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Eighth Annual Davidoff Education Day

May 17, 2011

Poster Submissions

Medical Student Education

Author(s) Institution Poster Title

Garbern, Stephanie, Kate

Currie, Pablo Joo Einstein

Does Leadership in a Student-Run Free Clinic

Correlate with Selection of a Primary Care

Residency?

Grayson, Martha S., Dale A.

Newton, Lori Foster

Thompson

Einstein

Influence of Debt and Anticipated Income on

Medical Student Career Choice in Internal

Medicine

Gutwein, Andrew Jacobi/Einstein

How Much Competency Do Medical Students

Self-Report in the CDIM Medicine Sub-

internship Curriculum After a One-Month

Medicine Sub-internship?

Indyk, Diane, Darwin Deen,

Alice Fornari, Maria T.

Santos, Wei-Hsin Lu, Lisa

Rucker

Einstein

The Influence of Longitudinal Mentoring on

Medical Student Selection of Primary Care

Residencies

Kesselman, Amy, Christopher

Cimino, Linda Gillespie, Scott

Chudnoff, Penny Grossman,

Nadine Katz

Einstein/Montefiore

The Results of Implementing a Transparent

Clerkship Grading Policy Emphasizing Clinical

Performance

Kitsis, Elizabeth A., William

B. Burton, Hannah I. Lipman Einstein

Debate and Role-Play as Teaching Methods for

Preclinical Medical Students Learning to

Identify Ethical Issues in Clinical Cases: Work

in Progress

McEvoy, Mimi, Sheira

Schlair, Zsuzsanna Sidlo,

William Burton, Felise Milan

Einstein

Assessing Third-Year Medical Students’

Ability to Recognize and Address a Patient’s

Spiritual Distress During an Acute Medical

Crisis

Nosanchuk, Joshua, Liise-

anne Pirofski Einstein

Electronic Cases: Do They Have a Role in

Basic Science Courses?

Sparr, Steven A. Montefiore/Einstein

Creative Expression in a Neurology Clerkship:

A “Right Brain” Approach to Understanding

Neurologic Patients

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Resident or Fellowship Education

Author(s) Institution Poster Title

Bilotta, Federico, Apolonia

Elisabeth Abramowicz, Luca

Titi, Antonella Cianchi,

Giovanni Rosa, Ellise Delphin

Montefiore/Einstein Educating Anesthesiology Residents to

“Anesthesia” for Awake Craniotomy

Esteban-Cruciani, Nora, Peter

Cole, Catherine Skae, Alfin

Vicencio, Swapnil Rajpathak,

Laurie Bauman

Einstein/Montefiore

Implementation of a Departmental ACGME-

Compliant Core Curriculum for Pediatric

Subspecialty Fellows

Herbitter, Cara, Jason

Fletcher, Finn Schubert,

Megan Greenberg, Marji Gold

Montefiore/Einstein An Evaluation of an IUD Initiative at Family

Medicine Residency Programs

Kazimiroff, Julie, Karla

Alvarado, Nanice Regis Blay Montefiore/Einstein

Integrating the Chronic Care Model into a

Dental Residency Training Program

Muenzenmaier, Kristina, A.

Schneeberger, M. Abrams, L.

Ruberman, L. Antar, S. Leon,

S. Mouzon, J. Battaglia

BPC/Montefiore/

Einstein

Trauma Training Modular Curriculum: A New

Approach to Education of Psychiatry Residents

Nevadunsky, Nicole D., Serife

Eti, Enid Rivera, Peter

Selwyn, Kimala Harris, Gary

Goldberg

Montefiore/Einstein

Palliative Medicine Educational Initiative for

Trainees in the Department of Obstetrics,

Gynecology and Women’s Health

Rahav, Miriam, Sharon

Leung, Darlene LeFrancois Montefiore/Einstein

Developing a Botanical Medicine Curriculum

for Medicine Residents: A Needs Assessment

of Knowledge, Confidence, and

Communication

Rivlin, Kenneth, Paul Sue,

Daran Kaufman, Auxford

Burks, Jeffrey C. Gershel,

Lewis M. Fraad

Jacobi/Einstein

Experiential Learning of Quality Improvement:

Converting Resident “Gripes” into Quality

Improvement (QI) Projects

Schlair, Sheira, Larry Dyche,

Felise Milan, Hillary Kunins,

Julia Arnsten, Eric Holmboe

Montefiore/Einstein

A Faculty Development Program to Prepare

Instructors to Observe and Provide Effective

Feedback on Clinical Skills to Internal

Medicine Residents

Sharma, Keerti, Amy R.

Ehrlich, Laurie G. Jacobs,

Deborah Greenberg, Kim

Freeman, Arnold Berlin

Montefiore/Einstein

Evaluating Surgical Residents’ Cognitive and

Functional Status Assessment Skills Using a

Standardized Patient Interview

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Curriculum Development and/or Evaluation

Author(s) Institution Poster Title

Auerbach, Lisa, Mimi

McEvoy, Felise Milan Einstein

Observing the Teachers: Is Faculty

Development Effective for Preceptors Teaching

Medical Students in a Physical Diagnosis

Course?

