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Questionnaire Templates for Residents Attitudes

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					   Poster Presentations


Sixth Annual Davidoff Education Day
              March 17, 2009




     Education & Faculty Support Committee
        Office of Educational Resources
                                      Davidoff Education Day
                                         March 17, 2009
                                        Poster Submissions

Medical Student Education
              Authors                                            Poster Title
Burger, Alfred, William Southern,     A Case-based Subintern Conference: An Interactive Approach to
Sharon Parish                         Internal Medicine Subintern Education
Fornari, Alice, Allen Hutcheson,      Chronic Disease and Palliative Care in a Family Medicine Third-
Peter Selwyn, Pablo Joo               Year Ambulatory Clerkship
McEvoy, Mimi, William B. Burton,      Religious vs. Spiritual Identity: A Necessary Distinction in
Bradley Morganstern, Lauren Glass,    Understanding Clinician Educators’ Behavior and Attitudes
Felise B. Milan                       Toward Clinical Practice and Medical Student Teaching
Santos, Maria Teresa                  The Observed Clinical Encounter (OCE) Among Different Third-
                                      Year Clinical Clerkships
Steinman, Howard M., Lawrence         Forming Small Groups in Basic Science Conferences: Teaching
Dyche, Alice B. Fornari, Barbara K.   Science and Fostering Professionalism
Birshtein


Resident or Graduate Student Education
             Authors                                           Poster Title
Beier, Meghan, Sonia Suchday, Paul    Graduate Student Burnout and Cardiovascular Health: Baseline
R. Marantz, Benjamin Kligler          Data
Blackstock, Oni, Darlene LeFrancois Internal Medicine Residents’ Self-assessment of Their Clinic
                                    Practice: An Ambulatory Patient-based Quality Improvement
                                    Workshop
Brahmi, Dalia, Cori Green, Shereen Needs Assessment and Evaluation of an IUD Training Program
Simon                               Among Pediatric Residents
Garankina, Olga, Muhammad
Ashraf, Gabriel El-Kass, Andrea       Comfort Level and Attitudes of Internal Medicine and Family
Galasso, Alina Gory, Betina Louis,    Practice Resident Physicians Towards Dementia Care
Emmanuel Opara, Gloria Alano,
Gisele P. Wolf-Klein
Gold, Marji, Jessica Dalby, Crystal   What Is the Extent of Family Planning Training in Family
Query, Cara Herbitter, Megan          Medicine Residencies?
Greenberg
Gorski, Victoria, Sandra Barnaby,     Intensive Case Management: A Multidisciplinary Team and
Amy Osorio, Fabienne Daguilh,         Resident Education Approach to "Not at Target" Diabetics
Jennifer Klein
Kumar, Vanita, Cara Herbitter,        Impact of Abortion Training on Family Medicine Residents’
Alison Karasz, Marji Gold             Pregnancy Options Counseling Skills
Reddy, Mamta, K. Chen, D. Strom,      Delivering Key Educational Messages to Promote Asthma Self-
A. Kapoor, R. Neugebauer              Management: Provider Priorities Versus Resource Availability

                                                                                           1
Reddy, Mamta, S. Kaipa, D. Strom,       Valved-Holding Chamber Technique in Housestaff Residents:
R. Neugebauer                           Knowledge Base Versus Skills Set
Roane, David M., Eda Inan, Sophia       A Model for Incorporating Research Education into Residency
Haeri, Igor I. Galynker                 Training
Schiff, Bradley A.                      The Current State of Mentorship Programs in Otolaryngology
                                        Residencies


Curriculum Development and/or Evaluation
              Authors                                              Poster Title
Burton, William B., Adele Civitano,     Clerkship Evaluations Administered with Paper Versus Online
Penny Steiner-Grossman                  Forms
Fletcher, Jason, Alice Fornari,         In the Patient’s “Shoes”: An Assessment of an Educational
Vincent Huang, Marji Gold               Intervention to Teach Students about Access to Emergency
                                        Contraception
George, Claudene J., Laurie G.          Medication Management Rounds: A Novel Multidisciplinary
Jacobs                                  Teaching Session
Kim, Diana, Priti Kaur, Edwin Lee,      Subjective Evaluation of an Intensive Cardiology Orientation
Robert Ostfeld                          Program
Lui, Yvonne W., Joaquim M.              Development, Implementation, and Assessment of an
Farinhas, Jacqueline A. Bello           Inexpensive Cerebral Catheter Angiographic Training Laboratory
                                        and Curriculum
Ouchida, Karin, Kim Freeman,
Debra Greenberg, Alessandra             A Novel and Interactive Elder Mistreatment Curriculum
Scalmati, Laurie G. Jacobs
Therattil, Maya R., Todd R. Olson,      Musculoskeletal Review Course Using Both Cadavers and Live
Sherry A. Downie                        Volunteers
Thomas, Mark A., Maya R. Therattil      Disability Etiquette: How to Optimize Medical Care for People
                                        with Disabilities


Innovative Programs
              Authors                                           Poster Title
Blanco, Irene, Elena Weinstein, Julie   Development of a Novel Cadaver-Based Clinical Skills and
Schwartzman, Todd R. Olson,             Anatomy Review Course for Rheumatology Fellows
Chaim Putterman, Sherry A. Downie
Downie, Sherry A., Todd R. Olson,       A Simple, Efficient and Accurate Method for Practicing
Maya R. Therattil                       Musculoskeletal Injections Using Cadavers and a Novel Injection
                                        Medium
Gory, Alina, Ruchika Harisingani,
Lori Katinas, Betina Louis, Olga        Are Physicians Referring Their Elderly Patients to Geriatricians?
Garankina, Gabriel El-Kass, Nina
Kohn, Gisele P. Wolf-Klein



                                                                                               2
Kaye, Rachel J., Marc Gibber,
Babak Sadoughi, Alexis Jackman,      Criterion-based Training to Reduce Surgical Errors
Biana Lanson, Joseph Jacobs,
Richard Lebowitz, Marvin P. Fried
Kaye, Rachel J., Marvin P. Fried,    Validation of the Voxel-Man TempoSurg Temporal Bone
Elizabeth A. Dinces                  Surgical Simulator



Work in Progress
            Authors                                          Poster Title
Anderson, Matthew, Anna Flattau      Promoting Research Among Primary Care Faculty Through a
                                     Collaborative Model: A Work in Progress
Glassman, Nancy R., Racheline G.     Let Me Show You How It’s Done! Desktop Sharing for Distance
Habousha, Aurelia Minuti, Rachel     Learning from the D. Samuel Gottesman Library
Schwartz, Karen Sorensen
Guilbe, Rose M.                      Strategies for Conducting Culturally Sensitive Meetings at the
                                     End of Life
Natal, Elizabeth, Surah Grumet       A Breastfeeding Educational Workshop for Family Medicine
                                     Physicians: An Interactive Problem-based Approach
Natal, Elizabeth, Alice Fornari      A Summer Preceptorship in Family Medicine: An Early Medical
                                     Student Experience
Tattelman, Ellen, Sherenne Simon,
Meg Rosenberg, Patricia A. Carney,   Comfort with Uncertainty in Clinical Decision Making
Marji Gold
Troneci, Lizica C., Ali Khadivi,     Teaching Skills for Rapid Patient Engagement in the Clinical
Jeffrey M. Levine                    Interview: A Template Model




                                                                                            3
Promoting Research Among Primary Care Faculty Through a
Collaborative Model: A Work in Progress
Matthew Anderson, M.D. and Anna Flattau, M.D.: Department of Family & Social
Medicine, Albert Einstein College of Medicine, Montefiore Medical Center


Theoretical Model: Academic achievement is conceived of and rewarded as an
individual enterprise, despite literature showing that productivity is increased through
teamwork. We propose a model of educational research through a collaborative structure
focused on the iterative process of 1) obtaining funding, 2) carrying out educational
projects, 3) making presentations, 4) publishing and 4)
publicizing/implementing/evaluating results.

Background: Primary care faculty face special obstacles to teamwork including
dispersed clinical sites, diverse areas of interest, and differing levels of experience with
research methodologies. The experiences (good and bad) of one department member are
not typically available to all. By building bridges between different faculty members, we
hope to mitigate these obstacles.

Methods: To operationalize our collaborative structure and goals, we broke down the
steps involved in scholarship. For example, grant funding relies upon: 1) preparing a
concept paper;
2) completing a literature review; 3) collecting preliminary data; 4) researching potential
funding opportunities; 5) sending a letter of intent; 6) writing grants; and 7) revising and
resubmitting grants. We outlined what resources are needed to help educators succeed in
each of these steps. We also consider how those resources can be delivered to clinician
teachers in an accessible and timely fashion.

Results: Division meetings, websites, wiki’s, and a list-serve are now being used to
develop the collaboration. These offer schedules of upcoming grants, conferences, and
resources such as templates for concept papers. We are developing a long-term strategic
vision.

Potential Impact/Evaluation: The success of this initiative can be measured in terms of
the number of participating faculty members, as well as in grants received, projects
completed, presentations made, papers published each year and improvements in our
teaching; these will be tracked over time and compared to baseline numbers. More
generally, a successful collaboration will create an infrastructure that harnesses common
strengths and shared experiences to facilitate the ongoing work of participants.




                                                                                               4
Graduate Student Burnout and Cardiovascular Health: Baseline Data
Meghan Beier (Ph.D. Candidate), Sonia Suchday, Ph.D., Paul R. Marantz, M.D., M.P.H.,
Benjamin Kligler, M.D., M.P.H.: Ferkauf Graduate School of Psychology and Albert
Einstein College of Medicine


Objective: To examine the effect of graduate school burnout on physiologic health
measures and assess future risk of cardiovascular disease.

Methods: Metabolic, physiologic and burnout (emotional exhaustion, physical fatigue,
and cognitive weariness) measures will be obtained in medical and doctoral students at
the beginning and end of each academic year. The burnout outcome measures will be
compared with the baseline metabolic and physiologic measures to determine if there is a
correlation between burnout and future risk of cardiovascular disease. The baseline data
will then be compared with parallel data collected in Spring 2009, Fall 2009 and Spring
2010.

