and faculty experiences. We have submitted these results to both the AAMC and AMEE annual meetings. Reflective Critique:

85 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

We have launched a national survey to identify best practices in Wikipedia-editing as a teaching and learning strategy in medical schools.

86 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 62

A Novel Half-Day Serious Illness Communication Workshop for UCSF Medical and Nursing Students

Brook Calton, MD, MHS, UCSF; Lynnea Mills, MD, UCSF; DorAnne Donesky, NP, UCSF; Wendy Anderson, MD, UCSF; Cindy Lai, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME), GME Domain(s) addressed: Communication, Interprofessional Education, Patient Care, Standardized Patients Category: Curriculum Development

Abstract: Purpose: To develop a ½-day workshop for 3rd-year medical students and 1st-year advance practice nursing students to learn and practice serious illness communication (SIC) skills. Background: Health professional trainees report insufficient education and feedback, along with low confidence, in SIC. Role play can improve learners’ confidence and communication skills (Berkhof 2011). Methods: We conducted a qualitative and quantitative needs assessment of our target audience. Based on the results, we developed a ½-day didactic and experiential workshop led by Palliative Care/Geriatrics fellows and faculty. During the workshop, students attend a 90-minute interactive session to review advance care planning concepts/tools, learn a 5-step SIC framework, and participate in role play. Each student then interviews a standardized patient (SP) with serious illness and observes a peer (20 min/SP). In these encounters, students are asked to learn about their SP’s life and discuss prognosis/treatment preferences. Students receive verbal and written SP and peer feedback and then debrief as a group. Results: The curriculum launched Spring 2016. The response rate to a survey of pilot participants was 86% (48/56). 98% (n=47) would recommend the workshop to peers; 98% reported the workshop improved their confidence eliciting a seriously ill patient’s goals/values. Curriculum strengths included the opportunity to learn and directly apply a SIC framework with SPs. Areas for improvement included requests for more SP time and a shorter debrief. We will be implementing a more extensive evaluation in the future. Discussion/Dissemination: The workshop was well-received by participants and is integrated into the Medicine and Nursing curriculums. Reflective Critique: Pilot participants were surveyed for their impressions; informal debriefs are done with all workshop facilitators. Feedback is continually incorporated. Berkhof M et al.. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011 Aug;84(2):152-62.

87 Education Showcase 2018 Mini-oral Abstracts – May 1, 4-B

Abstract # 69

Using Virtual Reality to Improve Care of the Critically Injured

Cortlyn Brown, MD, UCSF; Devika Patel, BS, ZSFG; Amanda Sammann, MD, ZSFG; Toff Peabody, MD, ZSFG

Area(s) abstract covers: GME Domain(s) addressed: Curricular Innovation, Interprofessional Education, Leadership , Patient Care Category: Curriculum Development

Abstract: Purpose: Each trauma team that assembles is ad-hoc - coming together from different specialties. Therefore, team members have little understanding of others' priorities and roles. " We plan to develop modules that use 360-degree video from different perspectives (e.g. the nurse, emergency physician/surgeon). " We will use human-centered design methodology to create, implement, and evaluate a leadership curriculum for residents participating in trauma activations. Background: Virtual Reality (VR), which is frequently used in medical education, is limited in that uses a computerized replication of an environment; however, 360-video, allows videos of actual clinical events. Methods: Interventions: 1) Residents will watch a 360-video scripted trauma resuscitation with motion graphics overlays (ex. the words "this is closed loop communication"). 2) They will then watch 360-videos of real trauma resuscitations with similar motion graphics. 3) After the videos, the resident will debrief. Results/Evaluation Plan: Staff will evaluate the resident running an actual trauma resuscitation with the Trauma Team Performance Observation Tool (TTPOT) pre- and post-intervention. This is a well-validated scoring system that assesses team performance in the following categories: leadership (empowerment of team members), situation monitoring (involvement of the patient), mutual support (timely and constructive feedback), and communication skills (clear information, check-backs, and safe handoffs). Staff will record speed of completion and completeness of the major Advanced Trauma Life Support steps. We will control for injury severity score and look at the outcomes of hospital length of stay and mortality in relationship to the TTPOT. To evaluate the intervention we will calculate means, standard deviations, and p values. Discussion/Dissemination: Poster, oral, manuscript. Reflective Critique:

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1) Human-centered design needs assessment with anesthesia, nursing, surgery, and EM on video content and assessment tools. 2) Presentation to Quality Improvement Committee.

