Impact and feasibility of a pharmacist-delivered pharmacotherapy rotation on pediatric resident education.

Pharmacotherapy training for pediatric residents is an important part of their overall education. Limited data exist describing formal engagement of clinical pharmacists in residency training. The objective of this study was to evaluate a novel pharmacotherapy rotation for learner gains and program feasibility. We designed a novel pharmacotherapy rotation (PTR) involving a pharmacist preceptor, pediatric resident, and final-year pharmacy students in the pediatric intensive care unit (PICU). Rotation objectives and content were based on learning gaps identified in a review of the resident curriculum. Data from PTRs completed 2014-2020 were used to evaluate PTR impact on residents' knowledge and confidence in pharmacotherapy decision-making, and interprofessional valuing. We also addressed PTR feasibility for long-term and for adoption by others. Measures for demographic, knowledge, and confidence measures were administered to intervention and control groups. Measures for interprofessional valuing and post-PTR feedback were administered only to the intervention group. Pre-post gains were greater for intervention residents (n = 7) than for control (n = 10), (knowledge: p = 0.02, confidence: p < 0.0001). Interprofessional valuing gain for the intervention group was significant (p = 0.004). Few PTR changes have been necessary since initial implementation. Residents provided high ratings of PTR experiences and specific value-added benefits. Designing an inter-professional PTR within the existing PICU and pharmacy rotation enhanced feasibility, curriculum consistency, and flexibility to optimize inter-professional learning.Participation in the PTR enhanced resident pharmacotherapy knowledge and decision-making, and engagement in interprofessional practice. Next steps include expanding the PTR to other settings and specialties with further evaluation study.

Neonatal Intensive Care Unit Boot Camp: A Preparatory Curriculum for Pediatric Residents.

Introduction: Resident training has changed significantly in recent years, resulting in reduced experiences and practice. Because pediatric residents have fewer required intensive care unit (ICU) rotations, we introduced a neonatal ICU (NICU) boot camp (2014-2015) that continues today to prepare residents immediately prior to beginning an NICU rotation. Methods: The NICU boot camp consists of three 1-hour sessions: two interactive lectures with case-based application and one hands-on, integrative learning using simulation. The sessions are designed to cover basic information to assist in daily rounding and decision making while in the NICU. After their NICU rotation, residents complete a 12-item questionnaire. Program evaluation includes direct observation during sessions, faculty debriefing, and a postprogram resident survey. Results: Fifty-seven residents participated; questionnaire responses were available from 46 (80.70%). Combined percentages of very useful and extremely useful responses for the three sessions were 82.61%, 78.26%, and 82.60%, with 86.95% for the overall program; 80.40% agreed that repeating boot camp prior to each NICU rotation would be useful. Analysis of narrative responses revealed that participation in boot camp enhanced residents' readiness and confidence for patient care in the NICU and as stated for each educational objective. Discussion: Program evaluation results support highly effective and sustainable implementation and achievement of educational objectives. Minor refinements continue for enhancing active learning and content materials and for increasing rigor of program evaluation. Results also suggest that our boot camp may benefit other pediatric programs and serve as a model for use in other resident specialty programs.

Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians.

OBJECTIVE: The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. METHODS: A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. RESULTS: The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. CONCLUSION: These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain.

Applying Educational Theory to Simulation-Based Training and Assessment in Surgery.

Considerable progress has been made regarding the range of simulator technologies and simulation formats. Similarly, results from research in human learning and behavior have facilitated the development of best practices in simulation-based training (SBT) and surgical education. Today, SBT is a common curriculum component in surgical education that can significantly complement clinical learning, performance, and patient care experiences. Beginning with important considerations for selecting appropriate forms of simulation, several relevant educational theories of learning are described.

A Regional Public Health Field Placement Program: making an IMPACT.

Beginning in 2010, the U.S. Department of Health and Human Services, Health Resources and Services Administration, made provisions in its Public Health Training Center cooperative agreements for field placements. This article describes best practices and lessons learned establishing and managing the South Central Public Health Partnership's Interns and Mentors Program for ACTion (IMPACT) Field Placement Program, which was initially funded through the Centers for Disease Control and Prevention's Centers for Public Health Preparedness Cooperative agreement in 2002. The IMPACT program is based on a six-step process that has been developed and refined over its 10-year history: (a) identifying field placement opportunities, (b) marketing field experience opportunities to students, (c) selecting students seeking field experience opportunities, (d) placing students with practice partners, students with practice partners, (e) evaluating student progress toward field experience objectives, and (f) evaluating the program. This article describes the program's structure and processes, delineates the roles of its academic and practice partners, discusses evidence of its effectiveness, and describes lessons learned from its decade-long history. Hopefully, this information will facilitate the establishment, management and evaluation of internship and field placement programs in other Public Health Training Centers and academic public health programs.

