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Academy of Distinguished Medical Educators

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					Academy of Distinguished
   Medical Educators




          Medical education day
               Thursday, November 17, 2011
                              Proceedings
               the acadeMy of distinguished Medical educators
                                        Medical education day
                                       thursday, noveMber 17, 2011

          The Academy of Distinguished Medical Educators was founded in 2006 to support and promote research,
           innovation, and scholarship in medical education at the University of Chicago. The Academy is led by
               Halina Brukner, MD, Professor of Medicine and Associate Dean of Medical School Education.

            In addition to hosting Medical Education Day, the Academy sponsors faculty development workshops
                               throughout the year and funds scholarship in medical education.



                                                        Keynote Speaker
                                                        Lisa Coplit, MD
                                     Associate Dean for Assessment and Faculty Development
                                                 Associate Professor of Medicine
                                            Quinnipiac University School of Medicine

Clerkship and Program Directors’ Education Workshop
         Gordon Center for Integrative Science, Room W301-303                                               8:00-11:30 am
         Residents ARE Teachers
         Halina Brukner, MD; H. Barrett Fromme, MD, MHPE; and the Residents Are Teachers
         Steering Committee

Keynote Address
        UCMC P-117                                                                                          12:00-1:00 pm
        The Value, Rewards, and Evidence for Residents as Teachers
        Lisa Coplit, MD

Poster Session
         DCAM 4th Floor Atrium                                                                              2:00-4:00 pm
         Innovations and Research in Medical Education at the University of Chicago

Plenary Poster Presentations: Three Oral Abstracts
         DCAM 4th Floor Atrium                                                                              4:00-5:00 pm
         • Geriatrics and Aging through Transitional Environments (GATE) MS1 Curriculum: Obtaining a
             Functional History
         • The Use of an Educational Simulation to Improve Neurology Resident Knowledge of and Experience
             with Thrombolytic Therapy
         • Characterizing Physician Listening Behavior During Hospitalist Handoffs using the HEAR
             Checklist

Awards Ceremony & Reception
        DCAM 4th Floor Atrium                                                                               5:00-6:30 pm
        Induction of new Masters and Fellows of the Academy of Distinguished Medical Educators
        Presentation of the LDH Wood Teaching Scholar Award

                                                                3
Table of Contents
    Keynote Speaker.......................................................................................................................................................1
    LDH Wood Teaching Scholar Award....................................................................................................................2
    Founding Members of the Academy ......................................................................................................................3
    Masters of the Academy .........................................................................................................................................4
    New Masters of the Academy ................................................................................................................................5
    Fellows of the Academy .........................................................................................................................................6
    New Fellows of the Academy .................................................................................................................................8

    Poster Listings
    Medical Education and Innovation
    1.      Learner Perceptions of an Ad-Hoc versus Modular Didactic Curriculum in Emergency
            Medicine Residency .................................................................................................................................... 12
                 Lindsay Jin, MD; James Ahn, MD; Christine Babcock, MD, MSc
    2.      Entrustment, Supervision and Autonomy of Housestaff During Inpatient Medicine
            Rotations: A Qualitative Study ................................................................................................................ 13
                 Kevin Choo, MS3; Vineet Arora, MD, MAPP; Paul Barach, MD, MPH;
                 Jeanne Farnan, MD, MHPE
    3.      Survey of Problem Based Learning for Medical Student Pain Curricula ......................................... 14
                 Dalia Elmofty, MD; Magdalena Anitescu, MD, PhD; Ashley Agerson, MD
    4.      Teaching Self-Directed Learning: Can This Be Done? .......................................................................... 15
                 Susan Glick, MD; Jennifer Glick, ; Maureen Willcox, MS4; Patrick O’Connor;
                 Michael O’Connor, MD
    5.      Use of Problem Based Learning Discussions To Allow Medical Student Cognitive Autonomy..... 16
                 Michael Hernandez, MD; Igor Tkachenko, MD, PhD; Catherine Bachman, MD
    6.      Visual Art and Medicine: A New Elective for 1st, 2nd and 4th Year Students at Pritzker ............ 17
                 Nicole Baltrushes, MS4; Celine Goetz, MD; Laura Hodges, MS4; Joel Schwab, MD
    7.      Clinical Simulation Initiative in Psychiatry for Medical Students: Development of a
            Free National Database ............................................................................................................................. 18
                 Michael Marcangelo, MD; Angela Blood, MPH, MBA; Laura Hodges, MS4
    8.      Geriatrics and Aging through Transitional Environments (GATE) MS1 Curriculum:
            Obtaining a Functional History .............................................................................................................. 19
                 Seema Limaye, MD; Shellie Williams, MD; Sandy Smith, PhD; Aliza Baron, MA
    9.      Responding to Student-Identified Learning Needs: A Mixed Method Survey to Guide
            the Family Medicine Curriculum ............................................................................................................. 20
                 Kohar Jones, MD; Mari Egan, MD, MHPE; Irma Dahlquist
    10.     Medical Students as Hospice Volunteers: Influence of an Early Experiential Training
            Program in End-of-Life Care Education ................................................................................................. 21
                 Melissa Mott, PhD, MS3; Stacie Levine, MD; Rita Gorawara-Bhat, PhD
    11.     Improving Student-Run Free Clinic Care Through Pre-Clinical Student Didactic
            Intervention: A Pilot Feasibility Study................................................................................................... 22
                 Andrew W. Phillips, MEd, MS4; Kristine Bordenave, MD; Rita Rossi-Foulkes, MD, MS
    12.     Integration of the Virtual Human Embryo into the First Year Anatomy Curriculum .................... 23
                 Callum Ross, PhD; James O’Reilly, PhD; Quinn Dombrowski; Sam Quinan
           Research funded by the Academy of Distinguished Medical          Research funded by the Graduate Medical Education Executive
                                                                                                                                                   Scholarship & Discovery
               Educators’ Grants for Medical Student Education                    Committee’s Grants for Resident/Fellow Education

                              Poster chosen for the 2011 Plenary Poster Presentation          Medical Education Research, Innovation, Teaching and Scholarship

                                                                                       7
Table of Contents
    13.   Qualitative Analysis of First Year Medical School Orientation ........................................................ 24
               Sean Swearingen, MS2; H. Barrett Fromme, MD, MHPE; Shalini Reddy, MD
    14.   Graduate Medical Education in Frailty: The SAFE Clinic ................................................................... 25
               Katherine Thompson, MD; Megan Huisingh-Scheetz, MD, MPH; Lisa Mailliard, APN, MSN;
               Patricia Rush, MD, MBA
    15.   Geriatrics and Aging through Transitional Environments (GATE) MS2 Curriculum:
          Introduction to Geriatric Assessments .................................................................................................. 26
               Shellie Williams, MD; Seema Limaye, MD; Sandy Smith, PhD; Aliza Baron, MA
    16.   The Hand-off CEX: Instrument Development and Validation ............................................................. 27
               Saba Berhie, MS2; Vineet Arora, MD, MAPP; Paul Staisiunas; Jeanne Farnan, MD, MHPE

    Patient Safety and Quality Improvement
    17.   Improving Post-Hospital Follow-up for Resident Clinic Patients Through a New
          Discharge Clinic ........................................................................................................................................ 28
               Katrina Booth, MD; Amber Pincavage, MD; Lisa Vinci, MD; Beth White, PharmD
    18.   Characterizing Physician Listening Behavior During Hospitalist Handoffs using the
          HEAR Checklist ......................................................................................................................................... 29
               Elizabeth Greenstein, MS3; Vineet Arora, MD, MAPP; Paul Staisiunas;
               Jeanne Farnan, MD, MHPE
    19.   Risk of Resident Clinic Handoffs: Showing up is Half the Battle..................................................... 30
               Amber Pincavage, MD; Megan Prochaska, MD; Julie Oyler, MD; Vineet Arora, MD, MAPP
    20.   Medical Education Curricula: Integrating Healthcare Quality and Patient Safety...................... 31
               Elizabeth Rodriguez, MBA, MS; Kevin Weiss, MD, MPH

    Technology and Simulation
    21.   Role of Social Media in Graduate Medical Education: A Blogger’s Perspective ............................. 32
               Wilma Chan, MD; James Ahn, MD; Alisa McQueen, MD; Christine Babcock, MD, MSc
    22.   Exploring Opportunities and Challenges Posed by Technology Integration:
          A Simulation Workshop for First Year Medical Students ................................................................... 33
               Vikrant Jagadeesan, MS2; Angela Blood, MPH, MBA; Stephen Small, MD; Saeed Richardson
    23.   ABCs in the Sandbox: Interdisciplinary Trauma Team Training ........................................................ 34
               Alisa McQueen, MD; Michele Harris-Rosado, RN, BSN; Grace Mak, MD; Mindy Statter, MD
    24.   Participant Satisfaction with Simulation of Minimally Invasive Spine Surgery Using
          Virtual Reality and Haptics ..................................................................................................................... 35
               Ben Roitberg, MD; Pat Banerjee, PhD
    25.   Incorporating Ultrasound Education into Anesthesia Resident Training:
          A Two Year Study ........................................................................................................................................ 36
               Matthew Satterly, MD; Angela Blood, MPH, MBA; Jeffrey Katz, MD
    26.   Pilot Curriculum for Teaching Residents Single Incision Laparoscopic Surgery (SILS):
          A Patient Safety Initiative ......................................................................................................................... 37
               Nancy Schindler, MD; Michael Ujiki, MD; Vivek Prachand, MD; Jose Velasco, MD



          Research funded by the Academy of Distinguished Medical          Research funded by the Graduate Medical Education Executive
                                                                                                                                                  Scholarship & Discovery
              Educators’ Grants for Medical Student Education                    Committee’s Grants for Resident/Fellow Education

                             Poster chosen for the 2011 Plenary Poster Presentation          Medical Education Research, Innovation, Teaching and Scholarship


                                                                                      8
Table of Contents
    27.   Publishing Evidence-based Medicine Writing Projects with Students .............................................. 38
               Umang Sharma, MD; Mari Egan, MD, MHPE; Adam Mikolajczyk, MD
    28.   Simulation-based Ultrasound Guidance and Procedure Training in Hospital Medicine:
          A Faculty Development Pilot Project ..................................................................................................... 39
               Nilam Soni, MD; Angela Blood, MPH, MBA; Stephen Small, MD
    29.   The TIME (Technology in Medical Education) Project 2011: An Update– The Past,
          Present and Future .................................................................................................................................... 40
               Scott Stern, MD; Brian Paterson
    30.   The Use of an Educational Simulation to Improve Neurology Resident Knowledge of
          and Experience with Thrombolytic Therapy .......................................................................................... 41
               Rachel Stork, MS3; Jeffrey Frank, MD; Morris Kharasch, MD; Ernest Wang, MD
    31.   Wait Till Your Father Sees This! Simulation Training for Residents During their
          Pediatric Anesthesia Rotation ................................................................................................................. 42
               Igor Tkachenko, MD; Michael Hernandez, MD; Stephen Small, MD

    Faculty
    32.   Doctoring Without a Script: The Improvising Physician..................................................................... 43
               Daniel Brauner, MD; Gretchen Case, PhD
    33.   Migration Analysis of Physicians Practicing in Hawaii from 2009-2011 ............................................ 44
               Laura Dilly, MS4; Kelley Withy, MD, PhD; Goutham Rao, MD
    34.   The Impact of Faculty Characteristics on Internal Medicine Residency Candidates
          Interview Scores ......................................................................................................................................... 45
               Julie Oyler, MD; Jim Woodruff, MD; Jeff Charbeneau; Vineet Arora, MD, MAPP
    35.   Relationship Between Inpatient Attending Physician Workload and Teaching Before
          and After Duty Hours: . A Seven Year Study .......................................................................................... 46
               Lisa Roshetsky, MD; David Meltzer, MD, PhD; Holly Humphrey, MD;
               Vineet Arora, MD, MAPP

    Global Health
    36.   Developing a Community-Based Family Medicine Clerkship in Wuhan, China .................................. 47
               Nicole Baltrushes, MS4; Mari Egan, MD, MHPE; Sarah-Anne Schumann, MD;
               Renslow Sherer, MD
    37.   Pre-hospital Disaster Management Education in Emergency Settings: Results of a
          Five-month Community-based Program in Rural Haiti......................................................................... 48
               Corey Bills, MD, MPH; Christine Babcock, MD, MSc, MSc; Luke Davies;
               Christian Theodosis, MD, MPH
    38.   A Community-based Cholera Surveillance and Education Program in Eastern Haiti..................... 49
               Corey Bills, MD, MPH; Christine Babcock, MD, MSc; Luke Davies; Christian
               Theodosis, MD, MPH
    39.   Assessment of Clinical Reasoning Skills of the Fifth Year Medical Students at
          Wuhan University ....................................................................................................................................... 50
               Aaron Cohn, MD; Nancy Luo, MD; Kate Lemler, MS4; Renslow Sherer, MD; Scott Stern, MD



          Research funded by the Academy of Distinguished Medical          Research funded by the Graduate Medical Education Executive
                                                                                                                                                  Scholarship & Discovery
              Educators’ Grants for Medical Student Education                    Committee’s Grants for Resident/Fellow Education

                             Poster chosen for the 2011 Plenary Poster Presentation          Medical Education Research, Innovation, Teaching and Scholarship


                                                                                      9
Table of Contents
    40.     Development of a Communication Skills Curriculum at Wuhan University Medical
            School: Implementing a Peer Role-playing Workshop .......................................................................... 51
                 Wei Wei Lee, MD, MPH; Renslow Sherer, MD
    41.     Attitudes Toward Neurology in Medical Students in Wuhan, China ................................................ 52
                 Rimas Lukas, MD; Brian Cooper; Ivy Morgan; Renslow Sherer, MD
    42.     Planning for The Start of Internship - Survey and Focused Interviews at a Chinese
            Medical School .......................................................................................................................................... 53
                 Yang Shen, MD; Hong Lei, MD; James Woodruff, MD; Renslow Sherer, MD
    43.     Evaluation of Student Attitudes and Training towards Geriatrics and Palliative Care
            in Wuhan, China.......................................................................................................................................... 54
               Sandra Shi, MS2; Renslow Sherer, MD; Ivy Morgan; Hongmei Dong
    44.     Observational Study of Hand Hygiene Compliance Rates in Intensive Care Units in
            Wuhan, China .............................................................................................................................................. 55
                 Lisa Sun, MS2; Wenjing Zong, MS2; Renslow Sherer, MD

    Community and Patient Health
    45.     A Qualitative Analysis of Interviews with Participants of the Literature & Medicine™
            Program at Select Veterans Administration Medical Centers ........................................................... 56
                 Abigail Cutler, MS3; Gabrielle Schaefer, MS3; H. Barrett Fromme, MD, MHPE
    46.     Communication and Utilization of Healthcare Services Amongst Adolescents .............................. 57
                 Sarah Horvath, MS4; Kavitha Selvaraj, MS4; Sophie Shay, MS4;
                 H. Barrett Fromme, MD, MHPE
    47.     Development of a Website for Transition Care for Providers, Patients, and their
            Families ........................................................................................................................................................ 58
                 Amy Lo, MD; Jennifer McDonnell, MD; Kruti Acharya, MD; Rita Rossi-Foulkes, MD
    48.     Development of an Educational Intervention for Resident Education Regarding
            Transition Care of Youth with Special Health Care Needs................................................................. 59
                 Jennifer McDonnell, MD; Amy Lo, MD; Sara Platte, MD; Rita Rossi-Foulkes, MD
    49.     Using Health Information Technology to Develop an Academic Medical Home:
            Effective Patient Education for Success in High School .................................................................... 60
                 Margaret Naunheim, MS3; Yingshan Shi, MD, MS; Janis Mendelsohn, MD; Michael Msall, MD
    50.     Patient Perception of a Point-of-Care Tablet Computer (iPad™) Being Used for
            Patient Education....................................................................................................................................... 61
                 Andrew Nickels, MD; Vesselin Dimov, MD; Valerie Press, MD; Raoul Wolf, MD
    51.     Challenges in Transition: Barriers to Subspecialty Care for Adults with Developmental
            Disabilities ................................................................................................................................................. 62
                 Joanna Perdomo, MS1; Alex Garnett, MS1; Richard Schroeder, MS1; Kamala Cotts, MD
    52.     Predictors of Third Year Medical Students’ Intentions to Practice in Underserved
            Areas: A National Survey ........................................................................................................................... 63
                 Krishna Ravella; John Yoon, MD; Kenneth Rasinski, PhD; Farr Curlin, MD

    Academy Funded Research ...................................... ..................... .......... ........................................................ ........69

    Request for Applications: Medical Education Research.............................................................................................70

           Research funded by the Academy of Distinguished Medical           Research funded by the Graduate Medical Education Executive
                                                                                                                                                      Scholarship & Discovery
               Educators’ Grants for Medical Student Education                     Committee’s Grants for Resident/Fellow Education

                               Poster chosen for the 2011 Plenary Poster Presentation          Medical Education Research, Innovation, Teaching and Scholarship


                                                                                    10
Keynote Speaker

                                                Lisa Coplit, MD

                      Associate Dean for Assessment and Faculty Development
                                               Associate Professor of Medicine
                                   Quinnipiac University School of Medicine



    Lisa Coplit, MD recently joined the Quinnipiac School of Medicine as an Associate Professor of Medicine and
    the Associate Dean for Assessment and Faculty Development. She completed her medical school, residency,
    and chief resident training at the Boston University School of Medicine. Dr. Coplit is an alumna of both the
    Harvard-Macy Program for Physician Educators and the Stanford Faculty Development Program in Clinical
    Teaching Skills.

    Prior to joining the faculty at Quinnipiac, Dr. Coplit was the Director of the Institute for Medical Education
    (IME) at the Mount Sinai School of Medicine (MSSM) in New York. As the Director of the IME, she worked
    with other medical educators to create and implement faculty development and professional development
    programs for educational leaders, basic science faculty, clinical faculty, residents, and medical students.

    Dr. Coplit served as the Co-Developer and Director of the Resident Teaching Development Program, a
    multi-specialty teaching skills curriculum for all residents at Mount Sinai Hospital and its twelve affiliates.
    She developed the “Teach the Teacher” curriculum which trained Mount Sinai and affiliate faculty to instruct
    teaching skills courses for the faculty and residents in their respective departments. Additionally, Dr. Coplit
    directed MSSM’s annual Educational Leadership Conference, similar to the University of Chicago’s Medical
    Education Day. She also co-directed Medical Education Grand Rounds, a fourth year medical student elective
    called “Becoming a Medical Teacher,” and helped to launch Training Tomorrow’s Teachers Today for medical
    students from around the country. Dr. Coplit was a member of the Curriculum Reform Team and Chair of
    the subcommittee to develop medical school competencies and teaching formats at MSSM. She served as Co-
    Director of the MSSM Curriculum Content Reform Task Force, whose role is to ensure a comprehensive review
    of the undergraduate medical education curriculum at MSSM.

    Dr. Coplit has published extensively on issues of medical education, particularly in the development and
    support of both medical students and residents in their teaching roles. Her work has appeared in Academic
    Medicine, Medical Education, and the Journal of General Internal Medicine.

    Dr. Coplit is active in both regional and national medical education organizations, and for the past two years
    has led the Academies Collaborative, a national organization of over thirty medical school Academies of Medical
    Educators. Currently, she is designing the programmatic assessments and the faculty development curriculum at
    Quinnipiac University School of Medicine.




                                                           1
LDH Wood Teaching Scholar Award

                                  Wylie Leighton McNabb, EdD
                                  Associate Faculty Dean of Medical Education Emeritus

                                  Emeritus Director, Center for Research in Medical Education and Health Care


                                  Dr. Wylie McNabb served as the Director of the Center for Research in Medical
                                  Education and Health Care at the University of Chicago for more than fifteen
                                  years, and as Associate Faculty Dean of Medical Education at the University
                                  from 1986 through 2002. During his years of valued service to the University
                                  of Chicago and the Department of Medicine, Dr. McNabb was the Principal
                                  Investigator for more than a dozen grants and published several groundbreaking
   works in the areas of health professions education, behavioral medicine, faculty and student evaluation,
   minority health, and lifestyle management issues in pulmonary, endocrine, and cardiovascular diseases.

   Dr. McNabb was the Principal Investigator of the Chicago Diabetes Demonstration and Education Cores,
   ushering in advancements in our knowledge of diabetes education. He served as the Co-Director of the Chicago
   Diabetes Research & Training Center with Drs. Arthur Rubenstein and Kenneth Polonsky. He was appointed
   as the University of Chicago’s Clerkship Director for the new Family Medicine Clerkship at MacNeal Hospital.
   His efforts in this endeavor led to the garnering of a $5 million grant award from the MacNeal Education
   Foundation to establish a permanent Department of Family Medicine at the University of Chicago Medical
   Center.

   Dr. McNabb has been a pioneer in introducing new pedagogic practices and innovative evaluation
   methodologies into medical education programs at the University of Chicago. In 1986, he introduced the use
   of standardized patients to assess and enhance the clinical skills of medical students, residents, and fellows. In
   cooperation with Dr. Eugene Geppert, he developed and established the “head to toe” physical examination
   using standardized patients as a requirement for passing the Physical Diagnosis course. Dr. McNabb oversaw
   the design and implementation of the first Clinical Performance Center on the University of Chicago campus.
   Another contribution was Dr. McNabb’s implementation of a comprehensive and standardized approach
   to student evaluation, requiring faculty observation of medical student performance of history and physical
   examination at both the beginning and the end of the Family Medicine clerkship. He instituted the use of
   patient and procedure encounter forms for students to identify the types of patients seen and types of medical
   procedures performed. These strategies and instruments for student evaluation were ultimately adopted by all
   clinical clerkships in the medical school. Finally, Dr. McNabb also made a major contribution to the system
   of faculty evaluation by developing a standardized unified approach for the evaluation of faculty teaching by
   students, which is still being utilized today.

   Now retired, Dr. McNabb continues to contribute to the Pritzker School of Medicine as a Senior Evaluation
   Consultant for the Pritzker Initiative.




                                                            2
Founding Members of the Academy
  The core missions of the Academy are to:
   •   Promote excellence in teaching at the Pritzker School of Medicine.
   •   Support scholarship among medical educators.
   •   Enhance the Pritzker School of Medicine curriculum by supporting, recognizing, and rewarding its outstanding teachers.
   •   Build community among medical educators at the Pritzker School of Medicine.
   •   Facilitate the creation of an environment that enhances the status of medical educators at the University of Chicago.




