P001: Making “Z” Grade: Calibrating Performance Grades Across the Clinical Year
Grading in the clinical years is difficult, complex and highly variable across institutions. The sense of grade inflation among clerkship directors has risen from 55 to 61% between 2012-16. Although many believe competency-based assessment using described behaviors is best, less than 50% of clerkships report faculty are adequately trained in evaluation of students. Another potential concern is the USMLE’s consideration of reporting only Pass/Fail grades. In order to combat grade inflation and appropriately stratify student performance, we wanted to implement a standardized scoring method to account for improved student performance across the academic year. To determine if summed, weighted z-scoring of graded clerkship components could adjust for the numeric grade score differences across the year, we compared students’ grades and rankings using traditional numeric scores and the summed, weighted z-score. We found the following: 1) Numeric grade cutoffs for Honors and Excellent varied greatly across the year, 2) This variance impacted ranking despite equivalent letter grades, 3) There was no difference in z-score cutoffs for Honors and Excellent over the year, 4) this resulted in fewer Honors and Excellent grades, and 5) Ranking by z-score was not disparate due to rotational differences in scoring. This may implications for more equitable determination of student rankings and combating grade inflation.
Presenter: Joseph Wayne, MD, MPH, MACP, Albany Medical College
P006: Longitudinal QI: A Novel Med/Peds Residency Quality Improvement Curriculum
Given Accreditation Council for Graduate Medical Education (ACGME) requirements and scheduling difficulties, our Med/Peds residency program developed a novel Med/Peds Quality Improvement (QI) curriculum. Implemented in 2017 and based on academic & industry examples, this longitudinal, team-based approach ensures resident education in QI methodologies. Initial aim was increased resident QI scholarly output with a long-term goal of > 70% residents reporting regular practice of QI on post-graduation surveys by 2022. The curriculum builds each PGY-year. The PGY-1 residents still participate in categorical introductory didactics. PGY-2 experience includes a novel, “mock QI project” where a Quality issue is identified, allowing instruction in QI methodologies in a low-stakes, longitudinal environment. With close mentorship from program leadership, they complete a 4-step worksheet and receive feedback to ensure understanding. The PGY-3 residents collectively complete a formal QI project. PGY-4 year, they can continue their projects and/or submit their data to academic meetings. This year, PGY-4 residents will newly participate in a capstone rotation in patient safety. Since implementation, three Med/Peds classes have completed mock projects and each graduating class has presented their project at a local academic conference. The 2018 class won a departmental award for QI and presented their data nationally. Post-intervention data from graduate surveys will be collected this summer. Residents enjoy the curriculum and provide continual feedback for improvement. They report subjectively increased understanding of diagramming root causes and designing interventions. Future steps will balance workload for program leadership, standardize didactics, and promote participation in Pediatric patient safety initiatives.
Presenter: Paul Shaniuk, MD, Case Western Reserve University School of Medicine
P008: A Novel, Multi-disciplinary Curriculum to Improve Nutritional Assessment Skills of Internal Medicine Residents
Nutritional counseling is a necessary tool for the prevention and treatment of many chronic diseases. A needs assessment at Hofstra-Northwell revealed that 68% of our residents were ‘not’ or ‘minimally’ comfortable conducting a nutritional assessment. Lack of knowledge was identified as a primary barrier to performing these assessments. These observations led to the development of a novel, multi-disciplinary curriculum with the goal of increasing resident ability in conducting a nutritional assessment.
This curriculum was developed in collaboration with Internal Medicine Residents, Gastroenterology Faculty, and Registered Dieticians. We developed a three-part curriculum; a traditional lecture, a small-group case-based learning exercise, and an objective structured clinical examination (OSCE) with directed feedback. The lecture reviewed components of the nutritional assessment, with emphasis on the dietary history, anthropomorphic data, and counseling techniques. Clinical cases were based on common clinical scenarios. Lastly, residents conducted a nutritional assessment with standardized patients using previously learned techniques and a standardized checklist.
Pre and post-intervention surveys evaluated for changes in provider comfort and perceived barriers for nutritional assessment and counselling. The proportion of residents who responded they were “quite comfortable” completing a nutritional assessment increased from 4.8% to 41.3% post survey, while the proportion who responded “not at all comfortable” decreased from 35.7% to 0%. The proportion of residents who found lack of individual knowledge as a barrier decreased from 60.5% to 42.5%. Residents cited “interactivity” and direct feedback as particularly useful.
This multidisciplinary curriculum was successful in increasing internal medicine resident comfort with conducting a nutritional assessment.
Presenter: Anita Ganti, MD, Donald and Barbara Zucker School of Medicine at Hofstra Northwell
P010: Implementation of a Longitudinal Leadership Development Curriculum for Med-Peds and Pediatric Residents
Residents develop clinical leadership skills, including team leadership abilities, relationship management, emotional intelligence, situational leadership, and the capacity for reflection, ad-hoc through on-the-job learning. We developed a longitudinal leadership development curriculum for mid-level residents to introduce leadership skills and provide residents with opportunities for self-reflection and practice. Residents participated in six two-hour sessions over nine months. All 23 residents completed the DiSC assessment and 70% participated in five of six sessions. In the comparison of pre and post surveys, there was global agreement on the importance and the impact of the leadership development curriculum on participants’ perceived ability to lead clinical teams and serve in leadership roles in the residency, institution, and community. Qualitative comments included valuing the small group interaction, enjoying the active participation and ability to practice skills, engaging peers in conversation about challenges, and building on effective communication through learning about leadership styles. We incorporated feedback into modifications for this year’s curriculum and will adapt the sessions to a virtual format due to COVID. We will increase the medical relevance of the content and train the clinical faculty to lead the sessions to allow for a sustainable curriculum model. We will incorporate residents who participated in the leadership development curriculum last year into the sessions this year, which will help engage participants in active learning and practicing leadership skills. We feel these adaptations will improve peer engagement and provide a sustainable model for the leadership development curriculum for our residents, which could be adapted to other programs.