Participants: Fifty-three first-year medical and doctoral students were tested during their
first week of graduate school. Current participants will be asked to return in Spring 2009
to provide follow-up data and first-year students will be tested during the August medical
school orientation.

Measurements: Psychological measurements were taken by the Shirom-Melamed
Burnout Questionnaire and a short demographic questionnaire. Metabolic and
physiological measurements were taken with the Dinamap Pro100 Blood Pressure
Monitor and the Cardiochek system. Using the Cardiochek system, blood samples were
tested for Triglycerides, HDL Cholesterol, Total Cholesterol, Glucose and Ketone levels.
Participants were also measured for height, weight, and shoulder/waist/hip
circumference.

Results/Conclusion: Fifty-three first-year medical and doctoral students were tested
during their first week of graduate school. On average, student total burnout scores were
significantly greater than the normative data: Females t(3978) = 3.7164, p<.01. Males
t(6736) = 2.4443, p<0.01, suggesting that students are already experiencing
psychological stress before classes begin. There was no significant correlation between
burnout scores and physiologic measures. Future analyses will compare graduate
students with medical students on all measures.




                                                                                          5
Internal Medicine Residents' Self-assessment of Their Clinic Practice:
An Ambulatory Patient-based Quality Improvement Workshop
Oni Blackstock, M.D. and Darlene LeFrancois, M.D: Department of Medicine,
Albert Einstein College of Medicine, Montefiore Medical Center


Background and Goals: In keeping with the increasing recognition of the importance of
quality improvement in resident professional development, the ACGME is requiring that
each Internal Medicine resident evaluate her own ambulatory performance. The project’s
goals were to increase IM resident exposure to QI and to foster resident self-evaluation of
their clinic practice.

Methods: We designed a QI workshop to complement a standard QI lecture given during
the PGY2 ambulatory care rotation (ACR). In the first session, the PGY2s (n=13) learned
how to conduct a chart review, focusing on three primary prevention QI measures.
Residents used a software program to identify their ambulatory patients who had not met
the specified QI measure. In the second session, each resident shared her findings and
proposed a clinic-based QI intervention to correct identified lapses. PGY2s who had
taken the workshop and PGY3s (n=32), who had received only a standard QI lecture
during their PGY2 ACR, were surveyed about their perceived abilities and interest in QI.
Statistical analysis was performed using SPSS.

Results: Survey responses were measured on a Likert scale of 1 to 5 with “1” indicating
“strongly disagree” and “5”, “strongly agree”. Mean scores for assessing comfort with
performing a QI chart review and with proposing clinic-based interventions were greater
among PGY2s than PGY3s (3.9±0.3 vs. 2.1±1.2, p=0.004, and 3.9±0.6 vs. 3.0±1.0,
p=0.003 respectively). PGY2s expressed that their exposure to QI during residency was
more likely to influence their future clinical practice (4.1±0.8 vs. 3.4±1.0, p=0.02).
PGY2s agreed that they now had a better idea of their own ambulatory performance
(4.1±0.9).

Conclusion: An applied approach to teaching QI, based on residents’ own clinical
practice, successfully increased their exposure to and interest in QI, and informed them
about their own clinical performance.

Implications: We anticipate that residents will more readily incorporate quality
improvement efforts into their clinical practice based on this experience.




                                                                                           6
Development of a Novel Cadaver-Based Clinical Skills and Anatomy
Review Course for Rheumatology Fellows

Irene Blanco, M.D., Elena Weinstein, M.D., Julie Schwartzman, M.D., Todd R. Olson,
Ph.D., Chaim Putterman, M.D., Sherry A. Downie, Ph.D.: Departments of Medicine
(Rheumatology) and Anatomy and Structural Biology, Albert Einstein College of
Medicine


The purpose of this project was to increase the confidence of rheumatology fellows using
a cadaver-based musculoskeletal course focusing on common complaints, pertinent
anatomy and joint injection techniques.

Prior to the course, participants completed an (1) exam to document knowledge of
common complaints and clinical anatomy and (2) a survey assessing comfort with
musculoskeletal anatomy, physical exam and joint injection techniques. Fellows then
participated in 4 didactic sessions: knee, ankle/foot, shoulder, and hand/wrist. A
rheumatologist began each session with a clinical lecture. The remainder of each session
was spent with an anatomist and rheumatologist reviewing regional anatomy on pre-
dissected cadavers and demonstrating injection techniques. The fellows injected colored
gels into the joints of the cadavers’ undissected contralateral limbs. After several
injections, joints were opened to evaluate the position of each gel. Following the course,
fellows completed confidence surveys and a post-course exam. Three fellows
participated. Exam results and surveys were averaged. Results are presented as percent
change of the group.

Confidence levels increased in all three categories. Confidence with injections increased
the most (36.8%), followed by examination skills (31%) and anatomical knowledge
(20%). Confidence increased most in the ankle (43%), wrist (39%) and shoulder (33%).
Pre-course confidence in knee clinical and anatomical knowledge was high, thus the post-
course increase was modest (8.5%). Both clinical and anatomical knowledge assessed by
the post-course exam were increased but to a lesser degree: 15% and 7% respectively.

Fellows participating in this course increased their confidence levels and knowledge of 4
joint groups. To better assess efficacy, we plan to increase the number of participants for
the next course. The comprehensive nature of this course makes it a valuable addition to
any training program interested in the musculoskeletal exam and joint injection
techniques. Preliminary results of this pilot program are encouraging.




                                                                                             7
Needs Assessment and Evaluation of an IUD Training Program Among
Pediatric Residents

Dalia Brahmi, M.D., M.P.H., Cori Green, M.D., M.S., Shereen Simon, M.P.H.:
Department of Family & Social Medicine, Albert Einstein College of Medicine,
Montefiore Medical Center

Background: The Bronx’s teenage pregnancy rate of 126 per 1000 births for women
ages 15-19 is the highest rate in New York. (1) Pediatricians are responsible for the
majority of adolescent visits and as a result need to be informed about effective
contraception for their patients. Intrauterine contraception is an effective and safe
method of reversible long-acting contraception that is underused in adolescents and
carries many myths among clinicians and patients.

Goal: The goal of this study is to assess physician knowledge, attitudes and practices
about intrauterine contraception for adolescents. The initial survey will constitute a needs
assessment and will direct the training curriculum for pediatricians.

Methods: A pilot survey was administered to a convenience sample of pediatric house
staff at Montefiore Medical Center. The pre-test was an anonymous survey which
assessed their knowledge, attitudes and practices regarding intrauterine contraception.
A curriculum was designed by the researcher and three training sessions were done in
which IUD eligibility and myths were discussed as well any concerns the participants
had. A post-test survey was distributed after the session and will be distributed six
months following the intervention. The data will be analyzed using paired t-tests to
compare pre- and post-test scores.

Results: There were a total of 31 participants including pediatric residents (n=28) and
adolescent fellows (n=3). 77% of the residents were interested in learning IUD insertion
and attitudes and knowledge scores improved after the instructional session. None of the
residents had IUD insertions skills and only 15% had ever referred a patient for an IUD.
After the intervention a significantly greater percentage of respondents, 75%, would be
likely to recommend an IUD to adolescent patients compared to 29% prior to the
intervention.

Conclusions: Preliminary analysis shows instructional sessions positively changed
pediatricians’ attitudes and knowledge of intrauterine contraception. This study
demonstrates pediatric residents’ desire to learn about intrauterine contraception,
including insertion skills.

Implications: Intrauterine contraception teaching and training should be offered in
pediatric residency training in order to decrease pregnancy rates in their adolescent
patients.


(1) Steiner Sichel, L. Who’s at Risk? Teen Pregnancy in New York City Bureau of Family Health New
York City Department of Health and Mental Hygiene Dec 2002.
                                                                                                    8
A Case-based Subintern Conference: An Interactive Approach to
Internal Medicine Subintern Education
Alfred Burger, M.D., William Southern, M.D., Sharon Parish, M.D.: Department of
Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, and Montefiore
Medical Center


Background: Subinternship in Internal Medicine is a period of increased clinical
responsibility and independence, yet few institutions have a standardized approach to
subintern education. Generally teaching rounds and resident focused educational
activities are relied upon.

Goal: Create a standardized case based conference that targets the educational needs of
subinterns.

Methods: During the subinternship, we held four one-hour case-based teaching sessions
based on CDIM Subinternship Curriculum Task Force learning objectives. Topics
selected were abdominal pain, hyponatremia, hyperglycemia, heart failure. Scenarios
created were composites of patient encounters. From the history and physical, differential
diagnosis, diagnostic studies, disease and treatment were discussed. Students were
anonymously surveyed. Students rated their comfort and competence with the case-
content on a 5 point scale prior to the first session and after the fourth. Comments on
positive and negative aspects of the course were gathered. A paired t-test was used to
compare pre- and post-session scores for each student. Scores were compared only for
sessions attended.

Results: At the time of analysis 21 students had participated. Eleven students missed one
session. None missed more than one. Overall attendance rate was 87%. Comfort and
competence rose by .75 (p=.006) and1.00 (p <.001) in hyponatremia, .48 (p <.05) and .68
(p =.005) in heart failure, .94 (p <.001) and .95 (p <.001) in hyperglycemia, and .10 (p =
.58) and .38 (p =.07) in abdominal pain. Two thirds of students commented that the most
important aspect was formulating a differential diagnosis around common problems. Half
stated they appreciated level specific conferences.

Conclusions: Students who participated in these sessions had significant gains in self
assessed comfort and competence in 3 of the 4 topics. Written comments reflected a
positive view of the conference.

Implications: This project suggests that case-based sessions held for subinterns
improved their educational experience and were valued by the students. Broader
educational programs should be considered at this level.




