Posters

P003: Combatting Interview Inflation: Impact of Giving Students Match Statistics at the Time of Interview Offers

Residency application inflation is an increasing problem. We suspected in the virtual season, interview acceptance inflation would be exacerbated due to increased convenience and decreased costs of interviews, and increased anxiety caused by the change to the usual recruitment process. Increased transparency of information may assist students to limit applications. A key characteristic of the millennial generation is inspiration to make the world just and equitable. We hypothesized (1) giving students concrete statistics about length of rank lists and likelihood to match, and (2) reminding students that interviews are a finite good, might encourage students to decline invitations to interview if we were not in their top 10 programs. We added a paragraph to our invitation email encouraging applicants to decline our invitation, making the slot available to others, if our program was unlikely to be in their top 10, and attaching an NRMP graph showing likelihood of matching against number of programs ranked. We surveyed students who declined interview invitations or cancelled interviews with us. Despite a low response rate, most common reasons chosen for declining were “not in my top 10 institutions list” (87%) and “I had already been invited to a desired number of interviews” (87%). Fourteen of 15 respondents (93%) said that having this additional information was helpful to them when deciding whether to accept an interview and 80% said it “encouraged me to turn down interview offer due to the number of interviews I had.” Only one respondent was turned off by this information.

Presenter: Jillian Catalanotti, MD, MPH, FACP
George Washington University School of Medicine and Health Sciences

P037: Usefulness and Cost-Effectiveness of an Online Intern Retreat During the COVID-19 Pandemic

With the progression of the COVID-19 pandemic and social distancing requirements, virtual meetings became essential to ensure the continuity of medical education. Creating an intern retreat, which entails participation in team building exercises and activities that require constant audience engagement is challenging when a virtual format is adopted. The curriculum was reinvented to enable delivery of content over a purely virtual platform. Efforts were executed around creating a cost-efficient model, spanning over a 10-hour period, instead of the usual 2-day period. Lectures and team building exercises were delivered through various modalities accessible via Microsoft Teams. Participants completed an online survey before and after each of the virtual sessions. A total of 40 internal medicine interns participated in this intern retreat remotely. At the beginning of the retreat, interns were least confident in their teaching skills and in providing constructive feedback. All sessions resulted in an increase in the percentage of interns reporting extreme confidence in the subject matter. The largest increase was seen in the session related to American Board of Internal Medicine preparation followed by the interns’ confidence in delivering high value care in a systematic approach. Despite challenges encountered during the online delivery, the intern retreat has proven to be effective in preparing interns to assume their responsibilities as senior residents. Given the success and cost effectiveness of this activity, it is likely that future sessions can continue to be held remotely online.

Presenter: Shaheena Raheem, DO
Wayne State University School of Medicine

P005: Building Preoptimization Education and Training into your Curriculum with both Preoperative and Subsequent Postoperative Evaluations

How to develop a preoptimization and consultative program/curriculum to better train residents in caring for their patients in the perioperative period. It includes continuity of care by providing education in both the outpatient preoperative setting along with postoperative follow-up. Consultative medicine is often taught in many different aspects of the curriculum but this program consolidates it for us. It helps educate residents in both a systems approach to care with a team model where each member needs to communicate effectively to improve patient outcomes. Being a consultant also demonstrates to a resident the different roles a general internist can have in medicine.

Presenter: Gina LaCapra, MD
Atlantic Health (Overlook)

P006: Evaluating the Impact of Diagnostic Time-Out as a Tool to Promote Clinical Reasoning During Night Float Presentations: A Pilot Study

With the emergence of “night float” admissions, trainees often present patients on rounds who were admitted by a different clinician. We hypothesized that incorporating a diagnostic time-out (DTO) on rounds would promote feedback and development of clinical reasoning. General medicine teams at the Hospital of the University of Pennsylvania were randomly assigned to use a DTO tool on rounds for new night float admissions or to a control group. The DTO consisted of 5 questions: Do we have an accurate, comprehensive summary statement? Do we have a complete, prioritized differential? Have we considered any biases impacting our clinical judgment? Did we consider and rule out “can’t miss” diagnoses? Have we acknowledged any uncertainty in our leading diagnosis? After each 2-week rotation, all participants were sent anonymous online surveys. Among interns, 91% in the intervention group and 75% in the control group felt that their diagnostic reasoning skills improved. A similar trend was observed with respect to feedback on diagnostic reasoning, with 82% of intervention group interns and 56% of control group interns reporting feedback. Furthermore, 0 out of 4 control group attendings compared to 4 out of 12 intervention group attendings (33%) reported perceived improvement in diagnostic reasoning skills. Implementation of the DTO on rounds was associated with numerically higher rates of improvement in diagnostic reasoning skills and feedback among interns as well as improvement in perceived diagnostic reasoning skills among attendings. A second phase of the study is ongoing, incorporating changes to overcome the barriers to DTO utilization.

Presenter: Mary Barrosse-Antle, MD
Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

P008: Harness Team Energy to Catapult Patients Into Success: Bite-Sized Lessons Regarding Social Factors

ACGME internal medicine program requirements ask that programs recognize and help address the social determinants of health (SDOH). Additionally, we desired that our residents more effectively utilize community resources to ultimately improve the health of our community. We collaborated with our local experts - the clinic social workers and pharmacist - in addition to general medicine faculty to brainstorm methods for developing a longitudinal curriculum. Each resident completes an ambulatory rotation three times/year, so the ambulatory SDOH curriculum is divided into three segments with one new segment experienced each time on the ambulatory block. We addressed the following themes during these segments: access to care and medication assistance, food insecurity and transportation, and immigration, language, and housing. Faculty members provided introductory didactics and didactics regarding immigration and language barriers and approach to appropriate interpreter incorporation. The social workers, pharmacist, and faculty partnered together to provide informational sessions. During a team workshop, we led into a virtual city tour activity for the residents. As part of this tour, residents used a local crime map, Google maps, the local bus route website, and other resources to determine the patient's location in comparison to the clinic, grocery store, pharmacy, schools, etc. Local non-profit organization leadership also provided information seminars to residents. This longitudinal series culminated in sharing positive success stories of our patients that would have been impossible without this multidisciplinary team. We received positive feedback via resident surveys regarding augmented knowledge of important resources to combat patients' social barriers.