Presenter: Jane Trinh, MD, FACP, FAAP, Duke University School of Medicine
P012: Facilitating Entrustable Professional Activity documentation during the Internal Medicine Clerkship: Pilot program reflections
This abstract summarizes how the Internal Medicine Clerkship team at Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) implemented the use of AAMCs Core Entrustable Professional Activity (EPA) assessments within the clerkship. As one of ten pilot programs selected for this EPA entrustment program, HWCOM was tasked with implementing EPA documentation within the clinical clerkships. After an initial voluntary year (Class of 2019) when students could select which EPA assessments they wished to complete during each of the seven core clinical clerkships, Class of 2020 students were specifically assigned certain EPA assessments that had to be completed during each clerkship. The required EPAs selected by the team for the Internal Medicine Clerkship included EPA 1 (history and physical), EPA 2 (prioritize differential diagnoses), EPA 3 (ordering/interpreting diagnostic tests), EPA 6 (oral presentations), EPA 7 (integrating evidence-based medicine), and EPA 9 (collaborating as an inter-professional team member). Results are presented, including total number of assessments completed within the IM Clerkship, as well as reflections on important factors required for successful training of teaching faculty and implementation of EPA surveys. Findings demonstrate that even when a large number of teaching faculty are involved, ranging from full-time university faculty to voluntary community-based faculty, successful completion of EPA assessments can be achieved. Future plans include compilation and review of EPA data by pilot entrustment committees, to provide an attestation regarding the level of competency for each medical school graduate.
Presenter: Amalia Landa-Galindez, MD, FACP, Florida International University Herbert Wertheim College of Medicine
P016: Inter-Visit Care Metric: A Novel Approach to Improving Provider Follow Up of Ambulatory Test Results
Test result follow up is important for patient safety and trust. Our objective is to improve residents’ follow up of lab results in the ambulatory setting through a feedback mechanism which we call the Inter-Visit Care metric (IVCM).
Presenter: Meghan Gwinn, MD, Henry Ford Hospital/Wayne State University
P021: Interactive Near-Peer Teaching: Preliminary Results of Ongoing Curricular Changes
Near-peer teaching improves learner satisfaction, knowledge acquisition, and may be used in the development of residents as educators. To our knowledge, the use of near-peer interactive learning models as a primary means of ambulatory curriculum implementation has not been well elucidated. The major aim of this study is to determine if the use of supervised interactive near-peer teaching, shifting content delivery to the learner, will result in improved engagement, satisfaction, knowledge acquisition, comfort, and increased skill development as an educator.
Residents employ interactive teaching techniques and complete pre and post-board style questions and surveys assessing comfort with diagnosis and treatment. Attendees assess quality, engagement, and effectiveness. Satisfaction, self-evaluation as an educator, and comfort with literature interpretation will be assessed every 4 months. Knowledge retention will be determined by in-training examination scores. Correlation between subjective and objective measures and retention will be investigated.
Preliminary data analyses included 105 pre-session tests/surveys and 95 post responses for 1 topic presented. There was a significant improvement in post-test scores. The proportion of residents from the pre-test group who felt very comfortable with treatment was 9.2%, whereas in the post-test group that proportion was 35.8%, which was statistically significant. Further, 7.4% of the residents felt uncomfortable with the topic initially while none did in the post-test.
The improvement in objective testing and comfort with topic treatment supports the use of supervised interactive near-peer teaching as a novel primary model for ambulatory curriculum delivery.
Presenter: Francisco Jose Reis Ferreira de Lima, MD, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
P022: Takin’ It to the Tweets: A Resident-Run Twitter Curriculum to Promote Learning and a Sense of Connection on the Medicine Clerkship
The COVID-19 pandemic has had a profound impact on the clinical learning environment and medical school training across the country. Student schedules and conferences were deeply impacted, and even after a return to a relative steady state after the initial March surge in COVID-19 cases, obstacles to learning remained. Residents and residency programs were also noted to have increased their use of Twitter for educational and recruitment purposes. However, few medical students were using Twitter for this purpose, and no formal training on Twitter in medical education existed previously. In July 2020 we created a Medicine Clerkship Twitter curriculum with the goals of providing asynchronous learning opportunities on the Medicine clerkship, fostering a sense of connection between students, residents and faculty, and demonstrating the utility of social media in undergraduate medical education. This curriculum was designed, under the guidance and supervision of two faculty members, by two PGY3 residents who have an interest in social media and medical education. Students were surveyed on their attitudes towards social media in medical education before and after the rotation. The curriculum was well received by students, but additionally, residents and faculty enjoyed contributing to the commentary on Twitter.
Presenter: Hannah Ravreby, MD, Lewis Katz School of Medicine at Temple University
P023: The Importance of Deliberate Practice: A Virtual Clinical Reasoning Elective
As students transition from the preclinical to clinical years of medical school, it becomes imperative not just to arrive at a correct answer on a multiple-choice test, but to be able to employ clinical reasoning skills for diagnostic assessments in real-word scenarios. These skills are often not taught explicitly and instead are left to be absorbed through observation of supervising clinicians, resulting in a non-systematic and non-standardized approach to clinical problem solving. There is a need for formal curricula in clinical reasoning to give students the vocabulary and space to practice clinical problem solving, while receiving feedback from expert faculty. In March of 2020 when medical students were removed from clinical rotations due to the COVID-19 pandemic, we recognized an opportunity to use the virtual classroom to deliver a curriculum to more intentionally develop clinical reasoning skills. We created four-week electives for MS3 and MS4 students at Loyola and Emory with three core learning objectives: (1) To teach core concepts and terms in the established framework of clinical diagnostic reasoning, (2) To foster application of these concepts through active engagement with practice cases, and (3) To develop educational materials to share with peers. As evidenced by student reflections on our electives, students craved this type of structured exposure to the vocabulary and theories of clinical reasoning, and found that deliberate practice was key towards becoming effective in developing skills in clinical problem solving.
Presenter: Anne Arnason, Loyola University Chicago Stritch School of Medicine
P024: What Is An Environment of Inquiry? A Survey of Resident Perceptions and Guide for Program Improvement
To facilitate an environment of inquiry (EOI), we first sought to understand trainee perception of an EOI to guide program wide initiatives to enhance an EOI. The main themes highlighted include an open and safe learning environment on team rounds, residents as educators, and scholarly activity. The results and insights of our trainees have impacted multiple educational domains across all sub-specialty divisions. Program-wide surveys of resident clinical and educational experience and real-time monitoring of these initiatives will help assess the strength and success of these initiatives.