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Abstract # 15

Clerkship Grading Committees: What is the Value Added?

Annabel Frank, University of Pennsylvania; Lynnea Mills, MD, UCSF; Patricia O'Sullivan, EdD, UCSF; Virginie Muller-Juge, MSc, University of Geneva; Karen Hauer, MD, PhD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Assessment and Testing, Clinical Instruction and Performance, Competencies, Faculty Development Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: The study explores how UCSF clerkship grading committees synthesize information and make decisions, and identifies their potential benefits and challenges. Background: The accuracy of clerkship grades is debated, and methods for assigning grades vary across and within institutions. Workplace assessments and grades are subject to biases and may lack validity. Group decision-making may improve the process of interpreting assessments. In 2016, UCSF School of Medicine began requiring core clerkships to utilize grading committees with at least three faculty educators. Methods: This qualitative study uses semi-structured interviews with clerkship directors and up to two other committee members. Interviews are recorded, transcribed, and analyzed with Dedoose software using content analysis with sensitizing concepts. Results: We interviewed 14 faculty members with several pending. Preliminary results show all committees focus their discussion on students on the Honors/Pass border. Each committee weights narrative comments, scores, and RIME adjectives differently. Grade decisions are especially difficult when comments are sparse or non-specific, and when there is discrepancy amongst evaluators. Across clerkships, professionalism issues are considered red flags. Committees are concerned about how unconscious bias related to race, gender, and personality impacts evaluations, yet uncertain about solutions. Interviewees express confidence in their committees’ shared mental models of Honors students although they rely on evaluator adjectives and normative comparisons. They believe their committees facilitate fair, consistent grading but recognize ongoing challenges to making decisions based on “imperfect information.” Discussion: Improving validity of methods to judge student performance represents an important target for future work. Further data collection and analysis may indicate themes related to specialty. We will share results locally and in a peer-reviewed journal. Reflective Critique: We are scheduled for a UCSF ESCape consultation to solicit feedback.

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Abstract # 18

Breaking the curve: moving from normative to criterion-based grading on neurology clerkship

E. Alexandra Brown, MD, UCSF; Nina Garga, MD, UCSF; Megan Richie, MD, UCSF; Nilika Singhal, MD, UCSF; Audrey Foster-Barber, MD, UCSF; Vanja Douglas, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Assessment and Testing, Competencies, Feedback Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: We developed a criterion-based grading system for our neurology clerkship. Background: Clerkship grades are often based on rank amongst peers rather than the achievement of objectives. Criterion-based grading may improve transparency. Methods: To establish face and content validity we used a modified Delphi method in 3 rounds involving 27 neurology faculty and residents to achieve consensus that 17 statements describing specific observable behaviors across 7 competencies effectively differentiate honors from passing performance. The authors performed 5 cognitive interviews to assess interpretation and narrow to 13 items. Each item on the pilot and standard evaluations consists of 4 performance-based statements (2 are non-passing, 1 describes the minimum competency, and 1 describes honors; each is scored on a 1 to 4 point scale). Next, during 2 clerkship cycles, 28 of 48 attendings and residents completed the pilot and standard evaluations, totaling 47 evaluations of 16 students; 26 recommended honors, 19 recommended pass, 1 recommended fail, and 1 did not state. Results: Internal consistency of both evaluations was high (Cronbach’s alpha 0.90 and 0.96 for the pilot and standard, respectively). The pilot mean was 3.55 (SD 0.35); the standard mean was 3.67 (SD 0.34). The correlation between pilot and standard scores was high (R2 0.81 (p<0.001). The correlation between the mean score and recommendation for honors was high for both the pilot and standard evaluations (R2 0.52 [p<0.001] and 0.58 [p<0.001], respectively). Discussion: These results suggest scoring is similar between the pilot and standard evaluations and that both correlate with honors recommendations. The pilot evaluation has the advantage of neurology-specific, observable, behavior descriptions, allowing for the development of honors criteria that may increase grading transparency. Reflective Critique: We presented this work at ESCape; feedback led to faculty development materials as well as posting the grading form onto the clerkship website for incoming students to review.