                                                                                          9
Clerkship Evaluations Administered with Paper Versus Online Forms
William Burton, Ph.D., Adele Civitano, B.S., Penny Steiner-Grossman, Ed.D., M.P.H.:
Office of Educational Resources, Albert Einstein College of Medicine


Objectives: We aimed to determine if differences exist in the quantitative and qualitative
information collected with paper versus online versions of a clerkship evaluation form.

Methods: We used clerkship data collected both before and after the switch from a paper
to an online evaluation system. The quantitative data consisted of a composite score
based on the average of 23 Likert-type items (possible score 1.0 – 5.0, with a higher score
being more favorable). We examined whether any changes in numeric ratings
corresponded to the timing of the switch from the paper to the online system. The
qualitative data consisted of two open-ended comments about clerkship strengths and
weaknesses. For these data, we looked to see if there were differences between the paper
and online forms in the percentage of students who provided comments, the length of
comments, the informative quality of comments, and the presence of “venting” in the
comments.

Results: Ratings for all clerkships were higher in the online condition (0=.0004), and the
increase was seen one year earlier for the three clerkships that switched to the new
system early, compared to the three clerkships that switched later (p=.009). Students
made significantly longer comments about both strengths and weaknesses on the online
form than on the paper form (p=.0001). Informative comments were three times more
likely to be made on the online form than on the paper form. No differences were found
in the prevalence of venting.

Conclusions: The findings of this study suggest that both quantitative and qualitative
data obtained with online evaluation forms can differ in important ways from data
collected with paper forms. We believe that these differences have more to do with the
setting in which evaluations are filled out (i.e., in class vs. at home), than they do with the
method per se (i.e., paper versus online).




                                                                                            10
A Simple, Efficient, and Accurate Method for Practicing
Musculoskeletal Injections Using Cadavers and a Novel Injection
Medium

Sherry A. Downie, Ph.D., Todd R. Olson, Ph.D., Maya R. Therattil, M.D.: Department of
Anatomy and Structural Biology, Albert Einstein College of Medicine

Objectives: A variety of methods, ranging from simulator manikins to cadaver courses
with fluoroscopic guidance, have been developed to provide physicians the opportunity to
practice and improve their therapeutic injection skills. Each method has its advantages
and disadvantages. Our goal was to create a simple, efficient, accurate and inexpensive
method to enhance the skills and confidence of residents in performing a variety of
therapeutic injections.

Design: Using undissected cadavers and a novel injection medium, 27 residents practiced
injections of joints, bursae and tendons, as well as peripheral nerve blocks and neurotoxin
injection techniques. A physiatrist and an anatomist facilitated the session and
encouraged senior residents to mentor junior residents. Surface anatomy and standard
palpation guidelines were used to identify the sites for injection. Injections were
performed using a colored gel (red, green or blue) with a consistency that minimized
diffusion from the site of injection. Three residents, each using a different colored gel,
injected into the same joint or region. Subsequently the joint/region was opened and the
accuracy of each injection was evaluated by the position of the gel.

Results: The colored gel injection technique provided residents with immediate feedback
about their injection accuracy. Residents commented that the cadavers, many of which
had osteoarthritis and other pathologies, provided a better representation of the anatomic
challenges of the patient population than synthetic models. The gel was inexpensive and
easy to use.




                                                                                        11
In the Patient’s “Shoes”: An Assessment of an Educational Intervention
to Teach Students about Access to Emergency Contraception
Jason Fletcher, Ph.D., Alice Fornari, Ed.D., Vincent Huang, M.S., Marji Gold, M.D.:
Department of Family & Social Medicine, Albert Einstein College of Medicine


Background: Emergency Contraception (EC), or post-coital contraception, is a safe and
effective treatment to prevent pregnancy after unprotected sex. Although it has been
available for years in the United States, it is under-prescribed and underutilized. Selected
AECOM medical students participated in a multi-faceted EC project during their third-
year Family Medicine clerkship. The main objectives were for the students to learn about
EC pharmacology and prescribing, and experience the role of patients trying to access
EC.

Goal: To assess the educational impact of an experiential community-based project and
peer teaching on medical students’ knowledge and attitudes about EC prescribing.

Methods: Students participating in the Family Medicine clerkship (N=103) were
surveyed pre-post rotation to measure change in their knowledge and attitudes about EC.
Students were assigned by rotation to intervention and control groups. A subset of
students (n=14) opted to participate in an intensive EC project which involved assuming
the patient role and teaching their peers. Their project and teaching experiences were
assessed in an in-depth structured interview following the clerkship.

Results: All groups showed improvement in knowledge and attitude scores, with the
greatest gains seen in knowledge scores. The largest gains were by students who
participated in the project. Though none of the gains were statistically significant, the
results suggest greater exposure to the project resulted in greater gains in knowledge and
attitude. The impact on students’ future practice behaviors and role as teachers of peers
were addressed in qualitative analysis.

Conclusion: The project compared change in knowledge and attitudes between students
who participated in the EC project and those who were only exposed to the brief peer
presentation.

Implications: Students learn about barriers to care and professionalism when they
assume a patient role. Students who have the opportunity to teach can influence both the
knowledge and attitudes of their peers.




                                                                                          12
Chronic Disease and Palliative Care in a Family Medicine Third-Year
Ambulatory Clerkship
Alice Fornari, Ed.D., Allen Hutcheson, M.D., Peter Selwyn, M.D., M.P.H., Pablo Joo,
M.D.: Department of Family & Social Medicine, Albert Einstein College of Medicine,
Montefiore Medical Center


Background: Despite the breadth of palliative care clinical services offered, our medical
students are not formally exposed to palliative care curricula. It is critical that students
not only gain exposure to palliative care, but also appreciate the particular issues faced in
serving the predominantly minority urban underserved population.

Goal: To describe a required palliative care curriculum developed for a third-year
ambulatory Family Medicine clerkship.

Project Description: This project is ongoing since 2007 and has integrated palliative
care learning opportunities for all third-year students (N=297) into the Family Medicine
clerkship through small-group sessions and clinical exposure. The curriculum has three
components: a lecture on palliative care concepts, an individual patient interview in the
primary care setting using the Palliative Care in Primary Care Tool (PCPCT), and by a
debriefing session with a palliative care faculty facilitator. Evaluation assesses
knowledge and comfort prior to and after their exposure to the curriculum components. In
a retrospective pretest analysis, students will be asked to separately rate knowledge and
comfort with goals of care interviewing.

Results: The quantitative results to date support increased knowledge about the scope of
palliative care and increased comfort with discussing end of life goals with patients.
Qualitative comments suggest both a baseline lack of knowledge of fundamental
concepts such as opioid therapy and advance directives, as well as an eagerness to learn
about a topic not covered in depth in the rest of their curriculum.

Conclusions: Medical students experience the expanded role of palliative care beyond
hospice and end of life interventions, by moving end-of-life goal setting into primary care
continuity practices.

Implications: This brief palliative care curriculum designed for the ambulatory setting
can be applied to other medical student ambulatory experiences. This experience with
palliative care will stimulate students’ interest in palliative care electives.




                                                                                           13
Comfort Level and Attitudes of Internal Medicine and Family Practice
Physicians Towards Dementia Care
Olga Garankina, M.D., Muhammad Ashraf, M.D., Gabriel El-Kass, M.D., Andrea Galasso,
M.D., Alina Gory, M.D., Betina Louis, M.D., Emmanuel Opara, M.D., Gloria Alano, M.D.,
Gisele Wolf-Klein, M.D.: Department of Medicine (Geriatrics), Albert Einstein College
of Medicine, North Shore-Long Island Jewish Health System


Background: Recent studies have demonstrated that practicing physicians have limited
confidence in their diagnostic skills and ability to manage demented patients. However,
there is a dearth of data on comfort level of physicians-in-training towards dementia care.
Thus, we designed a study to explore attitudes of residents in Internal Medicine and
Family Practice.

Methods: A standardized, validated survey tool (Kaduszkiewicz, 2008), designed to
assess self-rated attitude and comfort level regarding dementia care, was administered
anonymously in 3 teaching hospitals (NY).

Results: In the 98 surveys completed by 18 (18.4%) family practice and 80 (81.6%)
internal medicine residents. 81.6%), there was no difference between groups with
regards to gender (males: 44.4% in internal medicine, vs. 39.7% in family practice),
previous nursing home experience (“yes”: 27.8% vs. 16.3%, respectively) or having a
relative with dementia (“yes”: 16.7% vs. 13.9% respectively). However, family practice
residents were significantly older (median age: 34 y.o. vs. 29 y.o., p<.001), and more
likely to be Asian (Asians: 72.2% vs. 25%; p<.002).

Additional differences included using cognitive tests, and finding community resources.
Specifically, family practice residents were more likely than internal medicine to agree
with the following statements: “I actively search for dementia in all patients over 65”
(p=.001), “If I suspect cognitive problems, I regularly use cognitive tests” (p=.004), “I
assist the relatives in finding community resources to help with the comprehensive care
including legal issues" (p=.000), “I would welcome additional educational programs on
managing demented patients and their relatives" (p=.014), and “I would like to get a
formal geriatric psychiatry rotation" (p=.004).

Conclusion: Since there appears to be striking differences between internists and
family medicine residents, we believe that educational curriculum on dementia care
need to be encouraged for internal medicine residents to better prepare them for the
challenges of elderly demented patients awaiting their care.




                                                                                         14
Medication Management Rounds: A Novel Case-based
Multidisciplinary Teaching Session
Claudene J. George M.D., R.Ph. and Laurie G. Jacobs, M.D.: Department of Medicine
(Geriatrics), Albert Einstein College of Medicine, Montefiore Medical Center


Background: Prescribing for elderly patients has become increasingly complex as
treatment regimens have intensified, and the use of herbal and OTC medications has
increased.

Goals: This conference aims to teach physician and pharmacy trainees to examine the
pharmacology, potential drug and disease interactions, efficacy, adherence issues, and
goals of care for an elderly patient’s medication regimen.