                Halina Brukner, MD                     Bruce Gewertz, MD                 Holly J. Humphrey, MD
                 Professor of Medicine                   Former Professor                  Professor of Medicine
        Associate Dean for Medical Education         and Chairman of Surgery            Dean for Medical Education
                                                             (1981-2006)




                 Eric Lombard, PhD               Stephen C. Meredith, MD, PhD              Mark Siegler, MD
         Professor of Organismal Biology and         Professor of Pathology and         Lindy Bergman Professor of
                 Anatomy (Emeritus)             Biochemistry and Molecular Biology        Medicine and Surgery




                  Scott Stern, MD                   Ting-Wa Wong, MD, PhD             Lawrence D.H. Wood, MD, PhD
                 Professor of Medicine             Associate Professor of Pathology   Professor of Medicine (Emeritus)
          Assistant Dean for Technology and                                              Former Dean for Medical
          Innovation in Medical Education                                                   Education (1996-2003)


                                                             3
 Masters of the Academy
           Masters are faculty members who were inducted into the Academy of Distinguished Medical Educators because
           of their long-standing participation in medical education and their demonstration of the following:

           •	   Sustained excellence in teaching in the medical school.
           •	   Evidence of institutional impact of educational contributions.
           •	   Evidence of educational scholarship and/or innovation.
           •	   Serve as role models who inspire others with joy of teaching.




     Diane Altkorn, MD                  Eugene B. Chang, MD                     Adam Cifu, MD                    Linda Druelinger, MD
 Associate Professor of Medicine    Martin Boyer Professor of Medicine    Associate Professor of Medicine     Associate Professor of Medicine




  Godfrey Getz, MD, PhD                 Philip C. Hoffman, MD                 Aliya N. Husain, MD                 Jerome Klafta, MD
       Donald N. Pritzker                 Professor of Medicine                Professor of Pathology             Professor of Anesthesia
Professor of Pathology (Emeritus)                                                                                   and Critical Care




                        Patricia Kurtz, MD                   Joel Schwab, MD                 Mindy A. Schwartz, MD
                   Associate Professor of Medicine     Associate Professor of Pediatrics    Associate Professor of Medicine



                                                                      4
Newly Elected Masters of the Academy

                              Vineet Arora, MD, MAPP                                            Callum Ross, PhD

                              Associate Professor of                                            Associate Professor of
                              Medicine; Section of                                              Organismal Biology and
                              General Internal Medicine                                         Anatomy

                               Dr. Vineet Arora holds                                            Dr. Callum Ross serves as
                               multiple leadership positions                                     the Course Director for The
                               at all stages of medical                                          Human Body, one of the
                               education at the University                                       centerpieces of the first year
  of Chicago. She is the Assistant Dean for Scholarship            medical school curriculum. Dr. Ross gives the majority
  and Discovery, Co-Director of the NIH funded Summer              of lectures and attends all other lectures and labs,
  Research Program at the Pritzker School of Medicine,             representing a significant commitment of time over the
  Associate Program Director for the Internal Medicine             ten week experience. He works closely with his associate
  Residency Program, and Program Director of the                   course directors and teaching assistants to ensure an
  MERITS Fellowship in Medical Education. Dr. Arora                outstanding educational experience.
  also contributes to pipeline programs into medical school
  through her leadership of the NIH-funded TEACH                   The Human Body is the most highly rated first year
  (Training Early Achievers for Careers in Health)                 course at the Pritzker School of Medicine. Dr. Ross’
  Research Program, which aims to prepare and inspire              commitment to this course is reflected in his ongoing
  Chicago Public School minority students to enter health-         commitment to integrate new technologies, enhance
  related research careers through a unique team structure         quality and access to course material, and to support
  of mentorship and realistic experiences. Dr. Arora has           related educational initiatives. Under his leadership
  elevated medical education scholarship at the University         Radiology and Surgery have become integrated into
  of Chicago through her development, implementation,              the Human Body course in innovative ways. Dr. Ross
  and leadership of the monthly Research and Innovation            has been chosen as one of the favorite faculty of the
  in Medical Education (RIME) conference, in which                 graduating Pritzker classes for many years.
  faculty and trainees from throughout the medical school
  can present their works in progress and exchange ideas           Dr. Ross also serves in a leadership capacity in the
  about curriculum development and evaluation.                     overall curriculum, as a member of the Pritzker Initiative
                                                                   Steering Committee, the Preclinical Curriculum Review
  Dr. Arora has spearheaded major institutional                    Committee, and the Academic Progress Committee for
  educational interventions at the University of Chicago,          Year 1. He has supported the expansion of the University
  ranging from pharmaceutical industry interactions,               of Chicago’s global health and medical education
  sleep deprivation among housestaff, professionalism,             presence through his work on the Wuhan University
  and hand-off communications for medical students                 Medical Education Reform (WUMER) Project Steering
  and residents. Her work has appeared in numerous                 Committee.
  journals, including the Journal of the American Medical
  Association, Annals of Internal Medicine, Archives of            Additionally, Dr. Ross oversees an active research
  Internal Medicine, and Academic Medicine, and has                program in evolutionary morphology focusing on the
  received coverage from the New York Times, CNN,                  biomechanics of the head, with special emphasis on
  and US News & World Report. She has testified to the             the feeding apparatus. His research has resulted in the
  Institute of Medicine on resident duty hours and to the          authoring and publication of over 45 peer-reviewed
  U.S. Congress about the increasing medical student               journal articles and book chapters. Dr. Ross is President
  debt and the primary care crisis. She is the recipient           of the Anatomical Gift Association of Illinois.
  of numerous awards for her research and educational
  leadership, among them the 2011 Society of General
  Internal Medicine Mid-career Mentoring Award.




                                                               5
Fellows of the Academy




       Catherine Bachman, MD                   James Brorson, MD             Jeanne Farnan, MD, MHPE
  Assistant Professor of Anesthesia and   Associate Professor of Neurology   Assistant Professor of Medicine
              Critical Care




 H. Barrett Fromme, MD, MHPE               Javad Hekmat-Panah, MD                 Nora Jaskowiak, MD
   Assistant Professor of Pediatrics         Professor of Neurosurgery         Associate Professor of Surgery
                                          Neurology and Cancer Research




         Karen A. Kim, MD                       Stacie Levine, MD                   Karl Matlin, PhD
    Associate Professor of Medicine       Assistant Professor of Medicine           Professor of Surgery




                                                         6
Fellows of the Academy




    Michael O’Connor, MD                  Shalini Reddy, MD                 Kevin Roggin, MD
    Professor of Anesthesia and      Associate Professor of Medicine    Associate Professor of Surgery
           Critical Care




        David Rubin, MD                    Sarah Stein, MD                 Sandra Valaitis, MD
   Associate Professor of Medicine   Associate Professor of Medicine   Associate Professor of Obstetrics
                                                                               and Gynecology




         Monica Vela, MD              Darrel J. Waggoner, MD            James N. Woodruff, MD
   Associate Professor of Medicine      Associate Professor of         Associate Professor of Medicine
                                     Human Genetics and Pediatrics




                                                   7
Newly Elected Fellows of the Academy
     Fellows are faculty members who were inducted into the Academy of Distinguished Medical Educators because
     of their demonstration of the following:

     •	 Recognized and well-documented excellence in teaching in the medical school.
     •	 Significant contributions to medical school courses or clerkships, including serving as course or clerkship
          director.
     •	 Potential for continued contributions and leadership in medical education.

                          Keme Carter, MD
                          Assistant Professor of Medicine; Section of Emergency Medicine

                           Dr. Keme Carter is the Co-Clerkship Director for the Emergency Medicine Clerkship at the
                           University of Chicago Medical Center. In this role, Dr. Carter has worked to ensure a very
                           high standard of educational experience, which is borne out by the consistently outstanding
                           evaluation scores provided by medical students. Under Dr. Carter’s leadership, Emergency
                           Medicine became the first clerkship to introduce high fidelity simulation as a course
                           requirement. Dr. Carter’s teaching is highly rated by students and in 2011, the graduating
  students selected her as one of the Faculty Favorite. In addition to her leadership role in this required clerkship,
  Dr. Carter is the course director for Introduction to Emergency Medicine, which provides an early exposure to
  clinical medicine for first and second year students. Dr. Carter serves as a faculty instructor for Physical Diagnosis
  and as a faculty sponsor for the Emergency Medicine Interest Group. Dr. Carter contributes to the Emergency
  Medicine residency through her work supporting residents as teachers, including material on effective teaching of
  medical students, giving feedback, and incorporation of the medical student into the ED team. She contributes to
  the leadership of the Pritzker School of Medicine through her participation on the Clinical Clerkship Curriculum
  Committee and the Academic Progress Committee for Years 3 and 4. On a national level, Dr. Carter is an active
  member of the Clerkship Directors in Emergency Medicine, and was recently elected to an advisor position in the
  Academy of Women in Academic Emergency Medicine.




                          Heather A. Fagan, MD, MS
                          Assistant Professor of Pediatrics

                           Dr. Heather Fagan is the Program Director of the Pediatric Residency Training Program at the
                           University of Chicago. In addition to her oversight of the core residency program, Dr. Fagan is
                           also responsible for the nine subspecialty fellowships offered in the Department of Pediatrics as
                           well as the Child Neurology fellowship. Dr. Fagan has introduced multiple initiatives to ensure
                           the highest possible standard of training of residents and fellows, including two mandatory
                           fellow retreats per year to address such topics as professionalism, problem based learning and
  systems based practice. In addition, Dr. Fagan has introduced an innovative and unique set of scholarship tracks to
  support the development of future leaders in pediatric medicine. Each track allows a resident to pursue a four-year
  residency training program which includes attaining a Master’s Degree in Medical Education, Public Policy, Health
  Economics, or Human Genomics. Other contributions to the Pediatric Residency include her work developing and
  facilitating the highly regarded monthly Morbidity and Mortality conference and a monthly “mock code” for Pediatric
  Residents. Dr. Fagan also facilitates the yearly “Intern Survival Series” lectures at the outset of the PGY-1 year. Dr.
  Fagan offers a formal Pediatric Sedation and Procedure elective which is a required experience for multiple training
  programs. In addition to her role in graduate medical education, Dr. Fagan is the Course Director for the Pritzker
  School of Medicine’s senior elective, Pediatric Sedation and Procedure Service.




                                                              8
Newly Elected Fellows of the Academy
                          Sabrina Holmquist, MD, MPH
                          Assistant Professor of Obstetrics and Gynecology

                           Dr. Sabrina Holmquist serves as the Clerkship Director for the Obstetrics-Gynecology
                           Clerkship. She also holds leadership positions as Associate Fellowship Director for Family
                           Planning and Director of Education for the Ryan Center Training Program in the Department
                           of Obstetrics-Gynecology. Dr. Holmquist has made a major impact on the Obstetrics-
                           Gynecology clerkship through her work to ensure a high standard of educational experience.
                           Under her leadership the Obstetrics and Gynecology clerkship has enjoyed significant
  improvement in ratings from students. Dr. Holmquist has also contributed to the education of medical students by
  overseeing the fourth year sub-internship in Obstetrics-Gynecology, as well as through her significant contribution
  to the required second year course Clinical Pathophysiology and Therapeutics. Dr. Holmquist has served as an
  educational leader in the Obstetrics-Gynecology residency program as director of the rotation in family planning. In
  this capacity, she has introduced a newly designed lecture series, an online case study system, a question database, and
  a preceptor program for residents. On the national level, Dr. Holmquist participates in the Association of Professors of
  Gynecology and Obstetrics Solvay Scholars Program. She is pursuing a Masters in Health Professions Education at the
  University of Illinois-Chicago.

                          John McConville, MD
                          Assistant Professor of Medicine; Section of Pulmonary and Critical Care

                           Dr. John McConville is the Internal Medicine Residency Program Director at the University
                           of Chicago Medical Center. Before assuming this role in fall 2011, Dr. McConville served
                           as the Pulmonary and Critical Care Fellowship Director. In this role, he made significant
                           improvements to the structure and curriculum of the fellowship program, which included
                           creating post-graduate-year specific goals and objectives for each clinical rotation, restructuring
                           the curriculum of the weekly didactic conference, creating and organizing a two-week
  fellowship orientation program, designing a more comprehensive evaluation system of the clinical fellows; and
  designing and implementing an annual fellowship program evaluation system for both fellows and faculty. He created
  a four-hour class to teach chest tube insertion for in-house fellows as well as for other fellows in other universities in
  Chicago. Dr. McConville is currently creating a teaching curriculum that will incorporate web-based questionnaires,
  didactic lectures, and a simulation-based “hands-on” learning experience to standardize central line insertion practices
  throughout the Biological Sciences Division (BSD). Dr. McConville was the Department of Medicine’s 2010
  recipient of the Postgraduate Teaching Award and the inaugural winner of the BSD’s Distinguished Leader in Program
  Innovation Award. He has lectured at the American College of Chest Physicians Board Review course and at several
  international conferences and is a contributor to Harrison’s Principles of Internal Medicine.

                          Babak Mokhlesi, MD, MSc
                          Associate Professor of Medicine; Section of Pulmonary and Critical Care Medicine

                           Dr. Babak Mokhlesi is the Director of the Sleep Disorders Center and the Director of the
                           Sleep Fellowship Program at the University of Chicago Medical Center. In 2007, he developed
                           the first ACGME-approved Sleep Medicine fellowship training program at the University of
                           Chicago, a program that is now the largest in the state of Illinois. Dr. Mokhlesi developed all
                           aspects of the program, including curriculum, clinical training, and evaluation processes. He
                           provides 15 core lectures for the sleep fellowship as well as many lectures in the critical care
  didactic series. In addition to his work in the fellowship, Dr. Mokhlesi has an active involvement in the education
  of internal medicine residents and medical students in the Medical Intensive Care Unit, Morning Report, and the
  Procedure Service. His teaching evaluations are consistently outstanding. Furthermore, his teaching efforts have
  extended to educational sessions for sleep technologists and respiratory therapists in national meetings and continuing
  medical education conferences. Dr. Mokhlesi co-founded the Society of Anesthesia and Sleep Medicine (SASM)
  and is Co-Chairing the first SASM conference in Chicago: “OSA, Anesthesia and Sleep: The Common Ground.”
  In addition, he has been elected by other Sleep Medicine fellowship program directors to be a member of the Sleep
  Medicine Fellowship Directors’ Council of the American Academy of Sleep Medicine.



                                                               9
Newly Elected Fellows of the Academy
                         Julie Oyler, MD
                         Assistant Professor of Medicine; Section of General Internal Medicine

                          Dr. Julie Oyler is the Associate Program Director for the Internal Medicine Residency Program
                          at the University of Chicago Medical Center, and the Assistant Director of the Primary Care
                          Group. Additionally, she is a key leader in the Scholarship and Discovery Program at the
                          Pritzker School of Medicine, serving as the Track Leader for the Quality and Safety Track
                          and also serving as the course director for an elective in this area. She receives consistently
                          outstanding teaching evaluations from students and faculty. Formerly the Internship Selection
  Chair of the Internal Medicine Residency Program, Dr. Oyler has become the Ambulatory Associate Program
  Director, overseeing the Resident Continuity Clinic and Ambulatory Education. Dr. Oyler has received support
  from the Academy of Distinguished Medical Educators and Graduate Medical Education Committee to support her
  development and implementation of a 2-year longitudinal required curriculum for all Internal Medicine Residents
  using ABIM Practice Improvement Modules. She has published this work in the Journal of General Internal Medicine
  and Quality and Safety in Health Care. More recently, Dr. Oyler received support to develop a Quality Improvement
  curriculum for faculty, fellows, pharmacy students and medical students. Through her Quality Assessment and
  Improvement Curriculum for faculty, Dr. Oyler has helped faculty receive Maintenance of Certification Credit for
  ABIM Practice Assessment points in conjunction with the curriculum for internal medicine residents.
                         Rita Rossi-Foulkes, MD, FAAP, MS, FACP
                         Associate Professor of Medicine and Pediatrics; Section of General Internal Medicine

                          Dr. Rossi-Foulkes serves as the Residency Program Director for the Internal Medicine-
                          Pediatrics residency program at the University of Chicago Medical Center. Dr. Rossi-Foulkes is
                          the founder and director of a UCMC-wide Transition Care Steering Committee aimed toward
                          improving education of medical students, residents, faculty and other members of the health
                          care team regarding care of youth and young adults with special health care needs. Dr. Rossi-
                          Foulkes has contributed extensively to the residency program through the development and
  implementation of a revised Med-Peds Ambulatory Curriculum. Dr. Rossi-Foulkes’ contributions to medical education
  were recognized in 2007 with her receipt of the Department of Medicine Excellence in Clinical Care and Education
  Award. Her teaching evaluations from students and residents are outstanding. Dr. Rossi-Foulkes has served as Chair of
  the Medicine Pediatrics Executive Committee as a member of the Graduate Medical Education Committee, Medicine
  Curriculum Committee, and Medicine Pediatrics Ambulatory Task Force, among numerous other positions. On a
  national level, Dr. Rossi-Foulkes served on the American Academy of Pediatrics (ICAAP) Transition Care Workgroup
  which developed materials and organized a pre-course given at Midwest SGIM in September, 2011 on Transition Care.
  The workgroup continues to develop educational materials that will go onto ICAAP’s Transition Care website and will
  be used for providers desiring CME credits and Maintenance of Certification points.
                         Nancy Schindler, MD
                         Clinical Associate Professor of Surgery, NorthShore University HealthSystem

                          Dr. Nancy Schindler is the Vice-Chairman of Education for the NorthShore University
                          HealthSystem’s Department of Surgery and a member of the NorthShore University Health
                          System Medical Group Board of Directors. She is the University of Chicago Department of
                          Surgery Associate Program Director for the General Surgery Residency, the NorthShore Site
                          Director, and the University of Chicago Associate Director of Surgical Education. She leads the
                          Residents as Teachers and Leaders course in the Department of Surgery, as well as the Teaching
  Effectiveness Faculty Development course. Dr. Schindler is a leader in developing and leading numerous faculty
  development courses at both the University of Chicago and at NorthShore. She has taught many medical education
  topics at workshops at the Association for Surgical Education national meetings. In the past, she served for eight years
  as the Northwestern University Feinberg School of Medicine Surgery Clerkship Director. Currently, at the University
  of Chicago, Dr. Schindler is a MERITS Medical Education Fellowship Course Director and co-leads the workshop on
  Curriculum Development and Evaluation. She is also actively involved and a member of the Residents Are Teachers
  Steering Committee, Graduate Medical Education Committee, and the Surgical Education Committee. Dr. Schindler
  has received numerous awards for her excellence in teaching from the Feinberg School of Medicine and NorthShore
  University HealthSystem. She is currently pursuing her Masters in Health Professions Education at the University of
  Illinois-Chicago.

                                                             10
Newly Elected Fellows of the Academy
                         Sonali M. Smith, MD
                         Associate Professor of Medicine; Section of Hematology/Oncology

                           Dr. Sonali Smith is the Director of the Lymphoma Program in the Section of Hematology/
                           Oncology at the University of Chicago Medical Center and is a key contributor to the
                           University of Chicago Hematology/Oncology Fellowship. Dr. Smith’s contributions to teaching
                           fellows were recognized with her receipt of the inaugural Section of Hematology/Oncology
                           Teaching Award in 2011, as well as the Department of Medicine’s Graduate Medical Education
                           Award for Best Teaching Attending the same year. Dr. Smith is also an active teacher of medical
  students, serving as a preceptor for the second year Physical Diagnosis course and as a beloved attending physician
  on the Oncology inpatient service. Dr. Smith lectures in the Topics in Internal Medicine series, participates in the
  Internal Medicine Journal Club, and teaches Hematology/Oncology fellows in a monthly Lymphoma Educational
  Conference. On a national level, Dr. Smith serves on the Education and Communication Committees of both the
  American Society of Hematology and the American Society of Clinical Oncology. This year, Dr. Smith was selected
  to be coordinating lecturer for Highlights of ASH (lymphoma). She also organizes and chairs the annual International
  Chicago Lymphoma Symposium. The ICLS began as a tribute to Dr. John Ultmann, a University of Chicago master
  teacher and clinician, and has grown into an annual symposium on lymphoma for community physicians.
                         Avery Tung, MD
                         Professor, Department of Anesthesia & Critical Care

                          Dr. Avery Tung participates extensively in medical education and has, for many years, been a
                          lecturer and group facilitator of the Advanced Clinical Pharmacology Therapeutics, Clinical
                          Pathophysiology and Therapeutics, and other courses in the Pritzker School of Medicine. Dr.
                          Tung has contributed extensively to the Introduction to the Clinical Biennium experience at
                          the Pritzker School of Medicine to support the transition of medical students to the third year.
                          Dr. Tung is an active participant in the Perioperative Medicine and Pain Therapy Clerkship
  rotation at the University of Chicago Medical Center, serving as both a clinical and didactic teacher of junior and
  senior medical students. Dr. Tung has made significant contributions to the preclinical Pritzker School of Medicine
  curriculum, and for his extensive efforts in medical education, Dr. Tung was asked to deliver the keynote address for
  the Pritzker second year student retreat in 2005. Additionally, he is a teacher and mentor for residents and fellows
  alike, instructing in Anesthesia and Critical Care Medicine, among other topics. He regularly participates in resident
  didactic sessions, and his efforts have consistently been reflected by top evaluations of his teaching. Furthermore, Dr.
  Tung has been a leader in his department in Quality Care, participating on the Continuing Quality Improvement
  (CQI) Committee and conducting bi-weekly CQI Morbidity & Mortality conferences. Beyond this, Dr. Tung serves
  as the co-director of two annual conferences. He regularly teaches at the American Society of Anesthesiologists Annual
  Meeting, lectures at several national meetings of subspecialty societies on cardiothoracic Anesthesia, Critical Care, and
  Pulmonary Medicine, and instructs at multiple regional and national CME courses.




                                                             11
1.	 Learner Perceptions of an Ad-Hoc versus Modular
    Didactic Curriculum in Emergency Medicine Residency
    Lindsay Jin, MD; James Ahn, MD; Christine Babcock, MD, MSc



    Statement of Problem, Question, or Issue Addressed: Prior to initiation of this study, our emergency medicine
    residency operated with an ad-hoc curriculum. Multiple studies demonstrate a modular curriculum is a
    successful educational model. Studies in the medical school setting found that with initiation of a modular
    curriculum students score well on core competency testing and prefer learning in this model. Supporting
    evidence from obstetrics and gynecology and surgery literature corroborates this study.

    Objectives of Program/Intervention: The purpose of our study was to compare a modular didactic curriculum
    versus an ad-hoc curriculum in the setting of an emergency medicine (EM) residency.

    Description of Program/Intervention: During 2009-2010 a modular curriculum was implemented into a
    three-year EM residency program in a large urban tertiary care medical center. Our program shifted didactic
    conferences away from an ad-hoc format to a topic-based modules format. An identical survey was distributed
    to all residents during the 08-09 and 09-10 academic years querying the learners’ perceptions on didactic
    conferences. An unpaired T test was used to compare the results from 08-09 (prior to initiation of the modular
    curriculum) to 09-10 (after initiation of the modular curriculum) with statistical significance determined at
    p≤ 0.05.

