Fostering Success and Promoting Professional Development of Clinician Educator Mentees: A Workshop for Mentors.

Introduction: The goal of academic mentoring relationships is to enable the mentee to identify/achieve professional advancement. Although mentors of clinician educators (CEs) must understand the criteria for successful career advancement, few have received formal CE mentor training. Methods: The National Research Mentoring Network convened an expert panel to develop a 90-minute module for training CE mentors. This module included individual development plans, case studies involving challenges for CE faculty, and examples of the broadened scope of scholarly activity. The workshop was delivered to 26 participants across four institutions and evaluated by a retrospective pre/post survey. Results: Using a 7-point scale (1 = very low, 4 = average, 7 = very high), participants rated the overall quality of their CE mentoring as slightly below average preworkshop (M = 3.9) and as above average postworkshop (M = 5.2, p < .001). Areas of greatest self-perceived change in skills on a 7-point scale (1 = not at all skilled, 4 = moderately skilled, 7 = extremely skilled ) included setting clear expectations of the mentoring relationship (pre M = 3.6, post M = 5.1, p < .001), aligning mentor expectations with those of mentees (pre M = 3.6, post M = 5.0, p < .001), and helping mentees set career goals (pre M = 3.9, post M = 5.4, p < .001). Discussion: This module trains CE mentors using an interactive and collective problem-solving approach. Workshop participants better defined demonstrable markers for CE progression with potential to impact tailored guidance for mentees.

Faculty Communication Knowledge, Attitudes, and Skills Around Chronic Non-Malignant Pain Improve with Online Training.

OBJECTIVE: Many physicians struggle to communicate with patients with chronic, non-malignant pain (CNMP). Through the use of a Web module, the authors aimed to improve faculty participants' communication skills knowledge and confidence, use of skills in clinical practice, and actual communication skills. SUBJECTS: The module was implemented for faculty development among clinician-educators with university faculty appointments, outpatient clinical practices, and teaching roles. METHODS: Participants completed the Collaborative Opioid Prescribing Education Risk Evaluation and Mitigation Strategy (COPE-REMS®) module, a free Web module designed to improve provider communication around opioid prescribing. Main study outcomes were improvements in CNMP communication knowledge, attitudes, and skills. Skills were assessed by comparing a subset of participants' Observed Structured Clinical Exam (OSCE) performance before and after the curriculum. RESULTS: Sixty-two percent of eligible participants completed the curriculum in 2013. Knowledge-based test scores improved with curriculum completion (75% vs. 90%; P < 0.001). Using a 5-point Likert-type scale, participants reported improved comfort in managing patients with CNMP both immediately post-curriculum and at 6 months (3.6 pre vs. 4.0 post vs. 4.1 at 6 months; P = 0.02), as well as improvements in prescribing opioids (3.3 vs. 3.8 vs. 3.9, P = 0.01) and conducting conversations about discontinuing opioids (2.8 vs. 3.5 vs. 3.9, P < 0.001). Additionally, CNMP-specific communication skills on the OSCE improved after the curriculum (mean 67% vs. 79%, P = 0.03). CONCLUSIONS: Experienced clinician-educators improved their communication knowledge, attitudes, and skills in managing patients with CNMP after implementation of this curriculum. The improvements in attitudes were sustained at six months. A Web-based curriculum such as COPE-REMS® may be useful for other programs seeking improvement in faculty communication with patients who have CNMP.

Using elements from an acute abdominal pain Objective Structured Clinical Examination (OSCE) leads to more standardized grading in the surgical clerkship for third-year medical students.

BACKGROUND: There is poor reliability in the Likert-based assessments of patient interaction and general knowledge base for medical students in the surgical clerkship. The Objective Structured Clinical Examination (OSCE) can be used to assess these competencies. OBJECTIVE: We hypothesize that using OSCE performance to replace the current Likert-based patient interaction and general knowledge base assessments will not affect the pass/fail rate for third-year medical students in the surgical clerkship. METHODS: In this retrospective study, third-year medical student clerkship data from a three-station acute abdominal pain OSCE were collected from the 2009-2010 academic year. New patient interaction and general knowledge base assessments were derived from the performance data and substituted for original assessments to generate new clerkship scores and ordinal grades. Two-sided nonparametric statistics were used for comparative analyses, using an α = 0.05. RESULTS: Seventy third-year medical students (50.0% female) were evaluated. A sign test showed a difference in the original (4.45/5) and the new (4.20/5) median patient interaction scores (p < 0.01). A sign test did not show a difference in the original (4.00/5) and the new (4.11/5) median general knowledge base scores (p = 0.28). Nine clerkship grades changed between these different grading schemes (p = 0.045), with an overall agreement of 87.1% and a kappa statistic of 0.81. There were no differences in the pass/fail rate (p > 0.99). CONCLUSIONS: We conclude that there are no differences in pass/fail rate, but there is a more standardized distribution of patient interaction assessments and utilization of the full spectrum of possible passing grades. We recommend that the current patient interaction assessment for third-year medical students in the surgical clerkship be replaced with that found through trained standardized patients in this three-station acute abdominal pain OSCE.

Systematic outpatient screening for the elderly: care of the vulnerable elderly practice improvement module to assess resident care of older adults.

OBJECTIVES: To determine the feasibility of using the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module (CoVE PIM) in an internal medicine residency program and to assess aggregate resident documentation of geriatric screening in continuity clinics. DESIGN: Needs assessment chart review for single-site pre-/postintervention study. SETTING: Internal medicine resident primary care continuity clinics. PARTICIPANTS: Thirty-seven postgraduate year (PGY)-1 and PGY-2 internal medicine residents. MEASUREMENTS: Completion rate and time of CoVE PIM chart review, CoVE PIM user difficulty, and aggregate percentage of charts documenting geriatric screening measures. RESULTS: Sixty-five percent of residents completed the CoVE PIM in an average of 47 minutes (range 30-90 minutes); 72% of resident surveys rated the CoVE PIM as easy to use. Residents demonstrated very good documentation of chronic medical conditions, smoking status, height, weight, and blood pressure and poor documentation of falls and fall risk, hearing assessment, postural hypotension, balance, rigidity, bradykinesia, home safety assessment, seat belt counseling, code status, and surrogate decision-maker. CONCLUSION: The CoVE PIM can be used to assess aggregate resident performance of geriatric screening measures. In resident clinics, general adult screening performed by nurses is well documented, whereas geriatric-specific screening performed by physicians is poorly documented.