UCSF Education Showcase 2016
Welcome ...... 1 Showcase Schedule ...... 2 Speaker Biographies ...... 6 Cooke Award ...... 7 Workshops April 3 ...... 8 Workshops April 4-5 ...... 13 Plenary Abstracts ...... 17 Mini Oral Presentation Abstracts ...... 23
UCSF Education Showcase 2016
Welcome to UCSF Education Showcase 2016
Dear Friends,
On behalf of the Center for Faculty Educators, we are proud to present the fifteenth annual Education Showcase, an event that highlights the scholarly work in education of UCSF faculty, learners and staff. This year’s Showcase is the inaugural production of the Center resulting in a robust program for all to enjoy. The showcase includes a pre-event day of workshops for Teach for UCSF Certificate scholars, April 3, and spans two campus locations, Mission Bay on April 3-4 and Parnassus on April 5.
Scholarly presentations address questions and innovations in health professions education. Following a blinded peer review of all submissions, the Academy’s Scholarship Committee selected six plenary presentations based upon their quality and collective relevance to the audience of educators. Forty one presentations will be presented as mini-oral presentations replacing the poster format. We piloted this approach last year and enjoyed the engagement and dialogue so much we extended the opportunity to everyone this year. Additionally, between April 4 and 5, there will be six faculty development workshops chosen to address current topics in our teaching.
We are very pleased that Karen Mann, PhD, Professor Emeritus in the Division of Medical Education at Dalhousie University, Halifax, Nova Scotia, Canada, is this year’s visiting professor. Dr. Mann is involved in education, research and development across the medical education continuum and served as associate dean for Undergraduate Medical Education. She is the recipient of many honors, including the 2010 Merrill Flair Award from the AAMC and the Pinecone Award from the Dalhousie Medical Student Society “for a significant and lasting contribution to undergraduate medical education”. Dr. Mann’s keynote address, “Developing Patient-centered Clinicians: What can we do as educators?” will provoke us to think about how to attend to this important issue.
This year marks the Academy’s tenth annual Cooke Awards for the Scholarship of Teaching and Learning. Please join us for the awards presentation at the conclusion of Monday’s plenary session.
On Tuesday, April 5, Dr. Mann will lead a workshop, “Evidence-based facilitated feedback: A model to enhance learner engagement, feedback acceptance and use for improvement”. At noon Karen Hauer, MD, PhD, Professor of Medicine and Associate Dean for Competency Assessment and Professional Standards and an outstanding UCSF educational researcher will present “Assessment for Learning: How does it improve upon current assessment?”.
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,
Ann Poncelet, MD Helen Loeser, MD, MSc Patricia O’Sullivan, EdD Professor of Clinical Neurology Director, Academy of Medical Professor, Department of Medicine Chair, Academy of Medical Educators Director, Research and Educators Scholarship Committee Development in Medical Education
1 Education Showcase 2016 Schedule Online directory of sessions for links to evaluations, Teach for UCSF skills assessments, live stream/recordings and learning materials: http://tiny.ucsf.edu/2016dashboards
Sunday, April 3: Mission Bay Campus, Mission Hall
8:00-10:00am MH-1400 Learning Climate in Medical Education 9:00-10:00am MH-1401 Introduction to Simulation: Why, When, What 10:00-10:15am MH Lobby Break 10:15am-12:15pm MH-2100 Effective Use of Standardized Patients in Health Professions Education 10:15am-12:15pm MH-1401 Planning and Designing Mannequin•Based Scenarios 10:15am-12:15pm MH-1400 Writing Effective Performance•Based Narrative Evaluations 12:15-12:45pm MH-1400 Lunch 12:45-5:00pm MH-1400 Developing Skills in the Art of Effective Feedback 12:45-5:00pm MH-2103 Small Group Teaching 12:45-2:45pm MH-1401 Conducting Scenario•Based Simulations 2:45-3:00pm MH Lobby Break 3:00-5:00pm MH-1401 Debriefing Scenario•Based Simulations
Monday, April 4: Mission Bay Campus, Mission Hall
8:30-10:30am UCSF Education Showcase Plenary Session MH-1400 Presentations: Asynchronous Learning Modules to Teach Core Scholarship Skills: Michael Le and team Editing Wikipedia for medical school credit – results from four cycles of an elective for fourth-year students: Amin Azzam and team Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth: Stanley Vance, Jr. and team Outpatient Systems Analyses - An Interprofessional Curriculum to Teach Patient Safety: Maya Dulay and team Teaching to Operate: A Residents-as-Teachers Curriculum with a Surgical Focus: Marron Wong and team What makes a good team? An exploratory study of variation in teamwork perceptions among team members: Bridget O’Brien and team 10:30-10:45am Break 10:45-11:45am Keynote Address by visiting scholar Karen Mann, PhD: Developing Patient-Centered Clinicians: What can we do as educators? 11:45-12:00pm Cooke Awards Noon-12:30pm Lunch (MH Lobby) 12:30-1:30pm Mini Oral Presentations for UCSF Education Showcase: Session A MH-1406 & 1407 See mini oral schedule for details
2 Monday, April 4: Mission Bay Campus, Mission Hall - cont.
1:30-2:30 Mini Oral Presentations for UCSF Education Showcase: Session B MH-1406, 1407 See mini oral schedule for details 3:00-5:00pm Bring Me a Basic Scientist Stat! Integrating Basic and Clinical Science MH-1406 3:00-5:00pm Well-Directed Learning: Mentoring learners toward life-long, self-directed “master MH-1407 adaptive learning”
Tuesday, April 5: Parnassus Campus, Teaching and Learning Center
8:00am-12:00pm Clinical Teaching CL-221/222 8:30-11:00am Evidence-based Facilitated Feedback: A model to enhance learner engagement, CL-220/223 feedback acceptance and use for improvement: by visiting scholar Karen Mann, PhD 11:15-noon Lunch TLC Lobby Noon-1:00pm Keynote Address by Karen Hauer, MD, PhD: Assessment for Learning: How does it CL-220/223 improve upon current assessment? 1:00-2:00pm Mini Oral Presentations for UCSF Education Showcase: Session C CL-221 & CL-222 See mini oral schedule for details 2:00-2:45pm Mini Oral Presentations for UCSF Education Showcase: Session D CL-221 & CL-222 See mini oral schedule for details 3:00-5:00pm Preparing to Teach Quality Improvement and Patient Safety CL-220/223 3:00-5:00pm The Force Awakens: Teaching with the Electronic Medical Record CL-221/222
3 UCSF Education Showcase 2016 Education Showcase 2016 Mini Oral Presentation Schedule Monday, April 4, Mission Bay Campus - Mission Hall 12:30-1:30, MH-1407 Mini oral session A-1 ID Title 1st author 10 Clinical Training Preparation including Simulated Preceptor Interaction Shabrell Development of Novel Simulation-Based Infant Lumbar Puncture Curriculum Targeting Problem- 18 Solving Abilities Laves GoPros in the OR: Using surgical videos to improve resident education, give feedback, and nurture 26 operative teaching skills Wong 35 Medical Emergency Management in the Dental Office: Simulation Training Program Manton 45 Student and clinician perceptions of interprofessional clinical teaching ~ what truly matters Chen
12:30-1:30, MH-1406 Mini oral session A-2 ID Title 1st author 3 An Innovative, Longitudinal Panel Management Curriculum for Interprofessional Trainees Eastburn 4 An Interactive Instructional Video to Improve Interprofessional Education and Teamwork Pon Development & pilot of a geriatric standardized patient exercise for advanced practice nursing 14 students Strewler 30 Interprofessional education on medication safety and communication at hospital discharge Lo PACT ICU: A trainee-led case conference to improve interprofessional, team-based care for high 37 complexity patients Strewler
1:30-2:30, MH-1407 Mini oral session B-1 ID Title 1st author Jumpstarting Faculty Development for Teaching Quality Improvement and Patient Safety: a Team- 31 based Approach van Schaik A Needs Assessment for Development of a Quality Improvement and Patient Safety toolbox for 2 Graduate Medical Education within a large institution. Fogh 5 An introductory training series in continuous process improvement Ranji Designing a faculty and staff development program to engage early medical students in improving 12 health systems Chang Development of an innovative UCSF faculty development opportunity: The Teach for UCSF 17 Certificate in Quality Improvement and Patient Safety Haehn Quality Improvement and Patient Safety Activities for Medical Students in Clerkships: A Toolbox for 40 Clerkship Directors Feng
1:30-2:30, MH-1406 Mini oral session B-2 ID Title 1st author 1 A Movement Disorders-Focused Neuropsychiatry Curriculum for Psychiatry Residents Seritan 7 Behavioral Approaches to Diabetes McGrath 23 Evaluation of a longitudinal psychiatry resident advising program Ridgeway-Diaz Implementation and Assessment of a Curriculum for Medical Students on Electronic and Telephone 27 Communication with Patients Ristow 29 Intern Half Day 2.0: Blended Learning in the Internal Medicine Core Curriculum Stetson 41 RISE: A Teaching Method for Collaborative Clinical Learning Olenik
4 UCSF Education Showcase 2016 Education Showcase 2016 Mini Oral Presentation Schedule Tuesday, April 5, Parnassus Campus - Teaching and Learning Center 1:00-2:00, CL-221 Mini oral session C-1 ID Title 1st author 8 Calibrated Peer Review (CPR): A Peer-Peer Evaluation System to Enrich Learning Yuan 9 Capturing how medical students integrate interdisciplinary content using Concept Maps Seol 15 Development and Validation of an Inquiry Assessment Tool for the UCSF Bridges curriculum Brondfield Learning by Osmosis: Can student created content and a spaced-repetition formative assessment 32 technology augment a collaborative student-driven curriculum? Azzam
33 Learning from Clinical Uncertainty: Developing “Practice Inquiry” for Third Year Medical Students De La Torre
1:00-2:00, CL-222 Mini oral session C-2 ID Title 1st author
11 Delivering a Novel Post-Graduate Global Health Curriculum: Lessons from the HEAL Initiative Scarpelli 22 Evaluation of a global health experience: Process and early findings Hall 39 Patient Family Centered Nursing Rounds at a referral hospital in rural Haiti Meyer 42 Social Determinants of Health and Health Disparities: What Every Researcher Needs to Know Dehlendorf 44 STEP UP: Interdepartmental GME Training in Health Equity Rothstein
2:00-2:45, CL-221 Mini oral session D-1 ID Title 1st author Development of a Feedback Based Curriculum: Transforming Milestone Based Evaluations into 16 Actionable Feedback for Residents Stafford 38 Palliative Care & Communication Skills curriculum for radiation oncology residents Garcia 43 SPRUCE, Supporting Provider Resilience by Upping Compassion and Empathy Ekman 46 Student's Perceptions of Caring Cuthbert
2:00-2:45, CL-222 Mini oral session D-2 ID Title 1st author Development and Evaluation of a Pediatric Resident Basic Pediatric Fracture and Splinting 13 Curriculum Bent Evaluating Medical Student and Radiology Resident Preferences for Interventional and Diagnostic 21 Radiology Kallianos 24 Factors Influencing Selection of a Medical Specialty Yen
28 Integrating Primary Care Transformation Principles into Resident Quality Improvement Curriculum Mooney 34 Leveraging the EHR to Improve Student Documentation Practices Ko
5 UCSF Education Showcase 2016
Keynote Addresses
Developing Patient-Centered Clinicians: What can we do as educators? Karen V. Mann, BN, MSc, PhD
Dr. Mann is Professor Emeritus in the Division of Medical Education at Dalhousie University where she was founding Director (1995-2006). She also holds an Honorary Professorship in Medical Education at Manchester Medical School, University of Manchester, UK. She is involved in teaching, research and development and writing across the medical education continuum. With colleagues Tim Dornan, John Spencer, and Albert Scherpbier, Dr. Mann co-edited and wrote a textbook of medical education: Medical Education: Theory and Practice. She was PI on a Health Canada study in inter-professional education. Current research interests are in self-assessment and feedback, reflection, assessment, professional identity formation, and distributed medical education. She serves on the editorial boards of Academic Medicine, Medical Education, the Journal of Continuing Education in the Health Professions, and Perspectives in Medical Education. She also supervises Masters and PhD students, and has been involved in developing and teaching in higher degree educational programs for health professions faculty.
In addition to giving the Keynote Address on April 4, Dr. Mann will present a workshop on Effective Feedback on April 5.
Assessment for Learning: How does it improve upon current assessment? Karen Hauer, MD, PhD
Dr. Hauer is Professor of Medicine and the Associate Dean for Competency Assessment and Professional Standards at UCSF. Previously, she served as Director of Internal Medicine Clerkships at UCSF and is past president of the Clerkship Directors in Internal Medicine national organization. She is an active researcher in medical education and a research mentor for fellows, residents and students, with a focus on new models of clinical learning in the workplace, competency-based medical education, learner assessment and remediation. Last year, she completed a PhD in Medical Education through a joint program with UCSF and the University of Utrecht in the Netherlands. She earned her undergraduate degree at Stanford University, and then completed medical school, internal medicine residency, and chief residency at UCSF. She is a practicing general internist in primary care. She is married and has 3 children.
6 UCSF Education Showcase 2016
The Cooke Award for the Scholarship of Teaching and Learning
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 were eligible for these awards, which are accompanied by a certificate and 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 2016 recipients:
Amin Azzam, MD, MA, UCSF; Lane Rasberry, Consumer Reports; James Heilman, MD, BSc, University of British Columbia; Kingsley Otoide; Jack McCue, MD, UCSF; Valerie Swisher, BA, Content Rules; Fred Trotter, BS, DocGraph, Inc.; Evans Whitaker, MD, MLIS, UCSF Library, for their work:
Editing Wikipedia for medical school credit – results from four cycles of an elective for fourth-year students
Maya Dulay, MD, UCSF; Krista Gager, MS, AGNP-BC, SFVA, UCSF; Josue Zapata, MD,MBA, UCSF; David Margolius, MD, Case Western Reserve; Bridget O'Brien, PhD, UCSF; JoAnne Saxe, DNP, ANP-BC, FAAN, UCSF, for their work:
Outpatient Systems Analyses - An Interprofessional Curriculum to Teach Patient Safety
7 UCSF Education Showcase 2016 Workshops April 3
Learning Climate in Medical Education This session provides faculty and trainees with an overview of the use of simulation in medical Led by: education, to set the stage for continued learning through the Teach for UCSF Certificate in Simulation Patricia O'Sullivan, EdD Teaching, or as a refresher for those experienced in Professor, Department of Medicine simulation at other institutions. Included are the Director, Research and Development in Medical rationale for use in learning and assessment, Education for the Center for Faculty Educators benefits to patient safety, as well as advantages to UCSF School of Medicine learning and patient care from the point of view of Megan Richie, MD the institution. Along with an introduction to Assistant Professor, Department of Neurology characteristics of effective simulations, this session addresses the importance of applying principles of Teaching in the clinical setting is curriculum development and learning theories to challenging. Creating a positive and effective designing, planning, conducting, and debriefing learning climate can be essential to maximizing the simulations. The session is meant as an introduction experience and education for learners (and the to subsequent workshops that delve into applying enjoyment for the teacher!). This workshop will give learning theories to these different elements of teachers the skills to create a positive learning simulation with opportunities to actively practice the climate – to make the clinical teaching setting a associated skills. place where learners want to be. These skills can At the end of this session, participants will be able transfer to other learning experiences including large to: and small groups.
Define and describe simulation During this workshop, participants will: Explain the rationale for using simulation in health professional education Engage in a discussion of the key behaviors which can enhance the learning climate List best practices for the use of simulation as an educational strategy Practice applications of the key behaviors pertinent to the learning climate Find your way to various simulation resources at UCSF and beyond Develop scripts to create a positive learning
climate for learners. By the end of this session, participants will be able Planning and Designing Mannequin-Based to: Scenarios
Establish a positive learning climate Led by: List key behaviors to create a positive learning climate Sandrijn van Schaik, MD, PhD Associate Professor of Clinical Pediatrics
Introduction to Simulation: Why, When, What? Are you ready to move forward with designing a Led by: simulation session? Do you know how the Kanbar Center can assist you in creating a simulation Sandrijn van Schaik, MD, PhD session? This workshop will cover how to plan and Associate Professor, Department of Pediatrics design a mannequin-based simulation session, with an emphasis on effective scenario design.