Presenter: Michelle Lundholm, MD, Loyola University Chicago Stritch School of Medicine
P029: Enhancing Resident Case Conference Participation and Critical Thinking with Free Text Interactive Audience Response System
Medical education in residency is often delivered with case conferences to foster an interactive learning environment. However, we observed that resident participation in large group discussions can be variable, with some residents speaking frequently and others disengaged. Although we foster a safe learning environment, the fear of performing poorly in front of colleagues could be a contributing factor to disengagement. Multiple-choice audience response systems are often used to address this problem, but this limits critical thinking. Instead, we embedded anonymous web-based free text audience response activities into presentations to improve participation in our case conferences.
Preliminary data suggests that incorporation of free text audience response systems into the conference increased general participation from 20% to 85.2%. Additionally, the quantity of unique differential diagnoses increased from 0.2 to 0.35 responses per resident.
Incorporation of pollEV into case conference presentations has allowed us to better engage with our residents. The anonymous nature of the software allows residents the ability to share their thoughts in real-time without negative ramifications for erroneous logic for individual learners. The integration of multiple activities throughout the presentation keeps the residents engaged during the entire educational hour and provide immediate feedback to the presentors.
Presenter: Jennifer Duke, MD, McGovern Medical School at the University of Texas Health Science Center at Houston
P031: Cultivating Character Development in the Clinical Learning Environment
We describe our early work to explore student perspective of character moments and character traits in the clinical learning environment using reflective narrative. Clerkship students learned about character moments and character traits, then reflected on their experiences in clerkships to date. They described behaviors that positive role models exhibited related with certain character traits, as well as consequences of missed opportunities to employ character in the clinical learning environment. These rich student narratives provide a framework for our ongoing work to teach and assess professionalism using a character lens; this framework will additionally guide future faculty development and residents as teachers sessions. We will also soon celebrate our student-identified character exemplars who lead by example in the clinical learning environment.
Presenter: Marty Muntz, MD, FACP, Medical College of Wisconsin
P032: Psychological Safety on Medical Education Teams – Reflections from the Clinical Learning Environment
Psychological Safety, defined as the belief that the work environment is safe for interpersonal risk-taking, is vital to high-functioning teams in complex workplaces like our clinical learning environments. We taught clerkship students concepts of PS and how it affects key patient care, learning, and interpersonal team outcomes and then asked them to reflect and write on their experiences with PS during clerkships. Students identified team leader behaviors that enhanced and threatened PS; students also reported specific behaviors that they exhibited when PS was present and avoided when PS was absent. These behaviors will be used to design faculty development and residents as teachers sessions, as well as to celebrate resident and faculty exemplars of PS in the CLE.
Presenter: Marty Muntz, MD, FACP, Medical College of Wisconsin
P034: Resident Retriever: A Machine Learning Approach to Screening Residency Applicants
Screening residency applications is time consuming and generally relies on simplistic “sortable” measures like USMLE scores. A multidisciplinary group of trainees, data scientists, and program directors at one institution developed a machine learning approach for automated pre-screening of residency applicants for interview. The model had good performance in discriminating candidates who were offered an interview through human review from those who were not. The machine learning model was then deployed with an interactive dashboard in parallel to human review in the current application cycle. The approach helps pre-screen candidates with low likelihood of invitation (screen out) as well as identify candidates who would otherwise have been screened out (screen in). This automated approach is generalizable to other programs and is resource sparing, permitting more holistic review.
Presenter: Jesse Rafel, MD, MRes, New York University School of Medicine
P036: Novel Clinical Reasoning Bootcamp to Foster Oral Presentation and Clinical Reasoning Skills in the Internal Medicine Inpatient Clerkship
Description of how the problem was identified and explored: During IM grading meetings, review of students’ clinical performance assessments (CPAs) suggested an opportunity for students to foster their oral presentations and clinical reasoning skills.
Descriptions of the innovations: In May 2017, the first clinical reasoning bootcamp was launched during orientation week for an integrated internal medicine, neurology, and psychiatry clerkship. In the first session, the small groups were given a de-identified H&P and asked to generate their own differential and assessment and plan. Next the small groups were given an update spanning hours to days into the clinical case. The students then re-worked their differential and plan. In the second session, two different students presented their group’s findings. One student provided an oral presentation for the clinical case, while another discussed educational take away points. Each small group received feedback from their peer groups and the faculty facilitator. After all small groups presented, a second set of de-identified clinical cases were distributed and the process was repeated. During the third session, each small group again presented their clinical case and take away points. The bootcamp concluded with a group debriefing where students shared thoughts on best practices for oral presentations and written notes.
Discussion/reflection/lessons learned: The bootcamp has been well-received by students and facilitators. The bootcamp provides realistic practice for what students encounter when they join their clinical teams and are asked to pick up patients who have been admitted overnight or do not respond to initial treatment plans.
Presenter: Katherine Walsh, MD, Ohio State University College of Medicine
P037: Enter and Discuss Orders and Prescriptions - Curricular Integration of an Entrustable Professional Activity for Fourth Year Medical Students
EPA 4, Enter and Discuss Orders and Prescriptions, has been identified as a weakness for many PGY1 residents. Our institution also identified this as a weakness amongst our graduates. We describe a curriculum, incorporated into a required fourth year sub-internship, which is successfully improving graduate confidence and skills in order entry.
Presenter: Kristen Lewis, MD, Ohio State University College of Medicine
P040: Adaptation of a Resident Teaching Rotation to Provide Non-Evaluative Resident-Led Coaching for Clerkship Students
Individualized coaching and direct observation are effective strategies to both remediate struggling learners and facilitate growth of all learners. However, training in coaching theory and techniques is often limited. Moreover, while best practice dictates separation of evaluator and coach roles, this distinction is difficult in practice. Our institution has developed a novel two-week senior resident teaching rotation employing residents as non-evaluative coaches for clerkship students.
Prior to the rotation, residents complete asynchronous training on clinical coaching, direct observation, and use of validated feedback tools. During the rotation, residents are assigned to directly observe and provide feedback on student pre-rounds and oral case presentations. To facilitate SMART goal-setting, targeted feedback, and concrete action plan development, an electronic QR-based feedback tool was developed, incorporating instruments for assessment of history and physical, oral presentation, and clinical reasoning skills.
