Publications by authors named "Jeanne M Farnan"

84 Publications

The University of Chicago Pritzker School of Medicine.

Acad Med 2020 Sep;95(9S A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools):S168-S170

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http://dx.doi.org/10.1097/ACM.0000000000003334DOI Listing
September 2020

Curriculum Changes and Trends 2010-2020: A Focused National Review Using the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II.

Acad Med 2020 09;95(9S A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools):S5-S14

W. Fitz-William is senior data specialist, Association of American Medical Colleges, Washington, DC.

Medical school curricula have evolved from 2010 to 2020. Numerous pressures and influences affect medical school curricula, including those from external sources, academic medical institutions, clinical teaching faculty, and undergraduate medical students. Using data from the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II, the nature of curriculum change is illuminated. Most medical schools are undertaking curriculum change, both in small cycles of continuous quality improvement and through significant change to curricular structure and content. Four topic areas are explored: cost consciousness, guns and firearms, nutrition, and opioids and addiction medicine. The authors examine how these topic areas are taught and assessed, where in the curriculum they are located, and how much time is dedicated to them in relation to the curriculum as a whole. When examining instructional methods overall, notable findings include (1) the decrease of lecture, although lecture remains the most used instructional method, (2) the increase of collaborative instructional methods, (3) the decrease of laboratory, and (4) the prevalence of clinical instructional methods in academic levels 3 and 4. Regarding assessment methods overall, notable findings include (1) the recent change of the USMLE Step 1 examination to a pass/fail reporting system, (2) a modest increase in narrative assessment, (3) the decline of practical labs, and (4) the predominance of institutionally developed written/computer-based examinations and participation. Among instructional and assessment methods, the most used methods tend to cluster by academic level. It is critical that faculty development evolves alongside curricula. Continued diversity in the use of instructional and assessment methods is necessary to adequately prepare tomorrow's physicians. Future research into the life cycle of a curriculum, as well optional curriculum content, is warranted.
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http://dx.doi.org/10.1097/ACM.0000000000003484DOI Listing
September 2020

A Peer-Led Social Media Intervention to Improve Interest in Research Careers Among Urban Youth: Mixed Methods Study.

JMIR Med Educ 2020 May 14;6(1):e16392. Epub 2020 May 14.

Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.

Background: Novel methods to boost interest in scientific research careers among minority youth are largely unexplored. Social media offers a unique avenue toward influencing teen behavior and attitudes, and can therefore be utilized to stimulate interest in clinical research.

Objective: The aim of this study was to engage high-achieving minority youth enrolled in a science pipeline program to develop a targeted social media marketing campaign for boosting interest in clinical research careers among their peers.

Methods: Students enrolled in the Training Early Achievers for Careers in Health program conducted focus groups in their communities to inform themes that best promote clinical research. They then scripted, storyboarded, and filmed a short video to share on social media with a campaign hashtag. Additionally, each student enrolled peers from their social circle to be subjects of the study. Subjects were sent a Career Orientation Survey at baseline to assess preliminary interest in clinical research careers and again after the campaign to assess how they saw the video, their perceptions of the video, and interest in clinical research careers after watching the video. Subjects who did not see the video through the online campaign were invited to watch the video via a link on the postsurvey. Interest change scores were calculated using differences in Likert-scale responses to the question "how interested are you in a career in clinical research?" An ordinal logistic regression model was used to test the association between watching a peer-shared video, perception of entertainment, and interest change score controlling for underrepresented minorities in medicine status (Black, American Indian/Alaska Native, Native Hawaiian, or Pacific Islander), gender, and baseline interest in medical or clinical research careers.

Results: From 2014 to 2017, 325 subjects were enrolled as part of 4 distinct campaigns: #WhereScienceMeetsReality, #RedefiningResearch, #DoYourResearch, and #LifeWithoutResearch. Over half (n=180) of the subjects watched the video via the campaign, 227/295 (76.9%) found the video entertaining, and 92/325 (28.3%) demonstrated baseline interest in clinical research. The ordinal logistic regression model showed that subjects who viewed the video from a peer (odds ratio [OR] 1.56, 95% CI 1.00-2.44, P=.05) or found the video entertaining (OR 1.36, 95% CI 1.01-1.82, P=.04) had greater odds of increasing interest in a clinical research career. Subjects with a higher baseline interest in medicine (OR 1.55, 95% CI 1.28-1.87, P<.001) also had greater odds of increasing their interest in clinical research.