8 UCSF Education Showcase 2016 Workshops April 3
Review and critique examples of During this workshop, participants will: evaluations Apply a set of guidelines or “tips” to Review the resources available at the improve a sample evaluation Kanbar Center; Practice composing a summary evaluation Discuss features that characterize effective from multiple individual evaluations simulation-based education; At the conclusion of this workshop, participants will Practice writing appropriate learning be able to: objectives and using a simple template for scenario design. Describe common challenges in writing learner evaluations At the end of the workshop, participants will be able List several systematic approaches to to: gathering data and using the data to compose learner evaluations Plan a simulation session utilizing high- Differentiate between summative and fidelity mannequins; formative evaluation/comments Create clear objectives for a simulation Write summative and formative evaluations session; that are performance-based, specific, and Design a simulation scenario appropriate focused for your learners. List common pitfalls in summary
evaluations Writing Effective Performance-Based Narrative Set personal goals for applying the skills Evaluations learned in this workshop to one's own practice setting, and review a tool designed Led by: to assess performance of new teaching skills. Jeanette Lager, MD Assistant Clinical Professor, Department of Obstetrics, Gynecology and Reproductive Sciences Effective Use of Standardized Patients in Health Professions Education Elizabeth Joyce, PhD Assistant Professor, Department of Microbiology and Led by: Immunology Sharon Youmans, PharmD Teachers are regularly called upon to provide learner Associate Professor of Clinical Pharmacy evaluations. It is difficult to write evaluation Vice Dean, UCSF School of Pharmacy comments that are appropriately supportive of all our learners while also accurately describing Anita J. Richards, MACM(c) performance and competency in transparent Simulation Education and Assessment Specialist language. This is an opportunity to talk about Kanbar Simulation Center common challenges and best practices of writing evaluations. This workshop introduces the use of standardized patients in health professions education. Workshop During this workshop, participants will: leaders provide an overview of the use of standardized patients including the theory and Identify and discuss common challenges in rationale for their use and provide examples of how writing evaluations SPs are being used for both formative (teaching) and
9 UCSF Education Showcase 2016 Workshops April 3 summative (assessment) exercises. Workshop experience of the entire group and review the faculty will also cover alternative uses of literature to write a foolproof guide to giving standardized patients including multiple mini- effective feedback. Participants will practice these interviews, hybrid simulations and value-free new skills in the workshop, specifically focusing on exercises. Participants will learn the process of SP challenging cases of their own. We also welcome case development and identify the key elements of a returning faculty to reinforce and build on previously standardized patient case. Participants will have the attained skills. opportunity to develop an outline for a standardized patient case and receive feedback from their peers. For the second part of the session, we will invite a panel of local experts in remediation to make At the end of the workshop participants will be able comments, and then field your questions about best to: practices (as they exist) for helping students and residents in need of larger-scale correction. Discuss the rationale for the use of standardized patients in health professions At the end of the session scholars will be able to: education. Describe the use of standardized patients in Develop language and improve process of health professions education for learner giving feedback to learners. skill assessment. Recognize situations in which feedback is Explain the process for developing an SP most appropriate and effective, and define case instances in which feedback may be Create an outline for a standardized patient counter-productive. case for formative (teaching) or summative Recognize and overcome personal obstacles (assessment) exercises to giving and receiving feedback. Set personal goals for applying the skills Use newly-identified feedback skills in learned in this workshop to one's own challenging real-life scenarios. practice setting, and review a tool designed Set personal goals for applying the skills to assess performance of new teaching learned in this workshop to one's own skills. practice setting, and review a tool designed to assess performance of new teaching skills. Developing Skills in the Art of Effective Feedback During the session, participants will: Led by: Review representative literature on Calvin Chou, MD, PhD feedback in medical education. Professor of Clinical Medicine Department of Medicine, VAMC Define “feedback” and discuss past experiences to develop a formalized Ryan Laponis, MD structure for giving feedback. Associate Professor Practice their skills of giving feedback and Department of Medicine, UCSF School of Medicine identifying barriers to effective feedback.
Feedback is a fundamental tool of effective teaching Small Group Teaching and is a skill that, though easily learned, takes a Led by: lifetime to master. We will use the wisdom and
10 UCSF Education Showcase 2016 Workshops April 3
Marieke Kruidering, PhD practice setting, and review a tool designed Associate Professor, Department of Cellular and to assess performance of new teaching Molecular Pharmacology skills.
Much of clinical and classroom teaching takes place in small groups. A faculty member can use the skills Conducting Scenario-Based Simulations for leading an effective discussion and encouraging Led by: active student participation in a variety of instructional formats including case studies, Sandrijn Van Schaik, MD, PhD problem-based learning, and small group Associate Professor, Department of Pediatrics discussions. The session will begin with an Director, Kanbar Center for Simulation, Clinical Skills introduction by the facilitator, who will describe the and Telemedicine Education roles and expectations just as we would with learners in real life. A handout derived from Tools for Shruti Kant, MD Teaching will serve as the basis for the discussion. Assistant Professor, Department of Emergency Medicine During this session scholars will: So you have your scenario and you have planned out Participate in three groups and subsequent your session, but how do you ensure that your debriefings. simulation session is effective? In this workshop, we Interact with expert small group facilitators will review the concept of fidelity, or how a scenario to address personal facilitation challenges. can be made realistic. We will address the roles that Discuss and formulate successful strategies equipment, environment, and psychology play in for creating, leading and guiding fidelity. discussions, and for asking and responding to questions. During this session, participants will: Practice leading a small group session during a hands-on group exercise. Learn how to optimize fidelity; At the end of this session, participants will be able Discuss the pros and cons of the use of to: confederates; Review various approaches to the instructor Discuss the characteristics of different kinds role; of small groups. Discuss common challenges and practice List two factors for success and two pitfalls dealing with unexpected developments. to avoid in development of new small group sessions. At the end of this workshop, participants will be able Create guidelines for asking and responding to: to questions. Apply small group techniques to effectively Explain the concept of fidelity and its teach content currently taught in lecture different components; format in a small group setting. Create an effective learning experience by Describe solutions to challenges of small enhancing fidelity; group learning both in design and group Anticipate common pitfalls in conducting dynamics. simulation sessions; Set personal goals for applying the skills Set personal goals for applying the skills learned in this workshop to one's own learned in this workshop to one's own
11 UCSF Education Showcase 2016 Workshops April 3
practice setting, and review a tool designed to assess performance of new teaching skills.
Debriefing Scenario-Based Simulations
Led by:
Darren Fiore, MD Associate Clinical Professor, 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. 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.
12 UCSF Education Showcase 2016 Workshops April 4 & 5
Bring me a basic scientist stat! Integrating Basic and Well-Directed Learning: Mentoring learners toward Clinical Science life-long, self-directed "master adaptive learning"
Led by: Led by:
Elizabeth Ann Joyce, PhD Sandrijn M. Vanschaik, M.D., Ph.D. Associate Professor, Department of Microbiology and Immunology In today’s era of rapidly expanding knowledge, yesterday’s best practice may be obsolete Marieke Kruidering, PhD tomorrow. Such an educational climate requires that Professor, Department of Cellular and Molecular medical schools focus on producing life-long, self- Pharmacology directed learners proficient in diagnosing and addressing their own learning gaps. The master Efrat Lelkes, MD adaptive learning concept takes this a step further Assistant Professor, Department of Pediatrics by stating that learners should also incorporate new knowledge into their practice. Mentors can play an The interrelationship of science and patient care is instrumental role in students’ development of the greater now than ever with the advances that have associated metacognitive skills and habits, occurred in the biomedical sciences. We have long facilitating “well-directed” learning by encouraging talked of integrating basic and clinical sciences in the students to integrate external feedback into the self- clinical years. However, what does it really take? In directed/master-adaptive learning paradigm. this workshop the presenters will discuss challenges that they have encountered in placing the basic During this workshop, participants will: scientist in the clinical setting. By the end of this workshop, participants will be able to: Discuss the concepts of metacognition, self- directed learning, self-regulation, and compare and contrast different approaches master adaptive learning and how they to engaging learners and faculty in basic relate to each other science during clinical education. In pairs, explore the differences between identify faculty development needs for self-directed and “well-directed” learning basic scientists and attending clinicians to Discuss examples from their own daily enhance the discussion of basic science in experience with learners and identify the clinical setting. opportunities for “well-directed” learning devise strategies to reduce barriers to Practice guiding learners in the integration of relevant basic and clinical development of metacognitive skills and science. habits needed to become a master adaptive During this workshop, participants will: learner At the end of this workshop, participants will be able work in small groups to compare and to: contrast strategies that would achieve meaningful integration. Identify the elements of self-directed, discuss faculty development needs for both master-adaptive learning scientists and attendings. Describe the role of a mentor/coach in generate a list of best practices to reduce “well-directed” learning barriers to integration of basic science into Guide learners in developing metacognitive clinical education. skills
13 UCSF Education Showcase 2016 Workshops April 4 & 5
Recognize everyday opportunities for Identify challenging teaching situations and coaching learners toward well-directed learners, and choose an appropriate learning teaching style/model for each Summarize current research on clinical teaching models Clinical Teaching Set personal goals for applying the skills learned in this workshop to one's own Led by: practice setting, and review a tool designed to assess performance of new teaching Andrea Marmor, MD, MEd skills Associate Professor, Department of Pediatrics
David Duong, MD Evidence-based Facilitated Feedback: A model to Assistant Professor, Department of Emergency Medicine enhance learner engagement, feedback acceptance and use for improvement This session will provide an exposure to common teaching models used in the clinical setting. Registration required: Specifically, participants will learn about the One http://tiny.ucsf.edu/EducationShowcase Minute Preceptor Model for teaching in the outpatient setting and the SNAPPS model. The Led by: session will focus on the provision of feedback as well as how to teach in challenging teaching Karen Mann, PhD situations and address problem learners. Professor Emeritus, Division of Medical Education Dalhousie University, Halifax, Nova Scotia During this session, participants will: Feedback is a critically important element of Observe common teaching styles in the competency-based medical education. It provides clinical setting on video learners with information about their performance Practice their teaching skills in different and guides their future learning. Yet, recent studies clinical scenarios demonstrate that learners do not always readily Learn how to provide positive as well as accept performance feedback or use it for constructive feedback improvement. This occurs for many reasons, Discuss the pros and cons of common including inconsistency of the feedback with self- teaching models assessment, concerns about data credibility, and Observe a variety of teaching situations perceived barriers to feedback use and change. including challenging learners and teaching Other factors include the feedback culture and situations teacher-learner relationships. In response, we have developed a theory and evidence-based four-stage Discuss the current research on clinical teacher knowledge and reasoning model for facilitating acceptance and use of formal feedback. The model incorporates: informed self- At the end of this session, participants will be able assessment to help learners understand, assimilate to: and use external data; person-centred approaches to actively engage recipients in their feedback and in Describe common and evidence based taking ownership of it; and behaviour change clinical teaching models and methods approaches to enable recipients to identify goals and Practice teaching models using clinical plans for change. Studies to date suggest the model scenarios
14 UCSF Education Showcase 2016 Workshops April 4 & 5 may be a useful addition to current feedback Advance Preparation approaches. Come prepared with an experience in which you During this interactive workshop participants will: have been asked to teach QI/PS
Discuss current challenges in giving Required Reading feedback and engaging learners to accept and use it AHRQ Patient Safety Primer: Systems Approach Experience a feedback model through a role play and practice using feedback scenarios. https://psnet.ahrq.gov/primers/primer/ Explore the potential application of the 21/systems-approach model in their setting “Error in Medicine” Leape LL. JAMA 1994; At the end of this workshop, participants will be able 272: 1851- to: 7 http://jama.jamanetwork.com/article .aspx?articleid=384554 Describe the role of the feedback culture “Patient Safety and Quality: An Evidence- and relationships in providing and receiving Based Handbook for Nurses”, Chapter 44. feedback Ronda G. Hughes, Ph.D., M.H.S., Identify and discuss approaches to R.N. http://www.ncbi.nlm.nih.gov/book maximize the effectiveness of feedback s/NBK2682/ Apply the approaches to engage learners in By the end of this workshop, participants will be able using it for improvement. to:
Define Quality Improvement and Patient
Safety Preparing to Teach Quality Improvement and Converse using terminology associated with Patient Safety QI/PS such as: quality gap, needs assessment, PDSA, LEAN, six-sigma Led by: Define types of errors in medical practice Describe how areas for improvement might Henry Crevensten, MD be identified Erika Price, MD Describe a framework for how QI/PS may be taught in a clinical setting Sunny Wang, MD During this session, participants will:
James Frank, MD Review the pretest to identify current knowledge level and to enable workshop As medical students and resident physicians become evaluation well-versed in Quality Improvement and Patient Participate in group discussion about the Safety (QI/PS) it can be difficult for faculty who were prerequisites with the goal of identifying not trained in QI/PS to be effective teachers of this any knowledge gaps topic. Would you like to teach these topics but are Use learner’s prior experiences teaching unsure of how to do so? This workshop will be of QI/PS to generate discussion about interest to UCSF faculty members who have the goal techniques to teach QI/PS. A standardized of improving their own understanding of QI/PS case will be available. fundamentals as a basis for teaching QI/PS to medical students and resident physicians.
15 UCSF Education Showcase 2016 Workshops April 4 & 5
The Force Awakens: Teaching with the Electronic Medical Record
Led by:
Peter V. Chin-Hong, MD Professor, Department of Medicine
Kathy Julian, MD Professor, Department of Medicine
Emily Abdoler, MD Medicine Resident
Rabih Geha, MD Medicine Resident
Clinical faculty welcome the electronic health record (EHR) to improve patient care. Once learners know how the system works, it becomes the attending’s responsibility to maximize the EHR as a teaching tool. We realize that faculty have a number of challenges to overcome to be able to comfortably teach. During this workshop participants will:
Observe and analyze challenging role plays around the use of the EHR Devise ways to use the EHR for basic/foundational sciences teaching, teaching with the patient and teaching away from the patient Develop strategies to overcome barriers
By the end of this workshop participants will be able to:
Identify best practices in how to use the EHR in teaching medical students and residents both during and outside of patient encounters Describe how to use the EHR to teach ACGME competencies Analyze the barriers to teaching with the EHR Provide tips for effectively using the EHR
16 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 6
Asynchronous Learning Modules to Teach Core Scholarship Skills
Michael Le, DDS, [email protected]; Anda Kuo, MD, Department of Pediatrics, School of Medicine, [email protected]; Matt Trojnar, MPA, Pathways to Discovery, School of Medicine, [email protected]; Naomi Wortis, MD, Department of Family & Community Medicine, School of Medicine [email protected]
Areas abstract covers: Medical Student Education (UME), GME
Domain(s) addressed: Computers and Technology, Curricular Innovation, Inquiry, Research
Abstract: Purpose: Develop and pilot asynchronous online modules on core scholarship skills relevant to Pathways to Discovery learners and make them accessible to all learners at UCSF. / / Background: Many medical schools promote careers in academic medicine by offering learners training in skills needed to design, implement, and disseminate scholarly work. The School of Medicine’s Pathways to Discovery (PTD) offers training in these areas, but it has been challenging to make high quality curricula available to all learners on a just-in-time basis. Online curricula provide flexibility in time and location of learning, facilitate novel instructional methods, and help personalize instruction to individual needs. / / Methods: We surveyed PTD faculty and learners to pick the most crosscutting topics with the fewest existing resources. Learners helped with design format of each topic. Topic experts helped develop objectives and content. Educational technology and library staff identified the best available technology. Two cycles of review resulted in modifications during the formative stage. We piloted all modules with PTD learners and collected evaluation data via survey and in-person feedback. / / Results: We developed 5 modules: literature review, proposal writing, qualitative research methods, abstract writing, and poster design. Modules include short screen-capture videos and narrated presentations. Of 67 respondents to 2015 Pathways Exit Survey, 20 used the abstract module and 30 used the poster module. All but one user would recommend the modules to a friend. In flipped classroom settings, modules allowed for more interactive and tailored in-person teaching. / / Dissemination: The modules are open to all UCSF learners on the Collaborative Learning Environment. In addition, UCSF Graduate Division uses some modules, and the Bridges development team plans to use the modules in its new Inquiry curriculum. / / Reflective Critique: Challenges include maximizing accessibility while also tracking usage and evaluations, and creating engaging video content without losing post-editing capacity.