Gonzalez, Cristina M., Aaron

D. Fox Montefiore/Einstein

Health Disparities: Awareness to Action – A

Curricular Innovation

Purcell, Jennifer M. Einstein

Psychometric Properties of the Team

Performance Scale in a Third-Year Medical

School Clerkship

Purcell, Jennifer M., Pablo

Joo Einstein

Evaluation of the Team-Based Learning

Curriculum in a Family Medicine Clerkship

Silbiger, Sharon, Darlene

LeFrancois, Penny Grossman,

William Burton, William Lee,

Eran Bellin

Einstein/Montefiore Incorporating a QI Exercise into the Einstein

Medicine Clerkship: A Pilot Study

Therattil, Maya R., Todd R.

Olson, Sherry A. Downie Montefiore/Einstein

Musculoskeletal Examination (MSKE) Pilot

Mini-Course: Increasing Medical Student

Exposure to the MSKE

Innovative Programs

Author(s) Institution Poster Title

Herron, Patrick D., Hannah I.

Lipman, Patricia (Tia) Powell,

Elizabeth A. Kitsis

Montefiore/Einstein

Video Recorded Simulations in Bioethics

Consultation Training: A Collaboration of the

Ruth L. Gottesman Clinical Skills Center and

the Einstein-Cardozo Masters of Science in

Bioethics Program

Katz-Sidlow, Rachel J.,

Allison Ludwig, Scott Miller,

Robert Sidlow

Jacobi/Einstein Smartphone Use During Inpatient Attending

Rounds: Help or Hindrance?

Morice, Karen, Michael D.

Skeels, Maya R. Therattil Montefiore/Einstein

Mastering Functional Independence Measures:

Comparison of Different Educational Strategies

Weinstein, Eleanor, Maria

Mendoza, Andrew Gutwein Jacobi/Einstein

Innovations in Resident Education:

Applications of Information Technology

Zuckerman, Tehila, Maria

Kassab, Anna Kochin, Dahlia

Rizk, Rebecca Calabrese

Beth Israel/Einstein Discharge Summary Quality Improvement

Project

Does Leadership in a Student-Run Free Clinic Correlate with Selection of a

Primary Care Residency?

Stephanie Garbern, Kate Currie, Pablo Joo, Department of Family and Social Medicine, Albert

Einstein College of Medicine

Background and Objectives: Declining student interest in primary care has prompted medical

educators to explore innovative methods to recruit students into the field. Over 49 American

medical schools operate student-run free clinics, providing medical students with broad exposure

to primary care settings. This study investigates whether students who served in a leadership

role at Einstein Community Health Outreach (ECHO), a student-run free clinic, were more likely

to match into a primary care specialty than their peers.

Methods: Residency match results for students who served in a leadership role at the ECHO

clinic were compared to their peers who did not serve in a leadership role at the clinic and to

nationwide data from the National Residency Match Program (NRMP) from 2007-2009. Chi-

square analysis was used to compare the results.

Results: Of the 59 students who served in a leadership role at the clinic, 38 students (64%)

matched into a primary care specialty of family medicine, general pediatrics, or internal

medicine as compared to 41.5% (188/453) of their classmates (p < 0.001). Students from the

medical school as a whole matched into primary care residencies at a similar proportion

(226/512, or 44.1%) as U.S. seniors nationwide (17,500/42,673, or 41.0%) (p = 0.148).

Conclusion: Our analysis shows that a high degree of involvement in a student-run free clinic

positively correlates with a greater likelihood of matching into a primary care residency.

Implications: Although self-selection almost certainly plays a role, serving in a student-run free

clinic may help to nurture an interest in primary care in those who are already considering the

field or to recruit students who would not otherwise be interested. Further study, such as

questionnaires or focus groups, is necessary to examine this relationship.

Influence of Debt and Anticipated Income on Medical Student Career Choice

in Internal Medicine

Martha S. Grayson, Dale A. Newton, Lori Foster Thompson, Albert Einstein College of

Medicine, New York Medical College, and Brody School of Medicine, East Carolina University

Background: Recent studies suggest that increasing debt and desire for higher incomes may be

influencing medical student career choice. This study examines career decisions of students who

begin medical school intending to pursue careers in Internal Medicine. The objectives were to

determine how debt, the self-rated importance placed on income, and future income projections

relate to intentions to pursue a subspecialty in Internal Medicine rather than General Internal

Medicine. The perceived salary increases associated with switching out of Internal Medicine

were also examined.

Methods: Students at New York Medical College and Brody School of Medicine at East

Carolina University were surveyed annually at matriculation (M1) and just prior to graduation

(M4). The data set included 17 consecutive years of M1 surveys and 16 years of M4 data. The

overall response rate was 81%. The responses of students who expressed an interest in Internal

Medicine at either M1 or M4 were analyzed. Additional analyses focused on the subset of

students who expressed an interest in Internal Medicine at M1 and subsequently completed a

follow-up survey at M4, yielding paired data that enabled the investigation of trends over time.