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Abstract # 37

Test-Enhanced Learning in a Therapeutics Course

Jaekyu Shin, PharmD, School of Pharmacy; Katherine Gruenberg, PharmD, School of Pharmacy

Area(s) abstract covers: Pharmacy education Domain(s) addressed: Assessment and Testing Category: Curriculum Evaluation/Educational Research

Abstract: Purpose To determine whether increasing the number of graded written assessments results in greater median examination scores in a pharmacy therapeutics course and to determine students’ perceptions and preferences with a greater number of written assessments. Background Practice testing improves academic performance and knowledge retention compared to reviewing or summarizing learning materials before an assessment. However, it is unclear whether graded written assessments also enhance learning. Methods This was a prospective study of second year pharmacy students enrolled in a therapeutics course with four written graded exams in 2017. A historical control group, who completed the course in 2016 with 2 written graded exams, was used to compare the change in median exam score during the course. Students in the 2017 cohort completed a survey about their perceptions and preferences with a greater number of graded written assessments. Results The first assessment score was comparable between the both cohorts. The median score of the last assessment in the 2016 cohort was not significantly different from that of the first assessment (76.7% vs. 76.9%, respectively), however the median assessment score on the last exam in the 2017 cohort increased significantly from the first assessment (84.0% vs. 76.9%; p<0.0001). Of 119 students in the 2017 cohort, 110 (91.6%) completed the perceptions survey. More than 90% of students preferred having more than two assessments in a therapeutics course and over 80% reported improved time management skills and reduced stress and test anxiety with more assessments. Discussion Our data suggest that increasing the number of graded written assessments in a therapeutics course may enhance student academic performance, improve time management skills, and reduce stress and test anxiety. To maximize test-enhanced learning, educators may consider the timing of assessment feedback, types of assessment questions, and overall academic workload. Reflective critique We have incorporated feedback on design and feasibility from pharmacy faculty.

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Abstract # 40

Aha! Moments: Breakthroughs in learning lumbar punctures and implications for instruction

Shruti Kant, MBBS, UCSF Department of Emergency Medicine; Ellen Laves, MD, UCSF Department of Pediatrics; Bridget O'Brien, PhD, UCSF Department of Medicine

Area(s) abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance, Metacognition, Other (please describe) Procedural education Category: Curriculum Evaluation/Educational Research

Abstract: Purpose: To elucidate the characteristics and catalysts of “Aha! Moments” as recalled by lumbar puncture (LP) experts. Background: Procedural competence requires knowledge of behavioral steps and cognitive schema formation. Pediatric residents are not achieving competence in pediatric LPs, despite multiple instructional approaches. This may be due to a focus on behavioral steps, with little attention to cognitive schema development. To address this deficit we need to better understand the process by which learners develop LP cognitive schema. Our study explores “Aha! Moments”, defined as moments of insight associated with rapid schema formation followed by sudden performance improvement, in order to understand the components that catalyze LP cognitive schema formation. Methods: Using a constructivist grounded theory approach we explored the “Aha! Moment”. We conducted semi-structured interviews with a purposeful sample of subject matter experts from pediatric emergency medicine, neonatology and pediatric hospital medicine. We iteratively collected and analyzed data, identifying themes through a process of constant comparison. Results: We interviewed 15 experts, 8 of whom recalled a past “Aha! Moment”. Respondents described crystallization of 3 key concepts - angulation, anatomy, and patient positioning – which when integrated into a schema characterized an “Aha! Moment”. “Aha! Moments” were catalyzed by reduction in physical and mental barriers, and use of new strategies to improve situational awareness. Experts described sedated patients and supportive instructors as aids to reducing physical and mental barriers. Discussion: Understanding and integrating key concepts into schema is critical to achieving competency in pediatric LPs. Instructional approaches that facilitate schema development alongside the behavioral steps have potential to improve resident competency in LPs. Reflective Critique: CFE instructors and the Simulation WIP group provided feedback that informed study design, interviews and abstract writing.