Rasch analysis for the evaluation of rank of student response time in multiple choice examinations.

The availability of computerized testing has broadened the scope of person assessment beyond the usual accuracy-ability domain to include response time analyses. Because there are contexts in which speed is important, e.g. medical practice, it is important to develop tools by which individuals can be evaluated for speed. In this paper, the ability of Rasch measurement to convert ordinal nonparametric rankings of speed to measures is examined and compared to similar measures derived from parametric analysis of response times (pace) and semi-parametric logarithmic time-scaling procedures. Assuming that similar spans of the measures were used, non-parametric methods of raw ranking or percentile-ranking of persons by questions gave statistically acceptable person estimates of speed virtually identical to the parametric or semi-parametric methods. Because no assumptions were made about the underlying time distributions with ranking, generality of conclusions was enhanced. The main drawbacks of the non-parametric ranking procedures were the lack of information on question duration and the overall assignment by the model of variance to the person by question interaction.

New faculty orientation in North American medical schools.

BACKGROUND: Little is known about common elements or "best practices" of new faculty orientation (NFO) programs in medical schools. PURPOSE: The objective was to examine school-wide NFO programs in North American medical schools. METHODS: We reviewed the literature and conducted a web-based survey. Analyses included descriptive statistics and content analysis. RESULTS: We found little evidence of "best practices." Of the 106 responding schools (106/148=71.62%), 72 (67.9%) reported some type of school-wide NFO program. The typical program was organized by an Office of Faculty Affairs or Faculty Development, targeted broad goals, 4 to 8 hour long, offered early in the academic year, and used 2 or more presentation formats (e.g., oral, print). CONCLUSIONS: Based on the literature, this study appears to be the first comprehensive description of NFO programs in medical schools. Multiple types of NFO are needed to accommodate the diversity of faculty and faculty responsibilities. School-wide programs may serve best to develop institutional affiliation and collegiality.

Enhancing residents' neonatal resuscitation competency through unannounced simulation-based training.

BACKGROUND: Almost half of pediatric third-year residents surveyed in 2000 had never led a resuscitation event. With increasing restrictions on residency work hours and a decline in patient volume in some hospitals, there is potential for fewer opportunities. PURPOSE: Our primary purpose was to test the hypothesis that an unannounced mock resuscitation in a high-fidelity in-situ simulation training program would improve both residents' self-confidence and observed performance of adopted best practices in neonatal resuscitation. METHODS: Each pediatric and medicine-pediatric resident in one pediatric residency program responded to an unannounced scenario that required resuscitation of the high fidelity infant simulator. Structured debriefing followed in the same setting, and a second cycle of scenario response and debriefing occurred before ending the 1-hour training experience. Measures included pre- and post-program confidence questionnaires and trained observer assessments of live and videotaped performances. RESULTS: Statistically significant pre-post gains for self-confidence were observed for 8 of the 14 NRP critical behaviors (p=0.00-0.03) reflecting knowledge, technical, and non-technical (teamwork) skills. The pre-post gain in overall confidence score was statistically significant (p=0.00). With a maximum possible assessment score of 41, the average pre-post gain was 8.28 and statistically significant (p<0.001). Results of the video-based assessments revealed statistically significant performance gains (p<0.0001). Correlation between live and video-based assessments were strong for pre-post training scenario performances (pre: r=0.64, p<0.0001; post: r=0.75, p<0.0001). CONCLUSIONS: Results revealed high receptivity to in-situ, simulation-based training and significant positive gains in confidence and observed competency-related abilities. Results support the potential for other applications in residency and continuing education.

The design and utility of institutional teaching awards: a literature review.