Overall, the analyses examined the relationships among the following factors: reported debt (in

dollars), anticipated income 5 years after residency (in dollars), student reported

influence/importance of income on career choice (Likert scale rating), association of self-rated

importance of income with anticipated income, and stated career choice.

Results: 239 entering first year students identified an interest in General Internal Medicine and

404 expressed an interest in a subspecialty in Internal Medicine. By graduation, these numbers

changed to 277 and 343 respectively. The trends shown in Table 1 were identified. In addition,

changes in anticipated income over time were documented. Overall, students who entered

medical school with interests in Internal Medicine careers reported an expected income of $186K

at M4, which was $47K higher than the $139K they anticipated at M1 (p< .001). However, finer

grained analyses indicated significant (p<. 01) differences among subgroups of these students,

with those planning to enter GIM at M4 anticipating $139K (only $14K more than the $125K

they anticipated at M1), those planning to pursue a subspecialty in Internal Medicine anticipating

$179K ($43K more than the $136K they anticipated at M1), and those who switched out of

Internal Medicine altogether anticipating $207K at M4 ($62K more than the $145K they

anticipated at M1).

Conclusions: Both debt and expected income may push medical students initially interested in

General Internal Medicine towards a career in a subspecialty of medicine or to a career in

another specialty outside of Internal Medicine. Changes in the payment system to more properly

reimburse general internists may be needed to attract talented students whose financial concerns

may otherwise discourage them from pursuing a generalist career. Since concern about debt is

associated with career choice, new loan forgiveness programs linked to practice in General

Internal Medicine should also be developed as a method to assist in sustaining the numbers of

students choosing this career path.

How Much Competency Do Medical Students Self-Report in the CDIM

Medicine Sub-internship Curriculum After a One-Month Medicine Sub-

internship?

Andrew Gutwein, Department of Medicine, Jacobi Medical Center, Albert Einstein College of

Medicine

Background: The internal medicine sub-internship is commonly offered at medical schools

across the country. There is a curriculum for the sub-internship published by the Clerkship

Directors of Internal Medicine (CDIM). It is largely unknown whether sub-interns feel they are

improving in the areas laid out in this curriculum.

Objective: This study was undertaken to see if the sub-interns felt they had improved in the area

listed in the CDIM curriculum.

Methods: All sub-interns rotating through one major academic center during academic year

2004-2005 were given a pre-sub-internship and post-sub-internship questionnaire. The

questionnaire included the 20 topics, 17 scenarios and 6 procedures that are listed in the CDIM‟s

curriculum. Data were analyzed using SPSS software and the paired T-test.

Results: Thirteen of the 20 topics (65%), 14 of the 17 scenarios (82%) and 2 of the 6 procedures

(33%) showed a statistically significant improvement in sub-intern confidence over the 4-week

internal medicine sub-internship. The topics, scenarios and procedures that improved were:

Topic Case presentation

Coordinating care with other health care workers

Prioritizing scut list/ sign out list

Identifying adverse drug reactions/ interactions

Using electronic databases

Literature appraisal skills

Grief management

Composing discharge summaries

Communicating with difficult patients

Assessing suicide risk

Delivering bad news

Dealing with emotional abuse from patients or colleagues

Ethics of withdrawal/ withholding of care

Interpreting advance directives

Scenario

Respiratory distress

Chest pain

Altered mental status

Acute gastrointestinal bleeding

Fever

Acute pulmonary edema

Electrolyte disorders

Abdominal pain

Hypertensive emergencies

Glycemic control

Acute renal failure

Pain management

Drug withdrawal

Nausea and vomiting

Procedure

Arterial blood sampling

Nasogastric tube placement

Conclusions: While most areas showed improved sub-intern confidence, some did not. The

reason for this difference is likely related to the amount of exposure to that area in a one-month

setting. There may be ways to improve the sub-interns experience and make them more

confident.

The Influence of Longitudinal Mentoring on Medical Student Selection of

Primary Care Residencies

Diane Indyk, Darwin Deen, Alice Fornari, Maria T. Santos, Wei-Hsin Lu, Lisa Rucker,

Sophie Davis School of Biomedical Education, Hofstra University School of Medicine,

Stony Brook University School of Medicine, Albert Einstein College of Medicine

Background: The number of students selecting primary care has declined by 41% in the last

decade, resulting in anticipated shortages.

Goal: The “Generalist Career Program” (GCP) was designed to determine if early contact with a

mentor, specifically a primary care clinician, would influence medical student career choice.