Methods: Bi-monthly hour-long conferences are facilitated by a geriatrician-pharmacist
in which medical students, PGY II and III IM and FM residents, geriatrics and
geropsychiatry fellows, pharmacy residents, a pharmacist, geropsychiatrist and
geriatricians participate. A trainee presents a case, including the complete history,
physical, medications, and pertinent laboratory data. A screening questionnaire is used to
guide discussion and highlight the goals, with the facilitator providing additional
questions and commentary, as well as verbal feedback at the conclusion. The trainees
evaluate the session using a 5-point Likert scale and may document additional comments.

Results: Twenty-three sessions have been held since its inception in January 2007, with
241 participants overall, and an average of 10.4 participants per session. Of the 161
unique participants overall, there were 49 medical students, 83 residents, 5 fellows, 6
attending, 2 pharmacy residents, and 1 pharmacists. Among the 241 participants, 67%
(163) completed an evaluation. All participants agreed or strongly agreed that learning
goals were clearly established. 98.7 % agreed or strongly agreed that the rounds increased
their knowledge of the care of older adults. Participants described the sessions as
interactive, informative, and educational.

Conclusion/Implications: Teaching medication management through a case-based
format with multidisciplinary trainees at different levels is an effective format that is both
interactive and informative. These sessions may be replicated in other settings and with
other disciplines.




                                                                                           15
Let Me Show You How It’s Done!: Desktop Sharing for Distance
Learning from the D. Samuel Gottesman Library
Nancy R. Glassman, M.L.S., Racheline G. Habousha, M.S.L.S., Aurelia Minuti, M.L.S.,
Rachel Schwartz, M.L.S., Karen Sorensen, M.LS.: D. Samuel Gottesman Library, Albert
Einstein College of Medicine


Background and Goals: Electronic resources at the D. Samuel Gottesman Library may
be accessed from lab, hospital, office, or home. Consultation with a librarian facilitates
efficient use of these resources. However, negotiating the research process by telephone
or email is frustrating for librarians and users. While we offer regularly scheduled
educational programs in the Library, this project extends our reach to students, residents,
clinicians/researchers, postdocs, and administrative staff when they need help, on or off-
campus.

Methods: Desktop sharing software connects librarians with users. We evaluated several
products before choosing Glance®, which allows us to interactively demonstrate features
of the library’s electronic resources. Learners follow and participate in the demonstration
through web browsers without installing special software or reconfiguring their
computers.

We are using this tool on the fly, one-on-one and conducting scheduled 15-minute
webinars on PubMed, Ovid Medline, PsycINFO, Web of Science, EndNote, and
RefWorks. Nine participants responded to our initial email broadcast announcement.
Immediately after each webinar, we emailed a brief electronic survey to measure
effectiveness, convenience, technical issues and interest in future sessions. All
participants responded to the survey. Zoomerang™ was used to create the survey and
tabulate and analyze results.

Results: Response to this initiative has been positive. Preliminary survey results indicate
respondents found sessions helpful and would attend future webinars. User computer
issues and session duration were problems identified. Because this is an ongoing project,
additional results are pending.

Conclusions/Implications: We will reach out to future users via broadcast and e-board
messages, library website and brochure, and faculty development workshops.
Forthcoming projects include customized “lunch & learn” webinars, scheduled full-
length classes and group training during which participants connect simultaneously from
multiple sites to the instructor. Existing survey will be used to evaluate these projects.
Popular sessions will be recorded and posted on our website.




                                                                                         16
What is the Extent of Family Planning Training in Family Medicine
Residencies?

Marji Gold, M.D., Jessica Dalby, M.D., Crystal Query, M.D., Cara Herbitter, M.P.H.,
C.P.H., Megan Greenberg, B.A.: Department of Family & Social Medicine, Albert
Einstein College of Medicine, Montefiore Medical Center


Background/Goals: The ACGME for family medicine requires training in contraception
and options counseling for unintended pregnancy. In 1997, Steinauer et al. reported that
most family medicine residents received inadequate family planning training.
This project evaluated the current level of family planning training in US family
medicine residencies by examining how family planning training has changed since 1997,
and whether options counseling, new contraceptive methods and medication abortion are
included.

Methods: Program directors (PD) and chief residents (CR) at 454 US family medicine
residency programs were emailed a link to an online quantitative survey. This survey
included questions from the Steinauer study and additional questions about options
counseling, medication abortion, and newer contraceptive methods. Non-responders were
mailed paper copies of the survey and telephone reminders were made. 220 PDs (48%)
and 98 CRs (22%) responded, representing 54% of all surveyed programs. Data were
analyzed using SPSS and Excel.

Results:
Family Planning: CRs reported clinical training in each method: oral contraceptive pills
100% (1997-100%); Depo-Provera 92%; hormonal intrauterine device (IUD) 78%;
emergency contraception 75%; copper IUD 71% (1997-34%); tubal ligation 60% (1997-
38%); hormonal implant 20%.

Options counseling: 80% CR’s reported clinical training

Abortion: PDs indicated abortion training is routine at 7% of residency programs and
optional at 42%. 32% of PDs reported that residents receive clinical training in
medication abortion and 23% reported resident training in aspiration abortion. 40% of
CRs’ reported clinical experience with at least one abortion method, an increase from the
15% reported in 1997.

Conclusion: CRs generally reported less training than PDs. Most family medicine
residents receive some training in contraception. Abortion training has increased since
1997. Nonetheless, training in the full range of contraception options and early abortion
care is still not adequate.

Implications: Family planning and abortion education should be increased to prepare
family physicians to meet women’s reproductive health needs.


                                                                                        17
Intensive Case Management: A Multidisciplinary Team and Resident
Education Approach to 'Not at Target' Diabetics
Victoria Gorski, M.D., Sandra Barnaby, R.N., C.D.E, Amy Osorio, M.P.H., Fabienne
Daguilh, M.D., Jennifer Klein: Department of Family & Social Medicine, Albert Einstein
College of Medicine, Montefiore Medical Center


Objectives:
  1. To provide individualized, interdisciplinary diabetes education to high-risk
      patients with an A1C>9 and LDL > 100 or BP > 130/80.
  2. To reinforce resident education in the Chronic Care Model by providing
      experience in the intensification of diabetes treatment with a biopsychosocial
      approach.

Design:
   1. Multidisciplinary team: physicians, RN/certified diabetes educator, health
      educators, social worker established protocol for assessment and a six-week
      program of intervention.
   2. Clinical care once weekly. Interventions include self-management support using
      MI, medication adjustment, and social work referral for depression. Inter visit
      phone calls support medication and behavior changes.
   3. Three and six months follow up visits and a yearly “reunion”.
   4. Second and third year family medicine residents join the team while on
      cardiology rotation. ACGME competency oriented objectives are established for
      the resident learning experience.

Results: The first cohort of fifteen patients started with an initial average A1C of 10.8.
At graduation, average A1C was 8.8. At twelve months after graduation average A1C
was 8.2.

Qualitative data gathered from patients at the reunion highlight the sense of enthusiasm
and support generated by the different members of the intervention team. Interviews with
the family medicine residents who have completed the rotation reveal high levels of
satisfaction with the rotation, which allows them to learn about intensification of
treatment and self-management support.

Conclusions: Guided by the principles of the Chronic Care Model, a multidisciplinary
team is able to improve clinical parameters in diabetics not at target through a structured
program of intensification. Family medicine residents value time spent with the team and
increase their comfort with diabetes management.




                                                                                             18
Are Physicians Referring Their Elderly Patients to Geriatricians?
Alina Gory, M.D., Ruchika Harisingani, M.D., Lori Katinas, M.D., Betina Louis, M.D.,
Olga Garankina, M.D., Gabriel El-Kass, M.D., Nina Kohn, M.D., Gisele Wolf-Klein,
M.D.: Albert Einstein College of Medicine, North Shore-Long Island Jewish Health
System


Background: A survey of geriatric academic programs suggested that the role of
geriatricians should be primarily directed to the “most vulnerable older adults” (Warshaw
et al, 2008). We studied the referral patterns of physicians to geriatricians, to determine
reasons and barriers for geriatric consults.

Methods: An anonymous survey was distributed during Medicine Grand Rounds in 3
teaching hospitals with in-patient geriatric consult services. Data collected included level
of training, comfort level in the management of geriatric syndromes and referral patterns.

Results: Of the 115 surveys gathered, 69.2% were from non-attendings (medical
students, residents, fellows, and physician assistants) and 30.8 % from attendings. The
majority (69.8%) reported that half of their patients were over 65. Although almost a
third (28.7%) acknowledged limited training in Geriatrics, 75.7% indicated being
comfortable treating elderly patients in general, though less with specific conditions such
as falls (55.7%), frailty (47.8%) and dementia (43.0%); only 34.8% were comfortable
with nutritional issues and 33.0% with depression. Most physicians (81.7%) knew about
geriatric consult service and 65.4% would “probably or always” consider referring their
patients to a geriatrician. Of interest, 82.1% thought a consult could “maybe, probably or
always” lead to transfer of care to a geriatrician. Non-attendings were significantly less
comfortable treating elderly (p<.006) and more likely than attendings to refer to
geriatricians (p<.003), particularly for frailty (p<.0005), polypharmacy (p<.008),
nutrition (p<.0002) and palliative care (p<.002); they also stated that geriatric consult
would improve quality of life (p<.0014).

 Conclusion: Internists in practice appear to underutilize geriatric consults services,
despite recognized lack of geriatric training. We suggest that educational programs be
developed to encourage the utilization of geriatric consults for the benefits of elderly
patients.