    Results/Findings to Date: Responses were collected from 63% of the residency. 56.7% of residents thought that
    didactic conferences were organized under the modular curriculum vs. 17.2% under the ad-hoc curriculum (p
    < .0001). 69.0% of residents agreed that didactic conferences with the modular curriculum improved in-service
    examination performance vs. 39.2% in the ad-hoc curriculum (p = .0113). 86.6% of residents agreed that
    modular conferences improved clinical performance vs. 69.0% that ad-hoc curriculum improved performance
    (p < .0001). 60.0% of trainees had a positive educational experience in modular conferences vs 31.0% in the
    ad-hoc curriculum (p = .0006). 79.3% of learners observed that there was higher resident attendance after the
    modular curriculum was implemented. 27.6% of learners felt resident attendance was adequate under the ad-
    hoc curriculum (p < .0001).

    Key Lessons Learned/Conclusions: We found that EM residents at our institution preferred didactic conferences
    in a modular curriculum compared to an ad-hoc curriculum. Learners found the modular model more
    organized and more likely to improve both their in-training exam and clinical performance. Residents report
    a more positive educational experience when they attend modular didactic conferences. Lastly, resident
    attendance is higher in a modular vs. ad-hoc conferences, which argues that the modular curriculum is seen as
    more valuable to EM residents. Globally, the EM residents valued and preferred this curriculum style and it will
    be the permanent model in which our EM residency operates.




                                                           12
  2.	 Entrustment, Supervision and Autonomy of Housestaff
      During Inpatient Medicine Rotations: A Qualitative Study
Scholarship   Kevin Choo, MS3; Vineet Arora, MD, MAPP; Paul Barach, MD, MPH; Jeanne Farnan, MD, MHPE
& Discovery


              Statement of Problem, Question, or Issue Addressed: Attending physicians are regularly challenged in their
              decision when to allow their trainees autonomy in procedural tasks and clinical decision-making. Medical
              educators have struggled to find ways to evaluate trainees and assist faculty in determining when trainees are
              prepared to perform tasks independently.

              Objectives of Program/Intervention: The aim of this study is to create a conceptual framework that elucidates
              the factors determining both the attending and resident perceptions of trust as they pertain to clinical decision-
              making and patient care.

              Description of Program/Intervention: Internal medicine residents and attending physicians at a single academic
              medical center were interviewed between January and November 2006, within one week of their final call
              night on an Internal Medicine rotation. Participants were asked, using Critical Incident Technique, to describe
              important entrustment decisions made during the rotation and their last call night. The interviews lasted 45
              minutes on average and were audio-taped for transcription. All patient and personal data were de-identified
              during transcription. The interview transcripts were reviewed and analyzed to identify sentences and phrases
              that described the factors that promoted, undermined, or otherwise described trust, which were then coded into
              discrete subthemes. Two investigators (JMF and KJC) independently reviewed representative portions of the
              transcript until consensus was achieved. Inter-rater reliability was calculated using a generalized kappa-statistic
              (κ). The coding scheme was then applied to the entire set of transcripts.

              Results/Findings to Date: 42/50 (84%) of residents and 40/50 (80%) of attending physicians were interviewed.
              The analysis yielded 535 discrete mentions of trusting factors, which were coded into 35 subthemes. The inter-
              rater Kappa for coding was 0.84 between the two raters. Four major domains of trust were described, each with
              specific sub-themes: trainee factors (confidence, accountability and dedication, recognition of limitations, area
              of specialty/career plans); supervisor factors (approachability, area of clinical expertise, perception of clinical
              obligations); task factors (urgency/severity of illness, transitions, level of difficulty, situational characteristics);
              and, system factors (workload, duty hours and efficiency pressures, training philosophy). Supervisors frequently
              describe basing their trusting decisions on direct observation of trainee performance. In addition, relational
              factors such as personality characteristics and prior work experience were frequently mentioned.

              Key Lessons Learned/Conclusions: The development of trust is multi-factorial and comprises factors driven by
              the supervisor, trainee, task and environmental characteristics. Trust is often driven by subjective conclusions
              drawn from direct trainee observation. Supervising attending physicians base their decisions on personal
              characteristics of their trainees, including honesty, disposition, and self-confidence which may be at odds with
              the trainee’s competency. The criteria for entrustment need to be better understood to develop reliable and
              measurable standards to evaluate the readiness of residents to treat patients unsupervised.




                                                                         13
3.	 Survey of Problem Based Learning for Medical Student
    Pain Curricula
    Dalia Elmofty, MD; Magdalena Anitescu, MD, PhD; Ashley Agerson, MD



    Statement of Problem, Question, or Issue Addressed: Chronic pain is one of the most prevalent conditions
    encountered in clinical practice. Chronic pain can burden patients in multiple domains: socioeconomic,
    psychological and quality of life. In 2010, the Department of Health and Human Services enlisted the Institute
    of Medicine to examine pain as a public health problem. The committee reported that chronic pain affects
    at least 116 million adults in the US; more than those affected by heart disease, cancer and diabetes (1). In
    1988, The International Association for the Study of Pain (IASP) published a pain curriculum for medical
    schools and estimated that it would require a minimum of 74h (2). For a majority of medical schools, pain
    education encompass about 10 hr maximum during a 4 year time period. Pain education must be an integral
    part of medical student education at all levels in order to improve chronic pain management. It is essential for
    medical students to have adequate exposure in order to develop knowledgeable and skilled future healthcare
    professionals. While progress is taking place, many gaps still exist.

    Objectives of Program/Intervention: To promote pain education in PBLD format, allowing students to develop
    authority, competency, skills and attitudes that enhance the learning process.

    Description of Program/Intervention: At the University of Chicago, third year medical students complete a two
    week rotation as part of their surgical clerkship in Anesthesia and Critical Care. During these two weeks, they
    spend 5 hours in the Acute Pain Service (APS) and 8 hours in the Pain Clinic. The neurophysiology, etiology,
    ethical issues and management of acute and chronic pain are reviewed. More recently, in spring of 2011, we
    introduced a Problem Based Learning Discussion (PBLD) on the management of Chronic Low Back Pain
    to promote pain education. Low back pain is one of the most common complaints in our society. We chose
    PBL type discussion as it allows students to develop authority, competency, skills and attitudes that enhance
    the learning process. Each PBL session consisted of approximately 5-6 medical students and was 60 minutes
    in length. A case discussion was emailed to the students at least 24 hr before the scheduled session to allow
    adequate preparation time. As well, the Pain PBLD was performed during the second week of their rotation to
    ensure that all students had completed their APS and Pain Clinic rotation. An online survey of a series of seven
    questions using a Likert-type scale was then conducted regarding their experience during the Pain PBLD.

    Results/Findings to Date: We achieved a 100% response rate. Of the 18 medical students that attended the
    Pain PBLD, all responded to the survey. The majority of students were favorable towards this mode of learning.
    All but 1 student responding to the survey strongly agreed that their educational background knowledge was
    increased with this modality of learning.

    Key Lessons Learned/Conclusions: Implementing a pain assessment and management program for medical
    students can provide a solid foundation upon which students can continue to build as their career develops. A
    European survey conducted in 2007 highlighted the anxiety of final year medical students in managing chronic
    pain (3). Our survey showed that the most favorable response was “The case scenario enriched my background
    knowledge for the rotation.” The students felt very comfortable in stating their opinions within the group. This
    emphasizes that the fundamental knowledge to improve chronic pain management can be introduced in PBLD
    format rather than the standard lecture format. PBL allows students to work as a team and engage in group
    discussion.




                                                           14
 4.	 Teaching Self-Directed Learning: Can This Be Done?
          Susan Glick, MD; Jennifer Glick; Maureen Willcox, MS4; Patrick O’Connor; Michael O’Connor, MD
Academy
 Grant
          Statement of Problem, Question, or Issue Addressed: Self-directed learning is a requisite for lifelong learning.
          Third-year students are expected to be self-directed learners, selecting which content to study and the
          appropriate resources. Unfortunately, their educational experience in both college and medical school is
          overwhelmingly teacher-directed, hence our students are ill prepared for the transition to self-directed learning.
          How best to prepare medical students to become self-directed learners is unknown.

          Objectives of Program/Intervention: The Foundations in Clinical Medicine (FICM) course is an immersive,
          7-day classroom-based experience intended to prepare rising third-year students for the clinical years. One aim
          of the course is to develop students’ self-directed learning skills in preparation for the third-year clerkships and
          beyond.

          Description of Program/Intervention: The FICM course consists of 7 distinct content areas, 3 focused on
          self-directed learning. For two of these content areas (Data Interpretation and Hypothesis-Driven History and
          Physical Examination), we created a series of structured paper and pencil exercises that required self-directed
          learning. Students worked in groups of 4 to complete the exercises. They were provided with relevant print and
          on-line resources (textbooks, original articles, Up-to-Date) and were encouraged to seek others. Faculty were
          present to answer questions, but they were instructed not to initiate or lead discussion. For the other content
          area (FICM Laboratory), we created an unstructured setting for students to work individually or in groups to
          revisit content they had not yet mastered, and to extend their understanding. Faculty responded to students’
          questions, but did not initiate or lead discussion.

          Results/Findings to Date: In order to determine the effectiveness of our teaching methodology, self-directed
          learning was assessed on the first day of the course and again at its conclusion using a single instrument that
          combined two validated measures of self-directed learning: Garrison’s Model of Self-Directed Learning and Lee’s
          Self-Assessed SDL Ability. The response rate was 100% (n=47).

          Responses were stripped of identifiers and entered into a database. After obtaining IRB exemption from review,
          we analyzed the data.

          Scores were calculated by assigning a point value to each answer (5 = strongly agree to 1 = strongly disagree),
          and then dividing the total number of points by the total number of questions answered. Use of the mean score
          instead of total score was necessary to correct for unanswered items.

          Since histograms for each subscale and for the total scores were roughly unimodal and symmetric, a paired t-test
          using Student’s t-test was utilized to compare the change in self-management, motivation, self-monitoring and
          the total score (Garrison’s Model of Self-Directed Learning) as well as the total score (Lee’s Self-Assessed SDL
          Ability) before and after the course.

          There was statistically significant improvement in the score for each subscale and for both total scores following
          the course. For Garrison’s Model of Self-Directed Learning, scored on a 4-point Likert scale, the mean
          improvement was 0.127 (95% CI 0.0631-0.190, p=0.00022). For Lee’s Self-Assessed SDL Ability, scored on a
          5-point Likert scale, the mean improvement was 0.486 (95% CI 0.305 - 0.667, p = 0.00000115).

          Key Lessons Learned/Conclusions: We cultivated self-directed learning in our students by immersing them in
          time-pressured problem-solving situations, providing them access to the appropriate resource materials, and to
          faculty to keep them on-track. Self-directed learning can be taught to medical students.




                                                                   15
5.	 Use of Problem Based Learning Discussions To Allow
    Medical Student Cognitive Autonomy
    Michael Hernandez, MD; Igor Tkachenko, MD, PhD; Catherine Bachman, MD



    Statement of Problem, Question, or Issue Addressed: Third year medical students spend two weeks on the
    perioperative and pain medicine rotation during their surgery rotation block. During this two weeks, they are
    integrated into the anesthesia team and take part in the perioperative care of surgical patients. For most, this
    provides a first glimpse into the practice of an anesthesiologist. The operating room is a fast paced learning
    environment. Time is limited due to the need to maintain efficiency of practice, but also by the need to rapidly
    adjust to the patient’s physiological perturbations iatrogenic or otherwise. As a consequence, student’s questions
    have to be answered or recalled after a complex flurry of actions. The inability to pause and consider the
    rationale for actions is detrimental to the student’s understanding of the discipline.

    Objectives of Program/Intervention:

    1.   Provide a forum for student cognitive autonomy free from the time/situational pressures of an actual
         operative case.
    2.   Provide an opportunity for participants to engage in dialogue regarding the medical plan, in a peer setting
         where points and counterpoints can be entertained by the group.
    3.   Allow an opportunity to fill knowledge gaps that would otherwise remain despite good clinical experience.

    Description of Program/Intervention: Students on rotation are scheduled for a 1-2 hour problem based learning
    discussion with one of 2 faculty members experienced in facilitating the sessions. A case vignette is given to the
    students prior to the session. Students are told that the faculty member is there to facilitate, but not dominate
    the discussion. When there is no consensus, or a knowledge gap, the faculty facilitator provides input to resume
    the discussion.

    Results/Findings to Date:
    Scale: 1=strongly disagree to 5=strongly agree, 63 responses
    1.   The problem based learning educational style is a good way to learn. Average Score: 4.79
    2.   The PBL session adds something that is otherwise missing from the Anesthesia rotation. Average Score:
         4.56
    3.   The faculty member “running” the PBLD gave us enough slack to allow discussion and did not just
         lecture. Average Score: 4.89

    Key Lessons Learned/Conclusions:

    1.   The PBLD format may be a useful tool in settings where patient acuity or the fast pace of care would
         otherwise rob the student of opportunity for cognitive autonomy or a timely answer to their questions.
    2. The PBLD format allows students to consider the “art” of medical decision making in a novel fashion.
       Students are encouraged to consider the “pros and cons” of their plans, and to justify their decisions to their
       peers. This peer to peer debate fosters the student’s ability to communicate effectively to colleagues,
       to make decisions based on sound reasoning, and to consider alternatives when presented with opposing
       viewpoints. These skills are imperative for successful practice as a physician regardless of specialty.




                                                            16
6.	 Visual Art and Medicine: A New Elective for 1st, 2nd and
    4th Year Students at Pritzker
    Nicole Baltrushes, MS4; Celine Goetz, MD; Laura Hodges, MS4; Joel Schwab, MD



    Statement of Problem, Question, or Issue Addressed: The Visual Art and Medicine class was developed in
    partnership with the University of Chicago Smart Museum as an elective class designed to enhance medical
    students’ communication and visual observation skills, as well as a venue for students to discuss values and
    experiences in becoming a doctor. Art-based classes at other medical schools have been shown to enhance
    student observational skills, and the Visual Art and Medicine curriculum was designed to expand upon this
    model by guiding students in the exploration of meaning and values-based aspects of art as a way to reflect
    upon the medical school experience.

    Objectives of Program/Intervention: The objectives of the class were to hone students’ observational skills, as
    well as to build communication skills through observation, description, and analysis of art. Additionally, the
    class aimed to use artwork as a tool both to build empathy, and to create a safe space to discuss values and
    experiences in medicine.

    Description of Program/Intervention: Visual Art and Medicine: Using Art to Explore the Practice of Medicine
    was an eight session course held in April 2011 and offered to twenty 1st, 2nd and 4th year medical students at
    Pritzker. The elective curriculum was developed based on a review of other art and medicine curricula offered to
    medical students and residents. The course consisted of five sessions at the Smart Museum and three art-related
    excursions. The first half of each Smart Museum session consisted of art observation exercises, and the second
    half consisted of discussion sessions with guest faculty, which were facilitated by 4th year teaching assistants.
    Students were asked to bring in artwork pertaining to one of four topics: the body, illness and pathology,
    empathy, and becoming a doctor. Discussions were based on themes addressed by these works of art.

    Results/Findings to Date: A survey was created to assess the performance of the Visual Art and Medicine elective
    across key objectives. Seventy-five percent of students said the class enhanced their understanding of medical
    practice and/or the art of being a physician and 91.7% of students said they would sign up for the course
    again. Student comments were also very helpful. One student commented that the class created “an open space
    where there was no hierarchy and where everyone felt comfortable sharing thoughts, even ones that were very
    personal.” Other comments included that the class served as “a reminder of how I initially felt about medicine
    and becoming a physician” and that it “made me more aware of the things I am seeing in general.”

    Key Lessons Learned/Conclusions: Medical students value the opportunity to participate in an arts-based class
    that offers a safe space for discussion among students at various points in their medical education. The Visual
    Art and Medicine class offers students a humanistic way to approach their experiences in medical education.




                                                            17
 7.	 Clinical Simulation Initiative in Psychiatry for Medical
     Students: Development of a Free National Database
Academy   Michael Marcangelo, MD; Angela Blood, MPH, MBA; Laura Hodges, MS4
 Grant


          Statement of Problem, Question, or Issue Addressed: There is a growing movement in medical education
          emphasizing the importance of learner-centered strategies, while still valuing the integrity of traditional
          patient-centered instruction. In the last decade, medical educators have created national databanks of online,
          interactive teaching cases for clerkship students as a reflection of the learner-centered approach. For example,
          there are currently 32 online interactive pediatric cases known as the CLIPP cases (Computer-Assisted Learning
          in Pediatrics Program), 36 internal medicine SIMPLE cases (Simulated Internal Medicine Patient Learning
          Experience), 15 surgery WISE-MD cases (Web Initiative for Surgical Education), and 29 family medicine
          fmCASES (Family Medicine Computer-Assisted Simulations for Educating Students) that are widely used by
          clerkship directors. However, there is currently no equivalent collection in psychiatry.

          Objectives of Program/Intervention: We aim to create a free national database of Self-Learning Modules to
          provide alternative medical experiences for third year medical students who do not encounter certain required
          clinical conditions during their core Psychiatry clerkships. We will assess the modules by collecting data from
          online surveys to be completed by students.

          Description of Program/Intervention: A Clinical Skills Initiative (CSI) Task Force has been formed within
          ADMSEP (Association of the Directors of Medical Student Education in Psychiatry) and charged with
          developing new Self-Learning Modules for medical students during their core Psychiatry clerkships. These
          Self-Learning Modules will be based on the 14 common DSM-IV-TR diagnostic categories, as defined by
          the ADMSEP Psychiatry Learning Objectives Taskforce, which should be taught to clerkship students. The
          modules consist of filmed clinical scenarios with standardized patients, general patient care info relevant to the
          condition, and periodic quiz questions. The modules are not meant to replace actual clinical experiences with
          patients, but are meant to supplement student education when direct clinical exposure is not possible for a
          particular learning objective.

          Results/Findings to Date: To date, a total of five modules have been created, including patient cases depicting
          somatization disorder, adjustment disorder, and adolescent depression. In addition, pilot data from students
          examining the acceptability and utility of the modules has been gathered and will be presented.

          Key Lessons Learned/Conclusions: Going forward, our plan is to develop a significant library of cases and
          distribute them widely, for free, to medical schools through online resources such as MedEdPORTAL.




                                                                  18
 8.	 Geriatrics and Aging through Transitional Environments
     (GATE) MS1 Curriculum: Obtaining a Functional History
Plenary
          Seema Limaye, MD; Shellie Williams, MD; Sandy Smith, PhD; Aliza Baron, MA



Academy   Statement of Problem, Question, or Issue Addressed: The GATE curriculum teaches geriatrics across the
 Grant    spectrum of care settings, from home to independent living to hospital and nursing home. This MS-1
          experience is a home visit in an independent senior building that provides first year medical students the
          opportunity to take a functional history in a geriatric “trained patient” and conduct a brief home safety
          assessment.

          Objectives of Program/Intervention:
          1.   To develop geriatric assessment skills for Pritzker medical students in specific competencies, in particular:
          2.   Assess and describe baseline and current functional abilities in an older adult
          3.   Identify and assess safety risks in the home environment.
          4.   To record and reflect on their trained patient encounter.

          Description of Program/Intervention: Prior to curriculum implementation, we hosted a 2.5 hours training
          session for over 30 independent seniors at Montgomery Place Retirement Community to recruit “trained
          patients”. The curriculum consists of a 1.5 hour lecture, followed by a home visit to an independent senior
          building. The lecture focused on geriatric history-taking skills and components of a geriatric functional history.
          During the last 30 minutes of the lecture, an independent active older adult visited the class and took questions
          about her life story. Over the next 6 weeks, students (in pairs) were assigned to visit “trained patient” living in
          at Montgomery Place Retirement Community, and conduct a functional history-taking interview and a home
          safety assessment. Clinical interviewing skills are assessed by “trained patients”, who deliver verbal feedback to
          the students and complete structured written assessment. Students wrote a 250 word reflective essay about the
          encounter.

          Results/Findings to Date: Eighty nine students completed the interview experience. A random sample of 27
          reflective essays (30%) were evaluated using a grounded theory qualitative analysis. The following themes were
          identified:
          •    Patient independence;
          •    Fascination with the patient’s life story;
          •    Comfort with the geriatric patient;
          •    Discomfort with interview content;
          •    Importance of history-taking skills; and
          •    Learning from patients.

          Trained patients evaluated each student on their interviewing skills and provided excellent ratings of student
          skills. Open-ended comments were positive, with some comments providing congruence with the categories
          derived from the student essays.

          Key Lessons Learned/Conclusions: This curriculum afforded students the unusual opportunity to enter the
          home of an older adult “trained patient” to take a geriatric functional history and a home safety evaluation.
          Students’ self-reflections on the experience indicate significant value in the experience. For instance, students
          reported numerous positive aspects of this interview experience but also recognized the challenge of taking a
          functional history and of asking sensitive questions. Feedback from the trained patients indicated their delight
          in participation and their ability to contribute to the students’ education.




                                                                   19
9.	 Responding to Student-Identified Learning Needs: A Mixed
    Method Survey to Guide the Family Medicine Curriculum
    Kohar Jones, MD; Mari Egan, MD, MHPE; Irma Dahlquist



    Statement of Problem, Question, or Issue Addressed: Medical students struggle to master an informal curriculum
    on each of their clinical rotations. Medical educators must identify these concerns to successfully address
    student learning needs. A qualitative analysis of student reflective writing from the family medicine clerkship
    revealed frequently recurring themes and subthemes, including learning concerns that suggested the potential
    for curricular reform.

    Objectives of Program/Intervention: We surveyed fourth year medical students to understand which of the
    identified potential learning needs students wanted to obtain formal training in on their family medicine
    rotation.

    Description of Program/Intervention: We conducted a mixed methods survey of fourth year medical students
    who had already completed the family medicine rotation. Students were asked to rank in order which of the
    identified potential unmet learning needs they would like to learn more about during their family medicine
    clerkship. These included: health care reform, handing time constraints, developing into a doctor, building
    relationships, cross cultural awareness, and pharmaceutical industry relationships.

    Results/Findings to Date: 59 out of 83 medical students responded, a 71% response rate. Students identified
    “health care reform” as the topic they most wanted to see in future curriculum, closely followed by “handling
    time constraints.” “Pharmaceutical industry relationships” was the topic they least wanted to see.

    Key Lessons Learned/Conclusions: Reflective writings provide a rich source of data to assess medical student
    concerns. Our qualitative/quantitative analysis identified unmet learning needs for medical students on the
    third year family medicine clerkship. “Health care reform” and “time constraints” were themes that most
    concerned our sample of medical students. The family medicine curriculum has been modified to incorporate
    these student-identified learning needs.