Methods: This interdisciplinary program was designed to recruit first year medical students

(MS1) beginning in September 2005 and was funded through 2008. The grant supported four

core faculty, representing the primary care disciplines of FM, IM and PED, and a program

coordinator. Mentors were recruited from each of these disciplines. MS1 year students were

recruited for the GCP via e-mail, flyer, and an introduction to the program presented during

freshman student orientation. Students and faculty completed a database questionnaire, used for

the purpose of matching them both personally and professionally. Faculty attended an in-person

faculty development session The matching of mentors with mentees accommodated the mentee‟s

request (most commonly requesting a mentor by field of practice/gender/family), and was based

upon matched outside interests (most commonly hobbies and community involvements). The

GCP activities included: mentor-mentee meetings (monthly during the MS1&2 years and

quarterly during the clinical MS3 year); didactic conferences (monthly during MS1&2 years and

quarterly during the MS3 year); enhanced community-based primary care research opportunities

(summer between MS1&2 year); regional/national meeting attendance (any year) with a primary

care mentor or designated faculty; and participation in program evaluation. Mentors received a

small stipend ($30/month if meeting occurred) to compensate their time and defray the costs of

any activities shared. Mentors and students participated in focus groups at the end of each

academic year. Quantitative and qualitative results are presented.

Results: Students who remained in the mentoring program matched to primary care programs at

87.5% in the first year and 78.9% in the second year, compared to overall primary care match

rates of 55.8% and 35.9% respectively. Students reported a better understanding of the field of

primary care and appreciated a relationship with a mentor. We created "Best practices" guides

for mentors and mentees based on student and faculty feedback.

Conclusions: A longitudinal mentoring program can effectively support student interest in

primary care if it focuses on the needs of the students and is supportive of the mentors.

Implications: Medical schools that want to increase the number of graduates selecting primary

care can adopt a program like the GCP.

The Results of Implementing a Transparent Clerkship Grading Policy

Emphasizing Clinical Performance

Amy E. Kesselman, Christopher Cimino, Linda Gillespie, Scott Chudnoff, Penny Grossman,

Nadine T. Katz, Department of Obstetrics & Gynecology and Women‟s Health, Office of Student

Affairs, Office of Medical Education Albert Einstein College of Medicine – Montefiore Medical

Center

Background and Goals: Reliance on objective measures like written exams to assess clerkship

performance may penalize students who are not strong test takers and incentivize students to

prioritize studying for exams over clinical service duties. To address these concerns, our clerkship

implemented new criteria designed to motivate students to excel in all components of the clerkship

by emphasizing clinical and exam performance through a transparent grading process. The study‟s

goal was to measure whether our new policy achieved these objectives.

Methods: We invited 4th

year students from the class of 2010 (graded under the old policy) to

complete an online survey asking students to rate their agreement from “strongly disagree” to

“strongly agree” with 12 statements measuring satisfaction with and understanding of the grading

system that was applicable for them and whether it motivated them to succeed clinically and on

exams. Students from the class of 2011 (graded under the new policy) were asked to complete the

online questionnaire after their clerkship.

Results: We collected 44 and 52 responses from the class of 2010 and 2011, respectively. The

percentages of students who either agreed or strongly agreed with the statements were compared.

The new policy substantially increased students‟ motivation to excel clinically (85% for the class of

2011 versus 48% for 2010) without reducing motivation to excel on the written exam (89% for both

classes). The class of 2011 reported higher satisfaction with their clerkship experience (90% versus

77%) and a better understanding of how their grade was calculated (92% versus 70%). The class of

2011 also reported that their grade more accurately reflected their fund of knowledge (77% versus

43%) and their clinical skills (73% versus 43%).

Conclusions: The new grading system was transparent to students and encouraged them to excel

clinically while maintaining their incentive to excel on the written exam. It also provided a fairer

assessment of students who did not excel on the exam, but performed well clinically.

Implications: A transparent grading system that emphasizes both exams and clinical service duties

incentivizes students to develop clinical skills and teamwork in addition to excelling on their exams.

Debate and Role-Play as Teaching Methods for Preclinical Medical Students

Learning to Identify Ethical Issues in Clinical Cases: Work in Progress

Elizabeth A. Kitsis, William B. Burton, Hannah I. Lipman, Departments of Epidemiology &

Population Health, Medicine, and Family & Social Medicine, Albert Einstein College of

Medicine

Background and Goals: The development of ethical sensitivity-- the ability to identify ethical

issues embedded in a case--is one of the goals of our bioethics curriculum. The purpose of this

study is to determine whether debate and role-play are effective methods for teaching ethical

sensitivity to medical students.

Methods: A total of 359 medical students will participate in the study, which is ongoing. The

study is being conducted in two parts. Part 1 has been completed; Part 2 will be conducted in

April 2011. For both parts, Bioethics faculty participate in a workshop on debate or role-play.

In Part 1, following a lecture on Bioethics Consultation, 191 second-year medical students were

randomly assigned to 12 groups, which were then randomly assigned to debate or role-play as

the teaching method to be used in the subsequent 75 minute small group session. In Part 2,

following a lecture on Ethical Issues at the End of Life, 168 first-year medical students will be

randomly assigned to 12 groups, which will then be randomly assigned to debate or role-play.