Presenter: Suchita Pancholi, MD, FACP
University of South Carolina School of Medicine, Columbia

P012: Improving Resident Patient Satisfaction Scores

We performed a study to evaluate interventions that could increase the patient satisfaction scores for internal medicine residents. Over a period 10 months focus was placed on resident patient communications skills, specifically during the discharge process. New policies were created to require physician contact immediately prior to discharge and a universal after visit summary was implemented. Results showed inconsistent and variable patient satisfaction scores, that appeared to be from differences in individual rotating residents. Despite improving patient's sense of being respected and standardizing the discharge process no significant change was noted in the likelihood to recommend score. This was in line with current literature showing residents are well tolerated but lead to decrease in LTR scores. Given variable and clinically insignificant data, resident performance is best evaluated through alternative means and not through LTR scores.

Presenter: Saad Jamil, MD
Chicago Medical School/Rosalind Franklin University of Medicine & Science/Northwestern Medicine McHenry Hospital

P019: Silver Lining Playbacks, Asynchronous Learning in the Age of COVID

The COVID-19 pandemic and resulting focus on virtual learning has created inherent difficulties in delivering effective resident education. With this in mind, TJUH IM residency created a YouTube account recording virtual conferences to develop a lasting curriculum that expands and solidifies resident knowledge.

We used the analytics feature on YouTube to assess resident viewing and conducted an online survey of internal medicine residents in April of 2021 to assess when and why residents would watch videos, and in what capacity they deemed them educationally effective.

By April 22 there were 1,645 total views, 37 subscribers, and 50 videos on the YouTube channel. 93% of residents thought that the lecture videos enhanced their educational experience. 82% noted that the lecture videos helped them in preparation for clinical rotations, and 80% noted it helped them in preparing for board examinations. Residents were most likely to watch recorded lectures during ambulatory rotations then on floors and ICU.

The lectures were utilized significantly by the residents who overwhelmingly thought they enhanced their educational experience, especially during less hour intensive rotations. Extrapolating this data one can clearly see the benefits in developing residency video lecture repositories in fulfilling the ACGME medical knowledge core competency.

Presenter: Nicholas Young, MD
Sidney Kimmel Medical College at Thomas Jefferson University

P020: Beyond Buprenorphine: Resident Education on General Care of Patients with Opioid Use Disorder to Decrease Bias

With opioid use disorder (OUD) deaths skyrocketing nationwide, internists still feel undertrained and underprepared. There is compelling evidence of care gaps for this population, as well as negative bias from clinicians which impacts care outcomes. Caring for patients with OUD is also a recognized driver of burnout, professional dissatisfaction, and moral distress. We developed a novel curriculum on the general care of patients with OUD and created an addiction Implicit Association Test (IAT) to assess bias. The curriculum was intended to reduce bias against patients with OUD by affirming their worth regardless of recovery status and to reduce resident burnout by demonstrating the many ways to improve patient health regardless of recovery status. To measure bias we developed an addiction IAT, a computer-based assessment of implicit bias which is frequently used to measure implicit bias for other traits. IATs measuring implicit racial bias can predict disparities in medical decisions, thus an addiction IAT is felt to be a plausible measure of clinically meaningful bias. Mean D-score prior to the workshop was 0.389, consistent with a moderate negative association for people with addiction; after the workshop mean was -0.011, consistent with little to no implicit association (p=0.022). 100% of residents who evaluated the workshop agreed somewhat or strongly that it was useful and would impact their patient care. Knowledge and burnout scores (using the Professional Fulfillment Index) did not change. We hope to further validate and establish the utility of the addiction IAT as an assessment of educationally-sensitive bias.

Presenter: Jillian Zavodnick, MD
Sidney Kimmel Medical College at Thomas Jefferson University

P024: Longitudinal Health Disparities and Health Equity Curriculum for Internal Medicine Residents

Presenting a longitudinal health disparities and health equity curriculum developed for all VCU internal medicine residents as part of their core curriculum. The VCU internal medicine residency program recognized the importance in educating all of our residents about health disparities and teaching them how to apply these lessons to promote health equity in their own practice. The curriculum was designed to span over the three years of residency training and include multiple sessions in which the residents participate. The residents are led by internal medicine faculty and are encouraged to actively engage with topics such as social determinants of health, implicit bias, community outreach, micro and macro aggressions and the history of racism in medicine.

Presenter: Sarika Modi, MD
Virginia Commonwealth University School of Medicine

P025: Bridging the Gap - Development of a Learner-Directed Pathway and Clinical Rotation to Engage Internal Medicine Residents in the Care of Under-Represented Populations

In this poster we describe how a residency program with no existing explicit training in social determinants of health developed a program that achieved the dual goals of ACGME expectations for education about health disparities and resident-identified needs for additional learning on equity and advocacy. The programmatic innovations give residents who participate in the learner-directed pathway expertise in equity and advocacy and have also increased relevant content exposure to all internal medicine residents. We describe the curriculum that was implemented in the first year of the program, the steps in its development that we believe were key for establishing program sustainability, and how lessons learned will change the curriculum going forward.