                                                                                           19
Strategies for Conducting Culturally Sensitive Meetings at the End of
Life

Rose Guilbe, M.D.: Department of Family & Social Medicine, Albert Einstein College of
Medicine, Montefiore Medical Center


Background: Training residents to conduct culturally appropriate family meetings,
particularly when patients and their loved ones are facing eminent death, is a very
important aspect of residency teaching. In 2001 the Department of Family Medicine
conducted a survey to al1 30 family medicine residents to assess their learning needs
regarding the Montefiore hospital-wide Palliative Care Initiative. The survey highlighted
a large need to learn communication skills in the form of family meetings for end-of-life
care.

Goal: Goals of this project are to: 1) Develop and implement an ongoing curriculum to
teach residents the necessary skills for conducting culturally competent family meetings
2) Increase resident sensitivity of personal attitudes towards similarities and differences
among providers and the families they serve during end of life care.

Methods: We currently are creating a curriculum that will include structured didactic
teaching sessions that utilize videotaping of residents & attendings during family
meetings, role- playing activities and ongoing feedback discussions.

Results: The curriculum will educate about communicating health-related issues as they
pertain to EOL care such as mistrust of the medical community, lack of access to medical
care, and language/ cultural barriers. The curriculum will also provide education about
cultural beliefs and how they contribute to patients’ views on life, illness, and dying.

Impact: Incorporating these skills into ongoing resident teaching will provide residents
with the knowledge, attitude and skills to perform culturally appropriate family meetings
in preparation to meet the clinical and psychosocial needs of patients and their families at
EOL.

Conclusion: Facilitating the language of culture as it applies to communicating about
death and the dying process is essential in medical education. The family meeting is an
excellent venue for this application and its success.




                                                                                          20
Criterion-based Training to Reduce Surgical Errors
Rachel J. Kaye, MS II, Marc Gibber, M.D., Babak Sadoughi, M.D., Alexis Jackman,
M.D., Biana Lanson, M.D., Joseph Jacobs, M.D., Richard Lebowitz, M.D., Marvin P.
Fried, M.D.: Departents of Otorhinolaryngology, Albert Einstein College of Medicine,
Montefiore Medical Center and New York University Medical Center


Introduction: An innovative state-of-the-art simulation device has been developed by
Lockheed Martin to help train otolaryngology residents. This ES3 (Endoscopic Sinus
Surgery Simulator) system assesses and quantifies the performance of an entire task,
thereby providing constructive feedback to the training resident and making it possible to
ensure skill proficiency by training to expert criteria. In contrast, current surgical training
typically lasts for a specified time period or number of procedures, producing surgeons
with variable skill levels. Also, training on patients is becoming less acceptable for
patient safety. We propose to use the ES3 to train surgical residents to criterion
performance levels, and to investigate whether this criterion-based training is superior to
training for a fixed number of surgical cases.

Materials & Methods: Two groups of eight subjects each will complete a battery of
validated objective tests to assess visuospatial, perceptual, and psychomotor abilities on
the ES3. The subjects are otolaryngology junior residents who are placed in either a
control or an experimental group as determined by training site. The control subjects will
be train by repeatedly performing the same procedure on patients with no simulator
training, whereas the experimental subjects will train to performance criterion on the
simulator. Eight attending otolaryngologists have established performance criteria on the
simulator and will serve as comparators for infra-operative assessment. The control and
experimental subjects will be videotaped performing intraoperative surgical tasks both
before and after their training. All videos will be assessed for explicitly defined metrics
(difficulty, tool manipulation, tissue respect, completion, and errors) by a panel of
attending surgeons.

Results: The data collection for this study is ongoing. Thus far, three experimental and
two control subjects have completed their participation.

Discussion: We hypothesize that training to established criteria will reduce surgical
errors, and provide evidence for training on simulators before ever operating.




                                                                                             21
Validation of the Voxel-man TempoSurg Temporal Bone Surgical
Simulator
Rachel J. Kaye, MS II, Marvin P. Fried, M.D., Elizabeth A. Dinces, M.D.: Department of
Otorhinolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center


Introduction: Surgical simulation is rapidly becoming an essential tool for improving
understanding of 3-dimensional anatomy and learning of more rapid progression of
procedures. There are currently no validated commercially available virtual simulators
for learning surgical techniques and anatomy of the temporal bone. Although dissection
of cadaveric specimens have been used in otologic surgery training for over 50 years,
their availability has steadily waned over the last 7-10 years. A virtual computer-based
simulated environment used to supplement cadaveric dissections would substantially
reduce the number of cadaveric specimens required to train each resident to proficiency
in surgery of the temporal bone. To this end, we are undertaking a face and content
validity study of the VOXEL-MAN TempoSurg Simulator and collecting preliminary
data for a future construct validation.

Materials & Methods: Five groups of ten subjects will complete a pre-simulator
questionnaire, a training session on the simulator, practice time on the simulator, a
recording of the final simulated dissection, and a post-simulator questionnaire. The five
groups are based on temporal bone surgical knowledge as the simulator will be assessed
on all levels of the educational process: experienced otologic surgeons (>12 otologic
surgeries in the last year), experienced otorhinolaryngologists who do not regularly
perform otologic surgery, senior otolaryngology residents, junior otolaryngology
residents, and surgical residents in programs other than otolaryngology. Face and content
validity will be assessed by the pre- and post-simulator questionnaires, respectively.
Construct validity pilot data will be collected by videotaping the motion of the simulated
drill during each session.

Results: Thus far, one experienced otologic surgeon, one experienced
otorhinolarygologist, five senior and four junior otolaryngology residents, and one
surgical resident have completed their participation. Further data collection and
enrollment for this study is ongoing.

Discussion: We hypothesize that the VOXEL-MAN TempoSurg simulator will be shown
to have face and construct validity.




                                                                                        22
Subjective Evaluation of an Intensive Cardiology Orientation Program
Diana Kim, M.D., Priti Kaur, M.D., Edwin Lee, M.D., M.S., Robert Ostfeld, M.D., M.S.:
Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore
Medical Center


Background: The transition from medicine residency to cardiology fellowship can be
difficult. There are limited data on facilitating this transition.

Methods: We implemented a four-day intensive orientation program in 2004. It
consisted of lectures on core cardiology topics, fellow-to-fellow practical sessions, and
interactive sessions on the use of echocardiography machines and pacemaker
interrogators.

We prospectively surveyed fellows in 2006 and 2007 (N=13) with a questionnaire pre,
immediately post and 6 months after the orientation program. We retrospectively
surveyed cardiology fellows who began their fellowship in 2004 and 2005 (N=12) by
asking them to rate the program as they would have pre, immediately post and six months
after its completion. Using anonymous surveys, we asked about their confidence in
specific cardiology skills and overall confidence, and their overall support for the
orientation program. The responses were on a scale of 1-7, with 1 agreeing the least with
the statement, 4 being neutral, and 7 agreeing the most with the question. Retrospective
and prospective data were pooled. Non-parametric paired analyses were performed.
Medians and inter-quartile ranges are reported. The primary outcome was the change in
the confidence levels of cardiology fellows in regard to starting cardiology fellowship pre
versus post orientation.

Results: Twenty-five fellows were enrolled. Fellows' confidence in their cardiology
skills and overall confidence increased. The median and interquartile ranges were 20 (12,
21) and 36 (31, 38) respectively, (p<0.01). This increase was sustained after six months,
(p<0.01) versus pre-orientation. In addition, at all time points, fellows supported having
this orientation program.

Conclusions: An intensive orientation program improved cardiology fellows' confidence
when starting fellowship. Support for this program was high. This finding supports its
continuation.




                                                                                            23
Impact of Abortion Training on Family Medicine Residents’ Pregnancy
Options Counseling Skills
Vanita Kumar, M.D., Cara Herbitter, M.P.H., C.P.H., Alison Karasz, Ph.D., Marji Gold,
M.D.: Department of Family & Social Medicine, Albert Einstein College of Medicine,
Montefiore Medical Center


Background and Goals: In the US, 50% of pregnancies are unintended, and women
often seek counseling from their physician to decide whether or not to continue the
pregnancy. In order to provide accurate pregnancy options counseling, family physicians
should be knowledgeable about all options, including abortion. The RRC requires that
family medicine residency programs teach residents pregnancy options counseling. Our
educational evaluation examined whether observing abortion procedures during a routine
women’s health rotation is a valuable component of training residents to provide
pregnancy options counseling. Educational Goal: The goal of this training was for
residents to gain experience providing the full spectrum of women’s reproductive health
services.

Methods: 30 minute semi-structured interviews were conducted by a trained research
assistant between June 2006-March 2007 with all 28 family medicine residents, from two
urban family medicine residency programs, who participated in a women’s health
rotation between July 2005-November 2006. Residents were asked which aspects of
training were most surprising, helpful, or needed improvement, and about the impact of
training on their skills, attitudes, and future practices. Transcripts were analyzed using
thematic codes developed by three readers in consultation with a qualitative research
expert.

Results: Through exposure to routine abortion training, residents reported gaining the
knowledge, attitudes, and skills to provide open and informed pregnancy options
counseling. These include an understanding of the context of women’s lives when they
seek abortion care, familiarity with the procedure, and improved self-reported pregnancy
options counseling skills. Even residents who chose not to engage in hands-on abortion
training felt more comfortable providing options counseling.

Conclusion: Our evaluation found that residents who were exposed to abortion training,
including those who opted out of hands-on training, gained important options counseling
skills.

Implications: Our findings suggest that abortion training is a critical component of
teaching pregnancy options counseling and should be integrated into family medicine
curricula.




                                                                                       24
Development, Implementation, and Assessment of an Inexpensive
Cerebral Catheter Angiographic Training Laboratory and Curriculum

Yvonne W. Lui, M.D., Joaquim M. Farinhas, M.D., Jacqueline A. Bello, M.D.:
Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical
Center


Background: This project develops and implements an interactive cerebral angiography
laboratory and curriculum for educational purposes. Cerebral angiography requires
precise techniques. It may be helpful for trainees to practice on models.

Goals: To develop, implement, and assess an inexpensive hands-on learning program for
trainees in cerebral catheter angiography.