Survey data showed that 5/6 of residents felt their skills as a medical educator improved after completing the rotation (N = 6, response rate 86%). Moreover, 83% of clerkship students felt that it was beneficial to have the teaching resident observe presentations on rounds (N=35).
Novel adaptation of a senior resident teaching rotation has provided opportunity for education on clinical coaching and direct observation, while expanding capacity to provide in-person formative feedback for student learners outside of the evaluation system. In the future, this peer coach model could be scaled to non-clerkship or struggling learners with supervision by coaching faculty.
Presenter: Margot Cohen, MD, Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania
P043: An Interactive Patient Safety and Quality Improvement Workshop – Integrating EPA 13 into a Fourth-Year Medical Student Transition to Residency Bootcamp
Identifying systems failures and contributing to a culture of safety is AAMC’s thirteenth Entrustable Professional Activity (EPA). While most curricula teach principles of Patient Safety (PS) and Quality Improvement (QI), opportunities to participate in QI/PS discussions are not available to all students. We designed this workshop to allow students apply previously learned concepts to real adverse patient event (APE) cases.
This 3-hour capstone included didactic review of QI, PS, and TeamSTEPPS tools, and experiential components. Interactive small group discussions were student led. They collaboratively composed an incident report for the APE, conducted a Root Cause Analysis (RCA) by “interviewing” healthcare team members, and proposed error prevention ideas based on identified systems problems.
During AY2019, pre-post session mean knowledge scores and comfort with RCA and TeamSTEPPS concepts increased. For AY2020, increase in ability to identify Serious Safety Events (57.5% to 76.3%) and Escalation Chain of Command (58.2% to 77%) was observed. Evaluation by internal medicine specialty bootcamp students found 79.6% rated the workshop moderately-extremely effective.
This capstone provides a novel way to help students synthesize health systems science concepts through implementing problem-solving processes. Students gain an appreciation for the importance EPA13 and patient care perspective.
Ability to identify appropriate chain of command, escalate concerns, and correctly recognize serious APEs has implications in post-graduate training and practice. Using student facilitators and resident preceptors increases engagement and decreases faculty supervision burden. The workshop was successfully made virtual. Instructional format and facilitator flexibility will be invaluable as uncertainty due to the COVID-19 pandemic persists.
Presenter: Catherine Chen, MD, Rutgers Robert Wood Johnson Medical School
P046: Implementation of Telephone Visits in a Residency Clinic: A Strategy to Build Telehealth Skills, Improve Patient Ownership, and Enhance Continuity
Scheduled telephone visits are a convenient, effective method to deliver care; however, have not been widely incorporated into resident education. We piloted a telephone visit initiative in our residency clinic from October 2016 – December 2018 with the goal of developing telehealth skills in our trainees. We hoped that this novel visit type would also increase patient ownership and provider-patient continuity. During the pilot, nine of our 36 categorical internal medicine residents had a one hour block per week templated into their schedule for telephone visits. Unfilled openings were converted into acute office visits. All residents received direct or indirect attending supervision, depending on their PGY level, and all documentation was routed to the preceptor for co-signature. Measures included resident surveys and continuity data obtained through chart review. Seven residents were surveyed about their experience, with a response rate of 86% (6/7 residents surveyed). All respondents reported these visits increased their patient ownership, allowed them to build rapport with patients, and that the level of supervision was appropriate. With regard to continuity, out of the 273 telephone visits scheduled, 179 (65.6%) were with the patient’s PCP and 71 (26.0%) were within the PCP’s firm. We encountered several scheduling and supervision challenges during our pilot, which required refinement of our scheduling practices. We found that dedicated telephone visit time not only allowed residents to develop telehealth skills under appropriate supervision, but also improved patient ownership and preserved provider-patient continuity, thus we have expanded scheduled telephone visits for the current academic year.
Presenter: Jenna Laughlin, DO, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health Services
P047: Performance and Confidence of Medical Residents in Leading a Rapid Response Team: A Quality Improvement Project
Performance and Confidence of Medical Residents in Leading a Rapid Response Team. Formal education programs with mock rapid responses to improve housestaff comfort in both triggering and running an RRT.
Presenter: Andrew Moraco, MD, St. Elizabeth's Medical Center
P048: Simulating The Simulation: Virtual Orientation for Medical Interns in The Era of COVID-19
The Temple University Internal Medicine Residency Program conducted a fully virtual PGY-1 orientation in 2020 to comply with social distancing guidelines imposed during the COVID-19 pandemic. Procedure and emergency response training was conducted in a novel "virtual hands-on" format via streaming video. The format was well received by residents and survey data suggest an opportunity to conduct portions of future orientation events in a virtual format.
Presenter: Andrew Wickerham, MD, MPH, Temple University Hospital Samaritan
P049: Introducing the Core Competency of Effective Community Engagement for Internal Medicine Interns
Internal Medicine residency focuses on the core competencies of patient care and systems-based practice, both of which require significant interactions with surrounding communities. While instruction on the social determinants of health is an essential component of residency education, academic programs have not traditionally established formal didactics to introduce culturally competent approaches to effective community engagement that complement direct patient care. We have designed an introductory discussion-based curriculum to educate first year residents regarding a proposed competency in “effective community engagement.” The curriculum introduces learners to the historical context of the academic institution and its surrounding communities and incorporates the National Institutes of Health's Principles of Community Engagement to provide a structure for discussion topics. While it is not yet known how these didactics would impact individual relationships, preliminary results suggest learners appreciate the content and find the discussions engaging. We hope that through this curriculum, residents will recognize the complex dynamic of community engagement programs and be better equipped to become full patient advocates.