                                                          20
10.	 Medical Students as Hospice Volunteers: Influence of an
     Early Experiential Training Program in End-of-Life Care
     Education
    Melissa Mott, PhD, MS3; Stacie Levine, MD; Rita Gorawara-Bhat, PhD



    Statement of Problem, Question, or Issue Addressed: During pre-clinical training, medical students are rarely
    exposed to palliative medicine and end-of-life (EOL) care.

    Objectives of Program/Intervention: To provide first-year medical students opportunities to experience pertinent
    issues in EOL by serving as hospice volunteers.

    Description of Program/Intervention: Patients and Families First (PFF)-a training program in EOL care
    education-was piloted on two cohorts of MS-1s (2009-2011). Students received 3 hours of volunteer
    training, and were required to conduct at least two consecutive hospice visits in pairs to obtain course credit.
    Students’ pre and post-volunteering attitudes were evaluated through Bugen’s Coping with Death Scale (0-
    210); Reflective essays were analyzed using qualitative methodology; salient themes were extracted by two
    investigators independently and then collaboratively.

    Results/Findings to Date: PFF participants (N=42) demonstrated a trend in improvement in baseline and
    post attitudes towards dying compared to student controls (pre all students=129; SD=14.3), (post: PFF=144;
    SD=14.9), (controls=130; SD=15.5). Qualitative analyses yielded three major themes including students’:
    1.   Reactions - initial discomfort and vulnerability, amazement in normalcy of dying at home, devotion of
         caregivers, limitations in altering outcomes for patients at EOL, and personal reward through vicarious
         learning from elders;
    2.   Perceptions of patients’ unanticipated needs including relief of non-physical suffering and support of
         caregivers;
    3.   Reflections on own future death and value of volunteering in helping future physicians cope with death/
         dying.
    Female and male student essays differed: females addressed socio-emotional aspects of patient and family care
    compared to males focusing on instrumental issues.

    Key Lessons Learned/Conclusions: Hospice volunteering during pre-clinical years provides valuable experiential
    training for students in caring for seriously ill patients and their families by fostering personal reflection and
    building of empathic skills.




                                                            21
11.	 Improving Student-Run Free Clinic Care Through Pre-
     Clinical Student Didactic Intervention: A Pilot Feasibility
     Study
    Andrew W. Phillips, MEd, MS4; Kristine Bordenave, MD; Rita Rossi-Foulkes, MD, MS



    Statement of Problem, Question, or Issue Addressed: Student-run free clinics that are overseen by faculty are
    increasingly common throughout the country. Since their inception, concerns over maintaining high quality
    care provided by medical students, especially pre-clinical students, have been raised.

    Objectives of Program/Intervention: Determine the subjective feasibility of a vertically integrated, informal
    course for pre-clinical students to improve patient care at a student-run free clinic as measured by student
    perception of the intervention.

    Description of Program/Intervention: First year medical students voluntarily participated in a 15 minute small-
    group didactic session at the Community Health Clinic (CHC) each month before their shifts from January
    through April 2011 and one session at the University of Chicago in May 2011. Topics included diabetes
    mellitus, renal and nervous system components of hypertension, mood disorders, and low back pain and
    outpatient analgesia. Each session was divided into basic science and clinical perspectives with an emphasis on
    general management of patients with respect to integrating physiology, pathophysiology, and therapeutics.

    A proof of concept study was created using pre-obtained quality assurance and course data. Surveys composed
    of 7-point Likert scale questions and free response questions were analyzed with descriptive statistics.

    Results/Findings to Date: 14 of 26 students (54%) responded. All but one participant (92.9%) reported that
    the intervention presented unique material compared to required coursework to date. Free response sections
    described the intervention as a clinically relevant and clinically applicable elaboration of similar course topics.
    All students found the intervention to offer more information about standards of practice than their current
    courses with 78.8% of students strongly or very strongly agreeing.

    A cumulative total of 85.7% found the intervention helpful in understanding their patients’ disease processes
    and therapies. Moreover, 50% agreed that the intervention allowed them to provide improved patient care, and
    14.3% very strongly agreed, while 35% neither agreed nor disagreed. Free response answers most often cited
    greater understanding of the management decisions made by the attending and a perceived inability of first year
    medical students to change patient outcomes. Students overwhelmingly agreed (92.9% agreed, strongly agreed,
    or very strongly agreed) that the intervention improved their understanding of the rationales behind standard of
    care practices. Moreover, students reported a higher likelihood of using standards of practice care as a result of
    the intervention; 57.1% agreed and 21.4% strongly agreed, while 21.4% neither agreed nor disagreed. Students
    reported using information from the didactic sessions for patient care a median of 2.5 times over approximately
    5 clinic days, and all respondents reported at least one direct use.

    Key Lessons Learned/Conclusions: Pre-clinical students found the didactic intervention to contribute unique
    and helpful clinical pathophysiological and therapeutic information. They further reported an improved
    understanding of patient management and higher likelihood of employing standard of care practices. Our
    findings support the conceptual plausibility of a vertically integrated course for pre-clinical students to improve
    patient care in the student-run free clinic setting. Follow-up studies comparing objectively measurable patient
    outcomes are warranted.




                                                             22
12.	 Integration of the Virtual Human Embryo into the First
     Year Anatomy Curriculum
GME     Callum Ross, PhD; James O’Reilly, PhD; Quinn Dombrowski; Sam Quinan
Grant


        Statement of Problem, Question, or Issue Addressed: Historically, the Human Anatomy courses at the University
        of Chicago used serially sectioned chicken embryos and light microscopes to demonstrate the early stages of
        human development. This curriculum content was received with much skepticism by the medical students
        (“why am I looking at a chicken?”) and required them to reconstruct 3D relationships from sections that were
        arranged in lateral rows on microscope slides.

        Objectives of Program/Intervention: In order to make embryology more accessible and more relevant to medical
        student education, we decided to integrate online human embryological material in the course.

        Description of Program/Intervention: In 2007, we transitioned to utilizing the Virtual Human Embryo images
        produced by the Louisiana State University Health Sciences Center. These are digital images produced from
        serially sectioned human embryos from the Carnegie Collection. The sections are presented in the same
        fashion as serial CT or MRI images, allowing students to grasp 3D relationships more easily. In 2009, the
        original images from LSU were integrated with the Virtual Microscope interface that was also being introduced
        for Histology and Pathology in the first and second year curriculum to replace light microscopes. Unlike the
        original interface produced by LSU, the Virtual Microscope allows students to both zoom in from the entire
        image to specific areas of the section, and to follow that region from section to section. At the start of this
        project, specimens representing only the first 5 weeks of development (up to Carnegie Stage 14) were available.
        As later stages became available, they were integrated into the course.

        Results/Findings to Date: The introduction of the Virtual Embryo into the curriculum and its integration
        with the Virtual Microscope has substantially reduced skepticism regarding the importance of embryology,
        has dramatically improved the efficiency of teaching important 3D relationships during development, and has
        allowed the addition of laboratories addressing organogenesis to the first year curriculum.

        Key Lessons Learned/Conclusions: Our future efforts should include completing the integration of the latest
        stages made available from LSU, representing weeks 6 through 8 of development (Carnegie Stages 18 through
        23), improving the current annotation interface to make it more informative and user friendly, and adding
        functionality enabling us to link directly to specific sections of specific stages from text of our laboratory
        handouts.




                                                              23
13.	 Qualitative Analysis of First Year Medical School
     Orientation
    Sean Swearingen, MS2; H. Barrett Fromme, MD, MHPE; Shalini Reddy, MD



    Statement of Problem, Question, or Issue Addressed: How can medical school orientation be changed to improve
    the transition into medical school for the incoming first year class?

    Objectives of Program/Intervention: Find significant trends in the qualitative survey analysis, and then use these
    trends to improve the orientation process for the next incoming class.

    Description of Program/Intervention: A week before orientation, incoming first year medical students were
    asked to fill out a survey (online using Survey Monkey) that asked them about their concerns about coming
    into medical school, and what their expectations were for orientation. They were then sent a reminder email 3
    days before orientation started if they had not yet filled out the survey. Immediately following orientation, the
    new first year students were asked to fill out another survey which focused on what they thought of specific
    things in the orientation process that have the potential to be changed. Those that did not fill out the survey
    immediately were reminded to a few days later.

    Results/Findings to Date: Although the results will not be done being fully analyzed for another week or so,
    from the analysis so far we have found that overwhelmingly, the main concern students have when starting
    medical school is being able to balance the time commitment for school with having a life outside of medical
    school. Additionally, the thing they hope to gain the most from orientation is making social connections with
    their classmates. As far as things that were found to need improvement from the post orientation survey, the
    major points include facilitating group interaction, and changing up the timing of when certain events took
    place.

    Key Lessons Learned/Conclusions: We are still working on getting a definitive conclusion, but it seems at this
    point that there needs to be an effort to improve scheduling to benefit the incoming students, and to improve
    facilitation of social activities by the second year medical students involved in orientation.




                                                            24
 14.	 Graduate Medical Education in Frailty: The SAFE Clinic
         Katherine Thompson, MD; Megan Huisingh-Scheetz, MD, MPH; Lisa Mailliard, APN, MSN;
         Patricia Rush, MD, MBA
MERITS


         Statement of Problem, Question, or Issue Addressed: Frailty is a geriatric syndrome, characterized by: low energy
         or exhaustion, weakness, weight loss, slow walking speed, and low physical activity. As the number of adults in
         the U.S. grows every year, it will be increasingly important for physicians to identify and manage frail patients.
         Data suggests that the ability to identify frailty can enhance patient care through improved prognostication as
         well as more accurate preventive screening and treatment decision-making. No didactic or clinical education on
         frailty currently exists in University of Chicago’s Internal medicine (IM) resident curriculum. In addition, there
         is limited opportunity for IM residents to learn to work with interdisciplinary teams, which is an important
         aspect in the care of frail patients.

         Objectives of Program/Intervention: After participation in the SAFE Clinic frailty curriculum, IM residents will
         be able to:
         1.   Define frailty and identify frail patients.
         2.   Perform and interpret functional and cognitive assessment.
         3.   Appreciate the importance of interdisciplinary care for frail patients.
         4.   Appreciate the relevance of geriatric assessment to their future practice.

         Description of Program/Intervention: IM Residents will rotate through the Successful Aging and Frailty
         Evaluation (SAFE) Clinic, housed within the South Shore Senior Center geriatrics clinic, during their month-
         long geriatrics rotation. Residents will join the SAFE Clinic team for one day on two consecutive weeks. Week
         one will consist of a pre-test assessing frailty knowledge and attitudes. Residents will then have a 30 minute
         didactic lecture on frailty, given by a geriatrician, and then observe a frailty assessment and learn how to
         administer cognitive and functional tests. On week two, residents will return and perform a frailty assessment
         on a new patient while a practitioner (MD or APN) observes and gives feedback. The resident will then
         participate in an interdisciplinary team meeting with an MD, APN, and social worker for patient care planning
         based on frailty status. Week two concludes with a post-test.

         Results/Findings to Date: Six residents have completed the SAFE Clinic frailty curriculum to date. Initial
         resident satisfaction survey results have been very positive. Representative quotes include: “One week ago, I
         had never heard of frailty. Now I not only know what frailty is, I have completed a frailty evaluation with an
         82-year-old man,” and “I really enjoyed participating in the interdisciplinary team meeting. I felt like I learned
         about a lot of options for patients that I never knew existed.”

         Key Lessons Learned/Conclusions: The SAFE Clinic provides an innovative forum for residents to learn about
         frailty and practice interdisciplinary care. Early feedback suggests that resident satisfaction with this educational
         experience is high. Future work will quantify improvements in resident knowledge, skills, and attitudes. In
         the future, this experience will also be expanded to other learners including medical, APN, and social work
         students.




                                                                  25
 15.	 Geriatrics and Aging through Transitional Environments
        (GATE) MS2 Curriculum: Introduction to Geriatric
Academy
        Assessments
Grant   Shellie Williams, MD; Seema Limaye, MD; Sandy Smith, PhD; Aliza Baron, MA



        Statement of Problem, Question, or Issue Addressed: Competency-based assessment tools indicate whether
        students have mastered required skills. A 360 degree competency-based evaluation tool was developed for
        simulated patient cases focusing on geriatric assessment skills. A comparison of student self-evaluations with
        simulated patient and preceptor evaluations was conducted.

        Objectives of Program/Intervention:
        1.   To enhance geriatric assessment skills linked to AAMC Core Competencies.
        2.   To develop evaluation tools and methods based on the AAMC Core Competencies.

        Description of Program/Intervention: Lecture and Workshop: “Introduction to Geriatric Assessments” began
        with a lecture highlighting strategies for: communicating with elderly patients and their caregivers; conducting
        advance directive discussions and; administering common geriatric screening tests for pain, gait, falls,
        depression, functioning, and cognition. The lecture was followed by a practice workshop facilitated by geriatric
        team members for students to role play introducing and administering geriatric screening tools.

        Simulated Patient (SP) Experience: The 2-hour simulated patient encounters are a required course component.
        87 Pritzker MS2 students conducted an SP interview in 1 of 6 geriatric cases. Each case was observed by a
        preceptor and verbal feedback was provided immediately after the encounter by the preceptor and simulated
        patient.

        Evaluation: Each student, their SP and preceptor completed a competency-based evaluation of the student’s
        performance. In addition, students assessed their current and prior confidence in taking a functional history
        and performing geriatric exams and screening tests.

        Results/Findings to Date:
        1.   Self-confidence in taking a functional history and performing geriatric assessment. Students felt more
             confident after the intervention in 1) taking a functional history and 2) conducting a physical exam and
             conducting screening tests (t(86) = -16.08, p<.001 and t(86) = -17.1, p<.001) respectively).
        2.   360-degree evaluation of competencies
             a.   Geriatric Interviewing Skills: There was no difference in self, preceptor and SP evaluations of generic
                  interviewing skills for three cases (Depression, Health literacy and Dementia). SP scores were lower
                  than both student self-evaluation and preceptor evaluations for the MMSE and Gait cases. The
                  student self-evaluation was lower than the SP evaluation for the Advance Directives case.
             b.   Case Specific Clinical Skills: There was no difference in self, preceptor and SP evaluations of case
                  specific clinical skills for four cases (Depression, Health literacy, Dementia and Advance Directives).
                  For the Gait and MMSE cases, the SP evaluation was lower than the student self-evaluation and the
                  preceptor evaluation.

        Key Lessons Learned/Conclusions:
        1.   Geriatric SP experiences improve students’ self-rated confidence in targeted geriatric assessment skills.
        2.   Variation in geriatric interview skills was observed across individual cases. This may be attributable to
             student performance or SP expectations.
        3.   SPs were more critical of student performance in the Gait and MMSE cases. The technical nature of these
             cases suggests further investigation.
        4.   Creating faculty and SP training programs may standardize competency-based evaluations and improve
             inter-rater reliability.




                                                                 26
16.	 The Hand-off CEX: Instrument Development and
     Validation
    Saba Berhie, MS2; Vineet Arora, MD, MAPP; Paul Staisiunas; Jeanne Farnan, MD, MHPE



    Statement of Problem, Question, or Issue Addressed: The most recent iteration of the Accreditation Council for
    Graduate Medical Education (ACGME) duty hour regulations, released in July 2011, has further limited
    PGY-1 shift duration to 16 hours. Explicit language in these regulations also mandates handoff education for
    trainees and for residency training programs to assess handoff quality. However, there is a lack of validated tools
    for the assessment of handoff quality and to utilize for trainee education.

    Objectives of Program/Intervention: The specific aims of this project were to create video-based examples of
    varying levels of handoff performance for education, adapting the approach in this publication, and to validate
    an assessment instrument, the Hand-off CES.

    Description of Program/Intervention: Six video-based scenarios were developed which highlight varying levels
    of performance in the domains of communication skills, professionalism and setting. Each video permuted
    one domain of performance while holding the others constant. Scripts were based upon real-time clinical
    observations. Videos ranged in length from 3-5 minutes. Videos were shown and debrief occurred immediately
    after to identify barriers and facilitators to the displayed behaviors.

    Faculty were recruited via email to participate in a workshop on handoff education and evaluation to both pilot
    test the videos for instrument validation.

    Videos were shown in a random order and faculty were instructed to use the Hand-off CEX to rate the
    performance. Briefly, the Handoff CEX was developed in prior work by Arora et al as a paper-based instrument
    in which individuals are rated in six domains on a nine point scale (unsatisfactory[1] to superior[9]) with
    qualitative anchors defining each level of performance.

    Descriptive statistics and two tests of reliability, Cronbach’s alpha and Kendall’s coefficient of concordance, were
    performed. Two tests of validity were performed: a test of trend across ordered groups and a two-way ANOVA
    to examine for rater bias.

    Results/Findings to Date: Fourteen faculty from 2 departments participated. 73 of a possible 90 (82%) handoff
    observations were captured. Reliability testing revealed a Cronbach’s alpha of 0.81 (0.8=optimal) and Kendall’s
    coefficient of concordance of 0.59 (>0.6=high reliability). Faculty were able to reliably distinguish the different
    levels of performance in each domain (e.g. communication skills, professionalism and setting) in a statistically
    significant fashion. Two-way ANOVA revealed no evidence of rater bias.

    Faculty participants commented on face validity of video scenarios, specifically those portraying setting and
    communication skills. In addition, robust discussion resulted in identifying the barriers and facilitators to the
    behaviors demonstrated in the video.

    Key Lessons Learned/Conclusions: Video-based scenarios, utilized to highlight differing levels of performance,
    with focused debrief are an effective way to observe specific domains and behaviors in handoff communication.
    In addition, the Hand-off CEX is a reliable and valid tool to assess varying levels of videos depicting handoff
    performance.




                                                            27
17.	 Improving Post-Hospital Follow-up for Resident Clinic
     Patients Through a New Discharge Clinic
    Katrina Booth, MD; Amber Pincavage, MD; Lisa Vinci, MD; Beth White, PharmD



    Statement of Problem, Question, or Issue Addressed: University of Chicago internal medicine residents have
    consistently expressed difficulty in balancing inpatient responsibilities with outpatient continuity clinic patient
    care. This balance can be particularly challenging when trying to provide outpatient care for a medically
    complex clinic patient recently discharged from the hospital. Residents frequently cite limited appointment
    slots as a barrier to providing timely post-hospitalization follow-up care. Delayed time to follow-up in primary
    care also has implications for patients. Several studies have demonstrated that patients discharged from the
    hospital who are not seen in primary care clinic soon after discharge are at higher risk for readmission.

    Objectives of Program/Intervention: To improve both patient care and resident satisfaction, we have created a
    new weekly discharge clinic for resident continuity clinic patients who need early post-hospital follow-up.

    Description of Program/Intervention: The discharge clinic is a weekly half-day clinic which provides timely
    (1-2 weeks) post-hospital follow-up for resident continuity clinic patients who are unable to see their resident
    primary care physician due to lack of appointment openings. The clinic is staffed by a senior resident on an
    ambulatory rotation, a clinical pharmacist, and a general medicine attending preceptor. Visits are 1 hour in
    length, and each clinic can accommodate up to 4 hospital follow-up visits. The discharging teams are able to
    make appointments for patients via email and are asked to provide communication about the patients’ clinical
    needs prior to the visit.

    Results/Findings to Date: We plan to study the impact of the discharge clinic on time to follow-up in primary
    care after hospitalization, frequency of emergency room visits after hospitalization, and re-hospitalization
    rates. In addition, we hope to improve resident satisfaction with the balance of inpatient and outpatient
    responsibilities and provide education to residents about transitions of care after discharge.

    Key Lessons Learned/Conclusions: To date, residents have a positive experience with the clinic and anticipate it
    will improve care of their patients. Having a multi-disciplinary team is crucial to the quality of care provided.
    Key to the transition of care from inpatient to outpatient is communication between the inpatient team and the
    outpatient physician. Maintaining a high level of communication for these vulnerable patients has proven the
    most challenging aspect of this clinic to date.




                                                             28
  18.	 Characterizing Physician Listening Behavior During
       Hospitalist Handoffs using the HEAR Checklist
  Plenary
              Elizabeth Greenstein, MS3; Vineet Arora, MD, MAPP; Paul Staisiunas; Jeanne Farnan, MD, MHPE



              Statement of Problem, Question, or Issue Addressed: With the increasing use of hospitalists, handoffs have
Scholarship
              become more ubiquitous. Despite the increasing focus on handoffs by numerous physician groups, current
& Discovery
              recommendations and studies focus on the role of the person giving information in the handoff, or the sender.
              Given the importance of dialogue and two-way communication, we aim to observe and characterize listening
              behaviors of handoff receivers on an academic non-teaching hospitalist service.

              Objectives of Program/Intervention:
              1.   Displays of understanding, quantifying passive listening behaviors such as nodding,
              2.   Processing information, focusing on active listening behaviors such as note-taking and questioning
              3.   Interruption frequency and source

              Description of Program/Intervention: Handoffs were directly observed by a trained third party observer at
              a single academic medical center using the paper-based HEAR (Handoff Evaluation Assessing Receivers)
              checklist. The HEAR checklist was developed following a review of relevant literature and expert review.
              The checklist was piloted on the hospitalist service from June-November 2010. Descriptive statistics were
              performed and, where appropriate, two-sided t-tests, to compare passive and active listening behaviors. Pairwise
              correlations were calculated with the Handoff CEX instrument, developed to measure overall handoff quality.

              Results/Findings to Date: In the 48 handoffs observed, receivers displayed active listening behaviors significantly
              less frequently than passive listening behaviors (0.89 vs 1.65 (on a 0-3 scale) per handoff p<0.001). Read-back
              occurred 8 times (16.7%) and in 11 handoffs (23%) receivers took notes. The mean number of questions asked
              per handoff was 2.1, with 67% directly related to handoff content and 33% related to systems/other issues
              (mean of 1.42 vs 0.69 per handoff, p<0.01).

              Almost all (98%) of handoffs observed had at least one interruption and the median number of interruptions
              per handoff was 3 (0-12 per handoff ). The most frequent interruptions noted were: side conversations (42%),
              pagers going off (19%), and clinicians arriving for handoff (15%). Side conversations occurred at least once
              in 72% of handoffs, and the number of side conversations per handoff ranged from 0 to 5. Content included
              personal to job-related topics. The number of interruptions was also directly related to patients discussed. (r=
              0.56, p<0.01)

              Concurrent validity of the HEAR checklist was established by examining pairwise correlations with the
              domains of another measure of handoff quality, the Handoff CEX. A positive and significant correlation
              was observed between passive listening behaviors and four of the domains on the Handoff CEX: perceived
              communication skills (r=0.28, p<0.01), clinical judgment (r=0.31, p<0.01), patient focus(r=0.31, p=0.02) and
              overall assessment (r=0.24, p=0.02).

              Key Lessons Learned/Conclusions: Using the HEAR Checklist, we demonstrate that in hospitalist handoffs
              passive listening behaviors are common, while active listening behaviors that promote memory retention are
              rare. Handoffs are often interrupted, most commonly by side conversations. Future efforts should focus on
              education on listening behaviors for faculty and trainees and minimizing interruptions.