Methods: First-year neuroradiology fellows completed questionnaires regarding their
experience in cerebral angiography. Fellows recorded whether they were able to
successfully catheterize vessels or failed in the attempt, for six months. Eleven learning
sessions were developed utilizing interactive models and handouts. Trainee knowledge of
the curriculum was assessed by short quizzes administered before and after sessions. The
same multiple questions were asked pre/post session in a randomized order. Post-session,
trainees were asked to rate their comfort level with different techniques and perceived
utility of the session’s components using a 5-point Likert scale.

*Results: Two first-year fellows had initial 25% rate of successful cannulation of
cerebral vessels and 51% after six months. Five fellows reported average comfort level of
1.7 for various cerebral angiography techniques on a 5-point scale (1 = most, 5 = least).
Areas where fellow comfort level was 4/5 included selection of injection rate/volume,
reforming catheters, naming fluoroscopic views.

In data from eight sessions, trainees (total/1st/2nd year) reported average perceived utility
of 1.7/2.0/1.5 for handouts, 1.7/1.9/1.5 for didactic and 1.6/2.0/1.4 for interactive portions
of the session. Trainees had average correct response of 57%/62%/54% on pre-tests and
77%/77%/78% on post-tests. Trainees’ average comfort levels were 1.84/1.88/1.82.

Conclusion: Preliminary data suggest training may improve fellow knowledge. The
perceived utility of the program by trainees was high.

Implications: It is feasible to develop and implement an introductory hands-on cerebral
catheter training program. This program may be most useful if areas in which trainees
have expressed less comfort are highlighted.

*statistical analysis not performed




                                                                                           25
Religious vs. Spiritual Identity: A Necessary Distinction in
Understanding Clinician Educators’ Behavior and Attitudes Toward
Clinical Practice and Medical Student Teaching
Mimi McEvoy, M.A., R.N., William Burton, Ph.D., Bradley Morganstern, Lauren Glass,
Felise Milan, M.D.: Office of Education, Albert Einstein College of Medicine


Background/Purpose of Study: Social science literature generally views religion and
spirituality as separate constructs; 1 medical literature views them as a single entity. We
aimed to identify distinctions between clinician educators’ religious vs. spiritual (R/S)
identity with their self-reported behavior and attitudes regarding clinical practice and
undergraduate medical education in this realm.

Methods: Our medical school’s clinical affiliate’s list serve (n=1067) were emailed a
26-item survey on religious and spiritual issues aggregated into three summary scores:
clinicians’ practice with patients, medical student teaching, and attitudes about R/S in
health care. Based on participants’ response to the statements, “I consider myself to be
religious.” and, “I consider myself to be spiritual.” we created four groups: religious and
spiritual; Religious, not spiritual; Spiritual, not religious; and Neither religious nor
spiritual. We analyzed groups using ANOVA and T-tests.

Results: 633 (59%) surveys were completed. 32.5% of participants self-identified as
both religious and spiritual; 4.4% as religious, not spiritual; 30.6% as spiritual, not
religious; and 32.5% as neither religious nor spiritual. All four groups differed from one
another on all three summary scales – clinical practice (p<.0001); medical student
teaching (p<.0001); and attitudes regarding R/S in health care (p<.0001). Individual t-
tests showed the Both group scored higher than all other groups on all three summary
scales. The Neither group and Religious, not Spiritual group were less likely than other
groups to address patients’ R/S needs and teach medical students on the topic. The
Religious, not Spiritual group were less likely than the Spiritual, not Religious group to
teach medical students. The Neither group had less positive attitudes about the role of
R/S in health care than all the other groups.

Discussion/Implications: Clinician educators’ religious vs. spiritual identity is
associated with differences in self-reported behavior and attitudes regarding R/S in health
care. Faculty development might be enhanced by exploring the effect of these
differences on behavior and attitudes regarding this topic.




1
  Hodge, David R; Andereck, Kathleen; Montoya, Harry. (2007) Spiritual/religious life-style profiles and
community substance abuse perceptions: An exploration study among a predominantly Hispanic sample in
the American Southwest. Journal of Social Service Research; Vol 34(1): 43-54.


                                                                                                      26
A Breastfeeding Educational Workshop for Family Medicine
Physicians: An Interactive Case-based Approach
Elizabeth Natal, M.D. and Surah Grumet, M.D., M.P.H.: Department of Family & Social
Medicine, Albert Einstein College of Medicine


Background: Despite known benefits of breastfeeding, declining rates has been the
center of much debate. Leading organizations have campaigned to increase support of
exclusive breastfeeding. Physician knowledge and skills is important for breastfeeding
counseling. As such, a breastfeeding educational workshop was created to provide
Family Physicians with knowledge and skills to enhance breastfeeding counseling.

Goals:
To:
 1. Utilize a workshop intervention to enhance physician breastfeeding knowledge,
    attitudes and skills.
 2. Initiate a dialogue about politics in breastfeeding.
 3. Review precepting techniques to enhance breastfeeding counseling efforts.

Methods: All Faculty and Residents of the Family Medicine department were invited to
participate. Thirty-nine pre-intervention online surveys were received, assessing baseline
breastfeeding knowledge, attitude and skills. Twenty residents participated in a 75
minute educational workshop. Nineteen faculties participated in a separate 90-minute
workshop focused on preempting techniques. Both interventions included didactics,
instructional videos and problem-based role playing. The survey was re-administered
post-intervention to assess impact.

Results: Statistical analysis was performed utilizing chi-square test and confidence
intervals. Sixteen matched pre-post surveys were analyzed, preliminarily showing a
statistically significant increase with familiarity with “baby friendly hospitals,”
recommending breastfeeding over formula feeding, recommending “rooming in” and
recommending against pacifier use until breastfeeding well established. Percentile
increase was 45%, 4.9%, 29.9% and 0.2%, respectively, with a p value < 0.05.

Conclusions: An educational breastfeeding workshop intervention was effective in
enhancing physician knowledge and skills about various aspects of breastfeeding.
Detecting changes in attitudes proved more challenging and will require additional long-
term review and evaluation of clinical breastfeeding practices over time.

Implications: An intervention which is found to be effective in promoting breastfeeding
counseling can be utilized to train physicians in Family Medicine, Pediatrics and
Obstetrics/Gynecology. This may result in enhanced breastfeeding services and greater
patient support to increase breastfeeding rates to meet HP2010 breastfeeding goals.



                                                                                         27
A Summer Preceptorship in Family Medicine: An Early Medical
Student Experience
Elizabeth Natal, M.D., Alice Fornari, Ed.D.: Department of Family & Social Medicine,
Albert Einstein College of Medicine


Background: With an aging and culturally diversifying population we require a larger
primary care work force to meet its medical needs. Medical institutions must engage in
activities to increase student awareness about primary care fields. To that end, a two-
week summer preceptorship was created for medical students interested in learning more
about Family Medicine as a primary care specialty.

Goals:
To describe:
   1. Essential steps and tools used to plan, implement and evaluate a two-week
       summer preceptorship in Family Medicine.
   2. Successes and challenges of a two-week preceptorship.

Methods: Preceptorship goals were discussed with the associate dean and department
chair. The department chair provided six student stipends and Einstein provided
transportation. Students were selected by review committee after evaluation of written
essay expressing interest in Family Medicine and application. Students completed a two-
week block, rotated through various Family Medicine ambulatory clinic settings, the
Family Medicine inpatient ward and rounded with the Family Medicine hospitalist.
Students evaluated preceptors, completed a survey about their experience, wrote a self-
reflective piece and participated in an evaluative focus group. Faculty members provided
individual student feedback.

Results: Forty physicians and six students participated. Focus groups identified
physician contact, practice variety, population diversity and rounding with the Family
Medicine Hospitalist as strengths. Identified themes for improvement included
lengthening the preceptorship, adding orientation day and providing information about
clinic populations. Two students expressed an interest in a Family Medicine advisor.

Conclusion: An early preceptorship model can be effective at providing students with an
introduction to Family Medicine as a primary care specialty. This pilot program
supported the need for faculty leadership, as well as school and departmental support, to
design a quality educational experience.

Implications: A preceptorship can increase student awareness about Family Medicine as
primary care specialty and hopefully increase student interest in pursuing primary care
professions.




                                                                                         28
A Novel and Interactive Elder Mistreatment Curriculum

Karin Ouchida, M.D., Kim Freeman, M.P.H., Debra Greenberg, M.S.W., Ph.D.,
Alessandra Scalmati, M.D., Laurie G. Jacobs, M.D.: Department of Medicine
(Geriatrics), Albert Einstein College of Medicine, Montefiore Medical Center


Background: Each year, approximately 550,000 older adults are victims of elder
mistreatment (EM), yet physicians often fail to detect and report it due to lack of
knowledge and skill in assessment and intervention. An EM curriculum for medical
students can address these barriers.

Goals: The workshop aims to improve participants’ knowledge of “red flags” for abuse
and neglect, their ability to perform and document a comprehensive assessment, and their
appreciation of the physician’s role in identification, evaluation and referral of potential
EM victims.

Methods: The 2.5-hour workshop was offered during the Geriatrics clerkship beginning
June 2008. A multidisciplinary team delivers a didactic lecture and facilitates 2
simulated patient (SP) scenarios where students perform specific components of a
comprehensive assessment. One patient-caregiver dyad scenario provides experience
conducting multi-party and individual interviews. All students document these
interviews and receive feedback from the facilitator team on communication skills.
Finally, participants complete an 11-item evaluation utilizing a 5-point Likert scale that
measures perceived value of the workshop and self-assessment of their confidence and
skill in interviewing and documentation.

Results: To date, 140 medical students have completed the workshop. The majority
agreed or strongly agreed that the didactic lecture provided important background
information (98%, mean score 4.45), that the overall workshop content was excellent
(94%, mean 4.44), and that the SP cases added value (86%, mean 4.23). Most
participants also agreed or strongly agreed that the SP scenarios increased their skill in
interviewing suspected victims (83%) and caregivers (76%), and their ability to document
assessments (66%).