At the beginning of the small group session, students are provided with a written clinical case,

and asked to list the ethical issues relevant to the case. They then participate in either a role-play

or a debate. Following the role-play or debate, they are again asked to list the ethical issues in

the case.

The primary outcome measure is change in mean ethical sensitivity from baseline to completion

of the small group sessions. Ethical sensitivity is defined as percentage of ethical issues

correctly identified in a case. The correct list of ethical issues is determined using a modified

Delphi method. A multivariate analysis will be performed to determine whether additional

factors, such as gender, age, or previous bioethics courses are associated with study outcome.

Other outcome measures include a self-efficacy scale that measures students‟ perceptions of

confidence in their ability to identify ethical issues, and a student satisfaction survey.

Differences between the effectiveness of debate and role-play will be explored.

Assessing Third-Year Medical Students’ Ability to Recognize and

Address a Patient’s Spiritual Distress during an Acute Medical Crisis

Mimi McEvoy, Sheira Schlair, Zsuzsanna Sidlo, William Burton, Felise Milan,

Departments of Pediatrics and Medicine, Ruth L. Gottesman Clinical Skills Center,

Albert Einstein College of Medicine

Background: Assessment of students‟ ability to address spiritual distress is not well

studied.

Educational Objective: To inform curricular development, we explored: 1) How third-

year medical students (MS-3s) recognize/address a standardized patient‟s spiritual

distress during an acute medical crisis; and 2) The relationship between students‟

reported response to spiritual distress and clinical skills performance.

Method: Between March and April 2010, 170 MS-3s completed an 8-station videotaped

clinical skills assessment. One of the standardized patients (SP) is an older man with

acute chest pain who expresses fear of death, which he hopes to resolve by chaplain

consultation. After the encounter, students reported the nature of the patient‟s distress and

their response to it via a 4 question open-ended post-note. Separately, SPs assess

students‟ clinical skills performance, including history and communication. Mixed

methods analysis of the post-notes was conducted by 3 coders using NVivo 8 for

emergent themes. Analysis of inter-rater reliabilities using SAS revealed kappa

coefficients of > 0.6; codings with inter-rater reliability <0.8 were clarified by all coders

and fully adjudicated producing 34 codes. We also compared clinical skills performance

scores between students who reported making chaplain referral versus those who did not.

Results: 67% of students noted patient‟s fear of death. 49% of students reported

addressing patient‟s emotional state; 2% directly addressed his faith or spiritual beliefs.

64% of students reported chaplain referral. Students who reported chaplain referral had

slightly higher clinical skills performance scores than those who didn‟t on history

(mean=80.5 v. 78.7; p=0.23) and communication skills (mean=58.4 v. 56.4; p=0.11).

Conclusions/Implication: Most students report making a chaplain referral for a patient

in spiritual distress; yet few converse directly about the beliefs. Clinical skills

performance is not significantly correlated with report of chaplain referral. Hence,

teaching medical students to recognize/address a patient‟s religion/spirituality is a unique

domain and requires specific curriculum.

Electronic Cases: Do They Have a Role in Basic Science Courses?

Joshua Nosanchuk, Liise-anne Pirofski, Departments of Medicine and Microbiology and

Immunology, Albert Einstein College of Medicine

Background and Goals: We asked whether Einstein students in our second year Microbiology

and Infectious Diseases course would benefit from electronic cases designed to supplement

material presented in lecture.

Methods: Over three years (2009-2011), we refined our electronic case approach according to

student comments. The cases covered critical conditions in Infectious Diseases (e.g., meningitis)

and management processes (e.g., use of antibiotics). Cases were uploaded to “CobWeb” by the

Einstein Computer-Based Education staff and electronically assigned to students using

“MyAlbert”.

Results: The percent of students answering all questions in the cases ranged from 75-98%, and

>88% reported that the cases were educationally worthwhile. However, the students asked for

and were most satisfied by 1) cases that provided questions in multiple choice, single best answer

format rather than open ended questions and 2) immediate answer feedback for each question

rather than working through a case followed by a review. The most common complaint (85 of

180 students in 2011) was that there were not more electronic cases. The cases also allowed for

the delivery of uniform content for the entire class, which has not been achievable in the more

fluid setting of live small group sessions.

Conclusion: In conclusion, we found that electronic cases facilitated a deeper understanding of

difficult clinical processes (such as antibiotic management) and enhanced student satisfaction in

their learning experience.

Creative Expression in a Neurology Clerkship: A "Right Brain"

Approach to Understanding Neurologic Patients

Steven A. Sparr, Department of Neurology, Stern Stroke Center, Montefiore Medical

Center, Albert Einstein College of Medicine

Goals: Fostering "humanism" is a goal valued at all levels of medical education. One

technique that encourages and rewards the display of humanism is creative expression.