Conclusions: The spread of authentic and relevant peer-created messages via social media can increase interest in clinical research careers among diverse teens. Peer-driven social media campaigns should be explored as a way to effectively recruit minority youth into scientific research careers.
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http://dx.doi.org/10.2196/16392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256755PMC
May 2020

The Time Is Now for Mandatory Liver-Focused Clinical Experiences in Medical School.

Hepatol Commun 2019 Jun 25;3(6):847. Epub 2019 Mar 25.

Division of Gastroenterology and Hepatology University of Illinois at Chicago Chicago IL.

The national burden of chronic liver disease is steadily increasing and is only expected to worsen with the ongoing obesity and opioid epidemics fueling growth in the prevalence of nonalcoholic fatty liver disease and a resurgence of new hepatitis C infections. Our letter highlights the disparity between the rising prevalence of chronic liver disease and the proportion of medical students who receive exposure to patients with liver disease as part of their medical education. A more comprehensive survey of clerkship directors is needed to further corroborate this data, which may lead to reforms in medical school curricula to better address the expanding burden of chronic liver disease.
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http://dx.doi.org/10.1002/hep4.1338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546019PMC
June 2019

Development and testing of a web module to IMPROVE generic prescribing of oral contraceptives among primary care physicians.

J Clin Pharm Ther 2019 Aug 1;44(4):579-587. Epub 2019 Jun 1.

Pritzker School of Medicine, University of Chicago, Chicago, Illinois.

What Is Known And Objective: The use of generic oral contraceptives (OCPs) can improve adherence and reduce healthcare costs, yet scepticism of generic drugs remains a barrier to generic OCP discussion and prescription. An educational web module was developed to reduce generic scepticism related to OCPs, improve knowledge of generic drugs and increase physician willingness to discuss and prescribe generic OCPs.

Methods: A needs assessment was completed using in-person focus groups at American College of Physicians (ACP) Annual Meeting and a survey targeting baseline generic scepticism. Insights gained were used to build an educational web module detailing barriers and benefits of generic OCP prescription. The module was disseminated via email to an ACP research panel who completed our baseline survey. Post-module evaluation measured learner reaction, knowledge and intention to change behaviour along with generic scepticism.

Results And Discussion: The module had a response rate of 56% (n = 208/369). Individuals defined as generic sceptics at baseline were significantly less likely to complete our module compared to non-sceptics (responders 9.6% vs non-responders 16.8%, P = 0.04). The majority (85%, n = 17/20) of baseline sceptics were converted to non-sceptics (P < 0.01) following completion of the module. Compared to non-sceptics, post-module generic sceptics reported less willingness to discuss (sceptic 33.3% vs non-sceptic 71.5%, P < 0.01), but not less willingness to prescribe generic OCPs (sceptic 53.3% vs non-sceptic 67.9%, P = 0.25). Non-white physicians and international medical graduates (IMG) were more likely to be generic sceptics at baseline (non-white 86.9% vs white 69.9%, P = 0.01, IMG 13.0% vs USMG 5.0% vs unknown 18.2%, P = 0.03) but were also more likely to report intention to prescribe generic OCPs as a result of the module (non-white 78.7% vs white 57.3%, P < 0.01, IMG 76.1% vs USMG 50.3% vs unknown 77.3%, P = 0.03).

What Is New And Conclusion: A brief educational web module can be used to promote prescribing of generic OCPs and reduce generic scepticism.
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http://dx.doi.org/10.1111/jcpt.12853DOI Listing
August 2019

Effectiveness of SIESTA on Objective and Subjective Metrics of Nighttime Hospital Sleep Disruptors.

J Hosp Med 2019 01;14(1):38-41

University of Chicago Medicine, Chicago, Illinois, USA.

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.
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http://dx.doi.org/10.12788/jhm.3091DOI Listing
January 2019

Avoiding Pitfalls While Implementing New Guidelines on Student Documentation.

Ann Intern Med 2019 02 15;170(3):193-194. Epub 2019 Jan 15.

The University of Chicago Pritzker School of Medicine, Chicago, Illinois (A.T.P., K.S., J.M.F.).

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http://dx.doi.org/10.7326/M18-1924DOI Listing
February 2019

Characterising ICU-ward handoffs at three academic medical centres: process and perceptions.

BMJ Qual Saf 2019 08 12;28(8):627-634. Epub 2019 Jan 12.

Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Background: There is limited literature about physician handoffs between the intensive care unit (ICU) and the ward, and best practices have not been described. These patients are uniquely vulnerable given their medical complexity, diagnostic uncertainty and reduced monitoring intensity. We aimed to characterise the structure, perceptions and processes of ICU-ward handoffs across three teaching hospitals using multimodal methods: by identifying the handoff components involved in communication failures and describing common processes of patient transfer.

Methods: We conducted a study at three academic medical centres using two methods to characterise the structure, perceptions and processes of ICU-ward transfers: (1) an anonymous resident survey characterising handoff communication during ICU-ward transfer, and (2) comparison of process maps to identify similarities and differences between ICU-ward transfer processes across the three hospitals.

Results: Of the 295 internal medicine residents approached, 175 (59%) completed the survey. 87% of the respondents recalled at least one adverse event related to communication failure during ICU-ward transfer. 95% agreed that a well-structured handoff template would improve ICU-ward transfer. Rehabilitation needs, intravenous access/hardware and risk assessments for readmission to the ICU were the most frequently omitted or incorrectly communicated components of handoff notes. More than 60% of the respondents reported that notes omitted or miscommunicated pending results, active subspecialty consultants, nutrition and intravenous fluids, antibiotics, and healthcare decision-maker information at least twice per month. Despite variable process across the three sites, all process maps demonstrated flaws and potential for harm in critical steps of the ICU-ward transition.

Conclusion: In this multisite study, despite significant process variation across sites, almost all resident physicians recalled an adverse event related to the ICU-ward handoff. Future work is needed to determine best practices for ICU-ward handoffs at academic medical centres.
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http://dx.doi.org/10.1136/bmjqs-2018-008328DOI Listing
August 2019

Approaches to Teaching the Physical Exam to Preclerkship Medical Students: Results of a National Survey.

Acad Med 2019 01;94(1):129-134

T. Uchida is associate professor of medicine and medical education and director of clinical skills education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-3251-5872. Y.S. Park is associate professor of medical education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335. R.K. Ovitsh is assistant professor of pediatrics and assistant dean for clinical competencies, SUNY Downstate College of Medicine, Brooklyn, New York. J. Hojsak is associate professor of pediatrics and medical education and course codirector, The Art and Science of Medicine, Years 1 and 2, Icahn School of Medicine at Mount Sinai, New York, New York. D. Gowda is associate professor of medicine and course director, Foundations of Clinical Medicine Tutorials, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0001-7124-7615. J.M. Farnan is associate professor of medicine, associate dean for evaluation and continuous quality improvement, and director of clinical skills education, University of Chicago Pritzker School of Medicine, Chicago, Illinois. M. Boyle is clinical associate professor of emergency medicine, assistant dean for clinical formation, and course director, Patient Centered Medicine 2, Loyola Stritch School of Medicine, Maywood, Illinois. A.D. Blood is director of curricular resources, Association of American Medical Colleges, Washington, DC, and doctoral candidate in health professions education, University of Illinois at Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-2275-923X. F.I. Achike is professor of pharmacology, clinical skills, and anesthesiology; director, Clinical Skills and Simulation Program; and associate dean for interprofessional education, California University of Science and Medicine School of Medicine, Colton, California. R.C. Silvestri is assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-7706-2208.

Purpose: To assess current approaches to teaching the physical exam to preclerkship students at U.S. medical schools.

Method: The Directors of Clinical Skills Courses developed a 49-question survey addressing the approach, pedagogical methods, and assessment methods of preclerkship physical exam curricula. The survey was administered to all 141 Liaison Committee on Medical Education-accredited U.S. medical schools in October 2015. Results were aggregated across schools, and survey weights were used to adjust for response rate and school size.

Results: One hundred six medical schools (75%) responded. Seventy-nine percent of schools (84) began teaching the physical exam within the first two months of medical school. Fifty-six percent of schools (59) employed both a "head-to-toe" comprehensive approach and a clinical reasoning approach. Twenty-three percent (24) taught a portion of the physical exam interprofessionally. Videos, online modules, and simulators were used widely, and 39% of schools (41) used bedside ultrasonography. Schools reported a median of 4 formative assessments and 3 summative assessments, with 16% of schools (17) using criterion-based standard-setting methods for physical exam assessments. Results did not vary significantly by school size.

