ABSTRACT
SETTING AND PARTICIPANTS: Internal Medicine residents on general medicine inpatient service in a large, urban academic medical center. DESCRIPTION: Oral case presentations focus on reporting relevant data;however, an overly narrow construction of relevance excludes social data - often deemed unrelated to diagnosis or treatment. Such exclusion may hinder patient- centered care, defined as “care that is respectful ofpatient preferences, needs, and values”. Building on this concept, we share a pilot intervention where residents include social history in opening one-liners for new patient presentations. We hypothesize this as a sustainable opportunity for residents to connect with patients and to appreciate social/cultural factors that impact health. During the intervention, residents receive training, followed by daily “best practice” emails the second week on service. Email reminders are discontinued the final two weeks of the rotation, but residents can choose to continue using social one-liners. EVALUATION: Pre/post surveys evaluate resident attitudes and self-reported behaviors. We measured feasibility by residents' adoption of the social oneliners;sustainability by continuation of social one-liners following the email phase;and assessed attitudes regarding patient care relationships. We report interim results after the 2nd of 5 pilot months. In pre-testing, most residents (12/15) did not incorporate social history into the one-liner (62% rarely;19% never). A small number agreed presenting social history would impact the overall care of patients (14%) and only 24% strongly agreed that incorporating social history might enhance patient-care relationships. In post-testing, 8/10 residents reported including social history during the email phase, and 20% continued the social one-liners after emails discontinued. Regarding attitudes, 40% strongly agreed that incorporating social history enhanced patient-care relationships and 30% felt patients were re-centered. In open-ended feedback, residents noted social one-liners “[benefited] the dispo plan” and “[emphasized] patient-centered not problem-centered care”. DISCUSSION / REFLECTION / LESSONS LEARNED: Preliminary data analysis reveals that residents report increased incorporation of and positive attitudes toward social one-liners. Of note, the pilot occurred during a COVID surge, which likely contributed to findings. Nonetheless, the simple nature of the intervention supports ongoing effort and lends itself to implementation elsewhere.
ABSTRACT
SETTING AND PARTICIPANTS: 66 first-year internal medicine residents at Northwestern Memorial Hospital were randomized to Group A or Group B. Curriculum participation was mandatory for all first-year internal medicine residents, but participants were given the option to exclude their answers from the study. DESCRIPTION: Prior to 2020, there was no formal radiographic curriculum for internal medicine residents at our institution. Additionally, the COVID pandemic necessitated a paradigm shift in medical education from in-person teaching to remote learning. Accordingly, we created a novel virtual learning curriculum to teach common CXR findings to first-year residents. Objectives of the curriculum include 1) providing first-year residents with a systematic approach to reading and interpreting CXRs, and 2) prompting pattern recognition via proper identification of common CXR findings. We created a randomized cohort study with cross-over design to evaluate the efficacy of our curriculum. First-year internal medicine residents at McGaw Medical Center of Northwestern University were randomized into two groups (Group A/B). In phase I, only Group A was administered the 11-week curriculum. Learners received 2-4 weekly CXRs focusing on a modified ”ABCDE” approach. Each weekly lesson was designed to be completed in 15 mins via smartphone or laptop. Multiple choice standardized assessments were administered before (Pre-Test) and after (Post- Test #1) administration. In phase II, Group B, but not Group A, was given the curriculum;both groups then completed Post-Test #2. This phase assessed curriculum efficacy (Group B) and learning retention (Group A). EVALUATION: Independent and paired-sample T tests were used to compare scores between and within groups. Group A scored higher on Post-Test #1 following curriculum administration, compared to on the Pre-Test (pre: 44 ± 15%;post: 59 ± 17 %;p= 0.005). Group B scored similarly on the Pre-test and Post-Test #1 (pre: 50 ± 14%;post: 44 ± 17%;p= 0.25), but higher on Post-Test #2, following their curriculum administration (60 ± 17%) than on Post-Test #1 (p= 0.04). There was no statistically significant difference in Post-Test #2 scores between Groups A and B (55 ± 17% and 60 ± 17%, respectively). In Group A, self-assessed confidence with CXR reading was higher at the time of Post- Test #1 than Pre-Test (72 ± 13%;55 ± 12%;p= <0.01). DISCUSSION / REFLECTION / LESSONS LEARNED: This study suggests that our novel remote learning curriculum is a practical, effective adjunct to standard residency education for reading CXRs. Notably, residents who received the curriculum demonstrated higher scores and had improved confidence with reading CXRs. Study limitations include small sample size and participant attrition. Future studies include applying our remote learning framework to other imaging studies.