Methods: Since October 2003 all students rotating through the Neurology clerkship at

Montefiore Medical Center were given the following assignment: Neurology is not the

study of neurological diseases; it is the study of people with neurological diseases. Using

any form that you prefer (story, poem, musical piece, art work, etc.), discuss the impact

of a neurological disorder on the patient, family or the physician. The creative piece was

accepted in lieu of one the 3 required H & Ps. The pieces were not graded, but students

were required to present their creative project to their peers on the last day of the rotation.

Results: Well over 200 submissions were received. These included short stories about

patients, short stories about students‟ family members, fictional accounts (usually placing

the reader "in the shoes" of a person or family member of a patient with a neurological

disorder), philosophical essays, poetry/haiku, paintings/drawing, original musical

compositions/songs, video, crafts, puzzles and performance pieces. Many of the

submissions were poignant and moving to the audience and reflected a deep emotional

connection with the patient. Some students opted for less emotionally charged

presentations such as crossword puzzles or expository pieces. Feedback from the

students was overwhelming positive. Most appreciated the opportunity to express

themselves in a more creative/emotional manner and most felt that they would use the

technique in their teaching careers.

Conclusions: Emotional expression is an educational technique that fosters humanism

by valuing its expression. Most students are capable of creating emotionally powerful

pieces and the assignment was well received.

Implications: Both humanism and technical skills are required in the successful practice

of all medical disciplines. Encouraging the appreciation of the impact that illness has on

patients and family fosters empathy and also provides an emotional outlet for the

physician in training.

Educating Anesthesiology Residents for “Anesthesia” for Awake Craniotomy

Federico Bilotta, Apolonia Elisabeth Abramowicz, Luca Titi, Antonella Cianchi, Giovanni Rosa,

Ellise Delphin, Department of Anesthesiology, “Sapienza” University Rome, Italy, Montefiore

Medical Center, Albert Einstein College of Medicine

Background: Anesthesia for awake craniotomy is a technique used for functional neurosurgery and

resection of brain lesions in eloquent areas. In this study, we have designed a dedicated training

program to teach anesthesia for awake craniotomy to residents in anesthesiology, and have

evaluated their learning curve.

Methods: Seven anesthesia residents underwent a dedicated training program to learn anesthesia

for awake craniotomy based on three tasks: local anesthesia, sedation/analgesia, and intraoperative

hemodynamic management. Evaluation of the learning curve was based on residents‟ self-

assessment and attending anesthesiologist judgment using a modified Likert scale (12 points from

“very-poor” to “excellent”). Based on the actual "learning-curves" recorded up to the 10th

procedure and on calculated slope coefficients, the trend of the learning process after the 10th

procedure was extrapolated. Advice request was also recorded.

Results: Each task has a specific learning rate. Local anesthesia showed the lowest score at the first

procedure, but has the fastest progression rate with a slope coefficient of 1.1, suggesting that a

training experience of 10 procedures should be adequate to guarantee the achievement of a “good to

excellent” ability score. Sedation/analgesia has an intermediate starting score and a slope coefficient

of 0.7, suggesting that a training experience of 15-25 procedures should be adequate to guarantee

the achievement of a “good to excellent” ability score. Intraoperative hemodynamic management

has the slowest learning rate with a slope coefficient of 0.3, suggesting that a training program of

20-30 procedures should be adequate to guarantee the achievement of a “good to excellent” ability

score. Data were confirmed by the trend in the number of requests for advice.

Conclusions: Learning subspecialty anesthesia techniques such as “anesthesia” for awake

craniotomy requires adequate theoretical background knowledge, dedicated training and effective

mentoring. This is an increasingly used approach in the subspecialty of neuroanesthesia, suggesting

the need for specific training. Several factors can influence the learning process, including the time

span it takes. In our study the number of procedure needed to achieve a “good-excellent” ability for

2 of the 3 tested tasks (sedation/analgesia and hemodynamic management) is derived by

extrapolating the trend of the actual learning curves, thus assuming that the learning process is

constant over time. A dedicated training program can provide “good-excellent” ability and self-

confidence necessary to accomplish this procedure.

Bar-plot of the number of advice requests. The number of advice requests made to the

attending anesthesiologist by the 7 residents over the 10 procedures is represented as a bar-

plot for each of the three tasks

Implementation of a Departmental ACGME-Compliant Core Curriculum for

Pediatric Subspecialty Fellows

Nora Esteban-Cruciani, Peter Cole, Catherine Skae, Alfin Vicencio, Swapnil Rajpathak, Laurie

Bauman, Department of Pediatrics, Children‟s Hospital at Montefiore, and Department of

Epidemiology & Population Health, Albert Einstein College of Medicine

Background: The Accreditation Council for Graduate Medical Education (ACGME) sanctioned

new accreditation standards that define core competencies in research and other scholarly activities

in 2007. There are few descriptions of organizational models designed to address these mandates.

Objective: To implement a department-wide core curriculum for pediatric subspecialty fellows

addressing ACGME core competencies.