                                                                      29
 19.	 Risk of Resident Clinic Handoffs: Showing up is Half the
      Battle
         Amber Pincavage, MD; Megan Prochaska, MD; Julie Oyler, MD; Vineet Arora, MD, MAPP
MERITS



         Statement of Problem, Question, or Issue Addressed: Many patients nationwide change their PCP when
         departing Internal Medicine residents graduate. No studies have examined this handoff.

         Objectives of Program/Intervention: Our study aims to assess patient outcomes of these care transitions.

         Description of Program/Intervention: In June 2010, graduating residents listed “high risk” patients on a signout
         with reasoning, target follow-up, and pending studies. Residents then discussed the patients during a designated
         handoff meeting. Chart audits examined when high risk patients were seen and by whom, acute care visits in 3
         months after the transition and if there were any associations between the clinic handoff process and outcomes
         (ED visits, hospitalizations and study follow-up). Residents assuming care were surveyed regarding their
         perceptions.

         Results/Findings to Date: Thirty graduating residents identified 258 high risk patients. Mean age was 61, 63%
         were female, and on average patients were transitioning to their 3rd PCP in 5 years. These patients had more
         co-morbidities (2.6 vs. 1.7, p<0.00001) and were more likely to be seen in the ED (58% vs. 42%, p<0.0001) or
         hospital (37% vs. 23%, p<0.0001) over 2 years than other resident patients. Nearly all the patients (97%) were
         scheduled for follow-up. However, one-third (29%, 75/258) of patients “no showed” or cancelled their first new
         PCP visit. Only 44% (113/258) of patients saw the correct PCP. Six months later, one fifth of patients had not
         been seen. Of 30 studies, 43% were not followed-up and 2/3 of these where abnormal or incomplete. Patients
         who missed their first PCP visit were less likely to have tests followed-up (0% vs. 75%, p<0.0001). A higher
         EMR “No show rate” (approximately 20%) was associated with a worse clinic handoff: seeing the incorrect PCP
         (p=0.05), missing the 1st PCP visit (p<0.001) and being lost to follow-up (p=0.02). While 47% of residents
         worried about missing important data, a similar proportion (48%) reported that patients are not ‘theirs’ until
         they are seen in clinic.

         Key Lessons Learned/Conclusions: While most patients were scheduled for appointments, many were not seen
         by the correct resident. Patients who miss appointments are especially at risk of poor outcomes after clinic
         handoffs. Future efforts should improve patient attendance to their first new PCP visit and increase PCP
         ownership.




                                                                30
20.	 Medical Education Curricula: Integrating Healthcare
     Quality and Patient Safety
    Elizabeth Rodriguez, MBA, MS; Kevin Weiss, MD, MPH



    Statement of Problem, Question, or Issue Addressed: Medical schools are trying to incorporate patient safety
    into both the formal and informal curriculum through development of education programs for faculty, staff,
    and trainees. But most medical schools have not incorporated any content on patient safety or quality. Even
    though, some safety and quality elements have been incorporated into organizational core competencies, the
    competencies that comprise patient safety remain unclear.

    Objectives of Program/Intervention: In order to demonstrate that medical schools must model excellence in
    their curriculum by integrating healthcare quality and patient safety (“HQS”), I concentrated on the new
    Northwestern Feinberg School of Medicine Physician Assistant Program (“Program”) as a pilot area in order
    to provide some guidance in integrating HQS curriculum. The Program is part of the school of medicine and
    started its first class in June 2010. It is an accredited, two year program that uses lecture, small group discussion,
    clinical experiences, team-based learning and problem-based learning. However, it does not have formal
    curriculum on HQS. Nonetheless, for the first time, HQS is required to be part of its curriculum. Thus, I
    developed and delivered a curriculum providing an overview of topics in HQS and assessed Physician Assistant
    (“PA”) student learning through the application of three assessments.

    Description of Program/Intervention: My intervention consisted of a short three hour seminar provided to all
    30 current students and first cohort of the Program. I coordinated the sessions, materials and logistics as well
    as three assessments. The PA student learning objectives were: (1) PA students will implement and measure
    improvements in their own practice setting and (2) improve their communication skills as they relate to
    the discussion of medical mistakes. The learning objectives were broken into detailed elements. These were
    then linked to the assessment that included the measure of key content taught at the seminar. Moreover,
    the seminar’s curriculum was also directly linked to the learning objectives, but also to the Program’s core
    competencies and curriculum requirements.

    Results/Findings to Date: While I could not assess improvement in patient care directly, I measured how
    knowledge in HQS was improved. There was a pre-quiz, post-quiz 1 (conducted the same day as the seminar)
    and a post-quiz 2 (completed one month after the seminar). Overall, the seminar intervention was a success
    because it resulted in higher scores in both post-quiz 1 and post-quiz 2. In the pre-quiz, all students scored
    under 60% (correct); in post-quiz 1, students scored mostly between 61-80%; and during post-quiz 2,
    most students scored between 51%-80%. However, post-quiz 1 scores are higher than post-quiz 2, which
    demonstrate deterioration of knowledge over time (proving that PA students will benefit from another seminar
    during their year 2 for reinforcement).

    Key Lessons Learned/Conclusions: PA students were able to attain a snippet of HQS curriculum. However, the
    results demonstrate that there is still much room for improvement, since the scores are not high enough to
    prove mastery in HQS. In fact, besides annually providing this type of seminar for all first year PA students,
    another seminar in the PA students’ second year with reinforcement elements and curriculum that was not
    covered during this first seminar may be a potential future investment. It is our duty as teachers and educators
    to ensure that patient care is directly improved through the training and resources that we provide new students
    and even current practitioners. In addition to this return on investment, these types of seminars will drive future
    Program rankings. However, it is important to consider a fully developed course with detailed HQS curriculum
    that should be embedded in the Program’s core curriculum, which will yield a maximum return on investment.




                                                             31
21.	 Role of Social Media in Graduate Medical Education: A
     Blogger’s Perspective
    Wilma Chan, MD; James Ahn, MD; Alisa McQueen, MD; Christine Babcock, MD, MSc



    Statement of Problem, Question, or Issue Addressed: Emergency Medicine Residents (EM/EMR) are
    overwhelmed with busy, irregular work hours and keeping up with medical literature becomes infrequent. Adult
    learners acquire information more readily if materials are provided in a variety of formats. Learning materials
    presented through interactive Social Media (SM) may increase the accessibility and frequency of EMRs self-
    learning.

    Objectives of Program/Intervention: A daily EM blog will increase the frequency of residents self-learning by
    providing accessibility to educational materials.

    Description of Program/Intervention: “Mitchell Cases,” an online weblog (“blog”) presents board-style questions
    with high-yield explanations detailing evaluations, diagnostics, treatments, and dispositions. Case questions
    posted at the beginning of the week encourage discussion of the clinical problem through the comments
    section. Participants submit answers anonymously and a case summary is posted at the end of the week. Topics
    highlight the core content of EMR curricula--the esoteric as well as high risk cases, including cardiac arrest,
    toxicology, environmental exposure, and endocrine emergencies. Additional blog entries feature EM faculty
    reviews of current literature, lecture summaries, EMR study tools, and career guidance. All posts and patient
    information are protected with private access only for EMR and faculty. Daily blog posts are scheduled Monday
    through Friday and Google Analytics gathers anonymous data such as: user traffic, time of day, frequency, and
    visit duration.

    Results/Findings to Date: Sixty-four invited visitors have access to the blog. Between August 26-September 25
    2011, Google Analytics data show 47 distinct visitors who follow the daily blog with a total of 234 visits and
    598 distinct pages viewed. Ninety-two percent of the 47 visitors return to the blog between that same period.
    On average, there are twice as may visits on Mondays and Tuesdays, independently, compared to other days of
    the week. Average time spent on the blog is 3min 49sec and visitors consumed between 1 to 6 distinct pages at
    each visit to the blog (average 2.56 pages).

    Key Lessons Learned/Conclusions: The educational blog is an interactive SM tool in graduate medical education
    (GME) that is accepted among EMR--data indicate its consistent use among returning visitors. Although SM
    has not gained complete acceptance in medical education settings, use of SM in GME may eventually replace
    more traditional learning methods. It is imperative for EM faculty and GME programs to be comfortable using
    SM tools for disseminating formal/ informal educational materials. It is unclear whether this format improves
    EMR clinical knowledge/ practice or standardized test scores--variations in individual study skills, experience,
    and small sample size do not allow us to make this conclusion. Future directions would include larger surveys
    and studies of EMR performance in clinical and test settings.




                                                           32
22.	 Exploring Opportunities and Challenges Posed by
     Technology Integration: A Simulation Workshop for First
     Year Medical Students
    Vikrant Jagadeesan, MS2; Angela Blood, MPH, MBA; Stephen Small, MD; Saeed Richardson



    Statement of Problem, Question, or Issue Addressed: The University of Chicago Simulation Center (UC Sim)
    was approached by a student-led organization, Students for the Advancement of Technology in Medicine,
    to create an event for first year medical students (MS1) for several reasons. First, there was limited awareness
    among pre-clinical medical students about simulation technology and resources. Second, the multi-station
    approach would allow students to observe technology integration in various clinical settings. Third, many MS1
    elective events are lecture-based, while a workshop would allow for active learning.

    Objectives of Program/Intervention: One of the challenges in creating a workshop for MS1 students was to
    ensure that the content would be specifically tailored to the learner’s level of experience and ability. While first
    year medical students did not have extensive clinical experience, they did have background in specific training,
    such as CPR, that could be applied. In order to address the purpose of the project while considering the
    learner’s abilities, the educational goals were to:
    1.   Expose first year medical students to simulation and technology at the University of Chicago.
    2.   Gauge the students’ understanding of the opportunities and challenges posed by technology in medicine.
    3.   Provide a conceptual framework for considering technological integration as it relates to patient safety and
         clinical outcomes.

    Description of Program/Intervention: A pilot workshop for 11 medical students began with a short didactic to
    introduce a conceptual framework. Content included examples of technology integration with both positive
    and negative consequences for patients, and a discussion of the changing job environments and training needs.
    Students then were separated into groups of three, and participated in five stations of 20 minutes each.
    Station I: Robotic Surgical Skills, Dr. Konstantin Umanskiy
    Station II: Laparoscopy Surgical Skills, Dr. Vivek Prachand
    Station III: Use of Ultrasound in Guiding Central Line Placement, Dr. Sean Smith and Dr. Nilam Soni
    Station IV: Interprofessional Team Training, Cynthia LaFond, R.N., Dr. Heather Fagan, Dr. Lisa McQueen
    Station V: Clinical Care Vignettes, Dr. Stephen Small
    Faculty leaders were recruited from Surgery, Hospital Medicine, Nursing, Pediatrics, and Anesthesia,
    emphasizing UC Sim as an institutional core facility.

    Results/Findings to Date: A course evaluation was included, collecting both quantitative and qualitative data.
    The student comments were overwhelmingly positive (M = 4.81 on a scale of 1-5), repeatedly requesting
    further workshop sessions. The qualitative data was especially informative, and will be showcased in the poster.

    Key Lessons Learned/Conclusions: Future sessions are planned for Fall 2011 to introduce UC Sim to the
    new MS1 class and current MS2 students. We will investigate the utility of integrating simulation into the
    existing pre-clinical curriculum. In addition, 100% of the students responded favorably to the prospect of a
    novel fourth-year elective course. Finally, student reflection during the debriefing session revealed that early
    simulation exposure and training could be a valuable preparatory exercise for the clinical years of medical
    education.




                                                             33
 23.	 ABCs in the Sandbox: Interdisciplinary Trauma Team
      Training
         Alisa McQueen, MD; Michele Harris-Rosado, RN, BSN; Grace Mak, MD; Mindy Statter, MD
MERITS



         Statement of Problem, Question, or Issue Addressed: Comer Children’s Hospital at the University of Chicago
         hosts the only Level I Trauma Center on the south side of Chicago, caring for over 400 injured children
         meeting “level 1” trauma criteria annually. While providing this important clinical service, the pediatric
         trauma and pediatric emergency medicine teams provide clinical education to over 200 residents each year.
         The critically injured child deserves the very best performance from all of us, requiring both institutional
         preparedness and personal preparedness. Our teams of physicians, nurses, technicians, and ancillary staff change
         frequently, and the critically injured child can arrive to the emergency department with little to no advance
         warning, so maintaining that institutional preparedness and personal preparedness is challenging. One strategy
         is through medical simulation.

         Objectives of Program/Intervention:

         1.   Practice the cognitive, motor, and communication skills required to resuscitate a critically injured child in a
              multidisciplinary team setting.

         2.   Critically evaluate one’s own performance and the team performance and deliver effective feedback during
              structured debriefing sessions.

         3.   Identify individual gaps in performance in order to form the foundation for deliberate practice of skills
              needed to resuscitate the critically ill child.

         Description of Program/Intervention: In the summer of 2010, we established monthly trauma resuscitation
         simulation exercises with support from the UC Simulation Center. Participants include surgical residents,
         emergency medicine residents, and emergency nurses who work as a team to resuscitate the “patient.” Scenarios
         simulate an actual trauma resuscitation using a computerized child mannequin, actual medications, and
         actual equipment. The recent addition of a procedure simulator allows trainees to perform invasive procedures
         including cricothyroidotomy, tube thoracostomy, and pericardiocentesis. Scenarios are videotaped and reviewed
         with all participants after each scenario, facilitated by faculty in a non-threatening debriefing session. Scenarios
         originate from prior challenging situations, and are designed both to train participants in a safe setting as well as
         to explore potential gaps in knowledge and performance.

         Results/Findings to Date: Participants report high levels of satisfaction with pediatric trauma simulation
         training. Features that contribute to a successful exercise include:
         1.   The opportunity to demonstrate improvement in a second simulation.
         2.   Conducting the exercises “in situ” in our trauma bay.
         3.   Interdisciplinary representation (nursing, surgery, emergency medicine).
         4.   The addition of a task trainer in which actual procedures are performed on the simulator.

         Key Lessons Learned/Conclusions: Simulation training provides important team training for our residents
         and nursing staff. We are currently working to broaden staff participation to include radiology technicians,
         respiratory therapists, and ancillary staff who are critical participants in the resuscitation of the critically injured
         trauma patient. The next step is to identify ways in which simulation training impacts on actual patient care.
         Performance measurement tools are in development to begin to answer this question.




                                                                    34
24.	 Participant Satisfaction with Simulation of Minimally
     Invasive Spine Surgery Using Virtual Reality and Haptics
    Ben Roitberg, MD; Pat Banerjee, PhD



    Statement of Problem, Question, or Issue Addressed: In the era of duty hour restrictions and emphasis on patient
    safety neurosurgery and other surgical specialties face an increasing need to enhance surgical training with
    simulation of key surgical tasks.

    Objectives of Program/Intervention: The purpose of this study was to evaluate participant satisfaction
    while performing a percutaneous spinal procedure on a head- and hand-tracked high-resolution and high-
    performance virtual reality and haptic technology workstation. We also aim to collect data on performance and
    accuracy.

    Description of Program/Intervention: 134 neurosurgery fellows and residents trained on an ImmersiveTouch
    system (63 on Thoracic 9,10 and 11 and 71 on Lumbar 2,3 and 4 virtual models). A virtual Jamshidi needle
    was percutaneously inserted into a virtual patient’s pedicle derived from a computed tomography data set.
    An entry point on bone surface and a target point within bone were predetermined by a spine neurosurgeon.
    Participants were allowed up to five minutes of practice attempts. They were then asked to repeat what they
    practiced. Accuracy (average Euclidean distance from predefined entry and target points) was measured for each
    insertion. Every participant was requested to fill an anonymous form asking whether they were satisfied with
    the realism of the simulation, and if not explain why.

    Results/Findings to Date: 108/134 participants filled the feedback form, 105 were satisfied and 3 were
    dissatisfied with the realism of the simulation experience. Those dissatisfied cited inability to see the image in
    3D. There were 268 measured attempts to insert the virtual needle, 248 successful, and 20 breached bone; 9
    out of 126 ( 7.14%) failed in the thoracic group, and 11/142 (7.5%) failed in the lumbar group (NS). Mean
    accuracy score of successful attempts was 13.83 mm (SD 6.74 mm).

    Key Lessons Learned/Conclusions: Satisfaction with the realism of the simulation is high. We plan a more
    detailed questionnaire in future studies. The accuracy of pedicle needle placement achieved by participants
    using the simulator is comparable to that reported in recent literature, further evidence of simulation realism.




                                                             35
25.	 Incorporating Ultrasound Education into Anesthesia
     Resident Training: A Two Year Study
    Matthew Satterly, MD; Angela Blood, MPH, MBA; Jeffrey Katz, MD



    Statement of Problem, Question, or Issue Addressed: Ultrasound technology is increasingly utilized in patient
    care and is recommended by regulatory bodies to enhance patient safety. In anesthesiology, ultrasound
    guidance is frequently employed to secure vascular access or place peripheral nerve blocks. While residents have
    opportunities in clinical settings to use ultrasound, it can be a rushed experience and finer nuances for optimal
    utilization may not be appreciated.

    Objectives of Program/Intervention: To create an educational program including topics from basic function to
    identification of anatomical structures necessary to safely perform various procedures, the programmatic goals
    were to:
    1.   Assess current understanding of ultrasound technology,
    2.   Assess knowledge of anatomical relationships used for vascular access/peripheral nerve blocks,
    3.   Educate in a concentrated fashion in these areas with multiple methods,
    4.   Assess knowledge growth by using a pre- and post-test after an Ultrasound Workshop.

    Description of Program/Intervention: During the week of September 12-17, 2011, residents attended morning
    lectures on various issues related to the use of ultrasound in patient care. Lecture topics included: the physics of
    ultrasound and use of the equipment (‘knobology’), specific peripheral nerve blocks, and a live demonstration
    of ultrasound and anatomy. The week culminated with a workshop during which participants were split into 5
    groups which rotated amongst 5 faculty-led stations, including: the ultrasound machine, vascular access (both
    arterial and venous), upper extremity peripheral nerve blocks, popliteal/posterior sciatic nerve blocks, and
    femoral/anterior sciatic nerve blocks. Residents also had the opportunity to practice using ultrasound on gelatin
    molds in order to practice manipulation of the ultrasound probe and needle placement. The standardized
    patient-based stations allowed the residents to make direct comparisons of various physical anatomies within the
    context of procedure planning.

    To establish a baseline of the residents understanding of the use of ultrasound as it relates to patient care in
    anesthesiology prior to the educational intervention, all participants were administered a pre-test written
    by faculty who led the workshop and didactic series. At the conclusion of the workshop a post-test was
    administered to assess knowledge growth

    Results/Findings to Date: Using data collected over two years (2010, 2011), we found that the course
    evaluations submitted by the participants were uniformly positive. Residents stated they felt more facile with
    the equipment, were better at identifying key anatomical structures, and gained a better appreciation for
    ultrasound. Performance on a knowledge test pre and post intervention found a significant improvement in test
    scores after the intervention.

    Key Lessons Learned/Conclusions: Subjectively, residents feel much more confident about their skills utilizing
    ultrasound technology in patient care if they have the opportunity to take part in a simulation exercise with
    ultrasound on standardized patients. The ability to gain hands-on experience in a low stress environment by
    scanning live anatomy was deemed to be of great benefit. This program can also be readily adapted to train
    other UCMC personnel (students, residents, nurses, faculty, etc).




                                                             36
26.	 Pilot Curriculum for Teaching Residents Single Incision
     Laparoscopic Surgery (SILS): A Patient Safety Initiative
GME     Nancy Schindler, MD; Michael Ujiki, MD; Vivek Prachand, MD; Jose Velasco, MD
Grant


        Statement of Problem, Question, or Issue Addressed: Emerging technology and new surgical procedures are
        difficult to incorporate into surgical training.

        Objectives of Program/Intervention: This pilot curriculum was designed to investigate the feasibility and
        effectiveness of a multistage model of teaching new surgical procedures.

        Description of Program/Intervention: The Single Incision Laparoscopic Surgery (SILS) curriculum includes
        four stages:
        Stage 1: An electronically delivered, interactive module designed to equip residents with the required knowledge
        about indications, contraindications, risks, benefits and rationale for this new procedure.
        Stage 2: A box trainer simulation module designed to teach residents the required technical skills to participate
        successfully in a live animal SILS procedure.
        Stage 3: A swine animal lab designed to provide a safe learning environment for residents to perform their first
        SILS procedures and to improve their technique in a high fidelity environment.
        Stage 4: A live patient experience. Only after successfully demonstrating the required knowledge and skills, a
        resident will participate in an appropriately supervised live patient SILS operation.

        Results/Findings to Date: Stage 1: Residents participated in the electronically delivered curriculum and were
        successful in demonstrating significant gains in knowledge. Resident scores improved from 38% correct on a
        pretest to 92% on the post test. All residents met the required 85% correct to be eligible for the Stage 2 lab.

        Stage 2: Residents participated in a box trainer lab followed by both in lab and at home practice. Residents were
        assessed using a modified FLS (Fundamentals of Laparoscopic Surgery) scoring rubric. Upon completing the
        lab and providing practice time, only 30% of residents achieved a passing score. With additional opportunities
        for practice and re-testing, an additional 25% (total of 55%) achieved a passing score for the lab. The remaining
        residents did not pass and were not able to move on to Stage 3.

        Stage 3: Eleven residents were eligible for the Stage 3 animal lab and five attended the first Stage 3 lab. The
        first part of the lab was an opportunity for residents to practice their skills and to receive feedback on the live
        animal model. After completing either a SILS appendectomy or cholecystectomy in the first part of the lab,
        the residents were assessed on a new SILS procedure: a small bowel repair. Residents were scored using two
        checklists. Four out of five of the residents were successful in achieving a passing score on this task and will be
        eligible to proceed to the live patient experience. One resident will need to repeat the lab and be retested.

        Resident evaluation of the curriculum has been very positive, however, resident self-assessment of knowledge
        and confidence in SILS has not demonstrated significant improvement.

        Key Lessons Learned/Conclusions: Although SILS requires similar skills to traditional laparoscopic surgery,
        we found that residents required more than the anticipated amount of training and practice to ascertain the
        required skill level. This suggests that we may over-estimate our learners’ readiness to perform procedures and
        that appropriate supervision and guidance in the OR is important for patient safety. More study is needed to
        identify if box trainer practice alone will improve these skills or if the animal lab might be able to expedite
        achievement of the required skill level.




                                                                 37
27.	 Publishing Evidence-based Medicine Writing Projects with
     Students
    Umang Sharma, MD; Mari Egan, MD, MHPE; Adam Mikolajczyk, MD



    Statement of Problem, Question, or Issue Addressed: There are studies describing publication of evidence-based
    medicine (EBM) writing projects with residents, but to our knowledge, there have been no reports about
    publishing such projects with medical students.