BACKGROUND: Institutional teaching awards have been used widely in higher education since the 1970s. Nevertheless, a comprehensive review of the literature on such awards has not been published since 1997. AIM: We conducted a literature review to learn as much as possible about the design (e.g., formats, selection processes) and utility (e.g., impact on individuals and institutions) of teaching awards in order to provide information for use in designing, implementing, or evaluating award programs. METHODS: We searched electronic databases for English-language publications on awards for exemplary teaching. Targeted publications included descriptions and/or investigations of award programs, their impact, and theoretical or conceptual models for awards programs. Screening was conducted by dual review; a third reviewer was assigned for disagreements. Data were analyzed qualitatively. Results were summarized descriptively. RESULTS: We identified 1302 publications for initial relevancy screening by title and abstract. We identified an additional 23 publications in a follow-up search. The full text of 126 publications was reviewed for further relevance. A total of 62 publications were identified as relevant, and of these 43 met our criteria for inclusion. Of the 43, 19 described the design features of 24 awards; 20 reports discussed award utility. Nomination and selection processes and benefits (e.g., plaques) varied as did perceived impact on individuals and institutions. CONCLUSION: Limited evidence exists regarding design and utility of teaching awards. Awards are perceived as having potential for positive impact, including promotions, but may also have unintended negative consequences. Future research should investigate the impact of awards on personal and professional development, and how promotion and tenure committees perceive awards.

Evaluation of a faculty development program aimed at increasing residents' active learning in lectures.

BACKGROUND: Active engagement in the learning process is important to enhance learners' knowledge acquisition and retention and the development of their thinking skills. This study evaluated whether a 1-hour faculty development workshop increased the use of active teaching strategies and enhanced residents' active learning and thinking. METHODS: Faculty teaching in a pediatrics residency participated in a 1-hour workshop (intervention) approximately 1 month before a scheduled lecture. Participants' responses to a preworkshop/postworkshop questionnaire targeted self-efficacy (confidence) for facilitating active learning and thinking and providing feedback about workshop quality. Trained observers assessed each lecture (3-month baseline phase and 3-month intervention phase) using an 8-item scale for use of active learning strategies and a 7-item scale for residents' engagement in active learning. Observers also assessed lecturer-resident interactions and the extent to which residents were asked to justify their answers. RESULTS: Responses to the workshop questionnaire (n  =  32/34; 94%) demonstrated effectiveness and increased confidence. Faculty in the intervention phase demonstrated increased use of interactive teaching strategies for 6 items, with 5 reaching statistical significance (P ≤ .01). Residents' active learning behaviors in lectures were higher in the intervention arm for all 7 items, with 5 reaching statistical significance. Faculty in the intervention group demonstrated increased use of higher-order questioning (P  =  .02) and solicited justifications for answers (P  =  .01). CONCLUSION: A 1-hour faculty development program increased faculty use of active learning strategies and residents' engagement in active learning during resident core curriculum lectures.

Design and effectiveness of a required pre-clinical simulation-based curriculum for fundamental clinical skills and procedures.

BACKGROUND: For more than 20 years, medical literature has increasingly documented the need for students to learn, practice and demonstrate competence in basic clinical knowledge and skills. In 2001, the Louisiana State University Health Science Centers (LSUHSC) School of Medicine - New Orleans replaced its traditional Introduction in to Clinical Medicine (ICM) course with the Science and Practice of Medicine (SPM) course. The main component within the SPM course is the Clinical Skills Lab (CSL). The CSL teaches 30 plus skills to all pre-clinical medical students (Years 1 and 2). METHODS: Since 2002, an annual longitudinal evaluation questionnaire was distributed to all medical students targeting the skills taught in the CSL. Students were asked to rate their self- confidence (Dreyfus and Likert-type) and estimate the number of times each clinical skill was performed (clinically/non-clinically). Of the 30 plus skills taught, 8 were selected for further evaluation. RESULTS: An analysis was performed on the eight skills selected to determine the effectiveness of the CSL. All students that participated in the CSL reported a significant improvement in self-confidence and in number performed in the clinically/non-clinically setting when compared to students that did not experience the CSL. For example, without CSL training, the percentage of students reported at the end of their second year self-perceived expertise as "novice" ranged from 21.4% (CPR) to 84.7% (GU catheterization). Students who completed the two-years CSL, only 7.8% rated their self-perceived expertise at the end of the second year as "novice" and 18.8% for GU catheterization. CONCLUSION: The CSL design is not to replace real clinical patient experiences. It's to provide early exposure, medial knowledge, professionalism and opportunity to practice skills in a patient free environment.