Design/Methods: In 1998, we implemented a Science Course for pediatric subspecialty fellows,

with continuous improvements in response to trainee evaluations, faculty feedback, and needs

assessments. In 2007, we revamped the course to meet the new mandated ACGME core

competencies. The current 3-year curriculum offers 2-hour monthly or bimonthly sessions; each

curriculum year is tailored to level of training. Attendance is required unless the trainee is involved

in alternate education programs. Content includes basic and clinical research, bioethics, research

design, biostatistics, quality improvement, career development, finding a research mentor, teaching

skills, and academic preparation. We use adult learning techniques, self-directed learning,

opportunities for critical thinking, and multidisciplinary interaction. We monitor fellows‟

participation, feedback and evaluation of didactic sessions, self-assessed knowledge and ACGME

review cycle-lengths.

Results: Fellows‟ participation quadrupled since 1998 (x=47 participants/year, 2007-10), currently

85% of fellows from 16 different subspecialties. Sessions‟ attendance: 78%. Evaluation of sessions

was high: 4.7 + 0.2 out of 5= excellent (n= 195); 60% of didactic material was considered “new”

knowledge; 95% recommended keeping each session. Self-assessed-knowledge and research skills

were evaluated using a 42-item survey; course entry-scores increased from 1st to 3

rd year of

fellowship (2.9, 3.4 and 4.0, out of 5, p<0.01). ACGME review cycle-length increased from 3.3+

1

to 4.5+

0.7 years p<0.001) compared to prior review cycle-lengths. Factors associated with success:

1) Support: Department Chair, Vice Chair and Fellowship Directors; Biostatistician; Administrative

assistance; 2) Process: mandatory attendance; content tailored to ACGME requirements;

progressive levels of training; evening sessions; timely electronic communication; continuous

interdisciplinary quality improvement; 3) Faculty: distinguished pediatric/non-pediatric educators;

collaborative course leadership that incorporates basic/clinical/social science perspectives.

Conclusion: We have developed and implemented a highly successful and widely accepted

organizational model that provides hands-on multidisciplinary learning for pediatric subspecialty

fellows using a 3-year department-wide curriculum. This model addresses fellows‟ needs and

current ACGME mandates while facilitating continuous feedback and program improvement.

An Evaluation of an IUD Initiative at Family Medicine Residency Programs

Cara Herbitter, Jason Fletcher, Finn Schubert, Megan Greenberg, Marji Gold, Department of

Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine

Background: Despite the safety and efficacy of intrauterine devices (IUDs), only 39% of family

physicians insert them and 2% of US women using contraction choose IUDs. Lay and professional

misconceptions about IUDs and inadequate clinical training likely account for these low rates.

Another barrier to greater IUD utilization is their prohibitive cost. The objective of this study is to

evaluate a program aimed at increasing IUD training for family medicine residents and providing

grand-funded IUDs to women.

Educational Goal: This initiative aims to increase resident training and patient access to IUDs.

Methods: Design: Pre- and post-surveys Setting: Ten family medicine residency programs

Participants: Residency programs that were previous or current abortion training funding grantees

were eligible to receive free IUDs and educational materials. All residents and precepting faculty at

participating residency programs were invited to complete the surveys. Intervention/Instrument:

Participating programs receive a free supply of copper and hormonal IUDs, which they can offer to

continuity clinic patients at no cost. These programs have also received educational resources to

distribute to faculty and residents. Online pre- and post- quantitative surveys are distributed at

baseline and at 6 months after starting the project to assess its impact on the knowledge and

experience of faculty and residents. Main Outcome Measures: Number of IUDs inserted in previous

6 months, willingness to insert IUDs in various patient scenarios, intent to insert (for residents).

Results: At baseline, the majority (81.3%) of responding residents had not inserted copper IUDs

and approximately half (54.7%) had not inserted hormonal IUDs in the previous six months.

Common misconceptions included guidelines for patients with a history of STI/PID or ectopic

pregnancy and those who have not had a recent Pap smear. Data analysis is in process and will be

limited to respondents who completed both a pre and a post survey.

Conclusions: We anticipate the post-survey results will demonstrate increased IUD insertions and

greater adherence to established guidelines among residents and faculty.

Implications: Interventions that seek to increase resident training with IUD insertions may reduce

misconceptions among and increase the number of IUD insertions by residents and faculty.

Integrating the Chronic Care Model into a Dental Residency Training Program

Julie Kazimiroff, Karla Alvarado, Nanice Regis Blay, Department of Dentistry, Montefiore Medical

Center, Albert Einstein College of Medicine

Background: One goal of our training program is to use medical/dental integration with the Chronic

Care Model to improve oral health outcomes for persons with diabetes.