    Objectives of Program/Intervention: EBM writing projects provide an opportunity to teach EBM skills, hone
    student writing, enhance faculty editing skills, introduce students to the publication process, and provide
    publication for both students and faculty.

    Description of Program/Intervention: After reviewing the rationale for undertaking these projects, we will
    describe how we have been using an EBM writing project with fourth year students on their family medicine
    clerkship.

    Results/Findings to Date: We will review accomplishments and challenges we have had in implementing the
    program. A former student author will be present to discuss his view of the experience.

    Key Lessons Learned/Conclusions: We will review tactics to promote student success.




                                                          38
28.	 Simulation-based Ultrasound Guidance and Procedure
     Training in Hospital Medicine: A Faculty Development
     Pilot Project
    Nilam Soni, MD; Angela Blood, MPH, MBA; Stephen Small, MD



    Statement of Problem, Question, or Issue Addressed: The incorporation of technological innovations into the
    practice of medicine continues to evolve healthcare at a rapid pace. The use of portable ultrasound for guidance
    of bedside procedures is evolving into the standard of patient care. Patient safety may be compromised when
    newer techniques are not integrated into routine practice in a timely manner. A needs assessment revealed that
    a minority of physicians feel comfortable with the use of ultrasound technology or portable ultrasound to guide
    procedures. Achieving a mastery understanding of ultrasound technology is a necessary building block for
    performing ultrasound-guided procedures.

    Objectives of Program/Intervention: The educational objectives of the program were to:
    1.   Create a continuing medical education (CME) curriculum for understanding the fundamental principles
         of ultrasound and ultrasound-guided bedside procedures (central line placement, thoracentesis,
         paracentesis, lumbar puncture).
    2.   Provide opportunities for practice and demonstration of ultrasound-guided procedure skills with
         simulation task trainers and real-time feedback.
    3.   Develop assessment tools for the use of ultrasound in various procedures.

    Description of Program/Intervention: For both new and seasoned practitioners, the curriculum offered through
    The University of Chicago Simulation Center (UC Sim) included:
    1.   Understanding of ultrasound and procedural equipment
    2.   Awareness of indications and potential complications
    3.   Methods to perform the procedures
    4.   Practice of manual dexterity
    The content for each of the five modules included:
    1.   Pre-test
    2.   Didactic session
    3.   Video of procedure
    4.   Review of the procedural kit contents
    5.   Hands-on practice with simulation task-trainers
    6.   Scanning of patients
    7.   Post-test
    8.   Course evaluation
    From January through May 2011, the curriculum was delivered to a total of 25 hospital medicine providers. All
    participants attended the ultrasound and paracentesis modules. Participation in the remaining three modules
    (thoracentesis, CVC, and LP) was left to the discretion of the individual, as some hospital medicine providers
    perform only certain procedures in practice.

    Results/Findings to Date: A preliminary analysis of the pre-test and post-test data revealed that there was
    statistically significant knowledge growth for the participants who took part in the use of ultrasound module.
    Further analysis will be conducted to assess the significance of knowledge growth in the remaining learning
    modules. This preliminary finding is encouraging as it appears that the brief, simulation-based curriculum was
    effective in increasing the participants understanding and correct application of ultrasound technology.

    Key Lessons Learned/Conclusions: Based on the success of this pilot project, we appreciate that concise,
    simulation-based training sessions designed for busy clinicians can be effective at teaching basic ultrasound
    skills, and possibly other new technologies. The data are limited from this pilot program, but it does suggest
    that a brief training session for ultrasound-guided paracentesis may also increase knowledge of the procedure.
    Finally, the rate of skill extinguishment should be studied to determine how often training sessions must be
    held, or how many procedures must be completed, to maintain clinical expertise.



                                                           39
29.	 The TIME (Technology in Medical Education) Project
     2011: An Update– The Past, Present and Future
    Scott Stern, MD; Brian Paterson



    Statement of Problem, Question, or Issue Addressed: Current and developing technologies provide an almost
    endless array of possibilities to augment medical education, limited more by the imagination than inherent
    limitations in technology. The TIME project continues to develop new technologies and create meaningful
    partnerships that are allowing us to create new, innovative, and cutting edge tools that create a dynamic,
    interactive, competency based medical curriculum.

    Objectives of Program/Intervention: The TIME project has 4 objectives. First, to enhance vertical integration
    within the curriculum. Second, to facilitate the use of technology tools within and beyond the classroom.
    Third, to create dynamic, interactive, case based simulations to teach clinical reasoning and an array of topics
    in the medical school curriculum. Fourth, such tools could also be harnessed to develop a competency based
    curriculum.

    Description of Program/Intervention: First, to achieve vertical integration, a new content management system
    (TIME-Space) was developed which captures lectures and other electronic curricular materials, stores and
    indexes these materials and makes them discoverable and reusable by students throughout the curriculum.
    Second, to augment the use of electronic teaching tools, TIME-Teach, a web based teaching resource, is being
    developed. Third, two interactive software projects are under development that will teach clinical reasoning
    and other basic science content. The first software tool provides a step by step diagnostic aid to students and
    residents as they evaluate patients with common internal medicine problems. The aid prompts students for
    key information from the history and physical exam and systematically limits the differential diagnosis as data
    is entered. This web based program will run on Smart phones, i-Pads and computers. An additional software
    project is being developed in conjunction with i-Human by Summit Performance. This interactive simulation
    will provide hundreds of interactive patient cases that will be linked to interactive learning exercises that can
    help to reinforce topics throughout the basic science and clinical curriculum. Ideally, such a program could
    ensure exposure to key diseases and document competency and mastery of key topics.

    Results/Findings to Date:
    1.   TIME-Space has been widely used by the students who download thousands of documents each month.
    2.   TIME-Teach will continue being developed this year with the recent addition of Elissa Johnson to the
         TIME team.
    3.   The diagnostic app is under active development with the expected release of a beta version by January 1,
         2012. Already decision tress for more than half of the key symptoms in internal medicine have been
         created and are being converted to programming code. Finally, active discussions have begun with
         core faculty from the basic science curriculum who have begun work on the simulation project as we
         evaluate funding opportunities to spur development.

    Key Lessons Learned/Conclusions: Support from the Pritzker School of Medicine and BSD has been critical in
    the development of electronic tools to facilitate medical education. These tools augment vertical integration and
    will continue to push the envelope as they teach clinical reasoning, basic science content, provide interactive
    learning modules and provide a tool for ensuring broad exposure, assessing competency and mastery of
    material.




                                                            40
   30.	 The Use of an Educational Simulation to Improve
          Neurology Resident Knowledge of and Experience with
  Plenary
          Thrombolytic Therapy
              Rachel Stork, MS3; Jeffrey Frank, MD; Morris Kharasch, MD; Ernest Wang, MD

Scholarship
& Discovery
              Statement of Problem, Question, or Issue Addressed: Intravenous thrombolytic therapy (rt-PA) is the only FDA
              approved treatment for restoring brain blood flow in properly selected acute ischemic stroke patients, however
              many neurology residents will graduate with little or no experience with rt-PA use. rt-PA is underutilized in
              acute stroke patients and the inappropriate use of rt-PA leads to a higher risk of complications. Studies have
              linked underutilization and inappropriate use to lack of physician experience and training. Physician experience
              with rt-PA during training will be further limited by duty hour restrictions.

              Objectives of Program/Intervention: To assess if a simulated learning experience could improve Neurology
              resident knowledge, skill and experience with management of acute ischemic strokes.

              Description of Program/Intervention: Simulation is an educational modality well suited to increasing physician
              experience and training with the management of acute stroke patients with thrombolytic therapy, without
              risk to patients.In order to direct the design of the simulation curriculum, a short structured interview was
              conducted with 23 neurology residents, emergency medicine residents and neurology attendings to identify
              learning objectives for the simulation. Case data from the literature and from patients seen at University of
              Chicago were used to write case discussions and standardized patient/high fidelity patient simulator scenarios,
              which exemplified these objectives. These were encorporated into a half day educational simulation.

              Results/Findings to Date: The simulation was initially piloted with 4 medical professionals from the University
              of Chicago. Feedback from the pilot was used to improve the curriculum, which was then implemented with
              8 Neurology and Emergency Medicine resident volunteers from University of Chicago. All participants ranked
              their confidence in overall ability to manage acute stroke with thrombolytics higher after completing the
              simulation. The majority of participants (63%, n=8) went from incorrectly identifying the reversal agent to
              correctly identifying the reversal agent. In the exit survey, a majority of participants (88%, n=8) strongly agreed
              with the statement “I feel that I learned more in the simulation than I would have learned in a lecture covering
              the same material”.

              Key Lessons Learned/Conclusions: Simulation is an efficient and effective modality for improving knowledge of
              experience of Neurology residents with thrombolytic therapy.




                                                                      41
31.	 Wait Till Your Father Sees This! Simulation Training for
     Residents During their Pediatric Anesthesia Rotation
    Igor Tkachenko, MD; Michael Hernandez, MD; Stephen Small, MD



    Statement of Problem, Question, or Issue Addressed: During the Pediatric Anesthesia rotation anesthesia
    residents are exposed to variety of clinical cases. The goal of this rotation is to provide anesthesia residents
    with the most diverse clinical experience. One of the challenges in Pediatric Anesthesia is a skill of managing
    anxiety in parents as well as children. Parent present induction (PPI) is a common modality of stress-reduction
    in children undergoing induction of general anesthesia, where parents are present as the child goes off to sleep.
    The anesthesiologist is not only responsible for a safe anesthetic induction in the child, but also must manage a
    concerned parent. Dealing with complications and managing the patient’s airway in the presence of the parent
    can be difficult. Some parents become extremely anxious and can refuse to leave the OR. Often, residents never
    experience this clinical scenario during their training.

    Objectives of Program/Intervention:
    1.   Provide exposure to a rare but challenging pediatric anesthesia situation in a controlled environment.
    2.   Provide residents with the opportunity to manage this clinical scenario independently.
    3.   Provide the resident with the opportunity to watch the video recording of the case, discuss it, and receive
         feedback.

    Description of Program/Intervention: Anesthesia residents are offered an opportunity to participate in
    simulation training. Residents are given an introductory orientation to the simulation environment. A pediatric
    manikin is used with a team member playing the role of the “parent”. During mask induction the “child”
    develops airway complications, and the “parent” becomes extremely agitated and refuses to leave the OR.
    Residents are called upon to manage the patients complications as well as psychological aspect of dealing with
    an emotional parental response.

    Results/Findings to Date: Residents are asked to submit formal evaluations as well as informal feedback of the
    simulation case. Eighteen residents participated in the Simulation Training up-to-date and 18 responses were
    received. The residents were asked to rank the case on the scale from 1 to 5, with 1 representing “not at all” and
    5 representing “very much”. The question “Did the scenario seem realistic”, 17% ranked it 3, 11% - 3.5, 61% -
    4, and 11% - 5. The question “ Would you want to do more simulation training of this kind”, was answered as
    following: 15% - 3; 28% - 4, and 67%-5.

    Key Lessons Learned/Conclusions:

    1.   Simulation training is a valuable tool for providing exposure to rare clinical circumstances that residents
         may not otherwise get to experience.

    2.   Using a simulation allows the resident to function autonomously in a crisis, in contrast to a true clinical
         scenario in which an attending would likely intervene.

    3.   Video review of performance is helpful to allow residents insight into their rapport with the patient’s
         family.




                                                            42
32.	 Doctoring Without a Script: The Improvising Physician
    Daniel Brauner, MD; Gretchen Case, PhD



    Statement of Problem, Question, or Issue Addressed: Teaching students and physicians how to interact with
    patients in a compassionate and empathetic manner while still attending to the more factual and scientific
    aspects of this communication is a crucial agenda item for both undergraduate and postgraduate medical
    curricula. Previously we called for a more conscious appreciation of the physician as a performer and posited
    that empathetic imagination can be used as a tool for encouraging deeper doctor-patient interactions. In this
    project we look more closely at an aspect of this performance that can help to deepen this interaction further
    and is also an essential component of developing an empathic imagination, improvisation. Although the clinical
    encounter is highly structured this does not mean that it need necessarily be scripted, a potential pitfall of many
    curricular aimed at improving communication.

    Objectives of Program/Intervention: The objective of this program is to explore how improvisation as a method
    of rehearsal in the theater can be applied as a model for doctors, both in training and in practice for interacting
    with patients.

    In order for doctors to really engage with patients it is important to identify areas where physicians rely on
    scripted responses to sets of clinical issues.

    Doctors and those in training will learn how to incorporate the core concepts of improvisation when
    communicating with standardized and then actual patients.

    Description of Program/Intervention: By incorporating the underlying principle of improvisation, the “Yes,
    and...concept,” doctors can begin to learn to interact with their patients in an a real and empathic manner that
    honors the unique aspect of each patient in a way that more scripted discourse cannot.

    Results/Findings to Date: This is a theoretical construction to date but examples from programs that have begun
    using improvisation will be explored.

    Key Lessons Learned/Conclusions: Methods from improvisation can be applied to teaching about
    communication with patients as well as actually communicating with patients.




                                                            43
33.	 Migration Analysis of Physicians Practicing in Hawaii from
     2009-2011
    Laura Dilly, MS4; Kelley Withy, MD, PhD; Goutham Rao, MD



    Statement of Problem, Question, or Issue Addressed: Hawaii currently suffers a 20% shortage of physicians. A
    growing and aging population, coupled with the fifth-oldest physician pool in the United States, make Hawaii’s
    physician shortfall poised to worsen. The state’s unique cultural, geographic, and practice settings make
    physician recruitment challenging. This study was undertaken to examine physician migration patterns into and
    out of Hawaii to better inform physician recruitment and retention techniques.

    Objectives of Program/Intervention: To determine patterns of physician movement into and out of Hawaii.

    Description of Program/Intervention: This study used 2009-2011 practice location data on all non-military,
    practicing physicians in Hawaii, a secure resource maintained by the University of Hawaii John A Burns School
    of Medicine - Area Health Education Center (AHEC). Medical school attended was electronically extracted
    from an AMA Masterfile list for allopathic physicians and from the Internet and colleagues for osteopathic
    physicians. Internet searches and telephone calls to clinician’s offices were employed to ascertain practice
    location as of September 2011.

    Results/Findings to Date: There are currently 3,187 actively practicing physicians in Hawaii. Of these, 2,707
    (84.9%) trained at US medical schools (136 medical schools represented), 2615 (96.5%) attended an allopathic
    institution, and 92 (3.4%) attended an osteopathic institution. Nearly half of all US-trained physicians
    attended medical school in Hawaii, California, New York, Illinois, or Pennsylvania. International medical
    graduates represented 191 medical schools from 67 distinct countries, primarily in the Philippines or the
    Caribbean (23.1% and 14.0% of the 480 international medical graduates, respectively).

    Between 2009 and 2011, a total of 238 physicians listed on the AHEC database retired from medicine or
    transitioned to non-clinical activities, and 329 physicians left Hawaii to practice in other locations. California
    received the largest portion of Hawaii’s former physicians (26.7%). No other state received more than 5% of
    the physicians who left Hawaii. Only 15.5% of physicians returned to the state where they attended medical
    school, and graduates from California represented 45% of this subset.

    Key Lessons Learned/Conclusions: As Hawaii’s physician shortage is poised to worsen, optimizing physician
    recruitment and retention has become a critical priority. Aside from the strong representation from John A.
    Burns School of Medicine, medical schools with some of the most alumni practicing in Hawaii (e.g., Creighton,
    UCLA, UCSF, Georgetown) all have active Hawaii student clubs. This may indicate larger populations of
    students from Hawaii or a greater interest in the state. Therefore, this research recommends targeting medical
    schools with Hawaii clubs for recruitment efforts. Furthermore, examining residency training location in
    relation to practice in Hawaii would be beneficial.

    Few trends are apparent when considering the physicians who left Hawaii to practice elsewhere. Other
    than California, which gained over a quarter of the physicians departing Hawaii, no region or alma mater
    demonstrates notable associations with physician emigration. Future study recommendations include examining
    residency location and conducting exit surveys of physicians leaving Hawaii to identify primary reasons for
    leaving.




                                                             44
34.	 The Impact of Faculty Characteristics on Internal
     Medicine Residency Candidates Interview Scores
    Julie Oyler, MD; Jim Woodruff, MD; Jeff Charbeneau; Vineet Arora, MD, MAPP



    Statement of Problem, Question, or Issue Addressed: Research on the intern selection process has focused
    primarily on the impact of interview techniques and candidates characteristics on the effectiveness of resident
    selection. Few studies have examined interviewer characteristics on the candidate ratings.

    Objectives of Program/Intervention: Our goal was to determine whether faculty characterisitics lead to variation
    in residency candidate interview scores.

    Description of Program/Intervention: One time retrospective evaluation of previously existing interview data
    from applicants interviewed at the University of Chicago Internal Medicine Program from September 2004
    to March 2009. Faculty interviewers were assigned randomly according to their availability. Each interviewer
    received an electronic copy of the candidate’s Electronic Residency Application Service (ERAS) application
    prior to interview. Following the interview, faculty were asked to electronically rate applicants on a 1(worst) to
    10 (best) scale. Faculty characteristics were obtained from the Department website. Mulitvariate analysis was
    used to identify associations between faculty/candidate characteristics and interview score. IRB approval was
    obtained and data was deidentified before analysis.

    Results/Findings to Date: 1921 applicants were interviewed by 314 faculty for a total of 3813 discreet in-person
    interviews. Candidate characteristics which positively influenced overall score were PhD ( 0.48, p<0.01), AOA
    ( 0.48, p<0.01) and publications ( 0.41, p<0.01). Faculty characteristics which significantly affected candidates
    overall score were: Faculty years as MD (if>21 yrs, 0.39,P<0.01), Fellowship (0.31, p<0.01), PhD (0.42,
    p<0.01). Faculty with higher cumulative number of interviews or heavy involvement in the admission process
    (-0.46, p<0.01) were harder graders.

    Key Lessons Learned/Conclusions: Older, fellowship/PhD trained physicians tend to give higher scores to
    candidates independent of candidate characteristics. Program directors need to take faculty characteristics
    into account when using faculty scores for ranking process. Faculty with more interview experience or heavy
    involvement in the admission process use the full grading scale. Knowledge of this relationship is useful for
    optimal design of a residency program’s interview strategy, and the interpretation of faculty interviewer ratings
    of residency candidates.




                                                            45
 35.	 Relationship Between Inpatient Attending Physician
       Workload and Teaching Before and After Duty Hours:
MERITS
       A Seven Year Study
     Lisa Roshetsky, MD; David Meltzer, MD, PhD; Holly Humphrey, MD; Vineet Arora, MD, MAPP



    Statement of Problem, Question, or Issue Addressed: As attending workload increases with shorter resident duty
    hours, inpatient teaching may suffer. Although prior studies of resident workload demonstrate negative effects
    on resident education, health and patient care, no studies examine attending inpatient workload and outcomes.

    Objectives of Program/Intervention: We aim to investigate the association between inpatient attending workload
    and teaching.

    Description of Program/Intervention: From 2001-2008, all inpatient medicine attendings at a single teaching
    hospital were administered an end of rotation survey with Likert type-items regarding workload and teaching.
    Workload was measured using a conceptual framework initially developed by NASA and later adapted for
    physicians. A workload score (range 6-30) was generated from 6 items (effort, performance, frustration, and
    mental, physical and temporal demand). Time for teaching was measured using open-ended responses for
    hours per week didactic teaching, and a response of agree or strongly agree to “I had enough time for teaching.”
    Multivariable analyses, controlling for 2003 resident duty hour restrictions, season, and clustered by attending,
    were used to test the association between workload scores and teaching outcomes. We also investigated whether
    interactions between workload, season, and duty hours were significant.

    Results/Findings to Date: Response rate was 64% (458/719 attending blocks), representing 115 distinct
    attendings. Attendings reported a median of 3 hours/week (IQR 2-4) of didactic teaching and 42% reported
    enough time for teaching. Workload scores were normally distributed (mean=16, SD 2.7) with a weak positive
    correlation with actual patient volume (r=0.24, p<0.0001). In our multivariable regression model, odds of
    reporting enough time to teach was 21% lower for each point increase in workload score [OR=0.79 (95% CI
    0.69-0.91); p<0.001] and was also substantially lower after 2003 duty hours [OR=0.38 (95% CI 0.19-0.74);
    p<0.004]. No interaction between duty hours and workload score was noted. The odds of reporting enough
    time to teach was substantially lower in Winter and Spring compared to Summer. Workload-season interactions
    were significant in that increased attending workload during the Winter and Spring hampered teaching
    more than in Summer [Winter *workload interaction term OR=0.79 (95% CI 0.64-0.97); p<0.02]. In other
    words, our analyses predict that before 2003 duty hours, 76% of Winter attendings with low (25th percentile)
    workload scores would report enough time to teach, compared with 44% of attendings with high (75th
    percentile) workload scores during that period. However, after 2003 duty hours, roughly half (54%) of Winter
    attendings with low workload scores would report enough time to teach compared to only 23% of Winter
    attendings with high workload scores. Similar findings were noted in predicting odds of greater than median
    didactic teaching (>3 hours/week), although no season-workload interactions were observed.

    Key Lessons Learned/Conclusions: In this study examining inpatient attending workload and teaching before
    and after resident duty hours, we find that higher attending workloads reduce the likelihood of teaching,
    especially in non-Summer months. Because duty hours hampers teaching further, high attending workloads
    after duty hours result in minimal teaching. With shorter resident hours and increasing attending workloads,
    efforts to preserve teaching on inpatient ward rotations are critical.




                                                           46
36.	 Developing a Community-Based Family Medicine Clerkship
     in Wuhan, China
    Nicole Baltrushes, MS4; Mari Egan, MD, MHPE; Sarah-Anne Schumann, MD; Renslow Sherer, MD



    Statement of Problem, Question, or Issue Addressed: China’s health care and medical education systems have
    changed significantly over the past sixty years. Currently both are focused on highly specialized training
    with few educational experiences in outpatient primary care. However, in light of their aging population, a
    resurgence in infectious disease, and rising healthcare costs among other concerns, China’s Ministry of Health
    recently declared that Family Medicine will be the key to providing quality and cost effective care to its growing
    population. Medical education now needs to be created and implemented to educate and train these future
    Family Medicine physicians.

    Objectives of Program/Intervention: As part of the Wuhan University Medical Education Reform (WUMER)
    project, University of Chicago Pritzker School of Medicine (PSOM) faculty are helping Wuhan University
    (WU) faculty start a Department of Family and Community Medicine and develop the first reported required
    community-based family medicine clerkship. This clerkship will ideally help to raise students’ awareness of
    family medicine as a career, inspire students to work in a community setting, as well as introduce the merits of
    outpatient training.