Conclusion and Implications: An EM workshop combining didactic and interactive
activities effectively improved medical students’ perceived skills and confidence in their
ability to conduct assessments. This novel curriculum also addresses the Liaison
Committee on Medical Education (LCME) objectives for specific instruction in
communication skills and the diagnosis and reporting of violence and abuse.




                                                                                         29
Delivering Key Educational Messages to Promote Asthma Self-
Management: Provider Priorities Versus Resource Availability
Mamta Reddy, M.D., K. Chen, D. Strom, A. Kapoor, R. Neugebauer: Department of
Pediatrics (Allergy & Immunology), Albert Einstein College of Medicine, Bronx-
Lebanon Hospital Center


Background: The NAEPP’s asthma practice guidelines emphasize a partnership for
asthma self-management education. This initiative’s objectives included: 1) surveying
provider priorities in delivering the NAEPP’s key educational messages; 2) examining
provider access to educational tools that promote asthma self-management.

Program Description: A total of 66 inner-city pediatric primary care providers
participated in this educational intervention and 52 (78.8%) completed a survey asking
them to prioritize three out of ten key educational messages to integrate into a visit given
the constraints of time and also asked to identify which educational tools they had
immediate access to in their practice setting.

Evaluation: 87% of providers chose to differentiating between “controllers” versus
“quick-relievers” but only 35% had access to models depicting “inflamed versus normal
lungs” and only 32% had access to a visual tool (i.e., poster, website, samples) of the
different colors and appearances of various asthma inhalers. 48% of providers chose to
help patients identify triggers, including second-hand tobacco smoke but only 21% were
aware of referral resources to help patients address and mitigate environmental triggers
(i.e., integrated pest management, home visits by a nurse or an asthma educator, tobacco
cessation programs). The third most popular message chosen was to demonstrate
medication delivery device technique (44%); 37% had access to a sample spacer device
and 42% had access to a sample metered-dose inhaler, but only 27% had access to a
sample Diskus for office demonstration.

Conclusions: This information helps us understand how to enhance educational and
outreach initiatives to assure that providers are adequately equipped with the appropriate
tools and resources to convey the NAEPP’s key educational messages that promote
asthma self-management. In addition, providers should focus on expanding their
“educational repertoire” of messages and skills to improve overall asthma care,
particularly in the inner-city where pediatric asthma rates are disproportionately high.




                                                                                          30
Valved-Holding Chamber Technique in Housestaff Residents:
Knowledge Base Versus Skills Set
Mamta Reddy, M.D., S. Kaipa, D. Strom, R. Neugebauer: Department of Pediatrics
(Allergy & Immunology), Albert Einstein College of Medicine, Bronx-Lebanon Hospital
Center


Background: Patients may require education to understand that metered-dose inhalers
(MDI) used with valved-holding chambers (VHC) can be equally (or more) effective than
nebulizers at delivering inhaled medication. This initiative’s objectives were to assess
housestaff knowledge and ability in demonstrating proper MDI/VHC technique.

Methods: A brief survey assessed 38 pediatric and family medicine housestaff’s
knowledge of benefits of MDI/VHC use and steps in proper technique. A faculty-allergist
then rated housestaff’s skills in demonstrating MDI/VHC use (including using masks for
young children) utilizing a 9-point skills-assessment score. Following assessment and
critique, the allergist re-demonstrated proper technique in individualized training.

Results: Housestaff with previous training scored higher on skills assessment than their
counterparts without training (p= 0.017). Four skills assessment elements directly related
to elements of knowledge assessment: 1) Of the sample of 38 only 16 (42%) knew about
the slow, deep breath required for proper inspiration; of these 16, 11 (69%) failed to
correctly demonstrate this step; 2) 37 housestaff (97%) knew about the need for holding
breath for 10 seconds after the first puff but of these 37, 25 (68%) failed to demonstrate
this; 3) Only 18 housestaff (47%) knew about needing to wait 30-60 seconds between two
puffs while 9 of the 18 (50%) failed to demonstrate this; 4) Only 21 (55%) knew about
the effectiveness of MDI/VHC with young children but of these, 17 (81%) failed to
demonstrate the necessary modifications in technique.


Conclusions: To obtain optimal disease control, including maximizing patient/parent
self-management skills, it is critical that housestaff be given the expertise needed to teach
proper device utilization and other “hands-on” techniques. Formal instruction to help
housestaff develop these and other outreach, education and communication skills should
be fostered especially when working with populations (e.g. inner-city, new immigrants)
historically at high-risk for poor disease control.




                                                                                          31
A Model for Incorporating Research Education into Residency Training
David M. Roane, M.D., Eda Inan, B.A., Sophia Haeri, B.A., Igor I. Galynker, M.D.,
Ph.D.: Department of Psychiatry, Albert Einstein College of Medicine, Beth Israel
Medical Center

Background and Goals: A recent National Institute of Mental Health report warned that
the supply of psychiatrist-researchers is inadequate. In fact the number of psychiatrists
conducting investigative research has actually declined. While there is a clear need for
comprehensive research training during psychiatric residency, insufficient funding of
resident research, mentorship and psychiatry training infrastructure has proved
problematic. At Beth Israel Medical Center we have developed a program to attempt to
address this need.

Methods: The Psychiatry Acquiring Research Training Program (PART) has two goals.
One goal is to ensure that all residents obtain research competency. We also want to give
residents who are, or may become, interested in pursuing research careers full
opportunity to pursue research while in residency. Innovations of the program include: a)
it is replicable in any academic setting and does not require government funding or major
financial support; b) research competency is taught as a discipline unto itself, separate
from other academic courses over a 3 year period; c) training is experiential as all
residents are required to complete a research project where they learn about all aspects of
research, under mentorship, including: study design, data collection, data analysis,
synthesis of findings, and research ethics.

Results: From the 89 residents trained from 2001-2007 there have been 52 publications
in peer-reviewed journals. Residents have given 87 presentations to local, national and
international audiences since the program’s inception. Additionally, 12 residents been
recognized for their research achievement. Honors have included both regional and
national research awards from the American Psychiatric Association. The consensus is
that residents’ participation in research has been advanced through participation in
PART.

Conclusions and Implications: Ensuring basic research competency among all
psychiatrists is essential. The PART Program represents an approach to integrating
research education into psychiatric residency that can serve as a model.




                                                                                        32
The Observed Clinical Encounter (OCE) Among Different Third-Year
Clinical Clerkships
Maria Teresa Santos, M.D.: Department of Family & Social Medicine, Albert Einstein
College of Medicine


Background/Goals: The OCE is an important assessment tool that yields information on
the student’s clinical and interpersonal competence that is not available through other
venues. Ideally, OCEs should be conducted by trained observers, and students should
receive feedback delineating strengths and areas for improvement. There is no data on
how the OCE is being implemented by the different clerkships at our school. Conversely,
no information has been elicited from students on their OCE experience and its
usefulness. This project sought to answer questions, including:

       Who conducts the observation?
       Have the observers received training in observing and giving feedback?
       Is the OCE being used as an evaluative or formative tool?
       Do students regard the experience as beneficial?

Methods: Clerkship directors were surveyed to get background information and their
perspective on how the OCE is conducted in their clerkships. A longer, more detailed
survey using Survey Monkey was sent to the faculty observers to elicit more specific
information. An experienced facilitator ran a small focus group comprised of late third
year students to obtain their perspectives on the entire OCE experience.

Results: 6/6 (100%) of the clerkship directors and 60/119 (50%) of faculty observers
responded. There was great variability in how the OCE is conducted not only among the
different clerkships, but also among the different sites within the same clerkship. OCEs
were conducted mainly by attendings, but were done by fellows in some sites. The OCE
counted for 10-15% of the final grade in three of the clerkships. 42% of the observers
reported that they did not receive any faculty development training on giving feedback
and 71% on conducting an observation.

Conclusions/Implications: The majority of clerkship directors/ observers concur that
the OCE is an important educational tool. Having a standard set of trained observers and
processes improve outcomes. Students are not adverse to direct observation with real
patients and appreciate the faculty feedback. If the OCE will be used as an evaluative
tool, there is a definite need for standardization/training of the observers.




                                                                                     33
The Current State of Mentorship Programs in Otolaryngology
Residencies
Bradley A. Schiff, M.D.: Department of Otorhinolaryngology-Head and Neck Surgery,
Albert Einstein College of Medicine, Montefiore Medical Center


Background and Goals: Mentoring of residents is an important component of residency
programs. However, the structure and goals of mentoring programs vary greatly from
residency program to residency program. Almost no data exists on mentorship programs
in Otolaryngology residencies. Our goal was to obtain nationwide data regarding the
current state of mentoring in Otolaryngology residencies.

Methods: In conjunction with the University of Iowa, and with the American Board of
Otolaryngology, a questionnaire was sent out using survey monkey (a web based survey
site) to 1,411 otolaryngology residents, as well as 102 program directors. The surveys
given to the residents and program directors were similar, but not identical, and focused
on 3 separate areas; what is the current state of mentoring at your program, what factors
do you feel are important for a successful mentoring program, and how effective is your
mentoring program.

Results: We received responses from 391 residents (27.7%) representing 83 programs
(80.5%) and 39 program directors (38.2%). Over 50% of residents did not have a formal
mentor. However, of the residents with mentors, 74% felt that the mentoring program
was useful. Sixty one percent of program directors stated that their program had a
mentoring program, but only 20% of programs had formal guidelines. Eighty eight
percent of program directors felt that the mentoring program was useful to residents.

Conclusions: There is substantial variety in mentorship programs in Otolaryngology
residencies. While Otolaryngology residents are generally satisfied with their mentoring
program, over half of Otolaryngology residents do not have a formal mentor.

Implications: This study provides the only data on mentorship in Otolaryngology
residency programs. The data will give valuable information into the current state of
mentorship in Otolaryngology programs, and into the effectiveness of these programs.
This will hopefully lead to improved mentoring in Otolaryngology programs across the
country.