17 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 19
Editing Wikipedia for medical school credit – results from four cycles of an elective for fourth-year students
Amin Azzam, MD, MA, [email protected]; Lane Rasberry, Consumer Reports, [email protected]; James Heilman, MD, BSc, University of British Columbia, [email protected]; Kingsley Otoide, insp-i.com [email protected]; Jack McCue, MD, UCSF, Department of Medicine, [email protected]; Valerie Swisher, BA, Content Rules, [email protected]; Fred Trotter, BS, DocGraph, Inc., [email protected]; Evans Whitaker, MD, MLIS, UCSF Library, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Computers and Technology, Global Health, Motivation, Quality Improvement
Abstract: Purpose: Over 94% of medical students use Wikipedia for medical information, yet we do not train them to improve or use it critically. This is a lost opportunity for our learners & Wikipedia’s global audience. / Background: Since Fall 2013, we offered an MS-4 elective to edit Wikipedia’s health content. Faculty partnered with WikiProject Medicine, Wikipedia Education Program, and experienced Wikipedians to design, deliver and evaluate the course. / Methods: We assessed: 1) impact of the student edits on Wikipedia’s content, 2) impact of the course on student participants, and 3) readership of articles our students edited. / Results: 43 students made 1,528 edits (average 36/student), contributing 493,994 bytes of content (average 11,488/student). They removed lower quality and added higher quality references for a net addition of 274 references. The change in number of references cited ranged from subtracting 64 to adding 66 references (average +7 references/student). None of the contributions of the first 28 students have been reversed or vandalized since their creation, in some cases now over 2 years ago. While there was an increase in readability of most articles, students grappled with comprehensiveness vs. readability & translatability. All students enjoyed “giving back specifically” to Wikipedia and nearly all broadened their sense of the scope of physician responsibilities in our socially networked information era. During only the months that students were actively editing, Wikipedia traffic statistics indicate the 43 articles were collectively viewed 1,116,065 times. Subsequent to students’ efforts, these 43 articles have been viewed over 22 million times. / Discussion/Dissemination: Medical students contributing to Wikipedia is viable and has a large social impact. We have presented this at several regional & international conferences and have a provisionally accepted manuscript currently under revision. / Reflective Critique: We are now working with the Wikipedia Education Foundation to generalize and customize our model to other health professional schools.
18 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 20
Enhancing Pediatric Trainees' and Students' Knowledge in Providing Care to Transgender Youth
Stanley Vance, Jr., MD, [email protected]; Madeline Deutsch, MD, MPH, UCSF, [email protected]; Stephen Rosenthal, MD, UCSF, [email protected]; Sara Buckelew, MD, UCSF [email protected]
Areas abstract covers: Medical Student Education (UME), GME
Domain(s) addressed: Curricular Innovation, Evaluation of Programs, Interprofessional Education
Abstract: Purpose: To improve pediatric students’ and resident trainees’ knowledge of medical and psychosocial issues facing transgender youth. / / Background: There is a paucity of curricula that focus on transgender youth. Existing curricula are mostly geared towards specialists, have not been evaluated in the literature, and lack interactivity or clinic observational experiences. To that end, we piloted a curriculum to fill these educational gaps. / / Methods: We implemented a curriculum with 6 interactive, online modules and an observational experience in a pediatric gender clinic. Learners included 4th year medical students, pediatric interns, psychiatry interns, and nurse practitioner students rotating through their adolescent block. Learners completed a post-curriculum evaluation to assess learner satisfaction and perceived change in knowledge of transgender youth medical and psychosocial considerations using a retrospective pre/post design. / / Results: After 3 months, 13 learners participated in the curriculum with 100% completing evaluations, 100% reporting completing all 6 online modules, and 92% attending the gender clinic. On a Likert Scale from 1=Very Unsatisfied/Strongly Disagree and 5=Very Satisfied/Strongly Agree, learners’ mean rating of the quality of the curriculum was 4.6±0.7 and mean rating for expecting to use information gained in this curriculum was 4.8±0.4. Retrospective pre-post levels of knowledge were compared using Wilcoxon Signed-Rank test. Learners reported a statistically significant improvement in knowledge on all measures. / / Discussion: Preliminary data suggest that learners were satisfied with the curriculum. The improvement in perceived knowledge of medical and psychosocial issues facing transgender youth suggests the curriculum is effective in filling an educational gap for multidisciplinary learners. We plan to submit the curriculum to MedEd Portal. / / Reflective Critique:Learners’ evaluations solicit open-ended feedback about means to improve the curriculum. These comments are iteratively reviewed and incorporated when possible.
19 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 36
Outpatient Systems Analyses - An Interprofessional Curriculum to Teach Patient Safety.
Maya Dulay, MD, , [email protected]; Krista Gager, MS, AGNP-BC, SFVA, UCSF, [email protected]; Josue Zapata, MD,MBA, UCSF, SFVA, [email protected]; David Margolius, MD, Case Western Reserve [email protected]; Bridget O'brien, PhD, UCSF, [email protected]; JoAnne Saxe, DNP, ANP-BC, FAAN, UCSF, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Curricular Innovation, Health Systems, Primary Care, Patient Safety
Abstract: Purpose: Our patient safety (PS) curriculum goal is to teach a system analysis (SA) approach for assessing medical errors in a primary care medical home. Learning objectives include identifying safety problems, distinguishing individual and systems factors, and focusing error prevention on improving processes and systems. / / Background: The San Francisco VA Center of Excellence in Primary Care Education is part of an experimental model structured around interprofessional (IP), team-based training. Primary teaching methods are workplace learning, interactive small groups and reflective practice. / / Methods: IP trainees work in pairs, choose a case from a clinical experience, and perform a systems analysis with faculty mentorship. They present the SA and lead a discussion on safety issues and contributing factors. Faculty ensure learning objectives are met by reviewing key SA concepts and proposed solutions. Post- session surveys of all trainees are completed. / / Results: Since 2011, 69 internal medicine residents and 20 adult gerontology NP students have participated. In post-session surveys (n=160), learners rated the overall quality of session as 4.6 (SD 0.7) on a 1-5 scale (1=poor, 5=excellent). A qualitative analysis of 43 SA’s revealed the most prevalent contributing factors were poor communication between PCPs and providers outside the team (65%), and poor provider-patient communication (51%). / / Discussion: We developed a highly rated, case-based approach to PS education for IP trainees. Communication factors contributed to the errors in the majority of cases reviewed, emphasizing the importance of communication and teamwork education. The innovation was presented at the 2015 Society for General Internal Medicine Annual Conference and will be submitted for 2016 California's Macy Regional Conference: Innovations in GME. / / Reflective Critique: Trainee feedback led us to more formally share SA outcomes with facility stakeholders and QI workgroups. After discussions with content experts we shifted the nomenclature Root Cause Analysis to Systems Analysis.
20 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 47
Teaching to Operate: A Residents-as-Teachers Curriculum with a Surgical Focus
Marron Wong, MD, [email protected]; Jeannette Lager, MD, UCSF, [email protected]; Meg Autry, MD, UCSF, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Curricular Innovation, Feedback, Longitudinal Educational Activities, Residency
Abstract: Purpose / To create a longitudinal, skill-based Residents-as-Surgical-Teachers (RaST) curriculum to help residents become better surgical educators. / / Background / Residents spend a quarter of their time teaching. Strong resident educators can inspire students, improve patient education, and boost resident retention of material. RaT curricula have been shown to improve student impressions of residents, resident experiences, and resident teaching ability. These curricula have traditionally focused on teaching in clinic or on the wards, not in a surgical setting. There is scant literature about RaT curricula designed to produce proficient resident educators in a surgical setting, or Residents-as-Surgical-Teachers (RaST) curricula. / / Methods / We conducted a literature review and a needs assessment of resident interest and perceived need for a RaST curriculum. We then created a longitudinal RaST curriculum focused on teaching residents to teach in the pace and demands of a surgical specialty. Our curriculum incorporates small groups, informal workshops, and observed structured teaching encounters (OSTEs) during skills labs and in the OR. / / Results / 22 residents completed a needs assessment. While 86% of residents felt it important to be an effective educator, 0% felt "totally prepared" to teach. 91% were interested in attending trainings on how to be a better teacher. Scores were higher for learning to teach fellow residents than students, and for OR skills over ward skills. Residents had high satisfaction with teaching workshops. It was helpful to tailor teaching topics to the residents’ training level. OSTEs seem to provide helpful feedback. / / Dissemination / We have an oral presentation at the CREOG/APGO annual meeting in New Orleans in March, 2016. / / Reflective Critique / We have collected feedback throughout the year. At the end of the academic year, we will give a post-curriculum survey of the residents to assess successes and challenges. Suggestions will be incorporated into the curriculum.
21 UCSF Education Showcase 2016 Plenary Presentations
Abstract ID: 48
What makes a good team? An exploratory study of variation in teamwork perceptions among team members
Bridget O'Brien, PhD, [email protected]; Rebecca Shunk, MD, UCSF & SFVA, [email protected]; Sandrijn vanSchaik, MD, PhD, UCSF, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Interprofessional Education, Primary Care
Abstract: Purpose: To examine the presence and impact of social cognitive asymmetries regarding teamwork within interprofessional teams. / / Background: Teamwork in healthcare is often evaluated by surveying individuals, inferring the quality of the team’s work from aggregated individual responses. This approach assumes team members have similar perceptions regarding key teamwork factors. The social cognition literature suggests that individuals can perceive similar experiences differently for various reasons including education, gender, or profession. This may result in variation among team members’ ratings of teamwork, which may suggest social cognitive asymmetries, or lack of shared perception of team dynamics. / / Methods: We conducted a cross-sectional survey study in three VA primary care clinics staffed by teams with interprofessional membership. We asked all team members to complete the Team Development Measure (TDM), a 31-item survey about team cohesiveness, communication and clarity of roles/goals. We calculated each team member’s TDM score (scale 0-100), and the mean TDM and standard deviation (sd) for each team. We calculated Pearson correlations between each teams’ mean TDM score and the standard deviation (as a measure of variation among individual team members). / / Results: 105/135 (78%) members from 20 teams completed the survey. The mean TDM score across teams was 70.1 (sd 7.1) with standard deviations ranging from 4.4 to 16.7. This variation in TDM data within and across teams suggests social cognitive asymmetry. We found a significant positive correlation (0.608, p=0.004) between each team’s mean TDM score and standard deviation. / / Discussion: We found signs of social cognitive asymmetry, or lack of shared perception of teamwork, within primary care teams. Teams with greater within-team variation tended to rate teamwork higher than teams with less variation. / / Reflective Critique: Our findings warrant further investigation since they are based on correlation, but raise provocative questions about potential benefits of divergent perspectives within teams.
22 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-1
Abstract ID: 10
Clinical Training Preparation including Simulated Preceptor Interaction
Elizabeth Shabrell, RN, MS, FNP, [email protected]; Angel Chen, RN, MSN, CPNP, UCSF, [email protected]; Patricia O'Sullivan, edD, UCSF, patricia.O'[email protected]; Erica Monasterio, RN, MN, FNP, UCSF, [email protected]
Areas abstract covers: GME, CME
Domain(s) addressed: Clinical Instruction and Performance, Curricular Innovation, Interprofessional Education, Simulation
Abstract: Purpose: To better prepare students for their clinical rotations, we trained students in effective communication in interprofessional settings through didactic content and a simulated preceptor interaction. / Background: Most clinical preceptors are volunteers and lack training in clinical teaching. Preceptors include Physicians Assistants, Nurse Practitioners and Medical Doctors who may not be aware of the expectations for students from different professions. Students should be prepared to train under a variety of professions and take control of their own learning. / Methods: Utilizing Kern’s Curriculum Development, we identified a gap preparing family nurse practitioner (FNP) students for their clinical practicum. Deficiencies included knowledge of clinical expectations, having learning objectives for clinical experiences, recognizing trajectory of clinical progression, and development of self direction. Two teaching approaches to rectify these were developed. A three hour class and a case simulating a difficult conversation with a preceptor were developed. Paid actresses played the role of Pediatricians (MDs) who lacked knowledge of FNPs. Students had to negotiate a mutually acceptable plan to meet clinical rotation learning objectives and explain the role of a nurse practitioner. / Evaluation Plan: FNP students received this curriculum in December 2015 and January 2016. Students and preceptors complete their mid-quarter evaluation (early February) tied to the objectives of the curriculum. Additionally, FNP students will describe how they prepared for their clinical rotation, if they utilized any techniques taught in the lecture, development of learning objectives, and communication about their professional role. Preceptors will indicate if the student was well prepared for clinical, clearly articulated their learning objectives and explained their role as appropriate. / Dissemination: Data, analyzed in March, will be submitted for dissemination at the National Nurse Practitioner Conference.
23 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-1
Abstract ID: 18
Development of Novel Simulation-Based Infant Lumbar Puncture Curriculum Targeting Problem- Solving Abilities
Ellen Laves, MD, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Curricular Innovation, Health Care, Simulation
Abstract: PURPOSE: To design a novel simulation-based lumbar puncture curriculum to improve transfer to the clinical context / BACKGROUND: Simulation-based education is commonly used to teach procedural skills, however studies show suboptimal skill transfer to the clinical setting. This is possibly due to poor understanding of how simulation can help learners develop problem-solving skills. Other domains (music, typing) use challenges and task deconstruction to create adaptable learners. We applied this pedagogy to procedural skill training using infant lumbar puncture (ILP) as a proof-of-concept model. / METHODS: We developed a novel simulation-based ILP curriculum incorporating challenges and task deconstruction into the simulation. We integrated this approach into 3 distributed sessions of an established pediatric procedural skills program. Following a video and demonstration, learners practiced routine ILPs on task trainers. Once learners endorsed comfort with routine ILPs, they received 2 challenges consisting of difficult needle angulations. Learners deconstructed the challenge using a model spinal column for illustration, and then corrected the needle angulation. Trained instructors assessed resident skills using a validated checklist. To compare the new curriculum with a traditional simulation curriculum we randomized interns to either approach and collected information about satisfaction, skill transfer and learner confidence using surveys. / RESULTS: We randomized 15 of 28 interns to the novel curriculum and 13 to the traditional curriculum. Both approaches took 45-60 minutes to complete and learner satisfaction ratings with both approaches were high. Further data collection and analysis is ongoing. / CONCLUSION: We successfully implemented a novel ILP curriculum integrating progressive challenges and task deconstruction. Evaluation of impact on skill performance, learner confidence, and transfer to the clinical setting is ongoing. / REFLECTION: TSP instructors/mentors, and the ESCape group reviewed the curriculum and provided feedback that informed adaptations.