Presenter: Victoria Gillet, MD
University of Wisconsin School of Medicine and Public Health

P026: Development of a Novel Mentorship Curriculum for Medicine-Pediatrics Residents

We developed an innovative, longitudinal mentorship curriculum to improve mentorship among medicine-pediatrics residents. That intervention has been augmented based on resident feedback and in order to comply with social-distancing restrictions resulting from the COVID-19 pandemic. Our current mentorship model is a multi-pronged intervention which includes five longitudinal components: 1) small-group peer mentoring; 2) brief, regular online check-ins with residency leadership; 3) online didacts and workshops focused on skill building; 4) a series of “Luminary Dinners” highlighting different career paths; and 5) dedicated faculty members who serve as “Faculty Bridges” to pair residents with mentors based on common interests. We performed an interim analysis on de-identified results from an annual residency survey which elicited resident opinions regarding overall programmatic mentorship and specific aspects of the mentorship curriculum between 2012-2020. We used chi-square tests to assess statistically significant differences pre- (2012-2015) and post-intervention (2015-2020). Overall, 103 residents responded to survey questions about mentorship. Residents’ satisfaction with overall residency mentoring improved from 57.6% pre-intervention to 78.6% post-intervention (p-value=0.14); satisfaction with emotional support improved from 63.6% to 81.8% (p-value=0.07); and satisfaction with career mentoring improved from 48.5% to 60.0% (p-value=0.59). Our results showed improved resident satisfaction with overall and career-specific mentorship, as well as emotional support, though given our limited sample size those findings were not statically significant. We used those results to inform changes to our model of mentorship that were implemented during COVID-19 pandemic, with a particular focused on career mentorship. A subsequent planned analysis will evaluate the impact of those interventions.

Presenter: Lao-Tzu Allan-Blitz, MD
Harvard Medical School Brigham and Women's Hospital

P028: Development of a Multisystem Point of Care Ultrasound Competency Assessment Tool

Point of Care Ultrasound (POCUS) is a skill that is rapidly growing across multiple medical specialties as well as across learner levels from medical students through in-practice physicians. POCUS is a skill that requires both image acquisition and interpretation by the user to answer focused, goal-directed questions about patient care for diagnostic purposes as well as guide performance of invasive procedures. While training in this skill have been well-established in the specialty of emergency medicine, clear guidance on training and methods to determine competency for certification are limited in other specialties. The recently established National Board of Echocardiography exam aims for participants to demonstrate mastery in critical care ultrasonography. However, tools to assess a learner’s achievement of basic competency across more broad applications are lacking. Therefore, we developed a tool to assess learner competency across multiple POCUS applications through a modified-Delphi approach via three rounds of voting, group discussion, and iterative revisions. Consensus was defined by ≥80% of experts agreeing to include an item. Items achieving >80% consensus for inclusion were discussed, revised, and considered for an additional two rounds of voting. During the first round of voting, 133 items achieved consensus, and after revision and revoting, an additional 21 items achieved ≥80% consensus. A total of 154 items were included in the final multisystem POCUS competency assessment tool with categorical selections with reference anchors. We have developed a multispecialty consensus-based POCUS competency assessment tool to evaluate basic skills in cardiac, lung, and abdominal ultrasound as well as PIV insertion.

Presenter: Christopher Schott, MD
University of Pittsburgh School of Medicine

P029: Improving Depression Screening in the Era of SARS-CoV-2

During the Covid-19 pandemic, there has been an unprecedented number of stressors leading to a three-fold increase in depression. Our goal was to design a quality improvement project to increase depression screening rates by at least 10% using the PHQ-2 and PHQ-9 in the Texas Tech Internal Medicine Clinic. After a thorough root cause analysis, we implemented the use of the PHQ-2 during the triage process and treated it as a vital sign. A positive screening triggered the administration of a PHQ-9. An easily accessible tab was incorporated into the EMR for proper documentation. Educational material was also made available to patients and healthcare professionals alike. Pre-intervention data was collected from July 1 through September 30, 2020 and January 4 through January 22, 2021 to establish a baseline screening rate. Subsequent data was collected post-intervention from January 25 through March 23, 2021. Pre-intervention data showed that of the 896 patient encounters only 67 patients (7%) were screened with the PHQ2 and 77 patients (9%) were screened with PHQ9. Post intervention data showed that of 623 encounters, 371 patients (60%) were screened with the PHQ2 and 108 patients (17%) were screened with the PHQ9. This represents a 75% increase in PHQ-2 screening post-intervention and an 88% increase in PHQ-9 screening. Placing emphasis on mental health screening in the triage process has successfully improved depression screening rates in our outpatient clinic. The early identification and treatment for depression will improve our patient’s quality of life thus improving overall morbidity and mortality.

Presenter: Jesus Guzman, MD
Paul L. Foster School of Medicine Texas Tech University Health Sciences Center

P030: Identifying Procedural Training Deficiencies and Development of Longitudinal Procedural Track

This poster describes the current challenges of procedural training and evaluates resident levels of procedural competency and the effects of implementing a new procedural training curriculum. We initially surveyed senior residents to understand current procedural numbers, self-assessed skill level, and importance in career path. We established a longitudinal curriculum during the residents' clinic week to rotate through several procedural areas to increase procedure numbers and further training. Initial survey results of those participating in the procedure track were reviewed based on which path of the procedural track the resident selected - outpatient, inpatient, or subspecialty. In most circumstances, the residents reported achieving fewer number of procedures than anticipated in order to feel competent in performing them. Residents in these paths also rated these procedures as highly likely to perform in the future. Initial review of procedure number shows greater number of procedures performed by residents participating in the track compared to those are not. However, further data analysis is needed to appreciate the impact and reduce confounding factors. We plan to repeat surveys to re-evaluate self-assessed skills.