                                                                                        34
Forming Small Groups in Basic Science Conferences: Teaching Science
and Fostering Professionalism
Howard M. Steinman, Ph.D., Lawrence Dyche, M.S.W., Alice B. Fornari, Ed.D., Barbara
K. Birshtein, Ph.D.: Department of Biochemistry/Office of Education, Albert Einstein
College of Medicine


Background: In Molecular and Cellular Foundations of Medicine, conferences of 20-22
first year students led by a faculty facilitator provide an interactive leaning environment
to integrate basic science and clinical content. When students worked in small groups of
4-5, participation in the whole group was livelier and students and facilitators expressed
satisfaction.

Goal: The pilot study was designed to evaluate if ongoing small group formation (4-5
students) would enhance learning and promote professionalism through communication
and collaboration with peers.

Methods: One conference group, under the direction of a single facilitator, was divided
into smaller groups that remained constant for three consecutive meetings. Each meeting
included 2-3 small group breakouts, interspersed with whole conference group
discussion. This pilot was described to students during their first meeting. Feedback was
actively sought through written comments on evaluation forms and these comments were
discussed in the subsequent meeting. A focus group using open-ended questions was held
after the 3rd meeting with four student volunteers. A behavioral science faculty attended
each meeting, for independent observation and peer advising of the faculty facilitator.

Outcomes: Student reactions to the small group experience were favorable based on
faculty observation, written comments and focus group feedback. Students actively
participated and showed increased efficiency in problem solving. Students reported
increased preparation, enjoyed the socialization and favored consistent membership of
the small groups. Full student participation during breakouts and increased verbal
interaction in the reconvened conference group, both supporting higher level thinking
skills, were evident. Mean examination scores of the group were not significantly
different from other conference groups.

Future Application: To evaluate reproducibility of student responses, this educational
strategy is being repeated with a second conference group led by a different facilitator.
Developing collaboration and communication in small groups is a first step in future
professionalism opportunities, including peer assessment.




                                                                                            35
Comfort with Uncertainty in Clinical Decision Making
Ellen Tattelman, M.D., Sherenne Simon, M.P.H., Meg Rosenberg, M.D., Patricia A.
Carney, Ph.D., Marji Gold, M.D.: Department of Family & Social Medicine, Albert
Einstein College of Medicine, Montefiore Medical Center


Background: Gerrity (1) defines uncertainty as the emotional reactions and concerns
engendered in physicians who face clinical situations that are unfamiliar or not easily
resolved and the behaviors used by physicians to cope with those emotions and concerns.
Uncertainty will always be present in medical decision making. Evidence-based medicine
puts pressure on physicians to have evidence for each decision made, though much in
clinical medicine is not evidence-based. Comfort with uncertainty is necessary to the
practice of medicine. Studies suggest that physician’s response to uncertainty is affected
by years of experience and that physician’s clinical work is, in turn, affected.

Goal: To assess family medicine residents' and attending physicians' reactions, approach,
and strategies in dealing with uncertainty in clinical care.

Methods: Two focus groups were conducted in the Bronx, NY and one in Portland,
Oregon with up to six family medicine attendings and six family medicine residents
participating. Initially, inner and outer circles separated the residents’ and attendings’
discussions. Then all joined in a common circle. Two cases were presented (1 narrative, 1
vignette) in each focus group. A validated questionnaire entitled “The Revised
Physicians’ Reactions to Uncertainty Scales” (1) was administered to all participants in
the focus groups.

Results: Evaluation generated quantitative and qualitative data. Quantitative analysis of
the reactions to uncertainty questionnaire will be presented. Qualitative analysis of focus
groups is ongoing.

Conclusion: We anticipate a variety of approaches to uncertainty with varied levels of
comfort increasing with years of experience.

Implications: As medical educators who train effective doctors, we must develop ways
to help physicians better adapt to uncertainty in clinical practice. As we better understand
how physicians develop comfort with uncertainty, we can ask how can we accelerate this
process. We can consider broadening our teaching to include adaptive approaches to
uncertainty in order to balance our teaching of evidence-based medicine.


1. Gerrity MS, White KP, De Villes RE, et al. Physicians’ reaction to uncertainty: refining the constructs
and scales. Motivation and Emotion. 1995;19:175-91.




                                                                                                         36
Musculoskeletal Review Course Using Both Cadavers and Live
Volunteers

Maya R. Therattil, M.D., Todd R. Olson, Ph.D., Sherry A. Downie, Ph.D.: Departments
of Physical Medicine and Rehabilitation and Anatomy and Structural Biology, Albert
Einstein College of Medicine, Montefiore Medical Center

Objectives: To develop an innovative course to teach the musculoskeletal examination
(MSKE) to Physical Medicine and Rehabilitation (PMR) residents.

Learners: Twenty-seven PMR residents

Methods: A needs assessment of our PMR residents using both Objective Structured
Clinical Exams (OSCE) and confidence questionnaires indicated cognitive and skill
deficiencies in conducting the MSKE. We developed a course in which teams of both
senior and junior residents simultaneously reviewed anatomical knowledge and practiced
musculoskeletal examination skills using previously dissected cadavers and living
volunteers respectively.

Design: The course consisted of four two-hour sessions with senior residents leading
teams of junior residents. A physiatrist and an anatomist with expertise in kinesiology
facilitated all sessions. During the first three sessions, residents completed flag-type
quizzes on previously dissected cadavers and reviewed principles of normal and
pathologic anatomy common to musculoskeletal disorders. The fourth session consisted
of multiple stations with a cadaver, a living volunteer, and instructions for conducting
specific provocative tests. Residents practiced palpation and provocative tests
(movements of the body intended to duplicate the patient’s symptoms) on the volunteers
then repeated the tests on the cadavers to clarify the anatomical rationale. Pre- and post-
course confidence questionnaires and post-course teaching evaluations were
administered.

Results: Confidence levels for all residents increased post-course both in doing and
teaching the MSKE. PGY2s had the greatest increase in performing the MSKE (2.56 to
4.38 on 1-5 Likert scale). Teaching skills of senior residents were rated high on both self
(4.05) and peer (4.25) evaluations. 100% of residents reported that integration of cadaver-
based anatomy with hands-on musculoskeletal exam practice was more useful than
previous separate sessions.

Conclusion: Confidence levels of all residents in performing and teaching the MSKE
were effectively increased by completion of a course that integrated cadaveric anatomy
review with hands-on musculoskeletal exam practice. In the future, pre-and post-course
OSCEs will provide objective data about the effectiveness of the course.




                                                                                          37
Disability Etiquette: How to Optimize Medical Care for People with
Disabilities

Mark A. Thomas, M.D. and Maya R. Therattil M.D., Department of Physical Medicine
and Rehabilitation, Albert Einstein College of Medicine, Montefiore Medical Center


Objective: To evaluate the usefulness of incorporating disability etiquette training in
medical school and residency curricula.

Background: Disability etiquette, sensitivity to issues related to physical or mental
disability, provides a behavioral template for interacting with the disabled population. It
improves care by improving communication and trust within the patient with disability-
physician relationship.

Design: Training sessions were introduced in 2007. Thirteen first year medical students
received nine hours of disability etiquette training in three 3-hour sessions over a period
of three months. Twenty-four PM&R residents and ten faculty physiatrists participated in
a single condensed version of training. Educational topics included disability-related
nomenclature, an introduction to the Americans with Disabilities Act (ADA) and
guidelines on interacting with patients with disabilities. Training by physical and
occupational therapists on assisting disabled patients with mobility and function was
provided. Students received hands-on training through patient interviews and
impairment/disability/handicap simulations. Behavioral change among program attendees
was evaluated using the ATDP [attitudes towards disabled persons] questionnaire, pre
and post comfort level ratings, and patient/faculty (360 degree) evaluations. Course
evaluation used the standard medical school format. The reflective writing technique was
used to understand the overall impact of the program on medical students.

Results: All medical students rated the course as excellent. All attendees acknowledged
that the training was helpful. 92% of medical students and 82% of residents stated an
increase in their comfort level in interacting with patients with disabilities. Evaluations
by patients indicated that students showed confidence, competence, an empathetic
manner, and did not invade their personal space. Improvement in the pre and post ATDP
scores was observed. Evaluations of medical student reflective writings suggested the
need to make the course available to all students in their class.




                                                                                          38
Teaching Skills for Rapid Patient Engagement in the Clinical Interview:
A Template Model
Lizica Troneci, M.D., Ali Khadivi, M.D., Jeffrey M. Levine, M.D.: Department of
Psychiatry, Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center


Background: Learning clinical interviewing remains a complex task. Medical students
are expected to master competing tasks requiring a variety of skills, including rapport
building, information gathering, and patient-centered treatment planning. Moreover,
students must learn to apply these skills effectively under time constraints. The
introduction of Step 2-CS has made such skills essential. Scant literature addresses
patient-centered interviewing under time pressure.

Objectives: To introduce a teaching method for rapid patient engagement by use of
specific templates which enumerate effective principles and strategies.

Methods: Using literature from behavioral sciences, a selective set of principles and
techniques for patient engagement were incorporated into templates. The templates focus
on teaching three sets of principles: understanding, validating, and empathizing. The
empathizing principle is subdivided into simple and complex empathic statements. Four
sets of templates are printed on one page. Each template contains examples with
suggested time frames and specific phrasing for each technique. Rationale for the
templates and further examples of their use are separately provided. Under varying time
constraints, students are asked to role-play using the templates, which they may carry and
to which they may refer.

Results: Success of this teaching method will be measured by using a standardized
evaluation form to rate the students’ performance on a live patient clinical interview (1)
after a general lecture on establishing rapport/empathy and (2) after learning and applying
the four sets of templates.

Conclusion: Rapid patient engagement is of increasing importance in medical education.
Templates provide a method of medical student learning in need of further evaluation.




                                                                                          39

				
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