Presenter: Regina Jacob, MD, Temple University Hospital Samaritan
P051: Implementation of a Unique Procedure Policy for a New Community-Based Internal Medicine Residency Program
In the development of a new community-based internal medicine program, an interventional radiology (IR) rotation was created to ensure interns completed the ACGME required number of procedures. However, it became evident that residents were not continuing to practice their skills after the completion of the rotation. Roughly 40 paracenteses, 30 thoracenteses, and 50 central lines are performed by the IR suite every month. Our goal was to create a protocol to move these procedures to the bedside to allow residents to practice their procedural skills throughout the entirety of their training. After a two-month time period, 18 paracenteses, 14 thoracenteses, and 40 central lines were performed by the teaching team on the floor. The protocol was successful in allowing residents to continue to practice their procedural skills after the completion of their IR rotation and moved a total of 72 procedure from the IR suite to the nursing floor.
Presenter: Grace McNutt, Texas Institute of Graduate Medical Education and Research (Tigmer)
P055: Utilization of Instagram as a Primary Tool for Residency Recruitment
The COVID-19 pandemic has posed unique challenges to resident recruitment. Given social distancing guidelines, and restrictions on travel and in-person gatherings, we sought to replace many functions of our in-person recruiting tools with the social media platform Instagram. Utilization of Instagram has allowed us to highlight the culture of our residency program and engage potential applicants who are unable to visit in-person. Based on our experience, we believe developing a social media presence is a low-cost, high-yield method to facilitate recruitment and promote resident camaraderie.
Presenter: Andrew Hwang, MD, University of California, Riverside School of Medicine
P058: Enhancing Ambulatory Education and Career Exploration in the Fourth Year of Medical School
Medical students traditionally have had less exposure to the ambulatory practice environment than to the inpatient setting. In the past, UCSF students completed a third year primary care preceptorship, however students had less systematic experience with ambulatory skills relevant to other specialties/subspecialties. The less structured fourth year of medical school provides an ideal opportunity for ambulatory curricular innovation. As part of institutional curriculum redesign we developed SPAN (Specialty Practice Ambulatory sub-iNternship), a required longitudinal ambulatory preceptorship for fourth year students. The goals of SPAN are to facilitate fourth year medical students’ a) development of advanced ambulatory skills b) exploration of a specialty/subspecialty of interest and c) mentoring and clinical coaching relationships with a faculty member in their chosen field.
SPAN students are paired 1:1 with a faculty member in a specialty/subspecialty of the student’s choosing. Students complete 16 half-day outpatient clinic sessions during the fourth year. Students and preceptors have periodic feedback sessions to review the student’s goals and growth; preceptors complete 8 direct clinical observations of the student and students complete 6 self-reflections over the year.
In the 2019-2020 inaugural year 132 students participated in SPAN; over 95% were matched with a preceptor in their first or second choice specialty. Mid-point feedback will be obtained in December 2019.
SPAN is a flexible, highly individualized longitudinal experience that provides graduating students a strong foundation of ambulatory skills relevant to their residency training. SPAN is easily transferable to other institutions as it draws on existing outpatient clinical and educational structures.
Presenter: Katherine Lupton, MD, FACP, University of California, San Francisco School of Medicine
P060: Innovating a Novel Virtual Rounds Curriculum for Medical Students’ Internal Medicine Clerkship During the COVID-19 Pandemic
During the spring of the COVID-19 pandemic, third-year medical students were unable to participate in on-site clinical activities. We identified Internal Medicine (IM) clerkship components that would be suboptimal if students learned solely from online didactics and case-studies (such as pre-rounding, oral presentations, diagnostic reasoning, and management discussions). Using this, we created a Virtual Rounds curriculum (VR) to provide IM clerkship students with clinical exposure.
Presenter: Smrithi Sukumar, University of California, San Francisco School of Medicine
P061: Development of a Quality Improvement and Patient Safety Longitudinal Curriculum and Multidisciplinary and Interprofessional Project Forum for Residents
Development of longitudinal 3 year curriculum for QI and Patient Safety for internal medicine residents with culmination in a multidisciplinary and interprofessional Quality and Patient Safety Forum to showcase resident projects in an academic setting across hospitals.
Presenter: Ashwini Komarla, MD, University of Central Florida College of Medicine
P062: Rethinking the Third Year Inpatient Medicine Clerkship
The transition from the classroom to the hospital is traditionally a significant adjustment in the learning environment for medical students. One’s learning experience often depends on the attending and resident physicians a student is assigned to, generating a variable learning environment. We sought to reimagine, improve, and standardize our medical student inpatient medicine clerkship and provide a continuous, reliable experience of teaching excellence for all of our third-year medical students.
Presenter: Omar Qazi, MD, University of Central Florida College of Medicine
P063: The SIGN OUT PROJECT: Standardized Inpatient GME Night Float Organized Quality Transfer of Patients
Transitions of care are a challenge in any clinical setting. Our internal medicine program implements a night team that works 12 hour shifts and signs out the patients admitted overnight to several day teams. We noticed several challenges with the morning signout process, including lack of knowledge of day teams’ census, disorganized process and resident dissatisfaction with the process. We devised a quality improvement project (QIP) to implement a formal multifaceted standardized morning sign-out process. The project was resident-led, allowing us to institute changes without significant difficulty. We analyzed our morning signout process using a roadmap analysis and a fishbone diagram. We surveyed residents regarding their satisfaction with the duration of signout, the distribution of patients, the quality of patient information, and the current overall signout process. We implemented several “Plan, Do, Study, Act” (PDSA) cycles, including establishing one central location for resident hand-off, proper technique for assigning patient to incoming day teams, a formatted whiteboard in the GME resident room with new night admission assignments for each of the teams, along with a new standardized EMR sign-out template. Outcome metrics were collected through periodic electronic surveys to measure resident satisfaction with different aspects of the sign-out process. Our preliminary results showed a 75% increase in resident satisfaction of the overall sign-out process and structure. As shift work in the U.S increases and residency programs continue to abide by specific work hours, the number of sign-outs during a patient’s hospitalization have increased. Undoubtedly, these mechanisms must be concise, complete, and accurate in passing along information to avoid potential patient harm and inefficient work for clinicians. This QIP showed that standardized and centralized processes can be placed to increase resident satisfaction in transferring patient information to the incoming team.
Presenter: Richard Henriquez, MD, University of Central Florida College of Medicine
P066: Creating Supportive Practice Space for Clerkship Students Using Coaching Teamlets
We have developed a team based coaching program during the 3rd year Internal Medicine Clerkship to promote skills develop and support students. Our poster will describe the development of our coaching program, successes and challenges we've faced, and plans for future development.