24 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-1
Abstract ID: 26
GoPros in the OR: Using surgical videos to improve resident education, give feedback, and nurture operative teaching skills
Marron Wong, MD, , [email protected]; Jeannette Lager, MD, UCSF, [email protected]; Lee-may Chen, MD, UCSF, [email protected]; Meg Autry, MD, UCSF [email protected]
Areas abstract covers: GME
Domain(s) addressed: Computers and Technology, Curricular Innovation, Feedback, Residency
Abstract: Purpose / To develop a program in which residents film surgical videos from their point-of-view, using the resulting videos to guide postoperative reflection, provide standardized feedback, and create a surgical library. / / Background / Compact, high-definition cameras allows for the preservation of footage from a surgeon’s perspective. Various cameras have been used successfully in proof of concept studies in neurosurgery and plastic surgery, with surgeons and learners preferring the surgeon point-of- view to traditional light-mounted or hand-held views. This technology is not commonly used in OB/GYN and there are no structured tools for using these videos to provide feedback. / / Methods / Video was made with headmounted GoPro Hero cameras. Filmed patients were consented and signed release forms. Footage was edited to create case-based instructional videos. Residents were surveyed about interest in filming and for feedback on a pilot instructional video. Feedback forms for residents and attendings were created for postoperative film debriefing to facilitate resident self-reflection and provide feedback about surgical technique, operative management, and teaching skills. / / Results / GoPro Hero cameras made high quality videos without obstructing the surgeon’s view or movement. After viewing a pilot video, 10 residents gave survey feedback. 100% said they would use the pilot and similar videos to prepare for cases and would find it useful to see a video of themselves operating to receive feedback. / / Dissemination / Our library of surgical videos is available on our residency Google Drive. We are presenting our GoPro program and findings at the CREOG and APGO annual meeting in March, 2016 in New Orleans. / / Reflective Critique / We gathered feedback from residents involved in filming and who had viewed the completed surgical videos. Filming residents noted forehead discomfort; a padded headband was added. Concerns about picture clarity were addressed by switching from Hero3 to Hero4 cameras and using Narrow and 1030/80 camera settings.
25 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-1
Abstract ID: 35
Medical Emergency Management in the Dental Office: Simulation Training Program
Jesse Manton, DDS, , [email protected]; Richard Fidler, PhD, CRNA, SFVAMC, UCSF, [email protected]; Shelley Miyasaki, DDS, PhD, SFVAMC, UCSF, [email protected]; Neil Mehta, MD, SFVAMC [email protected]
Areas abstract covers: GME
Domain(s) addressed: Clinical Instruction and Performance, Curricular Innovation, Patient Care, Simulation
Abstract: Purpose: / The Medical Emergency Management in the Dental Office curriculum is a simulation-based, experiential learning program customized for dental providers to improve emergency preparedness. / / Background: / Publications on medical emergencies in the dental practice are sparse. No mandated or centralized reporting system to track incidence of these emergencies exists. Graduating dental students receive minimal didactic and basic life support training. Dentists are providing care to increasingly complex patients, complicated by sedation, which increases the risk of medical emergencies. / / Methods: / Our team developed a 12-session curriculum with topics related to emergencies in the dental office. Pre and post surveys are used to measure participants' perceived confidence and skills. Participants are provided didactic content prior to each session. Sessions emphasized experiential learning through task-training and simulation scenarios. A deliberate practice approach provides foundational skills such as airway management, IV placement, defibrillation, and medication delivery. / / Evaluation Plan: / The pre and post survey data obtained will allow for data analysis of participants’ perceived confidence change across the curriculum. / / Dissemination: / Our intra-VA newsletter publication about this program in 2015 has lead to attention at the national level, with interest in expanding it to other VA sites across the country. A manuscript will be submitted to the Journal of Dental Education detailing the curriculum design and data analysis from the current participants. We plan to present the curriculum at the 2017 International Meeting for Simulation in Healthcare. / / Reflective Critique: / The iterative nature of this program has allowed changes to occur from session to session following feedback from involved program directors, educators and the current participants. This has been occurring over the past 8 years of development. Further implementation of this training program at other simulation centers and dental services will allow for collaborative curriculum improvement.
26 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-1
Abstract ID: 45
Student and clinician perceptions of interprofessional clinical teaching ~ what truly matters
Angel Chen, RN, MSN, CPNP, , [email protected]; Elizabeth Shabrell, RN, MSN, FNP-C, UCSF School of Nursing, [email protected]; Patricia O'Sullivan, EdD, UCSF School of Medicine, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Clinical Instruction and Performance, Faculty Development, Interprofessional Education
Abstract: Purpose: This project identifies best practices and barriers to interprofessional (IP) clinical teaching from the perspective of advanced practice nursing (APN) students and clinicians. / / Background: Health professional students receive clinical training from IP clinicians who often lack formal preceptor training. / / Methods: We triangulated three sources of data. APN students responded to a 57-item survey (0-7 for importance) to assess clinical teaching behaviors in 7 domains. We conducted 2-hour observations of NP/MD clinicians (nominated as Outstanding Preceptors) to observe effective teaching behaviors based on the literature. Current and potential preceptors completed a survey identifying barriers (Yes/No) and rated (5 point scale) their needs for training in 11 areas. / / Results: Forty-five students (45/114, 39%) completed the survey. The scores for the teaching domains were: enthusiasm 5.4, organization 6.0, professionalism and knowledge both at 6.1, and skill and supervision both at 6.2. Ten observations are scheduled through February; two are completed. Eight clinicians (8/232, 3%; 3 NP, 1 PA, 4 MD) have responded and all stated lack of time as barrier. Additional barriers include productivity (71%), space (51%), and lack of formal training, EMR, and knowledge of trainee’s goals (25%). They rated “agree” (4 out of 5) to needing training in time efficient teaching, then clinical reasoning, general teaching and interprofessional education (3.9). / / Discussion: Student results indicate skills reported in the literature are effective for IP teaching, and these align with skillsets preceptors desire. Planned observations will clarify best practices in these skillsets. Findings from students, preceptors and observations will be used to create a preceptor development program. / / Dissemination: Findings will be presented at National Association of NP Faculties Conference. / / Reflective Critique: This project is a part of HRSA funded grant and the team will seek feedback throughout the process.
27 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-2
Abstract ID: 3
An Innovative, Longitudinal Panel Management Curriculum for Interprofessional Trainees
Abigail Eastburn, MD, , [email protected]; Krista Gager, NP, SFVA, [email protected]; Anna Strewler, NP, SFVA, [email protected]; Bridget O'Brien, PhD, UCSF [email protected]; Maya Dulay, MD, SFVA, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Curricular Innovation, Interprofessional Education, Longitudinal Educational Activities, Primary Care
Abstract: Purpose / We aim to teach core panel management (PM) skills to interprofessional (IP) learners in a climate that promotes continuity with both peers and faculty. / / Background / With the increasing focus on performance metrics, it is essential for trainees to learn how to identify and improve gaps in care in their patient panels. The new ACGME Internal Medicine (IM) core competency, “Learns and improves by performance audit” focuses on these skills. / / Methods / We developed a longitudinal PM curriculum for IM residents and NP trainees at the San Francisco VA Medical Center. Trainees attend weekly, one-hour sessions. The same pair of IP faculty facilitates each session, and each cohort of trainees includes NP students, NP residents, and IM residents. / A new curricular theme is introduced every two months; themes include diabetes, CHF, and chronic pain. We introduce the trainees to different data sources with each theme. We employ a variety of teaching techniques, including brief didactics, pair-share, and independent chart review guided by worksheets we have developed. / / Evaluation / In this first year of our curricular innovation, trainees are highly supportive of both the format and content, rating the overall quality of the sessions as 4.5 out of 5 (N= 49, SD 0.8). Trainees’ written comments reflect positive perceptions of the curriculum, for example: “Most useful hour of the week. Great to have both structured didactics and time to get work done. Also good to hear input from other residents.” We will assess trainee achievement of their own panel management goals through review of their completed theme-specific worksheets. / / Dissemination Plan / We aim to disseminate our innovation through posters and workshops at regional and national meetings, as well as through the development of an online toolkit. / / Reflective Critique / We have sought feedback from all of our trainees on a monthly basis, and we have used this to modify aspects of the curriculum (such as revisiting themes from previous months). We also receive ongoing feedback from a national VA PM workgroup.
28 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-2
Abstract ID: 4
An Interactive Instructional Video to Improve Interprofessional Education and Teamwork
Tiffany Pon, PharmD, , [email protected]; Timothy Cutler, PharmD, UCSF, [email protected]; Deborah Johnson, RN, MS, NP, UCSF, [email protected]; Rosalind De Lisser, RN, MS, NP, UCSF [email protected]; Josette Rivera, MD, UCSF, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Communication, Interprofessional Education, Simulation
Abstract: Purpose: to foster and improve interprofessional communication through simulation and group activity / Background: Currently, UCSF lacks IPE curriculum that teaches effective communication in high-stakes environments; however, teaching students these skills is crucial to prepare them for actual practice. The University of Washington, a best practice IPE program, created simulation and standardized patient cases that place students in real-world simulations (e.g. ER, ICU) that aim to improve interprofessional communication and collaboration. Recording such simulations and providing examples of both poor and exemplary team interactions is an efficient way to improve student performance. This project implemented both strategies (high-stakes simulation and group activity) to create two IPE exercises in communication. / Methods: A code blue simulation exercise was conducted with students from Medicine, Nursing, Pharmacy, and Physical Therapy. Students performed the exercise 4 times and were debriefed after each cycle to discuss and document their “internal” thoughts on team interaction and barriers to communication. “Poor” and “Effective” versions of the simulation were video-recorded and edited. The “Poor” video was annotated with students’ “internal” thoughts. Both videos will be piloted in a didactic interprofessional small group exercise. / Results/Evaluation Plan: Students participating in the didactic exercise will complete validated pre-post surveys for interprofessional education assessment to evaluate initial bias and attitudinal changes. Results will be presented. / Discussion/Dissemination: The project is pending submission to the American Association of Colleges of Pharmacy Annual Meeting. / Reflective Critique: This began as a Seed Project funded by the Innovations in Education grant. We recruited an interprofessional team, which allowed for continual discussion and feedback throughout. Based on this structure, we developed a simulation case realistic from different professions’ viewpoints in addition to a small group activity that can be implemented campus-wide.
29 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-2
Abstract ID: 14
Development and pilot of a geriatric standardized patient exercise for advanced practice nursing students
Anna Strewler, AGNP-BC, , [email protected]; JoAnne Saxe, DNP, ANP-BC, FAAN, University of California, San Francisco, School of Nursing, [email protected]; Suzan Stringari-Murray, RN, MS, ANP, University of California, San Francisco, School of Nursing, [email protected]
Domain(s) addressed: Assessment and Testing, Clinical Instruction and Performance, Curricular Innovation, Standardized Patients
Abstract: Purpose: To develop and pilot a formative standardized patient exercise to provide Adult Gerontology Primary Care Nurse Practitioner (AGNP) students a uniform opportunity to practice and enhance their assessment and clinical management skills related to the care of older adults. / Background: Depending on assigned clinical placement sites, AGNP students’ confidence in geriatric assessment and clinical management skills can differ widely. Health professions training programs use standardized patient exercises to impartially observe, evaluate, and give feedback on students’ clinical skills. / Methods: Based on capacity and an initial student needs assessment, we developed and piloted four clinical case studies focusing on cognitive impairment, falls, polypharmacy, and advance care planning. Working in pairs, 10 students engaged in the exercise and completed critical thinking activities related to the cases. Feedback was given by observing faculty using standardized evaluation tools, skill demonstration, and time-efficient clinical teaching. / Results: Pre-exercise surveys (N=10) indicate a mean confidence level of 5.61 (SD=1.43) on a scale from 0-10 pertaining to 10 geriatric assessment skills. Post-exercise surveys (N=8) indicate a mean confidence level of 7.42 (SD=1.36) in these skill domains. Data is being collected from 6- and 12-month post-exercise surveys to assess whether the frequency with which participants practice the targeted geriatric clinical skills has increased. / Discussion/Dissemination: Early results show that the exercise increased students’ confidence in the targeted geriatric clinical skills. Data on its effect on clinical practice is being collected. The exercise will be repeated in the current academic year. Cumulative results will be presented at the annual UCSF Innovations in Geriatric Nursing conference. / Reflective Critique: Based on faculty and student feedback, the formative exercise will be integrated into the existing geriatric course curriculum, rather than as an independent learning activity along with yearly evidence-based clinical updates.
30 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-2
Abstract ID: 30
Interprofessional education on medication safety and communication at hospital discharge
Daphne Lo, MD, , [email protected]; Rachael Lucatorto, MD, University of California San Francisco, [email protected]; Joan Abrams, MA, MPA, University of California San Francisco, [email protected]; Sharya Bourdet, PharmD, University of California San Francisco [email protected]; Marilyn Stebbins, PharmD, University of California San Francisco, [email protected]; Josette Rivera, MD, University of California San Francisco, [email protected]; Anna Chang, MD, University of California, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Communication, Curricular Innovation, Health Systems, Interprofessional Education
Abstract: Background/Purpose: Collaborating with interprofessional (IP) teams and navigating health systems in discharge planning are often learned only experientially in residency, which may increase the risk of poor outcomes. A workshop on IP collaboration and systems skills for fourth year medical students (MS4) and third year pharmacy students (P3) addressed this knowledge gap before graduation. / Methods: A needs assessment of MS4s showed desire for knowledge of systems and roles and expertise of IP team members. To address the gap, UCSF School of Medicine (SOM) and School of Pharmacy (SOP) educators designed, implemented, and evaluated a workshop in the 2015 MS4 capstone Coda course. / Results: 28 SOM and SOP facilitators, 155 MS4s, and 17 P3s engaged in a two-hour IP workshop on a case from real examples of medication adverse events due to hospital discharge miscommunication. Learners explored IP team members’ roles and expertise, systems barriers during transitions, and ways to overcome these barriers. Overall workshop quality was rated 4.3/5 (1=poor, 5=excellent). Retrospective pre/post confidence in performing workshop objectives rose from an average 3.4 to 4.6/5 (1=poor 5=excellent). Learners enjoyed the IP interaction and gained knowledge of systems complexities. Most learners planned to engage IP team members in future discharge planning and to resolve medication discrepancies before discharge. / Discussion: This IP workshop improved MS4 and P3 confidence in identifying and overcoming systems barriers and spurred practice change intent. The workshop materials were distributed on the Portal of Geriatrics Online Education, presented nationally at the 2015 D.W. Reynolds Foundation Annual Meeting, and will be a poster presentation at the 2016 American Geriatrics Society Annual Meeting. / Reflective Critique: Feedback drove plans to shorten the case, build an interactive exercise for learners to practice new skills, and create a take-home list of actionable items. Sustainability efforts include streamlining materials and developing IP facilitator faculty champions.
31 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session A-2
Abstract ID: 37
PACT ICU: A trainee-led case conference to improve interprofessional, team-based care for high complexity patients
Anna Strewler, NP, [email protected]; Nate Ewigman, MPH, PhD, San Francisco VA Medical Center, [email protected]; Jessica Eng, MD, MS, San Francisco VA Medical Center, [email protected]; Bridget O'Brien, MS, PhD, University of California, San Francisco [email protected]; Rebecca Shunk, MD, San Francisco VA Medical Center, [email protected]
Areas abstract covers: Medical Student Education (UME), GME
Domain(s) addressed: Curricular Innovation, Interprofessional Education, Patient Care, Primary Care
Abstract: Purpose: We aim to improve care for highly complex patients while increasing interprofessional (IP) trainees’ understanding of team-based care through a monthly case conference called Patient-Aligned Care Teams- Interprofessional Care Update (PACT-ICU). / / Background: Team-based care and IP collaboration are central tenets of the Patient-Centered Medical Home. Despite training, learners are challenged by patients with the most complex medical and psychosocial needs. / / Methods: IP trainees at the SFVA Medical Center use a VA stratification tool to choose patients with a high risk of hospitalization or mortality to present during the hour-long PACT-ICU conference. IP trainees, staff, and care team-members discuss the case and formulate a treatment plan. A clinical teaching pearl is presented. The patient is then referred into a case management program, PACT Intensive Management (PIM), who work with the care team to coordinate the PACT-ICU treatment plan. We collected data from IP trainee evaluation forms after each session, a retrospective pre-post survey after the first session, and patient intervention outcomes. / / Results: 26 patients have been presented. Trainees rated interprofessionalism as very good to excellent (mean 4.6/5; sd 0.6; n=96), and indicated that PACT-ICU was helpful for development of a treatment plan (mean 4.1/5, sd 1.1, n=22). Their understanding of roles team members play in complex patients’ care was 2.7/5 (sd 1.0) before the session and 4.1/5 (sd 0.7) afterwards. Patient outcomes include IP co-visits, motivational interviewing, home visits, and assistance with in-home support and long-term care placement. / / Discussion: PACT-ICU has enhanced trainees’ understanding and practice of IP collaboration and teamwork and has improved care for complex patients. Results have been disseminated through an oral abstract at a regional meeting. / / Reflections: Based on feedback, we have changed PACT-ICU to increase IP inclusivity and trainee satisfaction. Faculty coaching of presenters and strengthening our partnership with PIM has been critical to these efforts.