Presenter: John Fritzlen, MD
University of Kansas School of Medicine

P038: Hospitalist Curriculum at a Community Teaching Hospital: Training Future Hospitalists

A large number of residents choose to practice hospital medicine after graduation. Although they are well prepared to manage medical problems, they have limited understanding of aspects of hospital medicine such as business practice, hospital quality metrics, and role of hospitalist as leader. We have designed a curriculum to address these topics during residency. This curriculum is for PGY-3 residents and they work under direct supervision of a teaching hospitalist. During this rotation emphasis is placed on learning of billing and coding, clinical documentation, high value care, hospital quality metrics including length of stay, patient surveys, readmission rate and hospital acquired infections. Our residents have reported improved understanding of billing, quality metrics, hospitalist administrative responsibilities, and choosing wisely. We propose that this will help them develop skills early to grow and succeed in their career as hospitalists.

Presenter: Charu Ramchandani, MD
Montefiore Medical Center/Albert Einstein College of Medicine (Wakefield Campus)

P039: A Novel Longitudinal Curriculum for Teaching Quality Improvement to Internal Medicine Residents

Systems-based practice and quality improvement are an important addition to the core competency requirements in internal medicine residency curricula. Our poster describes an intervention to create an effective, longitudinal, year-long QI curriculum (based on IHI Open School) targeted at first year internal medicine residents. This was a "flipped" curriculum, meaning that pre-assigned learning modules were supplemented with in-person interactive workshops focused on trainee engagement. QI knowledge was assessed before and after the intervention using a validated knowledge assessment tool (QIKAT-R).

Presenter: Karan Ramakrishna, MBBS
State University of New York Upstate Medical University College of Medicine

P015: Lanes to Justice: Improving Engagement in Antiracist Education and Action

Racism is a public health crisis which impacts patients and healthcare workers. Committing to antiracist work is the first step in addressing racism. This must be followed by antiracist education and action to create meaningful change. Lanes to Justice is a twice monthly antiracist education and action newsletter curated by the Legacy Inpatient Medicine Service and the Graduate Medical Education Diversity, Equity, and Inclusion Committees and provided to residents and faculty. ​Care is taken to provide both antiracist education and action opportunities that create concrete antiracist impact. ​ Our goal in creating Lanes to Justice, is to provide attendings with tools to teach antiracist education and action to learners, teach learners to be antiracist healthcare workers, and create a foundation of antiracist education and action to improve the social determinants of health of our community.

Presenter: Allison Abraham, DO, FACP
Legacy Health

P016: Using Reflection on the Black Lives Matter Movement to Facilitate DEI Goals

This innovation used individual reflection and a large group discussion to open the topic of equity and justice through the lens of the Black Lives Matter movement. In their reflections, residents described frustration that our society was not moving forward fast enough, a commitment to personal reflection about privilege and the observation that there was now an increased awareness about racism in daily life.

Presenter: Kathlyn Fletcher, MD, MA
Medical College of Wisconsin

P017: Five-Minute Moment to Teach Anti-Racism at the Bedside

Anti-Black racism is firmly rooted in American healthcare including in the structure and curriculum of medical education. There are few existing curricula or approaches to teach anti-racism pedagogy in the clinical learning environment. We created a teaching framework to address these concerns - the 5-Minute Moment for Racial Justice (5MM-RJ) – along with a curriculum of commonly encountered clinical cases. The core philosophies to the framework are that: 1) structural racism can be routinely taught during bedside rounds in concise teaching moments; 2) learning is augmented through historical narratives that elucidate the historical roots of racism as well as clinical significance. The structure of this framework was developed in partnership with educational scholars. Its content was created following interviews with clinician educators around barriers to discussing and teaching anti-racism. The framework provides language for educators to navigate teaching moments around race. The 5MM-RJ is a simple framework that can help educators to 1) identify topics in everyday clinical practice where racial bias exists, 2) organize educational content, and 3) empower them to create a transparent learning environment to promote meaningful conversations around race and racism. We believe that our framework aligns with promoting structural competency and that exposure to such a curriculum and framework will help trainees develop the knowledge and skills to understand how racism affects patient health with the eventual hope of them graduating from training with competencies to address racism in clinical care and change practice patterns that are currently entrenched in racial injustice.

Presenter: Samantha Wang, MD
Stanford University School of Medicine

P034: Training Bystanders to be Upstanders: Implementation of an Asynchronous Virtual Faculty Development Course on Managing Discriminatory Patient Behavior in the Clinical Learning Environment

The poster will include background material describing the incidence and impact of discriminatory patient behavior in the clinical learning environment. The poster will include a graphic overview of the curriculum, and some of the written materials from the asynchronous online course will be reproduced on the poster. QR code links to sample videos from the online course will be included on the poster for attendees to view on their personal devices. Results from the innovation will be displayed in graphs and tables.

P013: Point-of-Care Ultrasound Faculty Development—Maintaining the Momentum

Our primary aim is to increase the proportion of our faculty with core teaching skills in POCUS. Our secondary goals are to increase clinical use and supervision of POCUS by hospitalists as well as enhance integration of POCUS into bedside resident teaching rounds. We instituted twenty-four recurrent hands-on noon hour training sessions for hospitalists over a two-year period. Pre-session video work replaced didactics using a “flipped classroom” model. Residents that had completed our POCUS rotation helped serve as hands-on POCUS instructors for faculty across standardized patient stations. Clinical vignette quizzes and direct observation assessments illustrated excellent faculty POCUS skills acquisition. Group image review sessions emphasized views and findings most efficient and helpful during bedside resident team rounds. Key concept ultrasound “clips of the week” were routinely distributed, highlighting pathologic images acquired by recently trained hospitalists in order to help inspire those less experienced. On service faculty were routinely engaged for brief, high-yield, bedside “gel rounds”. Gel rounds utilized the faculty member’s own inpatients and were conducted one on one with a POCUS experienced hospitalist instructor. Gel rounds helped further energize faculty learners while developing hands-on skills for more challenging patients and refining image interpretation as well as clinical integration skills. Our supportive setting has enabled hospitalists to overcome initial perceived barriers to learning POCUS and has provided a solid foundation of core POCUS skillsets for our faculty. These multifaceted faculty development efforts have contributed to a steady increase in the clinical integration and teaching of POCUS at our institution.

