Creation of an asynchronous faculty development curriculum on well-written narrative assessments that avoid bias.

BACKGROUND: The COVID-19 pandemic in parallel with concerns about bias in grading resulted in many medical schools adopting pass/fail clinical grading and relying solely on narrative assessments. However, narratives often contain bias and lack specificity. The purpose of this project was to develop asynchronous faculty development to rapidly educate/re-educate > 2000 clinical faculty spread across geographic sites and clinical disciplines on components of a well-written narrative and methods to minimize bias in the assessment of students. METHODS: We describe creation, implementation, and pilot data outcomes for an asynchronous faculty development curriculum created by a committee of volunteer learners and faculty. After reviewing the literature on the presence and impact of bias in clinical rotations and ways to mitigate bias in written narrative assessments, the committee developed a web-based curriculum using multimedia learning theory and principles of adult learning. Just-in-time supplemental materials accompanied the curriculum. The Dean added completion of the module by 90% of clinical faculty to the department chairperson's annual education metric. Module completion was tracked in a learning management system, including time spent in the module and the answer to a single text entry question about intended changes in behavior. Thematic analysis of the text entry question with grounded theory and inductive processing was used to define themes of how faculty anticipate future teaching and assessment as a result of this curricula. OUTCOMES: Between January 1, 2021, and December 1, 2021, 2166 individuals completed the online module; 1820 spent between 5 and 90 min on the module, with a median time of 17 min and an average time of 20.2 min. 15/16 clinical departments achieved completion by 90% or more faculty. Major themes included: changing the wording of future narratives, changing content in future narratives, and focusing on efforts to change how faculty teach and lead teams, including efforts to minimize bias. CONCLUSIONS: We developed a faculty development curriculum on mitigating bias in written narratives with high rates of faculty participation. Inclusion of this module as part of the chair's education performance metric likely impacted participation. Nevertheless, time spent in the module suggests that faculty engaged with the material. Other institutions could easily adapt this curriculum with provided materials.

Facilitated Online Video Interviewing with Older People with Advancing Frailty: A Novel Approach to Co-Production

Background/aims: The voices of older people with advancing frailty (OPWF) are less often heard in research, made worse by the COVID-19 pandemic. In-person video interviews with this population about their care needs were adapted to a facilitated online video design. This paper assesses whether this design can support older people's participation in and co-production of research. Methods: Video-recorded interviews (N=10) were undertaken October- November 2020 with multi-actor(a-d) involvement, where a cliniciana facilitated interviews from the OPWF'sb home with the research teamc interviewing remotely via Zoom. Unpaid carersd (N=5) sometimes supported interview participation. Ages ranged from 70-99, 6 men, 4 women, with no internet access (N=5) or family facilitated internet access (N=5), and Clinical Frailty Scores of 6 (N=5), 7 (N=4), or 8 (N=1). Results: Multi-actor involvement led to less structured encounters than planned and more intuitive, co-produced, and situationally led interviews. Those interviewed felt that they had more opportunities to speak about things that were important to them, often expressing anger in feeling isolated and forgotten during the pandemic. The clinician described the benefit of the time given to the encounter, of the different conversations arising from a non- “routine” visit, and reflected on the different roles they held in supporting the participant by checking their understanding, helping to pace the interview, support silences, and provide emotional support following interviews. Conclusions: Innovating research design during the pandemic to enhance older people's voices is challenging within normative expectations of funding and ethics bodies, yet, with less in-person research, presents opportunities to trial novel co-productive approaches to involve older people. This novel approach highlights challenges and opportunities for remotely co-producing research with OPWF, with high costs and skill-set requirements as barriers but rich data and open conversations as rewards.

Older people with severe frailty talking about their palliative care needs: An interview and survey study during the covid-19 pandemic

Background: Older people with severe frailty (OPWF) are an unrepresented group in receiving palliative care (PC). Aim: A modified e-Delphi study nested in a wider mixed method study aimed to understand the most important PC needs for community-residing OPWF. Methods: The views of OPWF were collected by video-recorded interviews (N=10) and open questions in a facilitated survey (N=10), undertaken October-November 2020. OPWF's ages ranged from 70-99, 11 men, 9 women, living in owned, rented or sheltered accommodation, with Clinical Frailty Scores of 6 (N=8), 7 (N=9) and 8 (N=3). 9 of these participants have now died. Data was analysed using the 5 domains of PC need: physical, psychological, spiritual, practical and social. Results: Meeting care needs was challenging across all domains. Acute physical needs were responded to, yet important longer-term needs, e.g. mental well-being, rehabilitation, and managing long-term conditions were harder to address. The pandemic caused or worsened distress and anger about being housebound, loss of social contact, increased loneliness and feeling ignored. Access to health and social care was a struggle for OPWF, where previously received services were withdrawn and lack of resources and exposure to telehealth put a high reliance on families to facilitate virtual consultations. OPWF relied on unpaid carers to coordinate and deliver care, which intensified when health deteriorated. Carers vividly detailed the strain and unsustainability of this provision. Conclusions: Post-Covid learning must take account of the impact on this less-often heard PC population. Prolonged loneliness and reduced activity will have significant consequences for physical and mental health and wellbeing. Unpaid carers are vital to the provision of personalised care to OPWF, they need to be listened to and resourced in their caring work, and to have their own needs assessed and addressed. Funder: HEE/NIHR UK.