Attitudinal changes resulting from repetitive training of operating room personnel using of high-fidelity simulation at the point of care.

We investigated the impact of repetitive training using high-fidelity simulation (HFS) at the point of care on the teamwork attitudes of operating room (OR) personnel. Members of the general surgical OR teams at an academic medical center participated in two half-day point-of-care HFS team training sessions. Module 1 targeted teamwork competencies; Module 2 included a preoperative briefing strategy. Modules were separated by 1 month. For each training, participants completed pre- and postsession questionnaires that included a 15-item self-efficacy tool targeting teamwork competencies using a 6-point Likert-type scale. Pre- and postsession mean scores were compared with a t test. Matched pre- and postsessions questionnaires were collected from 38 and 39 participants for Module 1 and Module 2, respectively. Mean item improvement from pre- to posttraining was 0.43 units (range, 0.23 to 0.69 units) for Module 1 and 0.42 units (range, 0.15 to 0.53 units) for Module 2. After Bonferroni adjustment, statistically significant improvement in scores from pre- to posttraining increased from four items after Module 1 to nine items after Module 2. Repetitive training of interdisciplinary OR teams through HFS at the point of care increases the effectiveness of promoting attitudinal change toward team-based competencies among participants.

Improved operating room teamwork via SAFETY prep: a rural community hospital's experience.

BACKGROUND: Effective teamwork contributes to patient safety in the operating room (OR). For the busy rural surgeon, enhancing OR teamwork can be difficult. This manuscript describes results from the initial implementation of a preoperative briefing protocol at a rural community hospital. METHODS: From July 2006 to February 2007, teamwork among OR staff working with a single general surgeon at a rural hospital in Alaska was evaluated before and after introduction of a preoperative briefing protocol. After each case, participants completed a questionnaire applying a 6-point Likert-type scale targeting effectiveness of both the preoperative briefing and OR team interaction. Mean values were calculated from 20 cases before introduction of the preoperative briefing and from another 16 cases after its introduction. Statistical analysis of the difference between pre- and post-protocol team performance was conducted with Student's t test. Mean procedure times were calculated for matched cases pre- and post-intervention and were compared with Wilcoxon's exact test. RESULTS: Ten members of the OR staff, including the general surgeon, completed both pre- and post-protocol questionnaires. Four additional members of the OR staff completed only pre-protocol questionnaires, and three additional members of the OR staff completed only post-protocol questionnaires. After implementation of the preoperative briefing protocol, the mean score of overall preoperative briefing was 1.01 units higher than before (p < 0.0001), and overall OR team interaction was 0.50 units higher (p < 0.0001). The overall mean post-intervention procedure time was shorter than the overall mean pre-intervention procedure time (31 +/- 12 min versus 50 +/- 18 min) for four categories of matched cases. Because of the small sample size, statistical significance was not achieved (p = 0.057). CONCLUSIONS: Implementation of a preoperative briefing protocol improved overall preoperative briefing and OR team interaction in the study setting. These findings are encouraging for enhancing teamwork and patient safety through implementation of a systematic protocol.

High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care.

BACKGROUND: The operating room (OR) is a dynamic, high risk setting requiring effective teamwork for the safe delivery of care. Teamwork in the modern OR, however, is less than ideal. High fidelity simulation is an attractive approach to training key teamwork competencies. We have developed a portable simulation platform, the mobile mock OR (MMOR) that permits bringing team training over long distances to the point of care. We examined the effectiveness of this innovative, simulation-based interdisciplinary operating room (OR) team training model on its participants. METHODS: All general surgical OR team members at an academic affiliated medical center underwent scenario-based training using a mobile mock OR. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using t test. RESULTS: The mean gain in pre-post item scores for 38 participants averaged 0.4 units on a 6-point Likert scale. The significance was demonstrated in 4 of the items: role clarity (Delta = 0.6 units, P = .02), anticipatory response (Delta = 0.6 units, P = .01), cross monitoring (Delta = 0.6 units, P < .01), and team cohesion and interaction (Delta = 0.7 units, P < .01). CONCLUSION: High-fidelity, simulation-based OR team training at the point of care positively impacts self-efficacy for effective teamwork performance in everyday practice.

Implementation of a preoperative briefing protocol improves accuracy of teamwork assessment in the operating room.