Presenter: William Novak, MD
University of Rochester School of Medicine and Dentistry

P033: Passport to Clinical Teaching Year One: Interim Results

Passport to Clinical Teaching Year One: Interim results describe the preliminary year one of the implementation of the Passport to Clinical Teaching at the University of Chicago. The passport is a 24-month opt-in self-directed medical education faculty development program for hospitalists. Activities within multiple medical education domains including instruction opportunities, coaching, and medical education scholarship are completed individually by participants on their time and recorded/stamped in an online passport tool. This abstract describes rates of completion of activities within each domain at six- and 12-month intervals and demonstrates robust early engagement with the domains contribution to instruction and preparation/presentation of teaching topics. Results show a high engagement with medical education scholarship earlier than expected in the program and a lower than expected engagement with faculty development sessions. The high engagement with medical education scholarship is particularly relevant as passport participants have a high interest in developing into clinician educators in addition to improving their clinical teaching skills. Participants show an increase in scheduled teaching time, an important goal and outcome for the passport. And finally, the content of biannual reviews has shifted from review of passport completion to larger conversations about career development, mentoring and identifying a niche. Next steps include further consideration of ways to optimize engagement with faculty development. evaluation of participant satisfaction at 12-months, incorporation of a refined passport technology tool, and long-term comparison of teaching time and other outcomes to non-participants.

Presenter: Elizabeth Murphy, MD
University of Chicago Division of the Biological Sciences, Pritzker School of Medicine

P014: There’s An App for That: Leveraging Available Technology to Enhance Quality and Accessibility of Educational Resources

Internal medicine residents most frequently utilize desktop or laptop computers and mobile smartphones to access self-directed learning resources. We identified a need for an online platform that is easily accessible on such devices to host such resources for educational curricula. We leveraged existing institutional resources to create such a platform in the form of "low code" apps that require little computer programming background to create. We will share our process, resources, app utilization, and lessons learned.

Presenter: Rebecca Miller, MD
Virginia Commonwealth University School of Medicine

P036: The Use of an Escape Room to Build Workplace Social Capital in an Internal Medicine Residency Program

Workplace Social Capital (WSC) is the psychosocial environment of the workplace, defined as the camaraderie (mutual trust, shared experience, and bonding) of a work team. This year’s interns did not have opportunities (i.e., retreats, holiday parties, graduation) to form that social capital due to the COVID-19 pandemic. Medical Escape Room (MER) simulations have been shown to strengthen critical thinking, medical knowledge, technical skills, and inter-professionalism. We therefore hypothesized that interns who participate in a MER would build social capital, as measured by higher WSC scores after the activity. 51/52 interns participated in a MER in groups of 4-6 in spring 2021. The Modified Workplace Social Capital survey was used to assess this experience with baseline WSC measured 1-7 days prior to MER and follow-up scores assessed 1-7 days after. Forty-one (80%) interns completed pre- and post-surveys. Overall pre-MER average score was 4.66/5 with 70% of respondents strongly agreeing to survey statements. Post-MER survey scores increased to 4.90/5 (>;0.001), with an increased number of respondents 90% (>0.001) who strongly agreed with the survey statements. This is the first study to demonstrate that a MER contributed to resident camaraderie, as demonstrated by a statistically significant improvement in WSC scores. Free comments also supported the benefits of this activity. Overall, our study shows that MERs can strengthen the psychosocial environment of a resident workplace, which is thought to improve trainee's mental health. As residency continues to be a challenging time in training, it is important to offer programming that benefits resident well-being.

Presenter: Laura Ozark, MD, FACP
Loyola University Chicago Stritch School of Medicine

P004: Community Advocacy Training for Internal Medicine Residents: Feasibility and Learner Acceptability of an Adapted Community Pediatrics Training Initiative Project Planning Tool

Participation in community health and advocacy is increasingly recognized as a professional responsibility of physicians, evidenced by endorsement by the American Board of Internal Medicine Foundation (ABIM), and the American College of Physicians (ACP), and the American Medical Association (AMA). The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Milestones 2.0 objectives similarly recognize advocacy as an element of physician competency through “advocacy for populations and communities with health care inequities” and “influencing health policy through advocacy activities.” To implement a community health and advocacy curriculum for internal medicine (IM) residents in academic year 2020-21, we adapted a curriculum developed for pediatrics residency programs: the Community Pediatrics Training Initiative (CPTI) Project Planning Tool. The curriculum was delivered to all categorical internal medicine interns three 1-hour facilitated sessions over the course of an existing 3-week social medicine rotation. Learners asynchronously completed an independent learning activity using the tool. We administered anonymous course evaluation surveys to assess learner attitudes towards the curriculum and its perceived effectiveness for teaching community advocacy skills. The survey was completed by 18/25 (72%) participants, of whom 15/18 (83%) reported the effectiveness of the curriculum for improving their knowledge of community advocacy to be “extremely effective,” while 17/18 (94%) responded either “extremely effective” or “somewhat effective.” 18/18 (100%) felt the curriculum should continue for future interns. In conclusion, adapting and implementing the CPTI Project Planning Tool is feasible, acceptable to learners, and perceived to be effective in teaching community advocacy skills to internal medicine interns.