32 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 31
Jumpstarting Faculty Development for Teaching Quality Improvement and Patient Safety: a Team- based Approach
Sandrijn van Schaik, MD PhD, [email protected]; Anna Chang, MD, UCSF, [email protected]; Shannon Fogh, MD, UCSF, [email protected]; Melissa Haehn, MD, UCSF [email protected]; Rachael Lucatarto, MD, UCSF, [email protected]; Audrey Lyndon, RN PhD, UCSF, [email protected]; Bridget O’Brien, PhD, UCSF, [email protected]; Patricia O’Sullivan, EdD, UCSF, [email protected]; Sumant Ranji, MD, UCSF, [email protected]; Glenn Rosenbluth, MD, UCSF, [email protected], Niraj, Sehgal, MD, MPH, UCSF, [email protected]; Niraj, Sehgal, MD, MPH, UCSF, [email protected]; Niraj, Sehgal, MD, MPH, UCSF, [email protected]
Areas abstract covers: Medical Student Education (UME), GME, CME
Domain(s) addressed: Faculty Development, Patient Care, Quality Improvement
Abstract: Purpose: To jumpstart faculty development in teaching quality improvement (QI) and patient safety (PS) at UCSF by taking a team approach to participation in the American Association of Medical Colleges (AAMC) “Teaching for Quality” (Te4Q) program. / Background: QI and PS are cornerstones of healthcare delivery, and faculty must teach trainees the associated knowledge and skills. For many faculty at UCSF these are new domains, thus requiring faculty development to ensure educators have skills to teach these topics. The AAMC Te4Q program aims to help institutions develop QI/PS educators, through participation in workshops and educational projects. / Methods: We selected candidates for the program from stakeholders invested in healthcare delivery and education, favoring broad representation of disciplines/professions and educators. The original Te4Q program calls for individual projects, but we took a team approach. We identified 5 priority areas for faculty development in teaching QI/PS as the focus of team projects, asked participants to rank their interest in these areas, and formed 5 teams to participate in the Te4Q program. Teams used the initial workshops to jumpstart projects including: 1) On-line modules for faculty new to QI/PS; 2) A toolkit for graduate medical education programs; 3) A module for clerkship directors; 4) Guidelines for faculty to integrate early learners in QI work; and 5) A “Teach-for-UCSF” certificate program in teaching QI/PS. / Evaluation Plan: A year after the initial Te4Q workshop, all projects are on track and nearing implementation. Each project has an evaluation plan and is documenting progress toward its goals and objectives. We also will track the number of faculty who participate in the various programs and the number of related projects that follow the original initiatives. / Dissemination: We plan to publish our work and will present at the 2016 World Congress for Continuing Professional Development. / Reflective Critique: Project team leaders meet monthly to review team projects, discuss progress, challenges and exchange ideas.
33 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 2
A Needs Assessment for Development of a Quality Improvement and Patient Safety toolbox for Graduate Medical Education within a large institution.
Shannon Fogh, MD, , [email protected]; Weston Fisher, MD, UCSF, [email protected]; Steve Polevoi, MD, UCSF, [email protected]; Pooja Mittal, MD, UCSF [email protected]; Robert B. Baron, MD, UCSF, [email protected]; Glenn Rosenbluth, MD, UCSF, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Curricular Innovation, Evaluation of Programs, Health Systems, Quality Improvement
Abstract: Purpose / background: In order to meet Accreditation Council for Graduate Medical Education (ACGME) requirements, training programs need to develop educational tools to teach quality and safety concepts to residents and fellows. / / Methods: We surveyed program directors or their delegates at UCSF using an on-line survey. We modified a previously published questionnaire to understand current educational materials, tools in place, and desired resources to teach quality and safety. We contacted respondents a maximum of two times. We calculated descriptive statistics as percentages based on the total number of respondents to an individual question. / / Results: Thirty-nine programs responded from a wide range of clinical specialties. Most of the surveys were completed by the program director or assistant/associate program director (84%) with 12% completed by the Medical Director of Quality at the hospital or department level. For programs with some form of curriculum in place; only 4% were very satisfied with their curriculum. Forty eight percent were satisfied. 48% were dissatisfied or very dissatisfied with their current program. In addition we noted tremendous variability in resources available to program directors, a general dissatisfaction with current quality improvement and safety resources, and lack of consistent ways to measure the efficacy of teaching interventions geared at quality and safety. / / Discussion/ dissemination: Within a large institution, we find substantial variability regarding the existence of quality and safety education materials across departments. These results will be submitted to a peer-reviewed journal for publication and available for stakeholders at UCSF. Future goals are to develop and demonstrate the effectiveness of a quality and safety toolkit. / / Reflective Critique: Our project has been evaluated at weekly meetings throughout the year with feedback incorporated as the project has evolved. We will continue to work with project mentors and our group to develop the Quality Improvement and Safety toolkit.
34 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 5
An introductory training series in continuous process improvement
Sumant Ranji, MD, , [email protected]; Audrey Lyndon, PhD, RN, UCSF, [email protected]; Valerie Huwe, RNC, MS, CNS, UCSF, [email protected]; James Stotts, RN, UCSF [email protected]; Ralph Gonzales, MD, UCSF, [email protected]
Areas abstract covers: Medical Student Education (UME), GME
Domain(s) addressed: Faculty Development, Health Systems, Residency
Abstract: Purpose: Develop concise online training in systems skills important to continuous process improvement (CPI) for students, residents, staff, and faculty at UCSF Health. / Background: Students and learners are charged with learning and implementing systems skills. As a result, academic medical centers are striving to create learning health systems – systems that continuously seek to improve tquality and safety of care, optimize patient experience, and enhance the value of care. In order to achieve these goals, trainees, staff, and faculty must share a common vocabulary and core knowledge base. We sought to develop a curriculum in 5 key domains of systems skills under the umbrella of continuous process improvement. / Methods: Educators from the Schools of Nursing and Medicine partnered with leadership of the Continuous Process Improvement hub at UCSF Health to determine the content areas for training in CPI and the optimal format for delivery. A series of online modules were planned in 5 domains: Introduction to Lean methodology, Quality Improvement, Patient Safety, the Patient Experience, and Finance/Value. Learning objectives were developed emphasizing accessibility of the content for novice learners including faculty and trainees and linkages between domains. To maximize assimilation of the material, the content was formatted as short (10-15 minute) online modules. / Results/Evaluation Plan: Modules for quality, safety and lean methodology have been completed and will be pilot tested with medical students in the clinical microsystems clerkship as well as 4th year students in a quality improvement elective. Content for the patient experience and value modules have been developed and are in production. All content will be utilized for faculty development in the 2016 Bridges curriculum. / Discussion/Dissemination: We plan to engage departmental and divisional leadership to ensure wide implementation of the course material, ideally paired with facilitated discussion among faculty to highlight important quality and safety priorities.
35 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 12
Designing a faculty and staff development program to engage early medical students in improving health systems
Anna Chang, MD, , [email protected]; Lee Atkinson-McEvoy, MD, UCSF, [email protected]; Anna Chodos, MD, UCSF, [email protected]; Leah Karliner, MD, UCSF [email protected]; Brent Kobashi, MD, UCSF, [email protected]; Cindy Lai, MD, UCSF, [email protected]; Meg McNamara, MD, UCSF, [email protected]; Ranji Rao, MD, UCSF, [email protected]; Stephanie Rennke, MD, UCSF, [email protected]; Bridget O'Brien, PhD, UCSF, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Faculty Development, Quality Improvement
Abstract: Purpose: Design a faculty and staff development program that supports medical student participation in system improvement (SI). / Background: Integrating health systems sciences into medical school curricula to advance trainees’ ability to improve quality and safety is an emerging priority. Medical students are eager to help improve health systems, but few schools engage pre-clerkship students in systems education that aligns with the clinical mission. Little information exists about the faculty and staff development necessary to support such initiatives. / Methods: We reviewed pilot initiatives at UCSF to: 1) identify best practices that help faculty implement workplace learning experiences in which first-year medical students participate in SI, 2) articulate faculty and staff development needs for this implementation and 3) describe early outcomes from student participation in SI projects. / Results: Successful projects were typically identified as priorities by teams in the clinical microsystem (CMC). Faculty and staff in the CMC integrated students into the project, drawing on knowledge and skills students gained in a foundational SI curriculum. Faculty participated in monthly check-in meetings to share successes and collectively troubleshoot challenges. Early outcomes from these pilots revealed successes such as decreased clinic no-show rates in a safety-net subspecialty clinic and increased health screenings for high-risk patient populations. / Discussion: We are currently translating our findings into a comprehensive faculty and staff development program. This program will include a combination of workshops and online resources to maximize real-time access to training and support. Our early efforts suggest that targeted faculty development enables clinical faculty and staff to guide early learners through meaningful participation in SI. / Reflective Critique: Faculty, students, and curriculum leaders continue to provide feedback on factors that facilitate and inhibit learning SI through immersion in CMCs to guide our ongoing faculty and staff development efforts.
36 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 17
Development of an innovative UCSF faculty development opportunity: The Teach for UCSF Certificate in Quality Improvement and Patient Safety
Melissa Haehn, MD, , [email protected]; Henry Crevensten, MD, Department of Medicine, [email protected]; Mary McGrath, MD, MPH, Department of Surgery, [email protected]; Patricia O'Sullivan, EdD, Department of Medicine [email protected]; Sheri Van Osdol, PharmD, Department of Clinical Pharmacy, [email protected]
Areas abstract covers: Medical Student Education (UME), GME, CME
Domain(s) addressed: Curricular Innovation, Faculty Development, Quality Improvement
Abstract: Purpose: / The Teach for UCSF Certificate in Quality Improvement and Patient Safety program aims to create an opportunity for faculty to develop the expertise in teaching quality improvement (QI) and patient safety (PS). / Background: / Quality improvement and patient safety are increasingly important topics in medical education, but there are barriers to teaching these topics such as lack of faculty and learner engagement, topic expertise, and teaching strategies for a diversity of settings and learners. / Methods: / After authors participated in the AAMC Teaching for Quality workshop in January 2015, they developed the Teach for UCSF Certificate in QI and PS. This faculty development certificate aligns with other teaching certificate programs already in existence at UCSF. The certificate requires completion of seven workshops, three of which are new and in varying stages of development: key topics in QI/PS, teaching strategies, and data analysis. / Evaluation Plan: / The launch of the certificate is planned for Spring 2016, beginning with the inaugural offering the workshop Key Topics in Quality Improvement and Patient Safety. Existing workshops are available through UCSF Research and Development in Medical Education (RaDME) and Teach for UCSF Certificate program. Planned evaluation of the certificate will be based on number of workshop enrollees, certificate completion, and workshop feedback. / Dissemination: / The certificate will be advertised on the UCSF RaDME website and available for CME credit. After the certificate is fully launched, we will disseminate descriptions of interim progress and findings in several ways including departmental quality conferences, online resources such as MedEd Portal, and regional/national conferences focusing on interprofessional education and QI/PS. / Reflective Critique: / To date, feedback on the certificate program has been solicited from the AAMC Teaching for Quality workshop facilitators and UCSF attendees. Further feedback will be sought from workshop and certificate participants and the workshops will be modified based on this information.
37 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-1
Abstract ID: 40
Quality Improvement and Patient Safety Activities for Medical Students in Clerkships: A Toolbox for Clerkship Directors
Kent Feng, BS, , [email protected]; Arpi Bekmezian, MD, UCSF, [email protected]; Christopher Hess, MD, PhD, UCSF, [email protected]; Rachael Lucatorto, MD, UCSF [email protected]; Lindsay Mazotti, MD, UCSF, [email protected]; Jeffery Tice, MD, UCSF, [email protected]; Sandrijn van Schaik, MD, PhD, UCSF, [email protected]
Areas abstract covers: Medical Student Education (UME)
Domain(s) addressed: Competencies, Health Systems, Quality Improvement
Abstract: Purpose: Create an online toolbox for clerkship directors to (1) help them identify, adapt or create quality improvement (QI) and patient safety (PS) activities within their respective clerkships and (2) familiarize them with the QI/PS-related milestones that students should master during clerkships. / / Background: Competency in “system skills”, including QI and PS, is now required of all graduating medical students. In the UCSF Bridges curriculum, first year medical students will attain relevant milestones through their Clinical Microsystems Clerkship (immersion in a clinical setting) and formal QI/PS didactics. Students are expected to apply the acquired skills in subsequent years, but how they will gain the experience needed to master system skills during clerkships is unclear. / / Methods: We began our curriculum design project with a needs assessment surveying 10 core clerkship directors followed by semi-structured interviews to identify existing QI/PS activities and explore medical students’ involvement in these activities. We then created an online toolbox in the UCSF Collaborative Learning Environment consisting of: a module outlining QI/PS-related competencies and associated milestones, a repository of QI/PS activities mapped to the milestones and a compilation of resources to help clerkship directors select appropriate activities for their students. / / Evaluation Plan: We will assess whether the curriculum meets its objectives with a retrospective pre-then-post survey assessing clerkship directors’ familiarity with the milestones, confidence in implementing QI/PS activities, and satisfaction with the online module via Likert-scale evaluation and free-response questions. Long-term program evaluation will be based on student involvement in QI/PS activities obtained through questionnaires and clerkship evaluations. / / Dissemination: We plan to submit the toolkit materials to MedEdPortal. / / Reflective Critique: We solicited feedback from various faculty including core clerkship directors at several stages and will continue to do so prior to implementation.
38 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2
Abstract ID: 1
A Movement Disorders-Focused Neuropsychiatry Curriculum for Psychiatry Residents
Andreea Seritan, MD, , [email protected]; Nicholas Galifianakis, MD MPH, UCSF Neurology, [email protected]; Jill Ostrem, MD, UCSF Neurology, [email protected]
Areas abstract covers: GME
Domain(s) addressed: Clinical Instruction and Performance, Curricular Innovation, Patient Care
Abstract: Purpose: To educate psychiatry residents on neuropsychiatric aspects of movement disorders, in the interprofessional setting at the UCSF Surgical Movement Disorders Center (SMDC). Background: Currently, there is a dearth of neurology and neuroscience education in psychiatry residency programs across the country. UCSF psychiatry residency offers 3 hours of didactics on neurology topics. Methods: A 6 month to one year longitudinal elective rotation for PGY4 Psychiatry residents at SMDC has been proposed. The rotation will consist of 4 hours/week of clinical activities and one hour of lecture/month. The lectures will be open to all trainees on site, including neurology residents, movement disorders fellows, psychology interns, postdoctoral fellows. Lectures will include: introduction to movement disorders; Parkinson’s disease; deep brain stimulation procedure, relevant neuroanatomy, and neuropsychiatric impact; fragile X-associated tremor/ataxia syndrome; neuropsychiatric manifestations of movement disorders; neuropsychological testing; palliative care in neurology; and tardive dyskinesia. Evaluation Plan: The rotation will be evaluated by participating residents at 6 months and one year, by E-value. Informal feedback will also be collected on an ongoing basis. Lectures will be evaluated separately using a brief anonymous questionnaire distributed at the end of each lecture. Pre- and post- curriculum scores on Psychiatry Resident In Training Exam neurology questions for participating residents will be compared. Discussion/Dissemination: In order to reach more trainees, we will record selected lectures and make them available as online educational resources through the Psychiatry Residency website. Once sufficient evaluation data are available, an educational case report will be prepared for publication in Academic Psychiatry or another educational journal. Reflective Critique: The proposed curriculum was discussed with the SMDC team. Additionally, this will be discussed with an external consultant, past president of the American Neuropsychiatric Association.