Presenter: Ryan Nall, MD, University of Florida College of Medicine
P067: A Novel EPA Aligned Discharge Curriculum
Discharging a patient from the hospital is an integral part of an intern’s responsibility. Studies show that over 95% of students desire additional discharge training. As part of the medicine sub internship, 58 students at the University of Illinois completed a survey to identify their knowledge gaps in discharge planning. Gaps identified included documentation, roles and responsibilities of healthcare providers, medication reconciliation and identifying factors to prevent readmission. To help students develop entrustable professional behaviors regarding safe discharge practices, we designed a curriculum to improve students’ skills, attitudes, and knowledge. The curriculum consisted of 5 parts: an independent module, students providing discharge instructions to patients with direct preceptor feedback, following up by phone with patients after discharge, completing a self-assessment and a final small group session addressing ways to prevent errors and improve the discharge process.
Data was collected from 92 pre and 58 post-curriculum surveys. Differences in proportions were determined using chi-squared test. The results were as follows: knowledge increased in performing medication reconciliation (40% to 75%, p < .001) and writing discharge summaries (57% to 83%, p = .002), and attitudes improved regarding importance of transportation needs (64% to 96%, p < .001) and financial concerns (53% to 90%, p < .001) and direct student involvement in providing patient discharge education increased from 38% to 85%, p < .001. As this curriculum has been deployed for over two years with multiple preceptors, it has been standardized and can be easily implemented in different fourth year rotations.
Presenter: Asra Khan, MD, University of Illinois College of Medicine
P068: Use of a Discharge Observation Tool in Medicine Sub-Internship
Discharging a patient is an important activity that interns are expected to perform during residency. Despite this, over 95% of medical students desire additional training. We used a discharge observation tool originally used in the medicine clerkship to assess fourth year student’s performance when discharging patients during their medicine sub-internship. Students were required to have a preceptor provide real-time feedback while discharging a patient. The tool was used to provide feedback to 82 students in the following areas: patient communication, medication counseling, and team communication. The results were as follows: 92% provided appropriate medical terminology, engaged in the teach-back method, were responsive to non-verbal cues when discharging patients, 90% addressed patient’s concerns about the discharge plan, including questions about how factors such as cost, transportation and insurance may affect follow up, 82% provided counseling about new medications started during the hospitalization and described side effects of medications administered, 87% involved other members of the healthcare team, communicated with other physicians, and explained the follow up plan after discharge. The discharge observation tool is a workplace-based assessment, similar to the Mini-CEX for discharge. It is easy for preceptors to use, simple to implement, and can be used in a variety of settings with minimal preparation.
Presenter: Asra Khan, MD, University of Illinois College of Medicine
P069: QUIKCOACH: An Innovative Platform for Providing Workplace-based Formative Feedback
Three-year data from the intern orientation Entrustable Professional Activity (EPA)-based Objective Structured Clinical Evaluation (OSCE) demonstrated a gap between what is expected from the learners in terms of EPA proficiency and their baseline performance. We developed mini-structured clinical observation (MSCO) forms based on the EPA OSCE and designed a mobile platform to efficiently deliver just-in-time MSCO feedback forms in the patient care setting. Electronic MSCO forms based on EPAs were developed. Elements from the EPA station checklists which provided discrete performance data specific to the context of the patient problem were chosen. A mobile iOS platform, QUIKCOACH, was developed to deliver feedback. Core tenets used in development of this app included: learner-initiated request for feedback; timely delivery of forms to allow for direct observation, voice-enabled narrative comment capability, immediate feedback delivery to learners, and the ability for learners to assess the usefulness of supervisor feedback. A pilot is currently being conducted in the iOS TestFlight app. Assessment of feasibility, reliability and educational impact is being collected. Formative feedback based on direct workplace-based observation of learners is essential to the development of clinical skill competence. MSCO forms were designed to provide quick, formative feedback to learners based on direct observation. Actionable behavior-specific comments and global assessment are part of each form. The mobile iOS application makes the process of observation and formative feedback easy and time-efficient in the workplace setting. This initiative supplements existing evaluation processes by providing additional data to residents regarding their progress in reaching clinical skill competencies.
Presenter: Jane Rowat, University of Iowa Roy J. and Lucille A. Carver College of Medicine
P071: Peer-Based Formative Assessment and Feedback on Residents' Teaching Skills Using an Objective Structured Teaching Exercise
This poster will explain how we designed and implemented a time and resource efficient Objective Structured Teaching Exercise (OSTE) into our resident teaching skills curriculum to allow residents to demonstrate teaching skills and receive peer feedback. Objectives included: 1) demonstrate one-minute preceptor (OMP) microskills, 2) create an effective learning climate, and 3) provide peer feedback based on direct observation.
We will describe components of the OSTE and how we trained residents in their roles and responsibilities. We will show pictures of the instructions and the pocket card with the steps of the OMP that residents received. We will use figures to demonstrate how residents themselves served as standardized learners, resident teachers, and facilitators who debriefed the OSTE. We will show pictures of our residents participating in the OSTE in their specific roles. We will describe the large group debriefing, commitment to a teaching action plan, and the session and peer evaluations.
We will describe our findings regarding which of the microskills residents most commonly identified as needing improvement. We will describe the quality of the oral and written peer feedback with specific examples. We will report resident pre- and post-assessment of their own teaching skills in the OMP, feedback, and learning climate as well as resident evaluation of the usefulness and fidelity of the OSTE itself.
This OSTE provided an efficient, effective, and valued platform for residents to practice teaching skills and receive peer feedback based on direct observation. We believe it can be easily adapted by other programs.
Presenter: Krista Johnson, MD, University of Iowa Roy J. and Lucille A. Carver College of Medicine
P079: Student Tele-support to Reduce Isolation and VulnErability (STRIVE)
Social isolation (lack of or infrequent social connections) and loneliness (perceived isolation) are major public health concerns that are associated with poorer physical and mental health outcomes. Social distancing due to COVID-19, has exacerbated social isolation and loneliness-- both of which disproportionately affects patients who are already vulnerable – those who are older, with more chronic conditions, and those with limited social supports.