Presenter: Joel Burnett, MD
Oregon Health & Science University School of Medicine

P018: NET Rounding: A Novel Approach to Efficient and Effective Rounds for the Modern Clinical Learning Environment

Rounding is a foundational practice in the inpatient academic setting. Despite its importance, residents have described rounding as too inefficient for the modern clinical learning environment. Thus, we designed and implemented “NET Rounding”, a novel rounding framework, with a goal of completing rounds in 2.5 hours or less. We primarily assessed whether NET Rounding reduces rounding time while optimizing educational value, maintaining patient safety, and improving work hours. NET Rounding has three categories: novel rounding strategies, shared expectations, and time management. Resident teams at a large, quaternary academic hospital were asked to implement at least one strategy from each category into their daily rounds for two to four weeks. To date, residents and attendings (39) felt that the following strategies were most helpful: whole team readiness (12), purposeful rounding (11), prioritizing relevant data and problems during presentations (8), and establishing a daily rounding agenda (8). Over 269 rounding days, teams rounded; 2.5 hours 80% of the time, compared to 15% prior to NET Rounding (0.0001). No safety events were reported. Among residents, 81% (17/21) said rounds were “very” or “extremely valuable” for learning compared to 45% (10/22) (p=0.0366) prior. Perception of occasional duty hour violations among residents decreased from 77% (17/22) to 14% (3/21, p=0.0001). NET Rounding is a novel framework that reduces rounding time for resident teams in an inpatient academic setting, while maintaining patient safety, improving educational value, and decreasing the perception of duty hour violations.

Presenter: Shirley Chan, MD
University of California, San Francisco School of Medicine

P021: Improving Patient Promoter Response with Streamlined Intake Process in Resident Clinic: A Quality Improvement Project

A new check-in face-sheet was implemented, that systematically laid out vital clinical information in an organized, concise, and identifiable manner. Likert scale with components of “excellent”, “very good”, “good”, “fair” and “poor” was used in surveys to assess the patient’s response. The new face-sheet was then implemented during the check-in process. Patient satisfaction surveys were tracked in monthly intervals over the next 3 months to identify response scores. Data before and after intervention was compared. Pre-intervention positive patient response was 71%. Post-intervention positive patient response, at the end of the 90-day study period, was 83%. Net promoter response (NPR) was calculated, defined as the fraction of “positive patient encounters” to the total number of patient responses.  Accounting for all encounters, mean pre-intervention NPR was 65% and mean post-intervention NPR was 76%. Streamlining the check-in face-sheet had positive impacts on the overall patient satisfaction responses in the outpatient resident clinic. Implementing this new face-sheet increased the positive patient satisfaction response by 12% and the mean NPR by 11%.

Presenter: Ezhil Panneerselvam, MD
Texas Tech University HSC El Paso/Hospitals of Providence Transmountain Campus

P022: Is it What You Say or How You Say it?: Optimal Phrasing of Constructive Comments on Learner Evaluations

When it comes to writing constructive evaluation comments, how much does content versus phrasing matter? There is a lot of variability in how faculty write comments on learner evaluations.  The content of written feedback comments has received considerable attention from the medical education community. However, we know little about how grammar affects the impact to our learners. Grammar, you say? This isn’t semi-colons and apostrophes but rather syntax and point of view. This project featured preference testing of various narrative points of view and directive versus request framing to determine which grammatical structures were most effective for learners. Our poster will share data-driven tips to help faculty phrase comments in a way that learners feel is motivating and supportive. Our findings show a subtle twist might make a big difference.

Presenter: Kristy Deep, MD, MA, FACP
University of Kentucky College of Medicine

P031: Effective Patient Handoff Methods and Implementations for 4th Year Medical Students

“Transitions of care” refer to the movement of patients between health care practitioners, settings, and home as their condition and care need change. A specific type of transition of care within medicine is the patient handoff, which refers to the transfer of patient information from one team to another to ensure continuity and safe patient care. A 4th-year medical student may have observed a patient handoff at shift change, but rarely has performed one on their own. The importance of patient handoffs is highlighted by AAMC Core EPA 8 recognizing that giving and receiving patient handoffs is a needed competency for entering residency. Studies have shown throughout how medical errors and patient safety events have occurred as a result of communication failures during handoffs. This can be combated by implementing a standardized handoff method, as well as providing effective feedback on the implementation of that method. This has been proven to effectively reduce medical error significantly across all disciplines by about 23%. However, only 15% of clerkships have handoff training in medical school. To ensure all 4th-year medical students at UTMB have exposure to a standardized patient handoffs method and simulated practice, a transitions of care curriculum was weaved into their required transition to residency course. This was done by implementing a transition of care workshop (TOC) to all 4th-year medical students and incorporating patient handoffs as an aspect of their mock paging activity.

Presenter: Aesha Aboueisha, MD
University of Texas Medical Branch at Galveston School of Medicine

P032: Impact of an Integrated Medical Billing Curriculum on Billing Accuracy within the Internal Medicine Department

Our study evaluated the impact of dedicated residency education in medical billing and documentation on the overall impact of billing accuracy by the department as well as the potential impact on departmental finances.  To our knowledge this is the first study of its kind within an internal medicine residency.  Studies from other specialties have been performed on this subject however none have incorporated an ongoing resident curriculum as we have here.  Offering this curriculum has not only helped educate the residents about the documentation and billing aspects of medicine it has positively impacted the entire department of internal medicine and increased awareness of medical billing requirements.

Presenter: Catherine Jones, MD
Texas Tech University Health Sciences Center School of Medicine

P035: Opioid Dispensing Decreased by 84% in Residents' Clinic

Background: Up to 33% of primary care visits are for pain.  Our resident ambulatory clinic audit in 2015 tallied 148 hydrocodone prescriptions; with 9,859 tablets dispensed during three months of 2014, and 11,124 tablets dispensed during three months of 2015. We adapted CDC guidelines and initiated a checklist for opioid prescribing in 2016.