39 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2
Abstract ID: 7
Behavioral Approaches to Diabetes
Maureen McGrath, MS, , [email protected]; Kit Chesla, RN, PHD, ucsf, Chesla, Kit Domain(s) addressed: Curricular Innovation, Patient Care, Reflection, Simulation Abstract: In 2013 the UCSF School of Nursing developed the nation’s first diabetes minor for graduate nursing students to address the epidemic of diabetes and the influx of patients into the health care system due to the ACA. Three courses were developed- clinical Management of a) Pediatric and b) Adult Diabetes, and c) Behavioral Approaches to Diabetes Across the Lifespan. All courses have received outstanding evaluations (> 3.8/4.0) however the students highlighted the experiential learning of the 3 hour labs associated with the Behavior Course as the most beneficial to their future practice. In the lab, the students practice motivational interviewing, problem solving, and empowerment techniques as well as take part in a 4 day simulation of diabetes. During the simulation they use saline to inject for CHOs consumed and BGs checked. They log all of their injections, BGs, and food consumed for a 4 day period. They journal about the experience and a 3 hour lab is spent debriefing the simulation. Students with actual diabetes discuss the limitations of simulation. Throughout the 10 weeks, the students coach each other in achieving their own health goals using “SMART” goal setting and utilizing techniques they learn in the lab. They keep journals related to the barriers and successes of achieving their goal and share their journey with each other. / / With 3 years of evaluation and over 50 students completing the minor by June of 2016, we have now submitted abstracts to the American Diabetes Association and the American Association of Diabetes Educators. Each cycle of student evaluation has been incorporated in the next iteration of the management course as well as the Behavior Class. The response has been so overwhelmingly positive that certain labs (e.g., Teaching to Health Literacy Levels) are now being taught in the primary FNP curriculum. / 40 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2 Abstract ID: 23 Evaluation of a longitudinal psychiatry resident advising program Julia Ridgeway-Diaz, MS, [email protected]; Erick Hung, MD, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Evaluation of Programs, Longitudinal Educational Activities, Mentoring, Residency Abstract: Purpose: To assess whether the Residency Advising Program meets its goals of aiding residents in formative assessment, curriculum planning, and professional development. / / Background: In 2011, the UCSF Psychiatry Training Program launched its Advising Program, matching residents with a faculty advisor for the four years of residency training. The advising literature clearly shows that junior professionals benefit from the guidance of a senior advisor or mentor. Evaluating formal advising programs can be difficult, however, as many of the outcomes are intangible, such as the development of rewarding professional relationships or the discussion of personal values and how they affect professional development. / Methods: The authors conducted 11 semi-structured interviews with both resident advisees and faculty advisors. Six questions were asked of all interviewees regarding advisor/advisee matching, creating structure in the advising hour, the utility of E-Value, the advisor as both advocate and clinical supervisor, the frequency of meetings, and preparation for meetings. The interviews also included unstructured discussion of the relationship between the advisor and advisee. The interviews were coded and analyzed using an open coding approach, with plans to complete the more formal thematic coding subsequently. / Results/Evaluation Plan: Preliminary results show five themes emerging: boundary setting in the advising relationship, cooperative approaches to choosing the focus of the advising hour, the research interests of the advisors and advisees, interpretation of formative assessments, and developmental stages of residency. / Discussion/Dissemination: The findings will be disseminated in a peer-reviewed journal and local presentation at Pathways Symposium in Spring 2016. / Reflective Critique: Feedback on the content, goals, and methods has been solicited at four Works in Progress sessions with plans to participate in two more. One of the authors has also attended two ESCape workshops to discuss abstract writing and to generate ideas for scholarly dissemination. 41 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2 Abstract ID: 27 Implementation and Assessment of a Curriculum for Medical Students on Electronic and Telephone Communication with Patients Alexandra Ristow, MD, , [email protected]; Karen Hauer, MD, UCSF, [email protected]; Katherine Wrenn, MD, UCSF, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Communication, Computers and Technology, Curricular Innovation, Patient Care Abstract: Purpose: This study assessed the effect of a brief curricular intervention on third year medical students’ comfort with and attitude towards electronic and telephone communication with patients. / / Background: Few medical school programs have a curriculum dedicated to phone or electronic communication. Little is known about the effect a dedicated curricular intervention may have on students’ attitudes or abilities in these realms. / / Methods: A cohort of 14 third year medical students in the UCSF PISCES program were given a baseline survey assessing their attitudes about communicating electronically and via telephone with their patients. A brief interactive curriculum was delivered, and a post-curriculum survey was immediately distributed. The pre- and post-curricular surveys were analyzed using paired T-tests. / / Results/Evaluation: All 14 medical students completed the pre-curriculum survey; 12 completed the post-curriculum survey. The majority of students reported previous experience communicating with patients electronically (71%) or via telephone (100%), but none of the students had prior training in these subjects. / / Both before and after the intervention, students felt significantly more comfortable communicating with patients in person compared to electronically (p<0.05) or by telephone (p <0.05). Following the curriculum, students showed a small increase in their comfort with electronic communication (p = 0.010) and were more likely to rate electronic communication as educationally valuable (p= 0.045). There were no significant changes in students’ comfort level with or attitudes toward telephone communication. / / Discussion: A short, targeted curriculum may result in small improveents in students’ comfort with and attitudes toward electronic communication with patients. However, a brief intervention is not sufficient to change perceptions about phone communication, and more experience or more in depth instruction may be needed before students feel as comfortable with electronic or phone communication as they do with in person contact. 42 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2 Abstract ID: 29 Intern Half Day 2.0: Blended Learning in the Internal Medicine Core Curriculum Geoffrey Stetson, MD, [email protected]; Brad Sharpe, MD, UCSF, [email protected]; Elizabeth Harleman, MD, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Computers and Technology, Curricular Innovation, Residency Abstract: Purpose: / To implement a blended learning (BL) model in the internal medicine core curriculum. / Hypothesis: Learners exposed to a BL model will report higher satisfaction, increased collaboration with peers, score equivalent or higher in post-testing, and more learners will be exposed to the content. / / Background: / Multiple factors in GME have made delivering didactics content difficult. Online learning (OL) provides flexibility for busy learners. When compared to other formats, OL has similar knowledge outcomes. Blended learning–the combination of OL and face-to-face (F2F) learning–has shown higher academic achievement compared to purely OL or F2F learning. Some argue that social constructivism– knowledge creation through group work–is key to the improved outcomes with BL. / / Methods: / Interns will split into two groups. One group will receive a F2F lecture; the other group will watch OL materials and work in groups on complex clinical cases. Both groups will complete a pre-test to assess baseline knowledge, and a post-test focusing on approaches to similar patient cases. All learners will complete a questionnaire investigating satisfaction and the source of the information they used to complete the post-test. The number of individuals that access the OL materials will be tracked. / / Evaluation Plan: / Results indicating a successful curriculum would include improved knowledge outcomes and satisfaction with the BL model. Learners in the BL group would report more knowledge acquisition from colleagues. Lastly, more individuals will access the OL materials than who attend the F2F lecture. / / Dissemination: / All BL content will be made available to residents and medical students via an internal website. Each completed module will be submitted to MedEdPORTAL for peer review and publication. Results from the testing and questionnaires will be submitted for journal publication. / / Reflective Critique: / This study has been revised through submission to the academy of medical educators, and discussion with esteemed medical educators Pat O’Sullivan, Beth Harleman, and Brad Sharpe. 43 UCSF Education Showcase 2016 Mini Oral Presentations – April 4, Session B-2 Abstract ID: 41 RISE: A Teaching Method for Collaborative Clinical Learning Jennifer Olenik, MD, [email protected]; Marcia Glass, MD, UCSF, [email protected]; Larissa Thomas, MD, UCSF, [email protected]; David Irby, PhD, UCSF [email protected] Areas abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance Abstract: Purpose: To evaluate a teaching method that reinforces previously taught concepts through visual representations and collaborative learning. / Background: To enhance the effectiveness of resident teaching, a structured teaching method can be used to reinforce and consolidate previous learning of the ward team. The RISE method (Reintroduce, Involve, Summarize, Elaborate) draws upon the following learning principles: activation of prior knowledge, repetition, active engagement, and dual process learning (verbal/visual). / Methods: The RISE method requires senior residents to track key teaching points presented during the week. At the end of the week, the senior resident reintroduces previously taught concepts on a whiteboard in a skeletonized visual way for the learners to fill in collaboratively. The senior resident then summarizes and expands on the learning points. / For the pilot study, 10 self-selected PGY- 2 medicine residents learned the RISE method in a workshop. From a sample of clinical cases, they identified key teaching points and visually represented them on the board; thus modeling and then debriefing the method. A card containing RISE steps and a log for teaching points was distributed. / Subsequently, residents used the method with their teams. Residents provided feedback about feasibility and effectiveness by responding to a survey. Residents also submitted their preparatory materials and photos of the whiteboards. / Results: In survey responses, participants described the RISE method as appealing for structuring inpatient teaching and liked the use of repetition to consolidate learning. They perceived lack of time and creating the visual representations as the biggest barriers. / Discussion/Dissemination: Next steps include observations and longitudinal evaluation of implementation by the pilot cohort. Based on these results, we plan to modify and extend the training to all senior medicine residents. / Reflective Critique: After multiple ESCape and HPE Works- in-Progress meetings, the study became a proof of concept study; evaluation will be on-going. 44 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-1 Abstract ID: 8 Calibrated Peer Review (CPR): A Peer-Peer Evaluation System to Enrich Learning Patrick Yuan, BA, , [email protected]; Leah Goodman, BA, UCSF, [email protected]; Dana Rohde, PhD, UCSF, [email protected]; Amin Azzam, MD, MA, UCSF [email protected]; Dan Ciccarone, MD, UCSF, [email protected]; Patty Nason, , UCSF, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Basic Science Education, Clinical Instruction and Performance, Computers and Technology, Curricular Innovation Abstract: Purpose: To investigate the use of CPR as an MS1 learning and assessment tool in basic science and clinical skills. / / Background: CPR is an efficient and effective, online pedagogical tool that has demonstrated metacognitive, affective, and educational benefits. It has been used to teach medical students how to write high-quality chart notes and to help students grasp difficult basic science concepts. / / Methods: From 2014-2015, 151 UCSF MS1s were required to complete two basic science and two medical note-writing assignments based on standardized patients using CPR. Each assignment required students to submit an essay based on a prompt. Using a standardized rubric, the students then graded an exemplary essay (calibration), two peer essays, and finally, their own essay. Satisfaction data were gathered via Qualtrics and faculty were interviewed at the conclusion of the project. / / Results: 95 students completed at least 2 CPR assignments and 105 provided satisfaction data (mean 37.4% response rate). Satisfaction scores (1-5) were higher for basic science averaging 3.13 (SD=1.85) compared to 2.32 (SD=1.29) for note assignments. Using ANOVA, differences in satisfaction rates were significant at P ≤ 0.01. Students completing both note assignments showed greater improvement (16.2% increase) than those completing only 1 note (29.6% decrease). Faculty thought student learning was deepened by the CPR process but were concerned about logistical and technical challenges. / / Discussion: Conceptually, CPR holds great promise in deepening learning and engagement. Despite lower student satisfaction for note assignments due to an unfriendly user interface and technical flaws of CPR, the data suggests that students with low note-writing ability would benefit the most from CPR. Although iterative changes were made after each assignment, additional changes are necessary before further adoption. / / Reflective Critique: This project was reviewed and funded by the Academy of Medical Educators. Feedback was obtained from an advisory board and current medical students after assignments. 45 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-1 Abstract ID: 9 Capturing how medical students integrate interdisciplinary content using Concept Maps Allen Seol, BA, , [email protected]; Sam Brondfield, MD, UCSF School of Medicine, [email protected]; Arianne Teherani, PhD, UCSF School of Medicine, [email protected]; Katherine Hyland, PhD, UCSF School of Medicine [email protected]; Gerald Hsu, MD, PhD, UCSF School of Medicine, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Assessment and Testing, Basic Science Education, Curricular Innovation, Feedback Abstract: Purpose / The goals of our study are to investigate student perceptions of the utility of concept mapping in a multidisciplinary course and correlate scores of student-generated concept maps to other performance measures. / Background / Multidisciplinary content is often difficult for medical students as they often lack an organizational framework that allows for incorporating connections between disciplines. One approach to facilitate multidisciplinary learning is concept mapping, a metacognitive approach that may promote meaningful learning. In a concept map, concepts are graphically represented by nodes and connected to each other by linking phrases. They are dynamic and evolve to include more complexity, hierarchy, and connections, as new knowledge is acquired. / Methods / As part of a core pre-clinical course, second-year medical students at UCSF were required to complete two concept maps: one for a solid cancer and one for a hematological disorder. Instructions for map creation were provided in an online lecture and reinforced in lecture introductions throughout the course. Concept maps submitted by students will be scored and correlated with other measures of student performance (pre-clinical scores and clinical clerkship grades). Students will provide feedback about concept mapping and its utility in organizing multidisciplinary content using course surveys. / Results / Concept maps from 152 students have been collected. Surveying of students, scoring of maps and correlation with performance measures will begin when the course ends in December 2015. Preliminary data will be presented at the Education Showcase. / Discussion / Concept maps may reflect an ability that is fundamental to the practice of medicine: synthesis, evaluation, and communication of the relationships between domains of knowledge. Evidence of favorable student reception and correlation with other performance measures would support the incorporation of concept mapping in instruction, assessment, and remediation. / Reflective Critique / Feedback will be solicited and incorporated from medical education faculty. / 46 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-1 Abstract ID: 15 Development and Validation of an Inquiry Assessment Tool for the UCSF Bridges curriculum Sam Brondfield, MD, , [email protected]; Christy Boscardin, PhD, UCSF, [email protected]; Karen Hauer, MD, PhD, UCSF, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Assessment and Testing, Inquiry, Metacognition, Reflection Abstract: Purpose / We aim to develop and validate a tool for small group facilitators to use to assess preclerkship medical students’ inquiry behaviors. / Background / The new UCSF Bridges curriculum incorporates inquiry, defined as the process of challenging current concepts and creating new knowledge. To assess student progress in developing inquiry knowledge, skills, and habits, a tool is needed to enable faculty to document students’ behaviors and to provide effective feedback. / Methods / We followed guidelines by Artino (2014) and Downing (2003) for designing validated questionnaires and assessments. We conducted a literature review to identify essential elements of inquiry. A UCSF expert faculty focus group provided feedback on the literature review findings. We synthesized the literature review and focus group feedback into a list of potential student inquiry behaviors. We will perform a modified Delphi survey of UCSF faculty educators (n=33) and Pathways medical students (n=14) to generate consensus about essential elements of inquiry using a Likert scale (0 = absolutely do not include, 4 = very important) and obtain suggestions for additional assessment items. Second round surveys will include quantitative feedback about prior responses with mean and standard deviation data. / Evaluation Plan / The survey is in progress. We will include items with second-round mean response of 3 or greater with at least 80% consensus. The assessment tool will be presented. / Dissemination / We will pilot the assessment tool in small groups this year with full implementation next year. A publication is in progress. / Reflective Critique / Expert feedback is inherent to the Delphi process. Focus groups are planned to solicit feedback from course administrators, small group facilitators, and students for future tool modification. / References / Artino AR, La Rochelle JS, Dezee KJ, & Gehlbach H (2014). Developing questionnaires for educational research: AMEE guide no. 87. Med Teach, 36, 463-74. / Downing SM (2003). Validity: on the meaningful interpretation of assessment data. Med Educ, 37, 830-7. 