    Description of Program/Intervention: Almost three years after the partnership began there have been visits both
    to Chicago and China in order for both faculty to work together to create a family medicine curriculum which
    is based in community health centers (CHCs). The curriculum in Wuhan emphasizes the teaching of outpatient
    clinical skills and includes home visits, traditional Chinese medicine, and physical rehabilitation. PSOM faculty
    have provided faculty development in outpatient clinical teaching. Evaluation assessments have been conducted
    to identify characteristics and faculty development needs of the CHC preceptors as well as evaluate both the
    students’ and preceptors’ feedback after the first pilot clerkship. Clerkship development is ongoing, with the
    most recent PSOM faculty visit for a faculty development Teaching Symposium in September 2011.

    Results/Findings to Date: The Family Medicine Clerkship was piloted in autumn 2010 in the Qing Shan
    Community Health Center in Wuhan and the feedback received in the clerkship evaluations was encouraging
    and informative. Students enjoyed the exposure to the CHC setting, the unique doctor patient relationships,
    home visits, small group discussions, and the Traditional Chinese Medicine. Wuhan University Students,
    faculty, and CHC Preceptors alike requested ongoing faculty development.

    Key Lessons Learned/Conclusions: The Wuhan University faculty, administration, and CHC preceptors are
    motivated to continue developing and implementing the Family Medicine Clerkship. The pilot clerkship was
    well received and adjustments to the program to address the feedback received are being implemented. The
    second pilot of the clerkship is being implemented November 2011 and evaluation is ongoing. PSOM faculty
    and students are excited about the unique challenges and rewards this educational partnership offers. The need
    for primary care is becoming increasingly apparent in China, and around the world, and this new clerkship is
    an important and exciting step in the primary care direction.




                                                            47
37.	 Pre-hospital Disaster Management Education in Emergency
     Settings: Results of a Five-month Community-based
     Program in Rural Haiti
    Corey Bills, MD, MPH; Christine Babcock, MD, MSc; Luke Davies; Christian Theodosis, MD, MPH



    Statement of Problem, Question, or Issue Addressed: The January 12, 2010 Haitian earthquake resulted in
    massive destruction of Haiti’s infrastructure with a large number of Haitians seeking refuge in 1 of 1300
    displaced camps. Continued monitoring of these camps is essential and highlights the need for trained
    professionals in disaster management in order to respond to future calamity.

    Objectives of Program/Intervention: The aim of this study is to determine the effectiveness of a unique training
    program for Haitian national ‘Health Agents’ in disaster management and health surveillance.

    Description of Program/Intervention: A five-month training program was undertaken from September 1,
    2010 to January 31, 2011 based at a displaced persons camp in Fond Parisien, Haiti. Instruction in disaster
    management was multifaceted and included lectures, didactic sessions and fieldwork. Comprehension of
    material was based on pre and post-test analysis and assessment of field-based casework in comparison to
    objective norms.

    Results/Findings to Date: All eight Haitian staff members were hired and successfully completed the five-month
    course. Overall comprehension of lecture material was impressive with increased average pre- to post-test scores
    of 44.8% (28.8% and 73.6%, respectively; p<0.001). Collectively, health agents completed the components
    of an initial camp assessment, successfully prioritized the needs of camp residents and completed more
    comprehensive shelter, health, water and sanitation surveys.

    Key Lessons Learned/Conclusions: A highly skilled cadre of individuals trained in disaster management and
    health surveillance, at the local level, builds capacity in Haiti to respond to future disasters effectively and
    professionally.




                                                             48
38.	 A Community-based Cholera Surveillance and Education
     Program in Eastern Haiti
    Corey Bills, MD, MPH; Christine Babcock, MD, MSc; Luke Davies; Christian Theodosis, MD, MPH



    Statement of Problem, Question, or Issue Addressed: On October 21, 2010 a cholera outbreak was confirmed
    by the Haitian National Public Health Laboratory. Within one month cholera had spread to each of ten
    departments of Haiti.

    Objectives of Program/Intervention: The aim of this study is to analyze whether a Haitian national health agent-
    led cholera surveillance program combined with basic public health messaging can provide insight into cholera
    outcomes.

    Description of Program/Intervention: A health agent-led team assessed villages in the primary municipality of
    Fond Parisien in Ouest Department from November 2010 to January 2011. Data was gathered via in-depth
    and key informant interviews. A purposive sampling of presumed high-risk villages throughout the region
    with a cross-sectional sample of households within selected villages was completed. Individual households
    were questioned regarding cholera symptoms and provided with simple public health education. This data was
    compared to clinical and demographic data at the region’s primary cholera treatment center (CTC) for analysis.

    Results/Findings to Date: Continuous data collection in the form of household surveys and rapid assessment
    procedures monitored high-risk populations in several hard to reach villages in the region. Health agents noted
    multiple deaths secondary to cholera-like symptoms in communities not reported to clinical or public health
    authorities. A total of 2416 clinical cases of cholera presented to the CTC over the study period. The clinical
    fatality rate was 0.745%.

    Key Lessons Learned/Conclusions: The use of health agents trained in disaster management and mitigation was
    successful and contributed to public acceptance of the primary CTC and control of cholera deaths within the
    region.




                                                           49
39.	 Assessment of Clinical Reasoning Skills of the Fifth Year
     Medical Students at Wuhan University
    Aaron Cohn, MD; Nancy Luo, MD; Kate Lemler, MS4; Renslow Sherer, MD; Scott Stern, MD



    Statement of Problem, Question, or Issue Addressed: The Pritzker Initiative, a clinically focused curriculum, was
    iniated at the University of Chicago medical school in 2009. Wuhan University and Pritzker have colloborated
    to bring a similar curriculum to Wuhan. Courses in basic science, clinical reasoning, physical diagnosis and
    history-taking, ethics and professionalism are being adapted and scaled for use in Wuhan, starting with the
    students enrolled in the fall of 2009.

    Objectives of Program/Intervention: The objective of this study was to assess the clinical reasoning skills of the
    graduating class of the five-year medical education program, and to establish a baseline for future comparison to
    students in the reform curriculum.

    Description of Program/Intervention: We developed twenty clinical cases from the textbook “Symptom to
    Diagnosis” with stepwise clinical reasoning and questions addressing the following core competencies: data
    collection, differential diagnoses,evaluation to generate final diagnosis, management and overall performance on
    reasoning. The scoring algorithm was tailored to the emphasis of medical education at the undergraduate level,
    stressing the importance of developing a full spectrum of differential diagnosis and diagnostic evaluation for the
    final diagnosis.

    Results/Findings to Date: Senior medical students in Wuhan demonstrated a wide range in performance on a
    clinical reasoning exercise, with one third showing a substantial need for further skills development. Specific
    areas in which improvement was needed were ‘differential diagnosis’ and ‘history taking/data collection’.
    Reforms of curriculum in clinical years, as well as preclinical years, are needed in order to improve clinical
    reasoning skills to help students become competent physicians upon graduation.

    Key Lessons Learned/Conclusions: There is still significant room for improvement in clinical reasoning and
    development of a differential diagnosis for a given symptom, in both the Pritzker Initiative-inspired “reform
    curriculum” and the existing “tradional curriculum”. Continued comparison of the reform and traditional
    curriculums at Wuhan University medical school will help decipher what strategies work best for this cohort of
    medical students.




                                                            50
40.	 Development of a Communication Skills Curriculum at
     Wuhan University Medical School: Implementing a Peer
     Role-playing Workshop
    Wei Wei Lee, MD, MPH; Renslow Sherer, MD



    Statement of Problem, Question, or Issue Addressed: Several studies show that a physician’s communication
    skills correlate with improved health outcomes and health care quality. Guidelines from the Institute for
    International Medical Education (IIME) and the American Association of Medical Colleges (AAMC) highlight
    the importance of teaching communication skills in the medical school curriculum and there is evidence that
    good communication skills can be taught and learned.

    Medical education in China has been characterized by passive, lecture driven curricula and limited
    opportunities for small group learning. Wuhan University (WU) invited the University of Chicago (UC) to
    assist in their medical education reform effort and in 2009, 50 first year students at WU participated in a
    reform curriculum. As reform students enter into their third year, WU is developing an “early patient contact”
    curriculum modeled on the Pritzker Clinical Skills course. The new curriculum aims to teach communication,
    professionalism and allows for early exposure to clinical medicine. Limited resources precluded implementation
    of a standardized patient program and UC faculty were asked to assist in developing peer-role playing
    workshops to teach communication skills

    Objectives of Program/Intervention:

    1.   Work with WU faculty to develop a communication skills curriculum.

    2.   Pilot a peer role-playing workshop to teach patient-centered communication and allow students to practice
         and assess communication skills.

    Description of Program/Intervention: Presented lecture to WU reform students and faculty focused on patient-
    centered communication and delivering bad news. We developed 2 peer role-playing scenarios on lung cancer
    and chlamydia. The participants were divided into groups of five students and one faculty member. The
    students rotated to role-play “patient” and “physician.” On-looking students and faculty rated “physician’s”
    communication skills on a 5-point Likert scale. Fifteen minutes were allotted each for role play and feedback.
    The large group then reassembled to debrief and gave oral and written feedback on exercise.

    Results/Findings to Date: Feedback on peer role-playing exercise were grouped into strengths and weaknesses.
    The following comments reflected the strengths: a)“small groups promoted active participation and learning”
    b)“allowed us to experience emotions of both doctors and patient” c)“immediate feedback allowed us to see
    specific things we can improve” d) “realistic reflection of real life problems in doctor patient interactions” e)
    “relaxed, practical, very effective” The following comments reflected the weaknesses: a) “our first time doing
    a role play exercise, took too much time” b) “students lacked sufficient medical knowledge about diseases
    discussed” c) “not ‘real enough’ to simulate real life experience”

    Key Lessons Learned/Conclusions:

    1.   Peer role-playing workshops are a low cost, easily implemented and effective way to teach communication
         skills.

    2.   Students and faculty valued a formal communication curriculum and requested future collaboration to
         develop additional role-play cases for curriculum.




                                                            51
41.	 Attitudes Toward Neurology in Medical Students in
     Wuhan, China
    Rimas Lukas, MD; Brian Cooper; Ivy Morgan; Renslow Sherer, MD



    Statement of Problem, Question, or Issue Addressed: ‘Neurophobia’ refers to medical students’ dislike of
    Neurology based on the perception that it is overly complex. To date, little is known regarding neurophobia in
    China.

    Objectives of Program/Intervention: Neuroscience education for medical students at Wuhan University in
    Wuhan, Hubei province, China is undergoing significant reform as part of a collaborative undertaking with the
    University of Chicago via the Wuhan University Medical Education Reform (WUMER) project. Prior to the
    implementation of the revised Neuroscience curriculum in autumn 2011 a 5 question survey was administered
    to 41 5th, 6th, and 7th year students (analogous to 3rd and 4th year US medical students).

    Description of Program/Intervention: Modeled on previously reported surveys used in other countries,
    the surveys addressed students’ self-assessments of their knowledge of subspecialties, confidence in clinical
    neurology and career intentions, and their perception of teaching methods, with responses from 1-5 on a Likert
    scale.

    Results/Findings to Date: Of 41 surveys, 21 were from students at the Renmin Hospital site and 20 from the
    Zhongnan Hospital site, evenly divided among years.

    Of student knowledge in 8 medical specialties, Neurology received a mean score of 2.78, ranking it 6th lowest.
    Paired-samples test found neurology was significantly lower than the top 3 specialties. There was no significant
    difference between neurology and the other four specialties. In turn students self-perceived knowledge may be
    in the midrange amongst other specialties.

    Students with low confidence in diagnosing and managing neurological patients trended toward a lower
    likelihood of specializing in neurology (mean score 2.67) compared to students with high confidence in both
    (mean score 3.80). Students with low likelihood of specializing in Neurology (≤2) were less likely to report
    confidence in both diagnosing (≥4) and managing neurological patients (mean cumulative score of 2.64).

    Students rated bedside teaching (4.03, CI 3.69-4.37, SD 1.00) followed by small group teaching (3.78, CI
    3.42-4.14, SD 1.072) as having the greatest value in learning neurology. Learning derived from peers was rated
    as the lowest valued (3.30, CI 2.98-3.63, SD 0.951) method of learning neurology.

    Key Lessons Learned/Conclusions: In this exploratory study, students self perceived knowledge of Neurology
    was low, but not lowest, when compared to other specialties. These findings differ from data reported from
    institutions in North America/Caribbean, Europe, and Africa. Students with greater clinical confidence in
    diagnosing and managing neurological illness reported a higher likelihood of pursuing a career in neurology,
    and, conversely, students who reported a higher likelihood of pursuing a career in neurology also reported a
    higher degree of confidence in their clinical neurology skills. Traditional bedside teaching was viewed as having
    the greatest value for teaching neurology, although small group sessions were also rated highly. Internet based
    learning, textbooks, and learning from ones peers were all viewed as fairly equivalent. A complementary multi-
    modality approach may have the greatest benefit in teaching neurology.




                                                            52
42.	 Planning for The Start of Internship - Survey and Focused
     Interviews at a Chinese Medical School
    Yang Shen, MD; Hong Lei, MD; James Woodruff, MD; Renslow Sherer, MD



    Statement of Problem, Question, or Issue Addressed: In 2008, the Wuhan University Health Sciences Center
    in Wuhan, China invited the University of Chicago to serve as Technical Advisors to their medical education
    reform effort. Among the issues to be addressed were a largely lecture-driven curriculum, poorly integrated
    basic and clinical sciences, limited opportunities for small group, case-based, and independent learning, lack
    of formative evaluation, lack of a Department of Community and Family Medicine linked to public health
    and infectious disease care and prevention, and outdated teaching methods and materials. In the past three
    years, under the leadership of the Wuhan University Medical Education Reform (WUMER) project team, a
    new curriculum (see below) has been implemented. The new curriculum has emphasized the integratation of
    basic and clinical sciences and innovative teaching methods. In the surveys conducted in 2010, the students
    enrolled in the reform class have achieved higher scores in questions in terms of critical thinking and knowledge
    retention compared to their counterparts.

    Objectives of Program/Intervention: In order to design a course that helps the fifth year undergraduate medical
    student to better prepare for the incoming internship, we performed a study to investigate the needs of the
    students as well as the expectations of clinical faculty across various specialties.

    Description of Program/Intervention: A survey investigating the needs of the students regarding procedure
    skills, clinical reasoning, and clinical knowledge base was to be completed on a voluntary basis by at least fifty
    undergraduate students who are in their final year of study and who have completed job interviews. Both
    multiple-choice questions and short-answer questions were used in the survey.

    Interviews and small group discussion were to be conducted with ten faculty members in the departments
    of internal medicine, surgery, pediatrics and obstetrics/gynecology. The faculties were to be asked about
    the criterion of resident selection, expectation they have for the future residents and areas of improvement
    considering their experiences with current students and residents.

    Results/Findings to Date: A total of sixty undergraduate students voluntarily participated in the survey. All of
    the them had completed all required medical school coursework and had finished their job interview process.
    Among them, 68% were female, 32% were males. Except for one student who was pursuing graduate training
    in a field of basic science, fifty-nine students were planning to pursue further training in clinical medicine
    (83%) or directly enter practice (17%). Twenty-six students (43%) were planing to enter internal medicine and
    its associated sub-specialties, twenty-one students (35%) were to enter a surgical specialty, three students (5%)
    were to be pediatricians and three students (5%) were to enter the field of ob/gyn.

    Key Lessons Learned/Conclusions: The conventional medical education curriculum is characterized by a
    rigid curriculum that is based on lectures and a disease-driven pedagogy. These weakness are the focus of
    the curriculum reform which is underway (WUMER project). A move to require residency is also planned.
    A training course that helps students bridge to residency training is needed. Following discussion with
    the leadership of the WUMER, an elective course will be offered next Spring. This course utilizes clinical
    vignettes to help students practice clinical diagnostic reasoning and clinical management protocols of common
    complaints. Problem-based learning and small-group discussion are the main format of this new course.




                                                             53
43.	 Evaluation of Student Attitudes and Training towards
     Geriatrics and Palliative Care in Wuhan, China
    Sandra Shi, MS2; Renslow Sherer, MD; Ivy Morgan; Hongmei Dong



    Statement of Problem, Question, or Issue Addressed: Geriatrics is an emerging field in China, with no national
    certification or formal specialty training at present, and radical social reform in China has led to a growing
    geriatric population. At the same time in the past decade, China has prioritized shifting the delivery of primary
    care for urban populations to community health centers (CHCs) rather than larger public hospitals. The ease of
    access, closer proximity, and lower out-of-pocket costs make CHC care a more favorable alternative over sub-
    specialty care in tertiary hospitals for many elderly.

    Objectives of Program/Intervention: We evaluated faculty and student attitudes towards Geriatrics, and
    investigated whether the new CHC Clerkship experience at Wuhan University had any influence on student
    opinions. Finally we sought to explore the delivery of health care, particularly to the elderly, in local community
    settings.

    Description of Program/Intervention: As a part of the Wuhan University Medical Education Reform
    (WUMER) project, a new Community Health Family Medicine clerkship was created and piloted with 30 fifth
    year students at a local QingShan Health clinic in the fall of 2010.

    We surveyed students and faculty at Wuhan University Medical School, and elder care givers at the QingShan
    Community Health Center. A total of 18 CHC clerkship students (‘CHC students’) were surveyed, with
    questions regarding their perceptions of geriatrics as well as judgment on current exposure to geriatrics during
    clinical and preclinical training. Parallel surveys were administered to 41 fourth year medical students in the
    standard medical curriculum. ‘Elderly patients’ were defined as age over 60 years.

    Results/Findings to Date: Overall, CHC students reported working with a higher proportion of older patients
    during their CHC clerkship experience. The disparity found between CHC and Standard curriculum responses
    was found to be statistically significant (t stat= -3.94, p=0.0002). Though 80% of Standard Curriculum
    students agreed that they are willing to treat older patients only 41% felt they confident in treating older
    patients (n=41). Faculty generally supported greater inclusion of training specific for older patients.

    In general, more CHC students reported that their medical school training, both courses and clinical, was
    adequate in preparing them for work with the elderly. Also, more CHC students reported that their rotations
    had allowed for adequate contact with older patients (88% vs 66%) - see Table 1. None of these differences
    were statistically significant (Mann-Whitney test, no P values <0.05).

    Key Lessons Learned/Conclusions: We found that attitudes towards Geriatrics were uniformly positive in both
    the Standard Curriculum students and CHC students and in faculty. CHC students were exposed to a greater
    proportion of elderly patients, at a statistically significant level, which suggests that the planned expansion
    of CHC clerkship and inclusion into the curriculum as a required clerkship will increase exposure to older
    populations for medical students. Further work on geriatrics in Wuhan is in planning.




                                                            54
44.	 Observational Study of Hand Hygiene Compliance Rates in
     Intensive Care Units in Wuhan, China
    Lisa Sun, MS2; Wenjing Zong, MS2; Renslow Sherer, MD



    Statement of Problem, Question, or Issue Addressed: Health care associated infection (HCAI) is a major cause
    of patient disability, excess patient death, longer hospital stay and increased health care costs in China. Hand
    hygiene is the most important measure to prevent HCAIs, however limited data on hand hygiene compliance in
    China are available.

    Objectives of Program/Intervention: Hand hygiene compliance was evaluated among health care workers
    (HCWs) in ICUs in 2 hospitals (RH and ZH) in Wuhan, China.

    Description of Program/Intervention: An observational study of hand hygiene compliance among HCWs was
    conducted for each of the five WHO Moments for Hand Hygiene, i.e. 1) before patient contact; 2) before
    performing a clean/aseptic procedure; 3) after body fluid exposure risk; 4) after patient contact; and 5) after
    contact with patient surroundings.

    Results/Findings to Date: The overall hand hygiene compliance rate for ICU health care workers was 28%
    (N=3222). RH HCWs had a significantly higher hand hygiene compliance rate compared to ZH HCWS
    (P<0.0001). Among all ICUs observed, the RH neonatal ICU had the highest compliance rate, of 71%
    (N=281). Overall, nurses demonstrated a significantly higher hand hygiene compliance rate (38%, N=1261,
    P<0.0001) compared to the other ICU health care worker roles observed. Moment 1, before patient contact,
    had a significantly lower compliance rate compared to all other moments (P<0.0001).

    Key Lessons Learned/Conclusions: Higher hand hygiene compliance was found among RH HCWs in Wuhan,
    partly due to very high rates in the RH NICU. The compliance rate in the RH NICU was notably higher than
    all other ICUs and well above the US average of 44%. Possible contributing factors included a dedicated nurse
    supervisor and infection control team in the RH NICU, a higher proportion of filled towel dispensers in RH
    ICUs, and visible hand hygiene signs at RH, but not ZH. Also, the RH NICU conducted monthly infection
    control checks, which included inspection of hand hygiene. Other ICUs lacked these hand hygiene-supportive
    practices. The aggressive infection control procedures in the neonatal ICU at RH were partly attributable to a
    head nurse who received up to date infection control training and then revised, implemented, and monitored
    the standing infection control procedures. Based on the hand hygiene behaviors observed in both hospitals,
    an intervention to improve hand hygiene at ZH and other RH ICUs should build on the current successful
    practices at the RH neonatal ICU.




                                                           55
  45.	 A Qualitative Analysis of Interviews with Participants of
            the Literature & Medicine™ Program at Select Veterans
Scholarship
            Administration Medical Centers
& Discovery
              Abigail Cutler, MS3; Gabrielle Schaefer, MS3; H. Barrett Fromme, MD, MHPE



              Statement of Problem, Question, or Issue Addressed: Background: Founded in 1997, Literature & Medicine:
              Humanities at the Heart of Health Care™ is a hospital-based reading and discussion group for staff at
              community and academic medical centers. Once a month, physicians, nurses, administrators and support staff
              gather with a trained facilitator to discuss what they have read and reflect on what it means to them - as people
              and as healthcare professionals. Last year, 14 VA hospitals across the country took up the program, offering
              participants the opportunity to read and discuss literature relating directly to the experiences of their veteran
              patients and the challenges faced in caring for them.

              Problem: Healthcare providers cannot rely simply on their own experiences to understand their patients, who
              are often of a different religious, socio-economic or cultural background. This is especially true at a VAMC,
              where a large gulf exists between the patients (who although present heterogenous medical problems all share
              the experience of having served in the military) and their healthcare providers who for the most part are non-
              veterans. Literature offers these providers the opportunity to vicariously experience war, illness, death and
              human relationships among all peoples. Literature & Medicine™ is part of a larger movement to incorporate
              the humanities into medical practice and medical education, but it is unique as the only program of its kind
              that links hospitals on a statewide and national basis and involves a diverse mix of healthcare professionals. No
              previous study examined the impact of the Literature & Medicine™ on participating VAMCs or explored why
              such a program might be especially beneficial at an institution with such a unique patient population.