Methods: The plan was to educate residents and patients about opioid alternatives. 

Step 1:  Define pain - acute / chronic / traumatic / post-operative / Pain scale / PEG score (pain intensity, interference with enjoyment and general activity).

Step 2: Identify drug seekers using a screening tool.

Step 3: Take a history and examine the painful area.

Step 4: Set ground rules for opioid dispensing. (Maximum hydrocodone dose 15 mg/24 hours. Cancer or uncontrolled pain referred to pain clinic.)

Step 5: Treat the pain to a goal of 30% improvement of PEG score using alternatives.

Results: Pharmacy completed a hydrocodone audit for the first three months of 2014 to 2019. They found a three-month average of 10,605 tablets dispensed before the checklist. After initiating the checklist based on the CDC guidelines, there was a yearly decrease in hydrocodone prescribing. The 2019 prescribing audit found 1,744 dispensed tablets of hydrocodone for the first three months.

Conclusion: With an estimated 10.3 million people misusing opioids and 55% having an opioid use disorder, we reduced the number of tablets dispensed for the common opioid hydrocodone by 84% in our ambulatory clinic through a checklist and adherence to dispensing guidelines.

Presenter: Theodore Christou, MD, FACP
Loyola University Medical Center/Trinity-Mercy Chicago

P007: “I Do Not Feel I Will Ever be ‘Comfortable’…”: Faculty Experiences With Patient Bias Against Trainees at a Single Institution

Background

As we seek to improve diversity and equity in medical training, addressing the biases sometimes faced by trainees from patients or family members on the basis of their identity becomes increasingly important. Studies have indicated these experiences can impact physician learning, career trajectory, and career satisfaction. We conducted a survey of clinician educators in Internal Medicine at a single institution to determine prevalence of experiences with patient or family bias against faculty, trainees and other healthcare workers as well as faculty comfort with responding to these incidences and desire for additional training.

Methods

We conducted an email survey study of clinician educators in the Division of General Internal Medicine at UPMC over a two week period including multiple choice and free text response. Attitudes towards responding and training were assessed on a 5-point Likert scale.

Results

Our results demonstrated that 83.3% of the 48 respondents had experienced bias against a trainee from patients or family members. While 82.2% of faculty reported the patient or family behavior was addressed by themselves or a team member, the majority (52.4%) reported feeling uncertain regarding the effectiveness of the response. Furthermore, while the majority of faculty reported feeling comfortable addressing (61.3%) or debriefing (63.7%) instances of bias against trainees, 81.8% reported feeling they would benefit from additional training to do so. Preliminarily identified themes included requests for specific language to use with patients or families, how to respond while maintaining the therapeutic relationship, and debriefing with trainees.

Presenter: Maryam Zamanian, MD
University of Pittsburgh School of Medicine

P002: The Context of “Confidence”: Analyzing the Term Confidence in Resident Evaluations

This is a retrospective cohort study of all inpatient faculty evaluations of University of Pennsylvania internal medicine (IM) residents from 2018-2021, where we analyzed faculty evaluations of IM residents for gender-based patterns in use of the terms “confidence,” “confident,” or “confidently.” Through n-gram text-mining, we identified all evaluations containing these terms, and we performed multivariable logistic regression analyses to determine the association of references to confidence with resident gender.  We found that female IM trainees were more likely to have references to confidence (“confidence,” “confident,” or “confidently”) utilized in their faculty evaluations, which persisted after adjustment for faculty gender, resident post-graduate year, mean numeric rating, and service. There was a significant interaction effect between faculty and resident gender for both female concordant pairs and male faculty evaluations of female residents.  We also found that female residents were more likely to be described as having “too little confidence” in our subgroup analysis, more so in evaluations written by male faculty. This work highlights a potential area where biases may be introduced in overall competency assessments of residents through end-of-rotation narrative evaluations.

Presenter: Meagan Alvarado, MD
Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania

P009: Retrieval Practice as an Educational Tool in Internal Medicine Resident Education

Evidence supports the use of retrieval practice as a way of improving long-term retention of material. The type of retrieval practice, and how often it needs to occur to result in retention, is less clear in the education literature.  We aim here to better understand the effects of question type in repeat retrieval practice on long-term retention of material. In this study PGY-2 and PGY-3 internal medicine residents were preassigned to a combination of multiple choice and open response quiz questions at 0, 6 and 12 weeks and then a final test with open response format at 18 weeks. 69 residents participated. The open response and multiple choice questions were found to perform similarly at week 0. There was no difference found in performance on the final test despite earlier question type. The literature on retrieval practice suggests a potential threshold effect of more effortful testing on learning, which was not observed here. It may be that retrieval practice for lower level Bloom’s taxonomy objectives can be achieved by multiple choice questions, whereas higher level objectives may require more effortful retrieval, such as open response. This could inform future studies.

Presenter: Amber Deptola, MD
Washington University in St. Louis School of Medicine

P010: Virtual Insanity: Assessment of Faculty Perceptions of Residency Interview Format Effectiveness

Conducting exclusively virtual residency interviews is an attractive option to decrease financial burdens that have been associated with the traditional face-to-face-experience. Yet, little is known about the ways in which virtual methods may affect faculty’s ability to gather data that can impact applicant selection and recruitment. Our study aimed to directly compare the impact of virtual and traditional in-person interview formats on internal medicine faculty’s ability to assess factors used to determine residency candidates rank order. We surveyed all faculty who conducted residency interviews at a quaternary care internal medicine program. Survey items were based on prior National Resident Matching Program questionnaires and primarily utilize a 5-point Likert-type scale to compare effectiveness.