47 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-1 Abstract ID: 32 Learning by Osmosis: Can student created content and a spaced-repetition formative assessment technology augment a collaborative student-driven curriculum? Amin Azzam, MD, MA, , [email protected]; Jessie Heminway, , UC Berkeley-UCSF Joint Medical Program, [email protected]; Shiv Gaglani, BA, Johns Hopkins School of Medicine, [email protected]; Ryan Haynes, PhD, Johns Hopkins School of Medicine [email protected]; Rishi Desai, MD, MPH, Stanford University, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Computers and Technology, Feedback, Longitudinal Educational Activities, Motivation Abstract: Purpose: When students google anything and information is everywhere, how can medical schools evolve to use these technologies? Core guiding principles include 1) maximizing engagement in the classroom, 2) increasing information retention, 3) providing frequent formative assessment opportunities, & 4) optimizing student learning. Background: To address these factors, we embedded a collaborative formative assessment tool (Osmosis[1]) with student-created quiz content into our learner-led Problem-Based Learning (PBL) medical curriculum at the UC Berkeley – UCSF Joint Medical Program. Osmosis was designed to facilitate medical student peer-to-peer learning by serving as a central repository for student-created and other supplemental content. It leverages a spaced repetition algorithm to consolidate learning as part of the testing effect. Osmosis optimizes learning through customization to individual learners’ needs and curiosities[2]. Methods: To understand the impact of adding Osmosis, we assessed 1) use and penetrance, and 2) variation in “user-only” vs. “content- contributor” students. Results: During one semester (4 months) our 48 students were encouraged to engage with Osmosis. In aggregate, 36 students (75%) contributed content as follows: 1,104 questions, 2,405 flashcards, and 688 learning documents. Acknowledging wide variation across individual students, 35 students (73%) spent 1,068 minutes (17.8 hours) answering the 1,104 questions a total of 11,955 times (average of 342 times/student). Discussion/Dissemination: Via informal “curbside” queries, students described their favorite features, including: 1) mobile accessibility, 2) quiz customization and filtering, and 3) immediate and frequent formative feedback. / Reflective Critique: Today, content creation is only as good as the tools and technologies used for aggregation, curation and dissemination. These preliminary results have larger implications for how medical schools might leverage crowd- sourcing, peer-education, and spaced-repetition to optimize their students’ content learning and long- term retention. 48 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-1 Abstract ID: 33 Learning from Clinical Uncertainty: Developing “Practice Inquiry” for Third Year Medical Students Kazandra De La Torre, MS3, , [email protected]; Jennifer Sneden, MS3, UCSF, [email protected]; Krista Farey, MD, Contra Costa Family Medicine Residency Program, [email protected]; Lucia Sommers, DrPH, UCSF [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Inquiry, Metacognition, Patient Care, Reflection Abstract: Purpose: To explore how “Practice Inquiry” (PI), a small group practice-based process where primary care clinicians collaborate to learn from clinical uncertainty, could be adapted for medical students / / Background: Since 2001 clinicians in 30 Northern California sites and trainees in 4 Family Medicine residencies have met in PI groups to present their clinical and/or patient-clinician relationship dilemmas, consult evidence, revise judgments and create new interventions. For students 3rd-year clerkships provide first experiences in managing uncertainty, usually with an inpatient team. PI could augment such learning in the classroom. / / Methods: 25 students were assigned to participate in 6, 90-minute sessions over 3 months. 2 faculty facilitators guided students through PI to select, present and discuss patients. Students provided formative feedback at sessions 1-3 and received an open-ended 4-question anonymous survey based on previous PI survey instruments. Questions addressed seminar value for managing uncertainty in their patients, improving overall uncertainty comfort, using PI skills outside seminars, and ease of discussion. Survey responses were hand-coded by 3 authors for thematic analysis / / Results: Seminar attendance was 74%(111/150). Students presented 1-3 patients per session. All format changes (smaller group, open format, student facilitator) were tried out in sessions 4-6. Survey response was 13/25(52%). All students valued acknowledging uncertainty by presenting patients. 10/13(77%) mentioned increased overall comfort with uncertainty although 3 preferred inpatient teams for this. 77% reported using PI outside the seminar. Smaller groups and flexible formats were suggested by all. 6/13(46%) advocated set-aside time for discussing third-year emotional/interpersonal challenges. / / Discussion: Discussing uncertainty cases increased students’ comfort with uncertainty. Showcase 2016 is an initial dissemination venue / / Reflective Critique: We will seek student/faculty feedback on complementing PI with dedicated forums to support students’ emotional needs. 49 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-2 Abstract ID: 11 Delivering a Novel Post-Graduate Global Health Curriculum: Lessons from the HEAL Initiative Joseph Scarpelli, MPH, , [email protected]; Sriram Shamasunder, MD, DTM&H, UCSF, [email protected]; Phuoc Van Le, MD, MPH, DTM&H, UCSF, [email protected]; Sherry Chen, MPA, UCSF [email protected]; Chad Noble-Tabiolo, MPH, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Cultural Competence, Curricular Innovation, Global Health Abstract: Purpose / The HEAL Initiative aims to train the next generation of global health professionals to be effective in low-resource settings. A key component of this 2-year fellowship is delivery of a novel global health curriculum. / Background / There has been an increase in post-graduate global health training programs in recent years. However, there is not yet consensus on what should be included in a training curriculum. We developed a bidirectional, interdisciplinary global health fellowship, which places fellows in domestic and international underserved communities. / Methods / At the beginning of the fellowship, participants attend a 3-week training program, inclusive of both hands-on learning and didactic sessions. Over 40 global health leaders presented. The core competencies of this curriculum included: provision of high-quality care, engagement in health systems, leadership, teaching, advocacy, and ethics. A pre- and post-test was administered to participants to gauge the effectiveness of the curriculum. / Results / Prior to the training, 39% identified a primary interest in health systems strengthening, with other interests split among direct patient care, medical education, community engagement and research. Following the training session, fellows reported an improved understanding of health systems and financing, healthcare delivery, and advocacy skills. The most valuable sessions addressed teaching, advocacy, disaster response, health care financing, and personal well-being. These are subjects that are often not covered in traditional programs. / Dissemination / The HEAL Initiative is currently collaborating with other global health leaders to define what a standardized global health curriculum should include at all levels. Participants in this working group include representatives from UCSF, Partners in Health, and EqualHealth. / Reflective Critique / HEAL actively solicits feedback from all stakeholders, including fellows and partner sites. Stakeholders provide feedback via survey and key informant interviews and HEAL seeks to act on these critiques to improve the program. 50 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-2 Abstract ID: 22 Evaluation of a global health experience: Process and early findings Emily Hall, RN, MSN, MPH, [email protected]; Sharon Rose, MPH, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Competencies, Evaluation of Programs, Global Health Abstract: Purpose:The Global Health Nurse Fellowship aims to build competencies in global health nursing through experience working alongside the nursing staff of a rural hospital in Haiti to build educational capacity. In addition to field experience, this program aims to provide a robust global health curriculum to enhance learning through literature review and structured discussions. / Background:Interprofessional competencies for global health are being developed within the field. This fellowship and curriculum have been developed to provide enhanced experiential learning opportunities, as well as complimentary academic practice and mentorship.Methods:Fellows in the program provide feedback in response to open ended questions. Year-end data from the pilot year and mid-year evaluation data from year two are currently available. Additionally, self-assessment of program competencies were completed once during the pilot year and once during year two. This data was collected as part of a program evaluation used to improve learning obtained through the fellowship and its accompanying curriculum. Results/Evaluation Plan: Evaluations completed by the first cohort highlighted weaknesses in logistics and lack of clarity in objectives of the program. Mid-year evaluations in year two expressed overall satisfaction with the program. Improvement was suggested in the areas of coordination and logistics, and increased involvement of Fellows in big picture level project planning. Discussion/Dissemination:The improvement in the year two mid-year evaluations is attributed to the strengthening of aspects of the program in response to the pilot year responses. Written responses were provided to individual participants approximately one month after their evaluations were submitted. Themes of the evaluations were summarized and updates to the programming based on the feedback were shared. Reflective Critique: Armed with pilot data, faculty and staff reviewed procedures in preparation for year two. Structures to share information and promote inclusion in program planning were implemented. 51 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-2 Abstract ID: 39 Patient Family Centered Nursing Rounds at a referral hospital in rural Haiti Sarah Meyer, BSN, RN, CPN, MS, ACPNP, , [email protected]; Irene Ritterman, RN, MS, FNP, UCSF, [email protected]; Emily Hall, RN, MSN, MPH, [email protected]; Sharon Rose, MPH, UCSF, [email protected] Areas abstract covers: CME Domain(s) addressed: Global Health, Longitudinal Educational Activities Abstract: Purpose: A survey of staff nurses at a referral hospital in rural Haiti was conducted to evaluate satisfaction with and determine the utility of nursing rounds as a continuing education activity. Responses were meant to inform next steps in developing this program. / Background: Rounds occur three times a week rotating through different wards of the hospital and are conducted at the patient’s bedside. One nurse is chosen to present a case and lead a discussion each day. All nurses in the hospital and members of the patient’s family are invited to attend. Discussion revolves around pathophysiology of the patient’s disease, appropriate nursing care, and patient and family education. After rounds, nursing supervisors provide constructive feedback to presenters. Educational principles considered in the development of this learning activity included adult learning theory and direct application learning. / Methods: In November 2015, a survey containing 15 questions was distributed to staff nurses. Questions were multiple-choice, open-ended, or used a Likert scale. Nurses were asked about their level of satisfaction with rounds, the case preparation process, whether they were learning, ability to apply new knowledge, and changes they would like to see. Data were analyzed using MS Excel. / Results/Evaluation Plan: Twenty-six nurses completed the survey. One hundred percent were satisfied or extremely satisfied with nursing rounds on a five point Likert scale, with 77% learning new information at every rounds, and 72% stating that new information obtained through rounds helped them provide better care. Expanding on pathophysiology during presentations was one desired change. A one-page summary of survey results was disseminated to nurses. / Reflective Critique: The evaluation survey elicited feedback on nursing rounds at a hospital in rural Haiti. Based on responses, modifications are underway, including placing greater emphasis on pathophysiology during case presentations. 52 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-2 Abstract ID: 42 Social Determinants of Health and Health Disparities:: What Every Researcher Needs to Know Christine Dehlendorf, MD, MAS, , [email protected]; Irene Yen, PhD, UCSF, [email protected]; Kirsten Bibbins-Domingo, MD, PhD, UCSF, [email protected]; Maria Glymour, PhD, UCSF [email protected] Areas abstract covers: Medical Student Education (UME), GME Domain(s) addressed: Diversity, Health Care, Interprofessional Education, Research Abstract: Purpose: Racial/ethnic and socioeconomic disparities in health outcomes are prevalent and persistent. Researchers of all types must understand the relationship of social determinants to health outcomes and how to incorporate this understanding in order to perform high quality research with relevance to diverse populations. Those interested specifically in performing research designed to understand and address these differences require an understanding of conceptual and methodological issues specific to health disparities research. In order to address these two audiences, we developed a course in the ATCR program designed to introduce the socioecological model of health and how to incorporate this framework into human research, as well as cover more advanced material related to the conduct of health disparities research. / Background: The curriculum development process consisted of three phases: 1) assessment of external and internal resources; 2) identification of core competencies; and 3) outlining syllabi. To accomplish these goals, we surveyed the health disparities and social determinants research curriculum available at US medical and public health schools, including those currently available at UCSF, and spoke with experts in the field. / Methods: Based on this background research, we developed a course in social determinants of health and health disparities research methods which we have offered over the past two years. / Results/Evaluation Plan: Evaluations of the initial year in which this course was offered produced positive results. Students, who represented a range of disciplines and research areas, gave the course an average score of 4 out of 5 in the final evaluation. Comments from evaluations included students expressing the value of being exposed to a multi-level ecological model and appreciation of the opportunity to explore sensitive topics in a supportive environment. / Discussion/Dissemination: We plan to disseminate this curriculum both at UCSF and more broadly using on-line resources, incorporating ongoing feedback from learners. 53 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session C-2 Abstract ID: 44 STEP UP: Interdepartmental GME Training in Health Equity Joanie Rothstein, MPP, MPH, , [email protected]; Laura Gottlieb, MD, MPH, UCSF, [email protected]; Sharad Jain, MD, UCSF, [email protected]; Anda Kuo, MD, UCSF [email protected]; Melanie Thomas, MD, MS, UCSF, [email protected]; Sara Whetstone, MD, MHS, UCSF, [email protected]; Amy Whittle, MD, UCSF, [email protected]; Beth Wilson, MD, MPH, UCSF, [email protected]; Naomi Wortis, MD, UCSF, [email protected]; Rita Nguyen, MD, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Competencies, Cultural Competence, Curricular Innovation, Residency Abstract: PURPOSE / The Zuckerberg SFGH Training and Education Programs for Underserved Populations (STEP UP) is a joint effort across ZSFG-based UCSF residency programs to align and enhance teaching around care for vulnerable populations and to increase collaborations across departments and residency learner levels. / / BACKGROUND / There is a national call to train physicians to care for underserved populations to reduce health inequities. Since residents who train in safety-net settings are more likely to later practice in similar settings, it is critical to support training programs in these institutions. Despite innovation in medical care for the underserved, ZSFG-based residency programs have not often collaborated across programs to share training responsibilities and opportunities around serving vulnerable populations. / / METHODS / In 2013 faculty and residents formed the STEP UP Task Force to examine GME training in care for the underserved. The Task Force identified opportunities to increase collaboration among existing training tracks, as well as to increase training opportunities for residents outside of dedicated tracks. / / RESULTS / STEP UP has achieved the following: / • Created an online Competency Map with educational domains/competencies/learning activities related to care for the underserved. This is the first resource of which we know that links such competencies with asynchronous learning activities; / • Recruited a robust Community Advisory Board; / • Developed a Resident Workshop Series; / • Sponsored 4 Grand Rounds. / / DISCUSSION/DISSEMINATION / Thirty- two residents from 6 different programs have enrolled in the Health Equity Certificate Program. We will disseminate activities and outcomes through the STEP UP website, newsletter and future publications. / / REFLECTIVE CRITIQUE / The Community Advisory Board provides regular feedback and we conduct evaluations of all resident learning sessions to inform future program design. We are creating an evaluation for Health Equity Certificate graduates to assess program impacts on attitudes, confidence and skills. 54 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-1 Abstract ID: 16 Development of a Feedback Based Curriculum: Transforming Milestone Based Evaluations into Actionable Feedback for Residents Margaret Stafford, MD, , [email protected]; Diana Coffa, MD, UCSF, [email protected]; Christine Pecci, MD, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Clinical Instruction and Performance, Competencies, Feedback, Residency Abstract: Purpose: To provide structured actionable feedback to residents in response to new RRC standards, we developed a comprehensive milestone-based tool that can serve as a blueprint for individualized resident curricula. Background: Feedback, though not classically defined as “curriculum”, is fundamental in creating an individualized curriculum. In a setting where hands-on experience is the core teaching modality, feedback is one of the most important teaching tools. The milestones system has improved learner assessment, but it is not clear how residents can use these assessments to guide their development. Methods: We designed and piloted a new Resident Progress Report (RPR) beginning in 2014. The RPR provides feedback to residents about their milestone progress, quality metrics and scholarly and community projects. We combined these data to create a comprehensive overview of resident progress. Additionally, the Clinic Competency Committee generates narrative comments for each of 6 competencies, providing residents with an in-depth assessment and specific advice for growth. Advisors review the RPRs with residents biannually. To evaluate the pilot phase, we surveyed residents and advisors about satisfaction with the new system. We also compared clinical quality metrics and completion of professional tasks before and after introducing the RPR. Results/Evaluation Plan: Preliminary data suggest more rapid completion of professional tasks (e.g., applying for licenses) and increased resident satisfaction with the RPR. Discussion/Dissemination: We will share our evaluation at resident and faculty meetings and present at the Society of Teachers of Family Medicine meeting. We have a manuscript in progress. Reflective Critique: We hold monthly meetings in which improvements to the RPR are discussed. We conduct regular formal anonymous surveys. Examples of modifications include: creation of additional fields; adjustment of milestone benchmarks; reorganization of the form; and addition of a wellness check-in reminder. 