Conclusions: There was wide variation in how medical schools taught the physical exam to preclerkship students. Common pedagogical approaches included early initiation of physical exam instruction, use of technology, and methods that support clinical reasoning and competency-based medical education. Approaches used by a minority of schools included interprofessional education, ultrasound, and criterion-based standard-setting methods for assessments. Opportunities abound for research into the optimal methods for teaching the physical exam.
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http://dx.doi.org/10.1097/ACM.0000000000002433DOI Listing
January 2019

Enterprise Microblogging to Augment the Subinternship Clinical Learning Experience: A Proof-of-Concept Quality Improvement Study.

JMIR Med Educ 2018 Aug 21;4(2):e18. Epub 2018 Aug 21.

Department of General Internal Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.

Background: Although the Clerkship Directors in Internal Medicine (CDIM) has created a core subinternship curriculum, the traditional experiential subinternship may not expose students to all topics. Furthermore, academic institutions often use multiple clinical training sites for the student clerkship experience.

Objective: The objective of this study was to sustain a Web-based learning community across geographically disparate sites via enterprise microblogging to increase subintern exposure to the CDIM curriculum.

Methods: Internal medicine subinterns used Yammer, a Health Insurance Portability and Accountability Act (HIPAA)-secure enterprise microblogging platform, to post questions, images, and index conversations for searching. The subinterns were asked to submit 4 posts and participate in 4 discussions during their rotation. Faculty reinforced key points, answered questions, and monitored HIPAA compliance.

Results: In total, 56 medical students rotated on an internal medicine subinternship from July 2014 to June 2016. Of them, 84% returned the postrotation survey. Over the first 3 months, 100% of CDIM curriculum topics were covered. Compared with the pilot year, the scale-up year demonstrated a significant increase in the number of students with >10 posts (scale-up year 49% vs pilot year 19%; P=.03) and perceived educational experience (58% scale-up year vs 14% pilot year; P=.006). Few students (6%) noted privacy concerns, but fewer students in the scale-up year found Yammer to be a safe learning environment.

Conclusions: Supplementing the subinternship clinical experience with an enterprise microblogging platform increased subinternship exposure to required curricular topics and was well received. Future work should address concerns about safe learning environment.
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http://dx.doi.org/10.2196/mededu.9810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123538PMC
August 2018

The Consultation Observed Simulated Clinical Experience: Training, Assessment, and Feedback for Incoming Interns on Requesting Consultations.

Acad Med 2018 12;93(12):1814-1820

S.K. Martin is assistant professor of medicine and associate program director, Internal Medicine Residency Program, University of Chicago Pritzker School of Medicine, Chicago, Illinois. K. Carter is associate professor of medicine and assistant dean for admissions, University of Chicago Pritzker School of Medicine, Chicago, Illinois. N. Hellermann was a student, College of the University of Chicago, Chicago, Illinois, at the time of writing. The author is now a research assistant, Veterans Affairs Medical Center New York-Manhattan Campus, New York, New York. L.R. Glick is a third-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. S. Ngooi is research coordinator, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. M. Kachman is a second-year student, University of Chicago Pritzker School of Medicine, Chicago, Illinois. J.M. Farnan is associate professor of medicine and associate dean for evaluation and continuous quality improvement, University of Chicago Pritzker School of Medicine, Chicago, Illinois. V.M. Arora is professor of medicine, assistant dean for scholarship and discovery, and director of clinical learning environment innovation, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Problem: Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills.

Approach: In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE.

Outcomes: After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01).

Next Steps: The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.
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http://dx.doi.org/10.1097/ACM.0000000000002337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265083PMC
December 2018

Objective Evaluation of a Didactic Curriculum for the Radiation Oncology Medical Student Clerkship.

Int J Radiat Oncol Biol Phys 2018 08 26;101(5):1039-1045. Epub 2018 Apr 26.

Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois.

Purpose: A structured didactic radiation oncology clerkship curriculum for medical students is in use at multiple academic medical centers. Objective evidence supporting this educational approach over the traditional clerkship model is lacking. This study evaluated the curriculum efficacy using an objective knowledge assessment.

Methods And Materials: Medical students received the Radiation Oncology Education Collaborative Study Group (ROECSG) curriculum consisting of 3 lectures (Overview of Radiation Oncology, Radiation Biology/Physics, and Practical Aspects of Simulation/Radiation Emergencies) and a radiation oncology treatment-planning workshop. A standardized 20-item multiple choice question (MCQ) knowledge assessment was completed pre- and post-curriculum and approximately 6 months after receiving the curriculum.