Our goal was to reduce social isolation and loneliness by providing longitudinal companionship from medical students through virtual visitation, while creating innovative educational opportunities for medical students who were entering into a virtual learning environment.
Medical students enrolled in the STRIVE program contacted patients on a weekly basis via phone or video. In addition to providing social support and companionship, students screened patients for and provided resources to address unmet social needs, provided COVID-19 education, and reported to their physician preceptors weekly to discuss patient progress and necessary interventions. These students participated in weekly didactics and submitted reflective essays.
Fifty-three out of 65 patients were successfully reached and established care with a medical student. Of the patients reached, 43 (81%) were identified to have at least one unmet social need.
In conclusion, patients at high risk for social isolation and students can benefit from longitudinal contact that provides various forms of social support and serves as a continuous link to the patients' primary care clinic. This curricular innovation has developed into a permanent 4th year elective within the clinical component for our health systems sciences course.
Presenter: Madison Malfitano, University of North Carolina School of Medicine
P081: Initiation of a Chief Medical Student Role to Enhance Student Education and Representation
Poster title: “Initiation of a Chief Medical Student Role to Enhance Student Education and Representation.” Contributing authors will be listed below the title. Poster sections starting with upper left quadrant and moving counter clockwise: (1) Identifying the Problem, (2) The Medical Student Chief Role, (3) Aims, (4) Innovations, (5) Outcomes. The center of the poster will show a photo and/or graphic depicting our medical student morning report series, illustrating the structure of collaboration among fourth, third, and pre-clinical medical students.
Presenter: Robert Short, III, University of North Carolina School of Medicine
P083: Teaching Time Management Skills to Fourth Year Medical Students Using the PDSA Cycle
This intervention bridges the development of skills in time management and quality improvement (QI) over the course of a 4-week sub-internship by introducing QI principles to fourth year medical students and having them apply the Model for Improvement to their own time management skills. They attend an initial workshop and then submit worksheets that show their work over the course of their projects, receiving feedback with each week. At the end, they demonstrate knowledge retention by applying the core skills to a standardized case and their own case based on something they witnessed during their sub-internship. This curriculum has improved student’s confidence in their time management skills and ability to participate in and lead QI projects. It also improved students’ understanding of the importance of time management and learning QI for their future careers. Most students (81.8%) indicated that they planned to use skills learned during this project during their intern year.
Presenter: Jennifer Readlynn, MD, University of Rochester School of Medicine and Dentistry
P088: Correcting the Grade Inflation Phenomenon in the Internal Medicine Clerkship
Grade inflation in clinical clerkships is a national epidemic. In prior studies, the majority of internal medicine clerkship directors believe grade inflation exists at their institution. UT Southwestern’s Internal Medicine Clerkship has observed over 50% of students receiving Honors grades, sometimes without sufficient commentary in faculty evaluations to substantiate these grades. The clerkship sought to address this issue by adopting a multimodal approach to facilitate greater concordance between narrative observations and awarded grades as well as promote a more normative distribution of grades.
New evaluation forms prioritizing narrative feedback over numeric scoring were introduced. Subsequently, faculty development workshops were hosted at each clinical training site. Grading calibration mechanisms were designed to reconcile discrepancies between recorded observations and clinical grade assigned by faculty evaluators. Finally, a committee was convened to review grade appeals and ensure standardization. The primary outcome assessed was the distribution of grades.
The percentage of students awarded a grade of “Honors” decreased from 63% to 45% in the post-intervention cohort. An independent samples T-Test confirmed the effectiveness of the intervention to reverse the grade inflation phenomenon.
Implementation of new processes and initiatives to emphasize narrative feedback was successful in achieving a more normative grade distribution as demonstrated by a shift from Honors to other grade categories. This project serves as a framework for how narrative feedback and assessment reform strategies can be applied to achieve more normative grading distribution in an effort to better distinguish student performance and reverse the cycle of grade inflation.
Presenter: Justin Holmes, MD, University of Texas Southwestern Medical School
P090: Employing Patient Encounter Simulations to Boost Learners’ Confidence and Skills For Empathetically Communicating Difficult News
Communicating test results and treatment plans are an integral component of patient care, yet medical trainees receive limited instruction and feedback for this competency. To increase medical students' competency and confidence for difficult but empathetic conversations with patients and their families we created a communication simulation utilizing SPIKES and NURSES frameworks that was then delivered by VitalTalk-certified or trained faculty during the core Internal Medicine clerkship.
Presenter: Reeni Abraham, MD, University of Texas Southwestern Medical School
P095: Reinventing the Bootcamp Experience
Most Internal Medicine Program Directors (IM PDs) agree that Core Entrustable Professional Activity (Core EPA) #10, Recognize a patient requiring urgent or emergent care and initiate evaluation and management, is one of the top 5 Core EPAs that incoming residents should be ready to perform on day 1 of intern year. However, most medical students do not feel adequately prepared to perform this Core EPA by graduation. Recognizing the need to reinforce this essential clinical skill, we developed two case-based simulation experiences as a component of our fourth-year capstone experience.
Incorporating Core EPAs into our framework, we designed two case-based scenarios utilizing high-fidelity mannequins to simulate decompensating patients requiring urgent clinical evaluation and management. We scheduled students in pairs to mimic an intern-student team and each exchanged roles for the subsequent scenario. A total of 20 minutes was allotted for each simulation which included time for prebriefing and debriefing. Faculty facilitators evaluated student performance on multiple Core EPAs (including Core EPA 10) and provided direct feedback during the simulation debriefing.
A total of 38 students completed the simulation and 28 completed the survey for a response rate of 74%. The high-fidelity simulation experience was highly effective in improving students’ perceived preparation for intern year. Students also felt that the direct, structured feedback focusing on multiple Core EPAs was useful and practical.
This high-yield simulation experience enables reinforcement of key clinical skills, including gaps in certain Core EPAs, to better equip graduating medical students for intern year.
Presenter: Adam Garber, MD, FACP, Virginia Commonwealth University School of Medicine
P097: Implementation of Digital Direct Observation Moments in Resident Continuity Clinic
Despite being long recognized as critical tools for resident improvement, direct observations by faculty are increasingly difficult to prioritize in the outpatient setting. The implementation of direct observation curricula has also been challenged by the recent COVID-19 pandemic, where many outpatient clinics were canceled, postponed, or transitioned to telehealth. The balance of COVID-19 precautions with faculty direct observation must be addressed in a timely manner to ensure that learners are reaching clinical competency milestones.