Of the 134 respondents, more than 50% believed that both modalities were equally effective to assess all applicant attributes studied. However, in areas of applicant presence, communication with others, and recruitment, up to 45% of survey respondents believed that face-to-face interviews possessed advantages. Virtual interviews were not perceived to be more effective in applicant assessments than traditional interviews in any category. Overall, faculty are split on overall preferred interview format (46% face-to-face, 54% virtual). In those that preferred virtual interviews, applicant and program convenience and cost were commonly cited reasons for the choice. This study suggests that faculty assessment of applicants is largely comparable between virtual and face-to-face formats, but in important areas of recruitment and assessment of applicant interpersonal skills there may impacted quality. These findings should be considered when making decisions about future interview formats.

Presenter: Anjali Das, MD
University of Pittsburgh School of Medicine

P011: Hospital Medicine-Focused Education Experiences and Preferences Amongst Early Career Hospitalists

Hospital medicine focused education (HMFE), defined as dedicated hospital medicine electives, rotations, or longitudinal tracks or pathways, has expanded among IM residency programs in response to growing trainee interest in hospital medicine (HM). No study to date has evaluated the needs, preferences, and impact of HMFE from the perspective of trainees or early-career hospitalists (ECHs) who were recent learners. We developed a national questionnaire targeting ECHs to address this critical gap. We collected and analyzed data from both HMFE participants and non-HMFE participants across diverse training backgrounds. Key findings include the following: the prevalence of and ECH preferences for clinical, non-clinical, and curricular activities within HMFE were closely aligned; mentorship from HM faculty and career preparation for both academic and community HM are important gaps that HMFE should fill; and HMFE variably influenced participants’ interest in an academic hospitalist job. The overwhelming reason for non-HMFE participation was lack of opportunity at training programs, and most would have desired to participate. Our findings indicate that HMFE is valuable to ECHs and helps prepare young hospitalists for their first job; this may help persuade training programs considering implementing these rotations and support leaders vying for resources to develop or sustain HMFE. Our study suggests that HMFE directors should assess participants’ needs and offer flexibility regarding community-based or academic clinical exposure and curricular content. Overall, our study provides valuable insights from ECHs which may assist in the development and refinement of HMFE programs across IM residencies nationwide.

P001: Adapting a GME Consultation and Handoff Communications Bootcamp for Tele-simulation Post COVID-19

Technology and Innovation

Bootcamp during GME orientation periods are well described as successful strategies to instruct and assess incoming intern clinical skills, but typically require intensive in-person and facility resources to administer. This was a particular challenge during the first few months of the COVID-19 pandemic that required cessation of nonessential in-person activities and rapid adaption of virtual learning techniques. We describe the successful conversion of a previous traditional in-person simulation bootcamp to a tele-simulation bootcamp for the skills of calling a consultation and performing a patient handoff.

Presenter: Shannon Martin, MD, SFHM
University of Chicago Division of the Biological Sciences, Pritzker School of Medicine

P023: Resident Well-Being at the Front Line: Coaching Resilience Practices in the New Generation of Physicians

Stress, depression, burnout, and anxiety are commonly reported during residency and are more prevalent than in other fields. Such effects drive suboptimal patient care practices, more perceived medical errors, and increased distancing from patients. At Stamford Hospital, a quality improvement initiative in the summer of 2020 analyzing resident wellbeing through the COVID-19 crisis identified the persisting need for prioritizing resident welfare, institutional support, and wellness-directed interventions. Thus, the Stamford Hospital Risk Management Department and the Office of Graduate Medical Education have contributed to a grant towards the implementation and evaluation of wellness interventions focused on professional wellness coaching and wellness activities. Here we describe the preliminary results from a pre-intervention survey on resident wellbeing across the four residency programs at Stamford hospital.

Presenter: Luke Li, MD
Stamford Hospital/Columbia University College of Physicians and Surgeons

P027: Better Together: A Novel Web-Based Group Coaching Program for Female-Identifying Trainees in Medicine

Female resident physicians experience higher burnout than age-matched peers, making them vulnerable to professional development consequences.  Data show professional individual coaching from non-physicians has a sustainable positive effect on well-being. We hypothesize that group coaching from certified physician life coaches may have a greater effect due to the shared experience and increased credibility. This is a prospective, randomized control trial of a resident coaching program with a primary aim to decrease burnout, and secondary aims of decreased imposter syndrome, decreased moral injury, and increased self-compassion. Two CU faculty (AM and TF), certified professional coaches, built a coaching website with worksheets, webinars, and host two one-hour online group coaching sessions per week. Women CU residents enrolled and completed a pre-survey with validated indices assessing outcomes and will be offered a mirroring post survey. Participants were randomized into the intervention (coaching January-June 2021) or control (no coaching). Focus groups with intervention participants will inform a qualitative analysis. The control group will be offered coaching after data collection (July-December 2021). Preliminary results show participants are experiencing significant burnout. Intervention participants receive coaching on a wide range of topics including feedback reception, professional appearance, and balancing motherhood with work. We are excited to share the results of the program's novel online, asynchronous group-based delivery designed to mitigate time constraints and faculty development required of traditional programs. This coaching structure has not been described and may meaningfully contribute to resident wellbeing.

Presenter: Tyra Fainstad, MD
University of Colorado School of Medicine

P040: Do Depression, Time in Meaningful Work, and Gender Interact to Affect Physician Burnout?

We present results of our survey research examining depressive symptoms and time in meaningful work as possible factors in work-related wellbeing for residents and fellows, and tested gender differences in these factors. Both depression symptoms and time spent in meaningful activity predicted burnout in a regression model. For males, depression symptoms were a stronger predictor of burnout, but other gender differences were not found.

Presenter: Heather Hartman-Hall, PhD
MedStar Health (Baltimore)