Results: One hundred forty-six students at 22 academic medical centers completed the ROECSG curriculum from July to November 2016. One hundred nine students completed pre- and post-clerkship MCQ knowledge assessments (response rate 74.7%). Twenty-four students reported a prior rotation at a ROECSG institution and were excluded from analysis. Mean assessment scores increased from pre- to post-curriculum (63.9% vs 80.2%, P < .01). Mean MCQ knowledge subdomain assessment scores all improved post-curriculum (t test, P values < .01). Post-scores for students rotating de novo at ROECSG institutions (n = 30) were higher compared with pre-scores for students with ≥1 prior rotations at non-ROECSG institutions (n = 55) (77.3% vs 68.8%, P = .01), with an effect size of 0.8. Students who completed rotations at ROECSG institutions continued to demonstrate a trend toward improved performance on the objective knowledge assessment at approximately 6 months after curriculum exposure (70.5% vs 65.6%, P = .11).

Conclusions: Objective evaluation of a structured didactic curriculum for the radiation oncology clerkship at early and late time points demonstrated significant improvement in radiation oncology knowledge. Students who completed clerkships at ROECSG institutions performed objectively better than students who completed clerkships at non-ROECSG institutions. These results support including a structured didactic curriculum as a standard component of the radiation oncology clerkship.
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http://dx.doi.org/10.1016/j.ijrobp.2018.04.052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538302PMC
August 2018

A Standardized Handoff Simulation Promotes Recovery From Auditory Distractions in Resident Physicians.

Simul Healthc 2018 Aug;13(4):233-238

From the Pritzker School of Medicine (L.H.M.), Department of Medicine (J.M.F., V.M.A.), Accreditation and Innovation (K.W.H.), Office of Graduate Medical Education, Simulation Center (M.C.), and Harris School of Public Policy (E.S.B.), University of Chicago, Chicago, IL.

Introduction: Despite the increasing use of training simulations to teach and assess resident handoffs, simulations that approximate realistic hospital conditions with distractions are lacking. This study explores the effects of a novel simulation-based training intervention on resident handoff performance in the face of prevalent hospital interruptions.

Methods: After a preliminary educational module, entering postgraduate year 1 residents (interns) completed one of the following three handoff simulations: (1) no interruption, (2) hospital noise, or (3) noise and pager interruptions. Trained receivers rated interns using an evidence-based Handoff Behaviors Checklist and a previously validated Handoff Mini-Clinical Examination Exercise instrument.

Results: Of 127 eligible interns, 125 (98.4%) completed an online preparatory module and a handoff simulation. Interns receiving auditory interruptions were less likely to be heard adequately (48.8% noise and 71.8% noise + pager vs. 100.0% uninterrupted, P < 0.001) and scored lower on establishing appropriate handoff settings (5.7 ± 2.3 noise and 6.2 ± 1.8 noise + pager vs. 8.0 ± 0.8 uninterrupted, P < 0.001). Interns receiving noise only shared a written sign-out document more effectively (71.1% vs. 30.2% uninterrupted and 43.6% noise + pager, P < 0.001). There were no differences in averaged performance metrics on the Handoff Behaviors Checklist.

Discussion: While common hospital interruptions created nonideal circumstances for the handoff, interns receiving interruptions were rated similarly and recovered effectively. However, interns exposed to noise only used the written sign-out form more actively. Our findings suggest that this intervention was successful in promoting handoff proficiency despite exposure to common but significant hospital interruptions.
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http://dx.doi.org/10.1097/SIH.0000000000000322DOI Listing
August 2018

Attending Physician Remote Access of the Electronic Health Record and Implications for Resident Supervision: A Mixed Methods Study.

J Grad Med Educ 2017 Dec;9(6):706-713

Background : Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown.

Objective : We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use.

Methods : Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes.

Results : A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use.

Conclusions : In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.
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http://dx.doi.org/10.4300/JGME-D-16-00847.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734323PMC
December 2017

Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey.