              Objectives of Program/Intervention:
              1.   Identify what attracts participants to the Literature & Medicine program;
              2.   Distinguish the important elements of a successful reading and discussion group;
              3.   Determine impact on provider job satisfaction, perceptions of work environment and patient care;
              4.   Examine the Literature & Medicine™ program’s particular value to a VAMC.

              Description of Program/Intervention: To evaluate the program’s success at 14 VAMCs, I solicited via email
              the cooperation of participants who were interested in talking about their experience. I ultimately conducted
              interviews with individual program participants (n=13), one facilitator (n=1) and focus groups from two
              participating hospitals (n= 7 and n= 5). IRB exemption status was obtained and qualitative data from the
              transcripts was analyzed using constant comparative method.

              Results/Findings to Date: In interviews, participants of the Literature & Medicine program at VAMCs reported
              outcomes similar to those demonstrated previously reported by participants at non-VAMCs: increases were
              seen in colleague camaraderie and openness, empathy and compassion toward patients, appreciation and
              understanding of different perspectives, general morale and satisfaction with one’s work, and motivation to
              do better at one’s job. Interestingly, the program also demonstrated far-reaching effects: interviewees described
              sharing their thoughts and readings with non-participating staff hospital members and even patients. An
              overwhelming 100 percent of participants endorsed the program and expressed interest in both expansion and
              future participation.

              Key Lessons Learned/Conclusions: In order to understand and best serve their patients, healthcare professionals
              cannot rely solely on their own academic knowledge and life experiences. Patients not only present with their
              complaints and indications; they bring to the clinic their cultural backgrounds, religious and spiritual beliefs,
              and personal histories of the medical and non-medical kind.

              The Literature & Medicine program has proven to meet a deeply felt need in the hospital setting, by providing
              an opportunity for healthcare professionals to share insights with colleagues- an act that alone has made a
              significant impact on the way participants understand their work and their relationships with both patients and
              each other. It is also an innovative and cost-effective way to improve patient care, and it does so by increasing
              empathy for patients, interpersonal and communication skills, cultural awareness, and overall job satisfaction
              among providers.

                                                                      56
46.	 Communication and Utilization of Healthcare Services
     Amongst Adolescents
    Sarah Horvath, MS4; Kavitha Selvaraj, MS4; Sophie Shay, MS4; H. Barrett Fromme, MD, MHPE



    Statement of Problem, Question, or Issue Addressed: Many teens are unwilling to utilize medical care, even when
    it is free and accessible in settings like the Washington Park Free Youth Clinic. Barriers to utilizing medical
    care include adolescents’ perceptions of physicians, physicians’ perceptions of adolescents, trust of the health
    care system, and concerns regarding confidentiality. Additionally, lack of identification with the physician
    population acts as an obstacle in adolescent communication with clinicians.

    Chicago Youth Program (CYP) and Children Teaching Children (CTC) are two existing community programs
    which provide educational support to south side Chicago youth. CYP, which is housed in the same building
    as the Washington Park Clinic, is particularly concerned about rates of medical care uptake among its teen
    participants. We propose to work in conjunction with CYP and CTC to develop a novel program to address the
    issue of adolescent access of medical care.

    Objectives of Program/Intervention: The goals of the project are to 1) investigate the barriers to uptake of
    medical care and effective communication between medical professionals and their adolescent patients, from
    the adolescent point of view and 2) educate current and future physicians on ways to minimize them. We
    will empower the teens to create a workshop for medical students, residents and attending physicians which
    addresses barriers and adolescent health care issues they find most important. The workshop will then be
    presented to those who regularly staff the Washington Park Clinic. An evaluation of the intervention will
    be created in the form of a survey to be given both before and after the workshop in order to quantify the
    effectiveness of the program. This, too, will be directed by the teen participants.

    Description of Program/Intervention: We will design and implement a curriculum for eight teenagers giving
    them the skills, freedom and working environment necessary to create a 30-60 minute workshop for medical
    students, residents and attending physicians which addresses the barriers they find most important. The
    workshop will then be presented to those who regularly staff the Washington Park Clinic. An evaluation of the
    intervention will be created in the form of a survey to be given both before and after the workshop in order to
    quantify the effectiveness of the program. This, too, will be directed by the teen participants. The teens should
    feel empowered in their own medical decisions and serve as not only liaisons to the medical community, but
    also role models and peer educators to other teens. Ideally, this group will then participate in recruiting the next
    year’s new members. Each year, with the support of CYP, CTC and the SERVE class, the group will revise the
    workshop to keep it current and relevant.

    We will then integrate this teen-led workshop into Washington Park clinic’s annual board activities. Over time,
    it will expand the focus to present to boards and staff of other free clinics and groups of medical professionals at
    University of Chicago and around the city.

    Results/Findings to Date: We intend to qualify and quantify our results so that the program can be recreated
    in other settings where it may be useful. To do this, we will use a teen-created survey to evaluate med student/
    resident/doctor attitudes pre- and post- intervention (participation in the workshop).

    Key Lessons Learned/Conclusions: Our program seeks to provide education at many levels. As a community-
    based intervention, this study aims to involve adolescents directly in the creation of the workshop, empowering
    them to identify both barriers and solutions, while teaching them the skills necessary for implementing their
    vision effectively. They will then educate medical students, residents and attending physicians on how best to
    approach an adolescent patient. The curriculum will grow directly from the health care issues that are important
    to our teenage population. We hope to see a discernible difference in physician attitudes toward the treatment
    of teens and increased teen uptake of medical care as a result.




                                                             57
47.	 Development of a Website for Transition Care for
     Providers, Patients, and their Families
    Amy Lo, MD; Jennifer McDonnell, MD; Kruti Acharya, MD; Rita Rossi-Foulkes, MD



    Statement of Problem, Question, or Issue Addressed: Young adults with chronic disease and disabilities are
    surviving well into adulthood; in 2006, it was estimated that 15% of North American youth suffered from
    chronic physical or mental health conditions. As these patients reach adulthood, their medical care is often
    fragmented, interrupted or inadequate to meet their needs.

    Internal Medicine, Pediatrics and Med-Peds faculty and residents were surveyed regarding knowledge, attitudes,
    and barriers to transition care. Results demonstrated that few physicians were familiar or comfortable with
    issues regarding transition care, but a majority expressed willingness to care for this population and felt
    transition education was important. Barriers in caring for this population cited by the physicians included lack
    of ancillary services, time, and reimbursement.

    Objectives of Program/Intervention: To address some of these barriers regarding transition care, we created a
    website designed to be a toolkit that providers, patients and families can use to learn about issues surrounding
    transition care.

    Description of Program/Intervention: This website provides general information about transition care as well as
    more specific information about various types of insurance available to pediatric and adult populations, SSI and
    SSDI, education planning, patient autonomy, and local, statewide, and national resources for youth and young
    adults with special health care needs The website also contains handouts and forms that providers can download
    and give to patients and patients and families can access themselves. By providing this transition care toolkit
    to providers, patients and families, we believe that providers will become more knowledgeable about transition
    care and feel more comfortable caring for this population.

    Results/Findings to Date: Our website is now available to the UCMC community. We are currently
    introducing the website to clinicians for their use. We plan to update the website based on feedback from our
    provider community. We will re-survey faculty and resident physicians after full implementation of the website
    to determine if the website has improved provider comfort with transition care and addressed some of the
    barriers that providers cited in caring for this population.

    Key Lessons Learned/Conclusions: UCMC providers expressed barriers to comfort with and knowledge about
    transition care. We created a website to provide information about transition care to providers, patients, and
    families. The website includes information regarding topics that frequently need to be addressed in caring for
    this population. The website also provides a tool kit of documents and forms related to transition care for use
    by providers, patients and families.

    Our goal is to increase provider familiarity and comfort with transition care as well as provide a quick resource
    for frequently encountered topics that are addressed during the transition of care for youth with special health
    care needs.




                                                            58
48.	 Development of an Educational Intervention for Resident
     Education Regarding Transition Care of Youth with
     Special Health Care Needs
    Jennifer McDonnell, MD; Amy Lo, MD; Sara Platte, MD; Rita Rossi-Foulkes, MD



    Statement of Problem, Question, or Issue Addressed: Young adults with medical illnesses and developmental
    disabilities are surviving well into adulthood; in 2006, it was estimated that 15% of North American youth
    suffered from chronic physical or mental health conditions3. As these patients reach adulthood, their medical
    care is often fragmented, interrupted or inadequate to meet their needs.

    The University of Chicago is a tertiary care center that provides care to children and adults with complex
    chronic medical conditions. However, many adolescents with chronic medical diseases have difficulty navigating
    into the adult-oriented medical arena and are often lost to follow up.

    Objectives of Program/Intervention: We studied resident physician’s perceived barriers to transition with the
    goal of creating educational tools to address these. Surveys were mailed via interoffice mail to residents in the
    departments of medicine, pediatrics, and medicine/pediatrics and collected over a 3 month period. Residents
    identified lack of knowledge, lack of exposure, and lack of communication between adult and pediatric
    providers as barriers to transition care.

    Description of Program/Intervention: Based on the results of this data, a 1 hour educational lecture was
    developed addressing some of the frequent barriers encountered with transitioning youth with special health
    care needs from pediatric to adult care. Topics of this lecture included a definition of transition care, a proposed
    timeline for transition of patients, information about insurance gaps and insurance options, promoting and
    developing patient autonomy, information about guardianship and Chicago area resources for youth with
    special health care needs.

    Results/Findings to Date: The lecture was given to medicine/pediatrics residents at a monthly meeting and
    to pediatric residents at a noon conference. Evaluation of pediatric residents following the noon conference
    indicated that 17% of residents rated the overall presentation as “good” while 83% rated the lecture as
    “excellent.” In the future we hope to adjust the curriculum to be given in small groups at pediatrics pre-clinic
    conference as well as tailor the lecture for medicine residents.

    Key Lessons Learned/Conclusions: The educational curriculum was designed to increase resident exposure to the
    topic of transition care for youth with special health care needs and to address certain core knowledge topics
    that are encountered in the transition from pediatric to adult care. Plans for the future include adjusting the
    lecture to include internal medicine residents, creating an ambulatory curriculum, and creation of a transition
    care elective for UCMC residents and medical students. After these interventions, residents will again be
    surveyed regarding their knowledge and attitudes towards transition care.




                                                             59
  49.	 Using Health Information Technology to Develop an
            Academic Medical Home: Effective Patient Education for
Scholarship
            Success in High School
& Discovery
              Margaret Naunheim, MS3; Yingshan Shi, MD, MS; Janis Mendelsohn, MD; Michael Msall, MD



              Statement of Problem, Question, or Issue Addressed: The medical home is the model for twenty-first-
              century primary care, which addresses family-centered and community-integrated health promotion. Health
              information technology can provide effective patient education and enhance communication among healthcare
              providers, patients, and their families.

              While information about success in high school exists online, little of this information comes from informed
              medical care providers. Success in high school often predicts success in future endeavors, and primary care
              physicians can affect positive change in their patients’ lives by addressing this issue.

              Objectives of Program/Intervention:

              1.   Explore how to engage school-aged children and their parents and effectively address the issue of “How to
                   Succeed in High School and Beyond”.

              2.   Explore potential interventions for community outreach from collaboration between families and
                   providers.

              Description of Program/Intervention: A cross-sectional clinical survey was conducted in the Comer pediatric
              clinic (between 6/6/11-7/25/11) to find parents’ preferred sources and health topics for school-aged children.

              With collaboration from pediatricians, medical students led three high school students from UC Laboratory
              Schools, Hinsdale Central High School, and Walter Payton College Prep. These focused groups examined
              information currently provided to high school students about success including online resources, literature
              searches and pamphlets from the students’ current high schools. The web pages will synthesize and organize the
              information already accessible, while also supplementing it with information less readily available to emphasize
              physical, behavioral and mental health goals.

              Results/Findings to Date: Parents’ preference for sources of health information and topics 507 (86% response
              rate) parents responded to the survey and 487 questionnaires met inclusion criteria. For parents, the top
              sources of health information are their child’s physician (100%), online resources (93.2%), other healthcare
              professionals (82.1%), and their child’s school (56.0%). The top health topics parents preferred are the school
              physical exam (97.9%), vaccines (97.7%), lifestyle choices (95.8%), and school achievement (94.6%).

              Web page contents http://www.funandeducation.org/School_Health.htm

              The survey displays online education as a ubiquitous tool to connect school-aged children and their parents to
              health providers. Parents expressed a strong preference for school performance related topics. The web pages
              regarding “How to Succeed in High School” were designed for all students in high school to support their
              academic success and career orientation. The topic themes include physical, behavioral, and mental health;
              success in high school; college and alternatives to college; future challengers and career pathway options.

              Community outreach: In the survey, teen patients come from 77 high schools in the area. Involving these
              schools in the website is the first step to incorporate the academic medical home with the community.

              Key Lessons Learned/Conclusions: The school health online resources center provides online resources for
              teen patients and their families as part of continuing, comprehensive care; this can also facilitate community
              outreach efforts and the development of specific collaborations to improve health outcomes and reduce risky
              behaviors.




                                                                     60
50.	 Patient Perception of a Point-of-Care Tablet Computer
     (iPad™) Being Used for Patient Education
    Andrew Nickels, MD; Vesselin Dimov, MD; Valerie Press, MD; Raoul Wolf, MD



    Statement of Problem, Question, or Issue Addressed: During the fall of 2010, the Internal Medicine/Pediatrics
    program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™
    are intended to improve access to EMR, work flow, resident and patient education, and access to electronic
    clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve
    these goals.

    Objectives of Program/Intervention: This study is designed to gauge the initial patient perception of the iPad™
    when used for patient education.

    Description of Program/Intervention: This survey is a physician administered, 8 question patient survey
    administered to Allergy Immunology patients or their parents. Preloaded iPads™ with education materials
    (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients.
    Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis.

    Results/Findings to Date: 20 patients surveyed (11 resident/9 attending). For those survey items without 100%
    agreement, there was no statistically significant difference in responses based on level of training (p≥0.45).
    100% [0.861, 1] of participants liked the iPad™ use to help explain their children’s condition, 95% [0.783,
    0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would
    like to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was
    helpful for coming to understanding of their condition. Limitations of this study include a convenient sample,
    physician-administered survey, and observer bias.

    Key Lessons Learned/Conclusions: Patient perception was very positive toward the use of a point-of-care tablet
    computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an
    effect on patient perception. Confirmation of the results may be required before wider implementation.




                                                            61
51.	 Challenges in Transition: Barriers to Subspecialty Care for
     Adults with Developmental Disabilities
    Joanna Perdomo, MS1; Alex Garnett, MS1; Richard Schroeder, MS1; Kamala Cotts, MD



    Statement of Problem, Question, or Issue Addressed: The transition from pediatric to adult care occurs at age 18.
    This transition marks an important time in the health care trajectory of any individual, but holds significant
    gravity for individuals with intellectual and developmental disabilities (IDD). Individuals with IDD require
    lifelong interdisciplinary care from multiple health professionals, including primary care providers, neurologists,
    psychiatrists, orthopedic surgeons, and physical and occupational therapists. Due to the complexity of their
    medical needs, the transition period is especially challenging for individuals with IDD, as they must find adult
    replacements for each of their many pediatric health care providers. This task is made more difficult by the fact
    that there is a paucity of adult physicians who have intimate knowledge of IDD and feel comfortable caring for
    patients with IDD. Furthermore, the challenge of finding suitable adult physicians, particularly subspecialists,
    is heightened because many adults with IDD rely on Medicaid for insurance coverage; however, many hospitals,
    clinics, and individual physicians do not accept Medicaid at all or only accept Medicaid for pediatric patients.
    Unfortunately, there are few resources to facilitate the transition process, and many adults with IDD lack the
    subspecialty care they need.

    Objectives of Program/Intervention: This investigation began as a project in the first-year Health Care
    Disparities course. We sought to simulate the process an adult with an IDD, who is on Medicaid, would have to
    undergo in order to find an adult subspecialist in the fields of neurology, psychiatry, and orthopedics- the three
    main subspecialties that individuals with IDD must continue accessing throughout their lifetime. Specifically
    this study looked for suitable providers located in the South Side of Chicago. We aimed to document the
    difficulties of navigating the healthcare system and to compile a list of subspecialty providers that would provide
    care to adults with IDD on Medicaid.

    Description of Program/Intervention: Twelve federally qualified health centers (FQHCs) in the South Side were
    interviewed to determine if they accepted Medicaid, provided care for adult patients with IDD, and provided
    subspecialty services in neurology, psychiatry, and orthopedics. Based on their responses, further interviews
    were conducted with hospitals, clinics, and individual physicians to whom they refer patients for subspecialty
    services. These referral sites were asked the same set of questions.

    Results/Findings to Date: Out of twenty-two clinics contacted, two clinics were found to offer psychiatry
    services to IDD adults on Medicaid, while only one provides orthopedic services to this population. Finally, one
    clinic offered neurological services, but currently has a three month wait for a new patient appointment.

    Key Lessons Learned/Conclusions: Findings demonstrate a major shortage of subspecialty care clinics accepting
    adult patients with Medicaid on the South side of Chicago. This is especially problematic for adults with
    developmental disabilities, who often require extensive medical care from multiple medical specialists. However,
    the list of resources compiled in this study will serve as a useful tool for this population to access the care they
    require.




                                                            62
52.	 Predictors of Third Year Medical Students’ Intentions to
     Practice in Underserved Areas: A National Survey
    Krishna Ravella; John Yoon, MD; Kenneth Rasinski, PhD; Farr Curlin, MD



    Statement of Problem, Question, or Issue Addressed: Demographic trends in medical education suggest increased
    difficulty in recruiting students into medically underserved areas. Though many different characteristics of
    students’ personal backgrounds are associated with intentions to practice among the underserved, it is unknown
    whether admiration of a physician role model is specifically associated with intentions to practice among the
    underserved. Admiration may be an important factor influencing medical students’ decisions during the process
    of medical education.

    Objectives of Program/Intervention: We examine the various factors associated with medical students’ intentions
    to practice in a medically underserved area and to test the hypothesis that students’ admiration of role models
    are positively associated with comparable pro-social behavior.

    Description of Program/Intervention: From Jan-June 2011, we surveyed a nationally representative sample of
    960 third-year medical students. We used a two-stage clustered sample design, selecting 24 of the 133 allopathic
    (MD) medical schools with probability proportional to size and then randomly selecting 40 students within
    each of the 24 schools. The primary criterion variable was medical students’ self-reported intention to locate
    their practice in a medically underserved area. Primary predictors included students’ reported desire to follow in
    the footsteps of a physician they admire. Other control variables included gender, region, social mission score
    ranking, race, whether parent/grandparent is a physician, whether they grew up or ever worked in a medically
    underserved setting, and whether sense of calling or income considerations influence specialty choice.

    Results/Findings to Date: 563 out of 960 3rd year medical students responded (59%). 30% of U.S. medical
    students reported intentions to practice in an underserved area. Male students were less likely than female
    students to report intentions to practice among the underserved (23% vs. 40% female, multivariate OR 0.6
    [0.4-0.9]). Black students and students who grew up or previously worked in an underserved setting were also
    more likely to report intentions to work for the underserved. Students who also reported not having a physician
    parent/grandparent were more likely to report intentions to practice among the underserved (35% vs. 14%
    with physician parent/grandparent, 2.5 [1.3-4.6]). Finally, students who reported a desire to follow in the
    footsteps of a physician they admire were more likely to report the intention to practice among the underserved
    (multivariate OR 2.2[1.3-3.7]).

    Key Lessons Learned/Conclusions: In our nationally representative study of U.S. third year medical students, we
    found that female students, black students, students with previous exposure to medically underserved settings,
    and students who did not have a physician parent or grandparent were more likely to report intentions to
    practice among the underserved. We also found that admiration of a role model physician was also associated
    with medical students’ intention to locate his or her future practice in a medically underserved area. The
    emotional experience of admiration during medical education may play an important role in shaping students’
    attitudes toward practicing among the underserved.




                                                           63
Current Academy Funded Research


    grants      for    Medical student e ducation

    2010-2012

    Geriatrics and Aging Through Transitional Environments (GATE): Integrated, Longitudinal Geriatrics
    Curricula through the Pritzker Initiative
    Seema Limaye, MD; Shellie Williams, MD; Sandy Smith, PhD


    2011-2013

    Foundations in Clinical Medicine
    Susan Glick, MD; Michael O’Connor, MD

    Developing a Free National Databank of Online Psychiatry Teaching Cases
    Michael Marcangelo, MD




    grants      for    graduate Medical e ducation

    2010-2012

    Pilot Curriculum for Teaching Residents Single Incision Laparoscopic Surgery (SILS): A Patient Safety Initiative
    Nancy Schindler, MD; Michael Ujiki, MD; Jose Velasco, MD; Vivek Prachand, MD


    2011-2013

    Resident Perceptions of Teaching on Night Floats
    H. Barrett Fromme, MD, MHPE

    For further information about previously funded medical education grants, please refer to our website:
    http://pritzker.uchicago.edu/about/rfa.shtml




                                                          64
Request for Applications: Medical Education Research
    Sponsored by:
    The University of Chicago Pritzker School of Medicine’s Academy of Distinguished Medical Educators and the
    Graduate Medical Education Committee

    Deadline: Friday, January 20, 2012

    In order to foster a learning environment for students and residents that is characterized by creativity,
    originality, and rigor, the University of Chicago Pritzker School of Medicine’s Academy of Distinguished
    Medical Educators and the University of Chicago Medical Center are making research funding available to
    support a maximum of two proposals for projects in medical student education and two proposals for projects
    in resident/fellow education.

    The proposals pertaining to medical student education will be peer-reviewed through the Academy of
    Distinguished Medical Educators and those pertaining to resident/fellow education will be peer-reviewed
    through the Graduate Medical Education Committee (GMEC).

    We are especially interested in receiving proposals related to the following themes but welcome proposals in
    other areas as well:

    •   Integration of clinical medicine and basic science
    •   Fostering scholarship in medical school and/or residency training
    •   Innovative programs in Quality Improvement or Systems-Based Practice for students and/or residents
    •   Residents as Teachers

    If you are interested, please request an application form by emailing the University of Chicago Pritzker
    School of Medicine’s Dean for Medical Education (dean-for-meded@bsd.uchicago.edu). This email should
    include information as to whether the planned proposal pertains to medical student education, resident/fellow
    education, or both.

    Proposals are due on January 20, 2012. Total funding for projects should not exceed $25,000 per year for up
    to two years, equally shared between the grantee’s department and the Dean for Medical Education (up to
    $12,500 per year from each source, with documentation of anticipated support from department chairman).

    Awards will be announced by March 9, 2012 with funding to commence on July 1, 2012.

    This RFA is the sixth cycle of research support available for medical education at the University of Chicago
    and is one element of an ongoing series of initiatives to foster research, innovation, and scholarship in medical
    education and to promote and sustain a strong culture of teaching at the University of Chicago and the
    NorthShore University HealthSystem.




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