C4Tech: Virtual connections between the classrooms, clinicians, and community clinics to bridge the gap between research and practice.

AIM: E-learning technologies are becoming vital components of medical and health professions education, as highlighted during the current coronavirus disease (COVID-19) pandemic. The National Academy of Medicine (NAM) considers education technologies essential to forming connections between education and healthcare delivery systems, which promote evidence-based practice and continuous learning and quality improvement in healthcare. There is a lack of evidence-based models to guide the integration of technology in medical and health profession education, in particular models that form synergistic linkages between healthcare education and delivery systems. This paper presents the evaluation of an innovative blended learning model, which leverages virtual technology to connect students in the classroom with clinicians in community clinics (C4Tech) for authentic learning related to quality improvement (QI) and social determinants of health (SDH). METHOD: This study applied a case study approach to evaluate the efficacy of the C4Tech model in supporting learning outcomes and assessed how virtual collaboration influenced the process of learning. RESULTS: This study contributes to a more comprehensive understanding of how to design effective blended courses that connect the healthcare education and delivery systems through virtual technology. It also demonstrates how to connect students and practicing clinicians virtually to design evidence-based quality improvement projects.

Learning health systems from an academic perspective: establishing a collaboratory within a school of medicine and health sciences.

Learning Health Systems (LHSs) seek continuous improvement through the translation and integration of internally and externally generated knowledge across stakeholders within and external to the organization, yet current approaches are primarily described from the healthcare delivery perspective, leaving teaching and research responsibilities underexposed. Academic medical centers offer a unique perspective on LHSs because their mission includes teaching, research, and healthcare. This introduces an opportunity to enact, educate, and study processes and outcomes of LHSs within a single system. Little information is available to describe these processes and outcomes, resulting in a knowledge gap regarding the role of education and research in the quality improvement cycles and learning of LHSs. To close this knowledge gap, The George Washington University School of Medicine and Health Sciences initiated the Health Research and Education Collaboratory (GW Collaboratory) in 2017. The GW Collaboratory was established to study mechanisms supporting continuous quality improvement and learning in health systems within an academic medical center. We envision the GW Collaboratory as interconnected knowledge nodes facilitating collaboration among clinicians, patients, researchers, and educators to study the knowledge generation, dissemination, application, and evaluation required for continuous quality improvement and learning. We employ a project-based approach to foster communities of learning focused on exploring specific health problems of interest. We propose the GW Collaboratory as one model by which academic medical centers can contribute to the science of LHS.

Connecting Classrooms, Clinicians, and Community Clinics Through Technology (C4Tech) for Active and Collaborative Learning.

PURPOSE: This pilot study investigated the level of cognition that physician assistant (PA) students achieved through adoption of an innovative blended learning model that connects the classroom, clinicians, and community clinics through electronic-learning (e-learning) technologies (C4Tech) used in a PA course. This education intervention aimed to facilitate authentic learning collaborations between PA students and practicing clinicians that would result in higher-order cognition related to the manifestations of social determinants of health and health disparities. METHODS: A case study approach was adopted to assess levels of cognition and changes in those levels resulting from application of an innovative blended learning model. Content analysis using Bloom's taxonomy of cognitive domains facilitated determination levels of cognition and changes in those levels. The sample of 8 groups comprised 70 PA students and 8 clinical instructors from community clinics with underrepresented patient populations. RESULTS: Analysis of 2 course assignments revealed that application of the C4Tech model yields high levels of cognition. By the course's end, all 8 groups achieved at least the "evaluate" level of cognition and half of the groups achieved the highest level of cognition, the "create" level. A wide variation in the level of cognition was demonstrated between the first and second assignments in each group and among groups. CONCLUSION: Our findings suggest that e-learning technologies can be effective in blending classrooms and work environments for authentic and collaborative learning. Adoption of the C4Tech model yielded higher-order cognition related to course content.

Patient Satisfaction and Antibiotic Prescribing for Respiratory Infections by Telemedicine.

BACKGROUND AND OBJECTIVES: Respiratory tract infections (RTIs) are a common reason for direct-to-consumer (DTC) telemedicine consultation. Antibiotic prescribing during video-only DTC telemedicine encounters was explored for pediatric RTIs. METHODS: Encounter data were obtained from a nationwide DTC telemedicine platform. Mixed-effects regression was used to assess variation in antibiotic receipt by patient and physician factors as well as the association between antibiotic receipt and visit length or patient satisfaction. RESULTS: Of 12 842 RTI encounters with 560 physicians, antibiotics were prescribed in 55%. The provider was more likely to receive a 5-star rating from the parent when an antibiotic was prescribed (93.4% vs 80.8%). A 5-star rating was associated with a prescription for an antibiotic (odds ratio [OR] 3.38; 95% confidence interval [CI] 2.84 to 4.02), an antiviral (OR 2.56; 95% CI 1.81 to 3.64), or a nonantibiotic (OR 1.93; 95% CI 1.58 to 2.36). Visit length was associated with higher odds of a 5-star rating only when no antibiotic was prescribed (OR 1.03 per 6 seconds; 95% CI 1.01 to 1.06). Compared with nonpediatricians, pediatric providers were less likely to prescribe antibiotics (OR 0.44; 95% CI 0.29 to 0.68); however, pediatricians received higher encounter satisfaction ratings (OR 1.50; 95% CI 1.11 to 2.03). CONCLUSIONS: During DTC telemedicine consultations for RTIs, pediatric patients were frequently prescribed antibiotics, which correlated with visit satisfaction. Although pediatricians prescribed antibiotics at a lower rate than other physicians, their satisfaction scores were higher. Further work is required to ensure that antibiotic use during DTC telemedicine encounters is guideline concordant.

Ligation of erythrocyte CR1 induces its clustering in complex with scaffolding protein FAP-1.

The primary identified function of complement receptor 1 (CR1/CD35) on primate erythrocytes is to bind complement-tagged inflammatory particles including microbes and immune complexes. When erythrocytes circulate through liver and spleen, sinusoidal phagocytes remove CR1-adherent particles and erythrocytes return to the circulation. This process of immune adherence clearance is important for host defense and prevention of autoimmunity. CR1 was previously described as clustered in the human erythrocyte membrane, which was thought to be necessary for binding complement-opsonized particles. In contrast, we demonstrate that on erythrocytes CR1 is not clustered, but dispersed, and able to bind complement-tagged particles. When fresh erythrocytes are solubilized by nonionic detergent, CR1 partitions to the cytoskeleton fraction. Using a PDZ-peptide array, CR1's cytoplasmic tail, which contains 2 PDZ-motifs, binds PDZ domains 2, 3, and 5 of Fas-associated phosphatase 1 (FAP-1), a scaffolding protein. We show that FAP-1, not previously recognized as an erythroid protein, is expressed on circulating erythrocytes. CR1 and FAP-1 coimmunoprecipitate, which confirms their molecular association. Disperse CR1 on erythrocytes may be advantageous for capturing immune-complexes, while ligation-induced CR1 clustering may prevent ingestion of the erythrocyte during the immune-complex transfer to the macrophages by keeping the opsonic stimulus localized thus preventing phagocyosis.