Acad Med 2018 05;93(5):736-741

T. Uchida is associate professor of medicine and medical education and director, Clinical Skills Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-3251-5872. F.I. Achike is professor of pharmacology, clinical skills, and anesthesiology; director, Clinical Skills and Simulation Program; and associate dean, Interprofessional Education, California University of Science and Medicine School of Medicine, Colton, California. A.D. Blood is director of curriculum and education management, Rush Medical College, Rush University, Chicago, Illinois, and a doctoral candidate in health professions education, University of Illinois at Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-2275-923X. M. Boyle is clinical associate professor of emergency medicine, assistant dean, Clinical Formation, and course director, Patient Centered Medicine 2, Loyola Stritch School of Medicine, Maywood, Illinois. J.M. Farnan is associate professor of medicine, assistant dean, Curricular Innovation and Evaluation, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois. D. Gowda is associate professor of medicine and course director, Foundations of Clinical Medicine Tutorials, Columbia University College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0001-7124-7615. J. Hojsak is associate professor of pediatrics and medical education and course codirector, The Art and Science of Medicine, Years 1 and 2, Icahn School of Medicine at Mount Sinai, New York, New York. R.K. Ovitsh is assistant professor of pediatrics and assistant dean, Clinical Competencies, SUNY Downstate College of Medicine, Brooklyn, New York. Y.S. Park is assistant professor of medical education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335. R. Silvestri is assistant professor of medicine and site director, Practice of Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-7706-2208.

Purpose: To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools.

Method: The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education-accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size.

Results: Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors.

Conclusions: There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.
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http://dx.doi.org/10.1097/ACM.0000000000002051DOI Listing
May 2018

Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use.

Med Educ Online 2017 ;22(1):1396171

a Department of Medicine , University of Chicago , Chicago , IL , USA.

Background: Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use.

Objective: We piloted a 'Patient-centered EHR use' curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s).

Design: During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance.

Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001).

Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered.

Abbreviations: EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient.
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http://dx.doi.org/10.1080/10872981.2017.1396171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678228PMC
August 2018

Summary: Research Diseases Need Holistic Care.

Acad Med 2017 11;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S7-S11

L. Varpio is associate professor, Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland. J.M. Farnan is associate professor of medicine and assistant dean of curriculum development and evaluation, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Y.S. Park is associate professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois.

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http://dx.doi.org/10.1097/ACM.0000000000001923DOI Listing
November 2017

Electronic-clinical evaluation exercise (e-CEX): A new patient-centered EHR use tool.

Patient Educ Couns 2018 03 10;101(3):481-489. Epub 2017 Oct 10.

Department of Medicine, University of Chicago, Chicago, United States.

Introduction: Electronic Health Record (EHR) use can enhance or weaken patient-provider communication. Despite EHR adoption, no validated tool exists to assess EHR communication skills. We aimed to develop and validate such a tool.

Methods: Electronic-Clinical Evaluation Exercise (e-CEX) is a 10-item-tool based on systematic literature review and pilot-testing. Second-year (MS2s) students participated in an EHR-use lecture and structured Clinical Examination (OSCE). Untrained third-year students (MS3s) participated in the same OSCE. OSCEs were scored with e-CEX compared to a standardized patient (SP) tool. Internal consistency, discriminant validity, and concurrent validity were analyzed.

Results: Three investigators used e-CEX to rate 70 videos (20 MS2, 50 MS3). Reliability testing indicated high internal consistency (Cronbach's alpha=0.89). MS2s scored significantly higher than untrained MS3s on e-CEX [e-CEX 55(10.7) vs. 44.9 (12.7), P=0.003], providing evidence of discriminant validity. e-CEX and SP score correlation was high (Pearson correlation=0.74, P<0.001), providing concurrent validity evidence. Item reduction suggested a three-item tool had similar explanatory power (R-squared=0.85 vs 0.86).

Conclusion: e-CEX is a reliable, valid tool to assess medical student patient-centered EHR communication skills.

Practice Implications: While validation is needed with other healthcare providers, e-CEX may help improve provider behaviors and enhance patients' overall experience of EHR use in their care.
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http://dx.doi.org/10.1016/j.pec.2017.10.005DOI Listing
March 2018

Web Exclusives. Annals for Hospitalists Inpatient Notes - Gender Equality in Hospital Medicine-Are We There Yet?

Ann Intern Med 2017 09;167(6):HO2-HO3

From the Pritzker School of Medicine and Department of Medicine, University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.7326/M17-2119DOI Listing
September 2017

Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS.