This study examined the effect of implementing a new preoperative briefing protocol on self- and peer-assessments of individual operating room (OR) teamwork behaviors. From July 2006 to February 2007, OR teamwork performance at a rural community hospital was evaluated before and after training and implementation of the protocol. After each case, every member on the team completed a 360-degree type teamwork behavior evaluation containing both self- and peer-assessments using a six-point Likert type scale (1 = definitely no to 6 = definitely yes). Individual behavior change was measured using the mean scale score of pre and postprotocol assessments. Statistical analysis included t test for both pre/post and self/peer differences. Data were available for one general surgeon and nine OR staff (pre = 20 cases, post = 16 cases). The preprotocol self-assessment mean score was significantly higher than peer-assessment (5.63 vs 5.29, P < 0.0267). Pre and postprotocol peer assessment mean scores revealed a statistically significant gain in teamwork behaviors. No difference was observed in postassessment mean scores for self- and peer-assessments. Individuals overestimated their teamwork behaviors before protocol implementation. Using a preoperative protocol seems to improve OR staff teamwork behaviors and self-assessment accuracy. The use of a 360-degree assessment method targeting specific, observable behaviors may be useful in evaluating team-based interventions and enhancing teamwork effectiveness.

In for the long haul: sustaining and rebuilding educational operations after Hurricane Katrina.

In 2005, Hurricane Katrina and the subsequent levee breaks left 80% of New Orleans under water for weeks. Within 4 short weeks, the Louisiana State University Health Sciences Center at New Orleans had relocated its campus temporarily to Baton Rouge and resumed operations. Many lessons were learned in the first year of recovery and disseminated to the field regarding emergency and disaster preparedness and response. As we approach the second anniversary of the nation's most devastating natural disaster, we reflect on the long haul of rebuilding and offer new insights and lessons for sustaining operations and enhancing long-term rebuilding efforts.

Survival and recovery: maintaining the educational mission of the Louisiana state university school of medicine in the aftermath of hurricane Katrina.

Hurricane Katrina devastated New Orleans and the coastlines of Louisiana, Mississippi, and Alabama on August 29, 2005. The flooding in New Orleans left hundreds of thousands of people homeless and threatened to close businesses and institutions, including Louisiana State University (LSU) School of Medicine and its two principle training sites in New Orleans, Charity Hospital and University Hospital. In the weeks immediately after the storm, LSU School of Medicine resumed undergraduate and graduate medical education in Baton Rouge, Louisiana and elsewhere. The authors discuss the specific challenges they faced in relocating administrative operations, maintaining the mission of medical education, and dealing with the displacement of faculty, staff, residents, students, and patients, and the processes used to overcome these challenges. They focus on the school's educational missions, but challenges faced by the offices of student affairs, faculty affairs, and admissions are also discussed. LSU School of Medicine's experience provides lessons about organizational preparedness for a mass disaster that may be of interest to other medical schools.

Forecasting change in Louisiana physician age cohorts: 1994-2020.

A shortage of physicians is predicted in the near future, as there is a mismatch between the supply and demand for physicians. Our objective was to examine what effect an aging Louisiana physician population might have on these forecasts using data from the American Medical Association and population projections from the Louisiana Population Data Center. Our results propose a considerable rise in the number of Louisiana physicians who are older, with growth in younger physicians being continually flat. We forecast 44.2 percent of Louisiana physicians will be over 55 years of age in the year 2020. Acknowledging many limitations of a study such as this, we believe an aging physician population might lead to an overall decrease in the effective physician supply of Louisiana in the future.

The south central center for public health preparedness training system model: a comprehensive approach.

The South Central Center for Public Health Preparedness (SCCPHP) is a collaboration among the schools of public health at Tulane University and the University of Alabama at Birmingham and the state health departments in Alabama, Arkansas, Louisiana, and Mississippi. The SCCPHP provides competency-based training via distant delivery methods to prepare public health workers to plan for and rapidly respond to public health threats and emergency events. This article presents the training system model used by the SCCPHP to assess, design, develop, implement, and evaluate training that is both competency driven and practice based. The SCCPHP training system model ensures a standardized process is used across public health occupations and geographic regions, while allowing for tailoring of the content to meet the specific training needs of the workforce in the respective state and local health departments. Further, the SCCPHP training system model provides evidence of the reciprocal nature between research and practice needed to advance the area of emergency preparedness training and workforce development initiatives in public health.