55 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-1 Abstract ID: 38 Palliative Care & Communication Skills curriculum for radiation oncology residents Michael Garcia, MD, MS, , [email protected]; Wendy Anderson, MD, MS, Department of Medicine, Division of Hospital Medicine and Palliative Care Program, UCSF, [email protected]; Penny Sneed, MD, Department of Radiation Oncology, UCSF, [email protected]; Tracy Balboni, MD, MPH, Department of Radiation Oncology, Brigham & Women’s Hospital, Dana Farber Cancer Institute, Boston Children’s Hospital, Harvard Medical School [email protected]; Michael Rabow, MD, Departments of Medicine and Urology, UCSF, [email protected]; Daphne Haas-Kogan, MD, Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston Children's Hospital, Harvard Medical School, [email protected]; Steve Pantilat, MD, Department of Medicine, Palliative Care Program, UCSF, [email protected]; Steve Braunstein, MD, PhD, Department of Radiation Oncology, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Communication, Curricular Innovation, Patient Care, Residency Abstract: Purpose: To formally train radiation oncology residents in empathetic communication and delivery of difficult news using a new curriculum. / Background: A significant proportion of patients with cancer receive radiation during the course of their illness, and the majority have physical and psychosocial symptoms that profoundly interfere with quality of life. Good communication with the oncologist can build a therapeutic relationship and reduce ineffectual treatments, improve adherence, and help mood symptoms. Randomized evidence has shown communication skills can be taught effectively during internal medicine residency. Formal instruction in palliative care and communication is rare in oncology training. UCSF Radiation Oncology does not yet have a palliative care curriculum. / Methods: The UCSF Radiation Oncology curriculum consists of 1-month cancer-specific blocks with daily didactics. The curriculum being developed is a 1-week Palliative Care & Communication Skills block, which will be a unique experience in U.S. Radiation Oncology training. It will include multidisciplinary seminars on Delivering Bad News, Discussing Prognosis, Talking About Dying, and Holding a Family Meeting. We are collaborating with Harvard Radiation Oncology Program, and there is potential for mirroring this communications block with UCSF for Harvard residents. / Evaluation Plan: Effectiveness on resident communication will be measured using an objective skills clinical exam (OSCE) after the block. Faculty observers will give feedback. Residents will complete a self-evaluation before and after the block. / Discussion/Dissemination: Self and faculty assessment will give data for course effectiveness, which will be written for publication. The goal is to expand the curriculum to 1 month to include the screening of mood symptoms, evidence-based palliative radiation techniques, and pain assessment. / Reflective Critique: Feedback was received at the UCSF Open Proposals website. We made changes to improve sustainability of the OSCE component by joining one already established by Palliative Care. 56 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-1 Abstract ID: 43 SPRUCE, Supporting Provider Resilience by Upping Compassion and Empathy Eve Ekman, PhD, MSW, [email protected] Areas abstract covers: GME Domain(s) addressed: Computers and Technology, Curricular Innovation, Residency Abstract: Purpose: The primary goal of this project is to pilot test a scalable, technology-assisted, emotion regulation and mindfulness meditation training. It teaches tools to cope with work stress, sustain empathy, and reduce the likelihood of burnout with the limited schedule of resident learners. This curriculum is called SPRUCE: Supporting Provider Resilience by Upping Compassion and Empathy in three departments within UCSF, Family and Community Medicine, Internal Medicine and Pediatrics. / Background: Burnout among residents in training, ranging from 50% to 80%, is well documented. Trainings in mindfulness have been found to significantly reduce stress, improve coping, increase positive affect and well-being, and promote effective emotion regulation skills. These courses require a significant time commitment and attendance at live training sessions, making them unfeasible for the intensive schedule demands of residents. SPRUCE pilots a brief stress reduction training curriculum and assessment tailored for the high-demand schedule of residents at UCSF. / Methods: SPRUCE curriculum is currently being piloted with groups of residents across three departments. The resident learners receive 8 to 10 hours of live instruction and e-learning. Evaluation of the pilot program includes qualitative assessment through individual interviews, psychometrically validated survey measures and quantitative assessment of user experience given throughout the training. / Evaluation Plan: This study was launched in July 2015 and is ongoing through the completion of the medical school year 2016. Qualitative analysis of the interviews and focus groups, quantitative analysis of the psychometrically validated scales and assessment of online participation in e-learning will contribute to the evaluation of feasibility. / Discussion/Dissemination: The results of the study will be submitted to academic publications in medical education, presented at conferences and shared with collaborating residency programs for ongoing curriculum development. / Reflective Critique: Pre-study focus groups with residents. 57 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-1 Abstract ID: 46 Student's Perceptions of Caring Melinda Cuthbert, RN, MSN, PhD, , [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Communication, Curricular Innovation, Interprofessional Education, Reflection Abstract: Purpose: To understand how student nurses perceive caring. / / Background: Recent focus on quality, safety, technology, and new standards of documentation and care, has arguably led to a greater focus on the technical tasks of healthcare. There is a perceived erosion of caring and the important role of communication in both quality and safety. Yet, few studies examine how healthcare providers understand, or communicate, caring. / / Methods: This class in nursing communication covered the basic curriculum in a traditional lecture format, but also included readings on caring, rules on civility, and critical reflection exercises on caring. A self-reflection with 5 probes about caring in the classroom was completed by 26/28 (93%) MEPN (Master’s Entry Level Program in Nursing) students. Reflections were analyzed using descriptive phenomenology, a modified practice of Colaizzi’s method, and a second reader. Significant statements, meaningful mentions, themes clusters and, finally, themes were identified. / / Results: Ten essential themes emerged as key to the student’s experience of caring in the classroom: a healing-caring space for learning, a language and structure for communicating caring, exercises for communicating caring, ability to be authentically present, learning through awareness of self, opportunities for growth, interpersonal interaction, cultivation of beliefs and values, inspiration for transformation, and understanding dimensions of caring. / / Discussion: This study suggests that students can learn to communicate caring, by first becoming aware of how they experience caring. It suggests further, that the integration of caring exercises and structuring the learning experience, even within the traditional classroom format, may facilitate not only learning caring, but also peer and interdisciplinary interaction. / / Reflective Critique: A second reader and the ESCape community provided feedback. Next steps include publication and developing a survey to collect data across academic and clinical disciplines and examine impact on clinical practice. 58 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-2 Abstract ID: 13 Development and Evaluation of a Pediatric Resident Basic Pediatric Fracture and Splinting Curriculum Melissa Bent, MD, , [email protected]; Ellen Laves, MD, Pediatrics, [email protected]; Holly Martin, MD, Pediatrics, [email protected]; Taylor Clark, MD, Pediatrics [email protected]; Nicole Learned, MD, Pediatrics, [email protected]; Daniel West, MD, Pediatrics, [email protected] Areas abstract covers: GME Domain(s) addressed: Assessment and Testing, Curricular Innovation, Longitudinal Educational Activities, Residency Abstract: Purpose: To develop a curriculum on pediatric fracture recognition and splinting management with the goal of improving fracture knowledge, splinting skills, and confidence. / / Background: Despite the high rate of pediatric fractures presenting to general pediatricians, graduating pediatric residents have limited competence with fracture management. Pediatric resident curriculum development at SFGH is challenging because residents learn with various learners. We developed a pediatric fracture curriculum addressing knowledge and skill gaps that encouraged peer-to-peer learning, and incorporated it into an existing pediatric core lecture series. / / Methods: We created a fracture curriculum for multiple levels of learners from different specialties about pediatric fracture identification and management. Learners were medical students and residents from Pediatric, Family Community Medicine and Emergency Medicine. The curriculum was delivered by trained instructors and consisted of lectures on fracture management, and practical sessions on splinting. During practical sessions, learners did peer-to-peer evaluations using a 6-point checklist used in previous studies. Didactic sessions were followed by a 14- question multiple-choice exam based on pediatric boards. / To measure our impact on resident confidence, we will distribute surveys to residents who did and did not complete the curriculum. / / Results: 33 residents and 17 medical students participated in the didactic sessions (22 pediatric residents, 8 FCM residents, 3 EM residents) 25 residents participated in the practical sessions, 4 of 25 residents scored <100% on the splinting assessment. Mean score for the multiple-choice test was 71%. Survey collection of resident confidence on splinting is ongoing. / / Discussion: We developed a novel pediatric fracture management curriculum for a diverse learner population. Knowledge gaps remain on specific topics. Data analysis on resident perceived confidence is ongoing. / / Reflective Critique: Curriculum instructors and EsCape group reviewed and provided feedback. 59 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-2 Abstract ID: 21 Evaluating Medical Student and Radiology Resident Preferences for Interventional and Diagnostic Radiology Kimberly Kallianos, MD, , [email protected]; Emily Webb, MD, UCSF, [email protected]; Miles Conrad, MD, UCSF, [email protected]; Brendan Ahearn, MA, UCSF [email protected]; David Naeger, MD, UCSF, [email protected] Areas abstract covers: Medical Student Education (UME), GME Domain(s) addressed: Career Choice, Residency Abstract: Purpose: To assess the preferences of medical students and radiology residents for interventional radiology (IR) and diagnostic radiology (DR). / Background: The American Board of Radiology (ABR) has recently introduced a new integrated interventional radiology/diagnostic radiology (IR/DR) program, which may affect residency and career choices. / Methods: We surveyed medical students (n=198) and radiology residents (n=55) at our institution regarding preferences for IR and DR, rating interest on a 10- point scale from least to most interested. Interest in IR versus DR was compared between groups at different levels of training including MS1-2 medical students, MS3-4 medical students, PGY2-3 residents, and PGY4-5 residents. Participation was optional and anonymous. / Results: Response rates by residents (48/55, 87.3%) and medical students (186/198, 93.9%) were similar. The highest level of interest in IR (7.2 out of 10) was expressed by MS3-4 medical students, while the lowest level of interest in IR was expressed by PGY4-5 radiology residents (3.3 out of 10) (p<0.001). The highest level of interest in DR (9.5 out of 10) was expressed by PGY4-5 radiology residents, and the lowest level of interest in DR was expressed by MS1-2 medical students (5.2 out of 10) (p<0.001). / Discussion: Medical students expressed a higher interest in IR compared to DR, however this trend was reversed amongst radiology residents. This survey suggests that IR with it’s mix of patient contact and procedures may act as a “gateway drug”, enticing more students to pursue radiology, which leads to subsequent interest in DR in some as they proceed through residency training. Awareness of these trends is important in order to advise students and anticipate potential changes in residency applications due to the IR/DR program. / Reflective Critique: Surveyed students are from a single institution, while surveyed residents completed medical school at different institutions. Thus it is somewhat difficult to directly compare preferences of residents to a more homogeneous group of medical students. / 60 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-2 Abstract ID: 24 Factors Influencing Selection of a Medical Specialty Adam Yen, BS, , [email protected]; Emily Webb, MD, UCSF Department of Radiology, [email protected]; Eric Jordan, MD, UCSF Department of Radiology, [email protected]; Kimberly Kallianos, MD, UCSF Department of Radiology [email protected]; David Naeger, MD, UCSF Department of Radiology, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Admission and Recruitment, Career Choice, Motivation, Residency Abstract: Purpose: / To assess factors influencing medical students’ and radiology residents’ selection of a specialty. / / Background: / Factors contributing to medical students’ selection of a specialty remain incompletely evaluated. In particular, some prior studies may suffer from a bias towards more socially acceptable answers. / / Methods/Materials: / An anonymous survey was distributed on paper to the MS1-3 classes and radiology residents from a single institution between 10/2015 and 11/2015. Questions assessed respondents’ age, number of dependents, anticipated debt, and factors influencing specialty choice. Respondents selected their top 3 factors from a list of 7 choices, using a coding system that further protected the anonymity of their answers. / / Results: / The survey response rate was 236/246 (96%). The top 3 factors that medical students reported would influence their residency selection were: finding the daily work fulfilling (81%), work/life balance (76%), and interest in the subject (73%). Radiology residents indicated the same three factors, though ‘finding the daily work fulfilling’ was indicated less commonly (p=0.005). The 4 factors uncommonly selected were: similar personality to others in the field, income as an attending, competitiveness and/or prestige, and job market conditions, in decreasing order of rank. There was no significant association between degree of debt and influencing factors. / / Discussion: / Both medical students and radiology residents reported that work/life balance, personal fulfillment, and subject interest were the top considerations when choosing a specialty. Income, competitiveness/prestige of the field, and job market conditions were less ranked considerations. / / Reflective Critique: / Applications to radiology historically cycle with job market fluctuations, however students and radiology residents did not rank this as a high consideration in specialty selection. We wonder if there may be a residual bias towards socially appropriate answers, despite the high level of anonymity used. 61 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-2 Abstract ID: 28 Integrating Primary Care Transformation Principles into Resident Quality Improvement Curriculum Claudia Mooney, MD, , [email protected]; Lydia Leung, MD, UCSF, [email protected]; Diana Coffa, MD, UCSF, [email protected]; Brianna Stein, MD, UCSF [email protected]; Chen-Yuan Lu, MD, UCSF, [email protected] Areas abstract covers: GME Domain(s) addressed: Health Systems, Primary Care, Quality Improvement Abstract: Purpose/Background: Given the national movement to transform healthcare systems, residency programs must effectively teach residents to engage in and lead practice transformation that will improve patient access, quality of care, and cost effectiveness. Simply exposing residents to concepts is not sufficient. Mature conceptual frameworks for transformation must be combined with opportunities to practice the skills in real healthcare systems. / Methods: Historically, our quality improvement (QI) course has consisted of didactic and hands-on QI experiences during the third year of residency. In 2015-16, a team of educators has designed and implemented an expanded three-year curriculum. This curriculum not only teaches skills for developing and implementing QI projects, but also provides a comprehensive framework for overall health system transformation. Course evaluations, clinical quality outcomes, burnout metrics, and knowledge assessments are all being used to evaluate the curriculum. / Results: Every resident completes a longitudinal QI curriculum on topics strategically placed throughout training. The PGY-1 curriculum focuses on population health and care teams. The PGY-2 curriculum focuses on skill-building and contextualization of QI programs in the residency training clinic. During dedicated sessions in PGY-2 and PGY-3, residents collaborate with clinic staff to design and implement a QI project using the FOCUS-PDSA model. By aligning residents’ QI projects with clinic and health network goals, we can leverage resident engagement to improve care for our patient population. We anticipate that there will be an improvement in the attitudes, skills, and knowledge in the domain of quality improvement, as well as improvement in clinical quality metrics associated with resident QI projects. / Conclusions: This QI curriculum increases longitudinal, level-appropriate training in domains related to quality improvement. Through ongoing collaborative working groups with other primary care clinical educators we have been able to share our work and refine our curriculum 62 UCSF Education Showcase 2016 Mini Oral Presentations – April 5, Session D-2 Abstract ID: 34 Leveraging the EHR to Improve Student Documentation Practices Jocelyn Ko, BA, , [email protected]; Niraj Sehgal, MD, MPH, UCSF Department of Medicine, [email protected] Areas abstract covers: Medical Student Education (UME) Domain(s) addressed: Clinical Instruction and Performance, Computers and Technology, Curricular Innovation, Quality Improvement Abstract: Introduction: Electronic health records (EHR) are now the most common tool for documentation, but students are poorly prepared for writing notes in a digital era. The EHR could be leveraged to influence how students learn to provide high quality care. Our goal was to determine if a standardized note template would foster adoption of best practices. / Methods: We interviewed faculty experts and medical students to generate a set of best EHR documentation practices. Our intervention included piloting new electronic templates and distributing an education guide to 3rd-year medical students during their internal medicine rotation at Moffitt-Long Hospital. In group 1, we introduced the templates in the third week of the rotation. In group 2, we introduced the templates on the first day based on feedback from the first pilot. To evaluate the initiative, we audited notes for use of the template, and completion of the patient’s daily goal and inpatient checklist. / Results: Over two rotations, we audited 284 notes from 17 students. Before the intervention, 3% of notes included the patient’s daily goal and 43% had all inpatient checklist items. In group 2, 29% had the patient’s daily goal and 83% had all inpatient checklist items. Barriers to adoption included absence of certain tools available in the housestaff templates. / Discussion: We found that medical students will adopt best practices when given a standardized template. However, it’s also critical that their templates closely mirror housestaff ones and the practices be modeled by the team. We plan to share our findings with UCSF educators responsible for building the curriculum on the EHR student experience and through a professional society meeting. / Reflective Critique: Based on post-intervention student focus groups, we learned the importance of team culture. Misalignment of student documentation expectations with housestaff ones makes for a less authentic student experience in adopting alleged best practices. Future changes to student templates should be done with clinical and educational leaders of that service. 63