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Abstract # 61

Re-imagining clinical skills: longitudinal integration of first year medical students in interprofessional teams for meaningful systems improvement

Daphne Lo, MD, MAEd, University of California San Francisco; Stephanie Rennke, MD, University of California San Francisco; John Davis, MD, PhD, University of California San Francisco; Susannah Cornes, MD, University of California San Francisco; Shannon Fogh, MD, University of California San Francisco; Margaret McNamara, MD, University of California San Francisco; Anna Chang, MD, University of California San Francisco; Edgar Pierluissi, MD, University of California San Francisco

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Curricular Innovation, Health Systems, Quality Improvement Category: Curriculum Development

Abstract: Purpose Integrate systems improvement (SI) and interprofessional teamwork in pre-clerkship medical education. Background The Institute of Medicine calls for improved health systems, yet preclinical learners are overlooked as potential change agents. The UCSF Clinical Microsystems Clerkship (CMC) introduces MS1s and MS2s as health systems partners engaged in SI. Methods Following Kern’s six steps for curriculum design, review of UCSF’s pre-2016 curriculum revealed minimal formal pre-clerkship SI teaching. Cognitive learning theory informed SI curriculum creation with step-wise instruction and work-based SI learning. Small groups of Class of 2020 MS1s are embedded in microsystems in one of three health systems. Content experts and 28 faculty coaches provided foundational SI knowledge. Students reinforced and practiced their knowledge and skill by designing, implementing, and evaluating SI projects under coach and interprofessional team guidance. SI skills were assessed using two instruments: the QIKAT and SIT (systems improvement template). Results All Class of 2020 students (n=150) completed CMC completed the QIKAT and SIT, and presented 83 SI projects to classmates, faculty, interprofessional staff, and SI leaders in Fall 2017 at poster symposia. Discussion/dissemination Creating and integrating SI knowledge and skills into pre-clerkship learning resulted in new, mutually beneficial relationships between the medical school and health systems. Various elements of the CMC curriculum will be disseminated in regional AAMC and SGIM meetings and student projects have won Clinical Innovation prizes. Reflective Critique Evaluations shaped curricular improvement including a new introductory SI didactic series and aligning student projects with systems priorities.

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Abstract # 71

The Development of an EPA-Based Simulation Curriculum for Sub-Interns

Sneha Daya, MD, UCSF

Area(s) abstract covers: Medical Student Education (UME) Domain(s) addressed: Competencies, Feedback, Patient Care, Simulation Category: Curriculum Development

Abstract: Objectives: To 1) create a simulation-based curriculum for medical students surrounding commonly encountered ward scenarios 2) implement and evaluate this curriculum with fourth year medical students, and 3) develop and utilize a new EPA-based competency method. Background: Few opportunities exist that allow for supervising residents and attending physicians to directly observe medical student clinical management abilities. Medical students go on to residency without receiving feedback on their autonomous medical decision-making strategies, especially in acute situations. The Association of American Medical Colleges (AAMC) has developed a list of Entrustable Professional Activities (EPAs) that medical students should achieve before entering residency. These EPAs have yet to be utilized in the simulation setting to assess competence in clinical management. Methods: Fourth year medical students will lead the triage and management of acute clinical situations. Examples of cases include septic shock, arrhythmia, and acute myocardial infarction. Learners will be evaluated using an EPA-based checklist, and real-time feedback will be guided by EPAs. Evaluation: We will solicit feedback from the students throughout the curriculum. We will collect validity evidence throughout the development of the assessment tool, which will be similar to an Objective Structured Clinical Exam (OSCE). Dissemination: Once the assessment tool is validated, we will introduce it to other institutions and tailor it to GME level residency EPAs. We will present our findings during national meetings and via publication. Reflective Critique: In a pilot session, students reinforced the need for this evaluation by unanimously agreeing that they do not receive enough feedback based on direct observation. All participants agreed that this curriculum should be offered longitudinally in order to practice clinical skills and receive feedback on management strategies. The plan is to offer sessions every month to students in order to build upon clinical knowledge and encourage autonomy in medical decision-making.

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