Acad Med 2018 05;93(5):693-698

D.J. Ecker is assistant professor of medicine, assistant director of education, Hospital Medicine Group, and director, Integrated Clinicians Course, University of Colorado School of Medicine, Aurora, Colorado, and chair, Advocacy and Advancement Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1530-0079. F.B. Milan is professor of medicine and director, Ruth L. Gottesman Clinical Skills Center and Introduction to Clinical Medicine Program, Albert Einstein College of Medicine, Bronx, New York, and president, Directors of Clinical Skills Courses (DOCS). T. Cassese is associate professor of medical science and director, Clinical Arts and Sciences Course, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, and president-elect, Directors of Clinical Skills Courses (DOCS). J.M. Farnan is assistant dean, Curricular Innovation and Evaluation, associate professor of medicine, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and secretary, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1138-9416. W.S. Madigosky is associate professor of family medicine and director, Foundations of Doctoring Curriculum, University of Colorado School of Medicine, Aurora, Colorado, and chair, Nominations Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0003-0714-4114. F.S. Massie Jr is professor of medicine, director, Introduction to Clinical Medicine Curriculum, and director, Clinical Skills Scholars Program, University of Alabama School of Medicine, Birmingham, Alabama, and past president (2014-2015), Directors of Clinical Skills Courses (DOCS). P. Mendez is associate dean, Clinical Curriculum, associate professor of medicine, and director, Clinical Skills Program, University of Miami Miller School of Medicine, Miami, Florida, and representative, Southern Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). S. Obadia is associate dean, Clinical Education and Services, associate professor of internal medicine, and codirector, Medical Skills Courses, A.T. Still University, School of Osteopathic Medicine, Mesa, Arizona, and chair, Program Planning Subcommittee, Directors of Clinical Skills Courses (DOCS). R.K. Ovitsh is assistant dean, Clinical Competencies, and assistant professor of pediatrics, State University of New York Downstate School of Medicine, Brooklyn, New York, and representative, Northeast Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). R. Silvestri is assistant professor of medicine and site director, Practice of Medicine Clinical Skills Course, Harvard Medical School, Boston, Massachusetts, and chair, Research Subcommittee, Directors of Clinical Skills Courses (DOCS). T. Uchida is associate professor of medicine and medical education and director, Clinical Skills Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and treasurer, Directors of Clinical Skills Courses (DOCS). M. Daniel is assistant dean, Curriculum, and assistant professor of emergency medicine and learning and health sciences, University of Michigan Medical School, Ann Arbor, Michigan, and past president (2015-2016), Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0001-8961-7119.

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.
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http://dx.doi.org/10.1097/ACM.0000000000001874DOI Listing
May 2018

The Graduate Medical Education Scholars Track: Developing Residents as Clinician-Educators During Clinical Training via a Longitudinal, Multimodal, and Multidisciplinary Track.

Acad Med 2018 02;93(2):214-219

J. Ahn is assistant professor of medicine, Section of Emergency Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. S.K. Martin is assistant professor of medicine, Section of Hospital Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. J.M. Farnan is associate professor of medicine, Section of Hospital Medicine, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. H.B. Fromme is associate professor of pediatrics, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.

Problem: Residency clinician-educator tracks have been created; however, they have generally been limited to a single discipline or program and experienced some challenges. The Graduate Medical Education Scholars Track (GMEST), an embedded longitudinal, multimodal, multidisciplinary clinician-educator track for residents, was piloted at the Pritzker School of Medicine, University of Chicago, in academic year 2014-2015.

Approach: The GMEST is a two-year experience completed during residency training. The goal is to prepare trainees for academic careers as clinician-educators with a focus on medical education scholarship. This track is designed for residents from diverse training programs with variable clinical schedules and blends a live interactive program, asynchronous instruction and discussion, and overarching multimodal mentorship in medical education. Participants are expected to complete a capstone medical education project and submit it to institutional, regional, and/or national venues.

Outcomes: Data gathered from the 2014-2016 and 2015-2017 cohorts demonstrated that 21/22 (95%) participants were satisfied with the GMEST curriculum, felt it was important to their development as future clinician-educators, and felt it would positively influence their ability to work in medical education. Further, 18/22 (82%) participants wished to pursue a career as a clinician-educator and in medical education leadership and/or scholarship.

Next Steps: The authors will longitudinally track graduates' future career positions, projects, publications, and awards, and cross-match and compare GMEST graduates with non-GMEST residents interested in medical education. Faculty mentors, program directors, and the Medical Education, Research, Innovation, Teaching, and Scholarship community will be asked for feedback on the GMEST.
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http://dx.doi.org/10.1097/ACM.0000000000001815DOI Listing
February 2018

Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

Thorax 2017 12 30;72(12):1132-1139. Epub 2017 Jun 30.

Section of Pulmonary and Critical Care, Sleep Disorders Center, Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Background: Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence.

Methods: Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date.

Results: A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic.

Conclusions: In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care.

Trial Registration Number: ClinicalTrials.gov Identifier: NCT02553694.
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http://dx.doi.org/10.1136/thoraxjnl-2017-210106DOI Listing
December 2017

Developing a Virtual Teach-To-Goal Inhaler Technique Learning Module: A Mixed Methods Approach.