We surveyed Internal Medicine trainees and General Internal Medicine (GIM) faculty regarding perceived importance of ambulatory direct observations for resident education, preferred type of observation tool, and ideal clinical skills most likely to benefit from direct observations. As expected, faculty thought direct observations were important for resident self-improvement, which was discrepant from resident responses. Overall, faculty recommended more observations of communication-based domains of the clinic visit, while trainees preferred observations on physical exam maneuvers and outpatient procedures. Faculty also reported dissatisfaction and unfamiliarity with tools like mini-CEX and were interested in an electronic version of the tool.
We have since implemented an electronic direct observations outpatient tool that can be easily accessed via a QR code. In the 3 months of implementation, 43% of our intern trainees have been directly observed by faculty in the continuity clinic setting. We plan to administer a 6-month post-survey to faculty and residents to better understand implementation and effectiveness of this new tool, especially in light of the COVID-19 pandemic.
Presenter: Jessica Valente, MD, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
P099: Development and Implementation of an IM Residency Clinical Reasoning and Documentation Curriculum
Using an internally-developed, reliable documentation assessment tool, we have previously reported the relative lack of documented clinical reasoning among IM residents. EMR documentation can be a venue to demonstrate and augment clinical reasoning. We developed a longitudinal curriculum for second year IM residents using didactics, group discussion, and peer feedback to improve documentation quality. Our curriculum is nearing completion, was well-received, and changed attitudes and reported documentation practices. Using our EMR documentation assessment tool, we studied and report the effect of the curriculum on documentation quality to guide future curricular improvements.
Presenter: Karl Richardson, MD, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
P101: Developing Residents’ Critical Consciousness: A Half Day Social Determinants of Health Curriculum
Social determinants of health (SDH) contribute to health disparities. Current graduate medical education (GME) on SDH and health disparities is inconsistent, and residency programs are challenged to improve their curricula on this topic.
The goal of this project was to create a learning experience for Brown’s Internal Medicine residents to improve their knowledge and awareness of SDH specifically using a combination of didactic tools, experiential learning, and discussion/reflection.
We designed a half-day curriculum in partnership with Crossroads (the largest social services delivery agency and homeless shelter in Rhode Island) and the Rhode Island Department of Health (RIDOH). The curriculum included an introductory didactic presentation, a site visit to Crossroads, a site visit with presentation by the RIDOH, and an end of the day debriefing and reflection session, combined with debriefings after each site visit on a bus that served as our “travelling classroom.” Evaluation methods included a pre and post survey and a post-curriculum evaluation which were analyzed quantitatively. We also collected a reflective paragraph from each participant which we analyzed qualitatively using thematic analysis.
We found no statistically significant changes between our pre and post survey on knowledge, behavior or importance. We identified 3 themes in our qualitative analysis of residents’ post-curriculum reflections: 1) Positive feedback, 2) Suggestions for improvement, 3) Application of activity to practice. Most residents found the curriculum valuable and favored continuing it in future years. Residents found the visit to Crossroads especially valuable and suggested other community partners to consider for future site visits.
Presenter: Jessica Murphy, MD, MS, Warren Alpert Medical School of Brown University
P104: Teaching Junior Medical Students to Perform Medication Reconciliation
Medication reconciliation (medrec), the process of creating the most accurate list medication list and comparing across transitions of care, is often inaccurate with at least one error identified 10—67% of the time. Most education on medrec has focused on post-graduates. We developed an intervention to train medical students on medrec. In this abstract we describe results after 6 months and lessons learned.
Presenter: Diane Levine, MD, FACP, Wayne State University School of Medicine
P106: A Novel Coaching Team Structure to Foster Deliberate Practice
This poster describes a novel rotational structure designed to foster meaningful formative feedback where resident takes the attending role and the attending becomes resident's coach and introduces the concepts of Deliberate Practice and Growth Mindset. Our poster also includes the preliminary qualitative analysis of semi-structured interviews which were conducted at the end of the rotation.
Presenter: Ozan Unlu, MD, Weill Cornell Medicine
P107: Clinical Reasoning Happy Hour: Cheers to Virtual Syllogism
The SARS-CoV-2 pandemic has changed the medical education landscape in ways no one could have imagined. The anticipation and participation in clerkships is a milestone in medical school characterized by excitement as well as relief as one transitions from the classroom to the clinical setting and will finally be carrying out the role of student doctor. With the pandemic driven alterations in clinical experiences, an important piece of student satisfaction and competence are the connections and community components of being part of "the team." We created a virtual synchronous gathering for M3 and M4 students to share cases and teaching topics with each other, under the guidance of faculty. It was not a "course," it was not graded. Sharing was encouraged and allowed. Discussion of cases, from the pathophysiology, differential diagnosis creation, work-up and management were done. These kinds of sessions permit student personal and professional growth in a safe, non-threatening environment as well as opportunities for peer teaching and collegiality.
Presenter: Melissa Olken, MD, PhD, FHM, Western Michigan University Homer Stryker, MD, School of Medicine
P109: Reimagining M and M
Over the prior 24 months, morbidity and mortality (M&M) conference engagement at the University of Virginia dwindled to an all-time low of less than quarterly presentation of cases due to a mixture of resident discomfort presenting cases surrounding error as well as a lack of recognition of potential learning cases. Additionally, there was interest in promoting formal instruction and discussion of clinical reasoning and diagnostic error. Thus, M&M conference was reimagined in an innovative form, as a structured case conference embedding resident self-reflection with facilitated discussion of diagnostic error and bias mitigation that engages all residents in both small and large group discussion. Addressing the culture of the conference and intentionally shifting the content and language of case discussion has led to a dramatic re-engagement in this conference by our residents and in growth of knowledge and understanding of the role of our cognitive biases in leading to diagnostic error.
Presenter: Brian Ulthaut, MD, University of Virginia School of Medicine
P110: Finding Reasoning in an Academic Half Day
Presenter: Bizath Taqui, MD, Lewis Katz School of Medicine at Temple University