J Allergy Clin Immunol Pract 2017 Nov - Dec;5(6):1728-1736. Epub 2017 Jun 7.

Department of Medicine, University of Chicago, Chicago, Ill. Electronic address:

Background: Most hospitalized patients with asthma or chronic obstructive pulmonary disease misuse respiratory inhalers. An in-person educational strategy, teach-to-goal (TTG), improves inpatients' inhaler technique.

Objective: To develop an effective, portable education intervention that remains accessible to hospitalized patients postdischarge for reinforcement of proper inhaler technique.

Methods: A mixed methods approach at an urban academic hospital was used to iteratively develop, modify, and test a virtual teach-to-goal (V-TTG) educational intervention using patient end-user feedback. A survey examined access and willingness to use technology for self-management education. Focus groups evaluated patients' feedback on access, functionality, and quality of V-TTG.

Results: Forty-eight participants completed the survey, with most reporting having Internet access; 77% used the Internet at home and 82% used the Internet at least once every few weeks. More than 80% reported that they were somewhat or very likely to use V-TTG to gain skills to improve their health. Most participants reported smartphone access (73%); half owned laptop computers (52%). Participants with asthma versus chronic obstructive pulmonary disease were more likely to own a smartphone, have a data plan, and have daily Internet use (P < .05). Nine focus groups (n = 25) identified themes for each domain: access-platform and delivery, Internet access, and technological literacy; functionality-usefulness, content, and teaching strategy; and quality-clarity, ease of use, length, and likability.

Conclusions: V-TTG is a promising educational tool for improving patients' inhaler technique, iteratively developed and refined with patient input. Patients in our urban, academic hospital overwhelmingly reported access to platforms and willingness to use V-TTG for health education.
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http://dx.doi.org/10.1016/j.jaip.2017.04.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681390PMC
June 2018

Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents.

J Grad Med Educ 2017 Apr;9(2):241-244

Background: Unprofessional behaviors undermine the hospital learning environment and the quality of patient care.

Objective: To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors.

Methods: We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship.

Results: Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively;  < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%,  = .019).

Conclusions: The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.
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http://dx.doi.org/10.4300/JGME-D-16-00289.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398139PMC
April 2017

"Real-Time" Clinical Reasoning via the EHR? The EHR and Its Role in Clinical Supervision.

J Grad Med Educ 2017 Feb;9(1):137

Associate Professor of Medicine and Assistant Dean, Curricular Development and Evaluation, University of Chicago Pritzker School of Medicine.

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http://dx.doi.org/10.4300/JGME-D-16-00530.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319619PMC
February 2017

A Solution to the Problem of Sustainability of Opioid Initiatives in Graduate Medical Education.

J Grad Med Educ 2017 Feb;9(1):133

Associate Professor and Director of Graduate Medical Education Clinical Learning Environment Innovation, Department of Medicine, University of Chicago Pritzker School of Medicine.

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http://dx.doi.org/10.4300/JGME-D-16-00514.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319615PMC
February 2017

How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit?

Ann Am Thorac Soc 2017 Apr;14(4):543-549

6 Center for Nursing Discovery, School of Nursing, Duke University, Durham, North Carolina.

Rationale: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. Although the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare them adequately for this role.

Objectives: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified.

Methods: Mixed-methods observational study of graduating nursing (n = 51) and medical (n = 93) students who completed two "Room of Horrors" simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students' written hazard descriptions. Fisher's exact test was used to determine differences in frequency of hazards identified between groups.

Results: Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73 vs. 2%, P < 0.001), whereas nursing students noted that there was no order for the restraints (58.5 vs. 0%, P < 0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to those in the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous line (10% individuals, P < 0.0001). Nevertheless, teams of students missed many intensive care unit-specific hazards: 54% failed to identify the presence of pressure ulcers; 85% did not notice high tidal volumes on the ventilator; and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis.

Conclusions: Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the intensive care unit. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each other's roles and responsibilities.
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http://dx.doi.org/10.1513/AnnalsATS.201610-773OCDOI Listing
April 2017

Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep.

J Clin Sleep Med 2017 Feb 15;13(2):301-306. Epub 2017 Feb 15.

Department of Medicine, University of Chicago, Chicago, IL.

Study Objectives: Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives.

Methods: Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects.

Results: Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003].

Conclusion: Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.
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http://dx.doi.org/10.5664/jcsm.6468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263086PMC
February 2017