Goal: To train General Practice (GP) dental residents working in urban health center-based dental

clinics and hospital environments to understand and practice comprehensive dental care across the

lifespan in dental patients with diabetes using the Chronic Care Model (CCM)

Methods: 1) Outreach: Oral health promotion to patients and medical primary care providers (PCPs)

at community-based programs including PCP waiting rooms, health fairs, senior centers, and dental

staff communication with medical staff by means of handouts, oral presentations and oral health

education classes 2) Interventions: Diabetes Collaborative - Train residents: i) in management and ii)

monitoring and analysis of cytokines in diabetic and overweight/obese patients as oral health

indicators. 3) Evaluation: Practice Teams (GP and dental faculty) became familiar with the

Assessment of Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care

(PACIC); completed the ACIC for one chronic condition (e.g., how well they are providing oral

health care for diabetes). Adherence to Chronic Care Model was evaluated quantitatively by a

numerical score given by the respondents (Teams, patients) in which they rated the degree to which

each component (e.g., partnerships with community organizations, patient treatment plans) is being

implemented for that chronic condition, using a scale ranging from 0 (not at all) to 11 (fully).

Results: When we started the enhanced program, the scores ranged over 85% between "0" and "2" =

limited support for chronic illness care; six month average moved to between "3" and "5" = basic

support for chronic illness care.

Conclusion: To improve, we will use Systems-Based Practice (SBP) and Practice-Based Learning

and Improvement (PBL&I) for Team development to achieve between "6" and "8" = reasonably good

support for chronic illness care; and between "9" and "11" = fully developed chronic illness care.

Implications: The enhanced dental residency curriculum will provide the dental resident with the

tools necessary to perform interventions that will improve patient self-management for their chronic

illness.

Funded by HRSA Grant Award No: D88HP20119-01-00

Trauma Training Modular Curriculum: A New Approach to Education of

Psychiatry Residents

Kristina Muenzenmaier, A. Schneeberger, M. Abrams, L. Ruberman, L. Antar, S. Leon, S. Mouzon,

J. Battaglia, Department of Psychiatry and Behavioral Sciences, Bronx Psychiatric Center,

Montefiore Medical Center, Albert Einstein College of Medicine

Background: As psychiatry residents progress through training, they have contact with traumatized

patients from the initial phases of assessment through recovery. Considering the specific challenges

trainees face during their postgraduate years, we decided to assess the need for more extensive

trauma training and as a result developed a Trauma Training Modular Curriculum (TTMC) at

MMC/AECOM psychiatry residency training program.

Goals: The purpose of this poster is to present the results of the needs assessment for specific

trauma training and report on the TTMC developed for use in residency training.

Methods: In order to assess the current needs regarding trauma training of psychiatric residents in

different stages of their postgraduate training we developed a semi-structured questionnaire, which

was distributed to residents (n=29). Additionally information was elicited on a 4-point Likert scale

about three major areas (trauma assessment, barriers, level of comfort).

Results: Needs assessment: First and second year residents stated that the perceived barriers include a lack

of knowledge and skills, discomfort, and lack of appropriate setting; Third year residents‟ answers

focused on discomfort, timing, fear of re-traumatizing, and lack of rapport with patients; Fourth

year residents mentioned difficulties around their own shame, embarrassment and fear regarding the

topic, as well as cultural differences between patient and therapist. Recommendations on how to

improve training included the request for more lectures, protocols, and screening tools, more

evidence based information, structured interviews, sample questions, and more practice, and

requests for more specific training in interviewing and age-specific assessments, guidelines, and

role-plays.

Development of the TTMC: We have created the TTMC that can be adapted to the needs of each

postgraduate year. Each module is structured and has specific teaching goals and objectives, which

focus on conveying attitudes, knowledge and skills. From a teaching perspective, a multimodal,

multimedia, and multisensory approach elicits active participation.

Conclusion: Results of the written questionnaire shows the need for more specific trauma training,

which we addressed with the development of the TTMC. Next steps include program evaluation at

AECOM psychiatric residency training sites as well as collaboration with other residency training

programs on a national level.

Palliative Medicine Educational Initiative for Trainees in the Department of

Obstetrics, Gynecology and Women’s Health

Nicole S. Nevadunsky, Serife Eti, Enid Rivera, Peter Selwyn, Kimala Harris, Gary Goldberg,

Departments of Obstetrics & Gynecology and Women‟s Health (Gynecologic Oncology) and

Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine

Background and Goals: Women with gynecologic malignancies are confronted with pain,

debilitating symptoms and end-of-life decision making. Trainees in obstetrics, gynecology and

women‟s health may deliver improved care by implementing principles of Palliative Medicine.

Our goal was to evaluate baseline knowledge and the efficacy of a training program.

Methods: Fifty-six trainees participated in two interdisciplinary lectures that were themed an

Introduction to Palliative Medicine (IPM) and Pain Management (PM). Lectures were structured

on published curricula from the End of Life Palliative Education Resource Center (EPERC).

Participants completed a pre-test and post-test. The PM lecture included a case-based

component. Learner‟s level of training ranged from medical and physician assistant students to

fourth year residents. Statistical analysis was performed using Students T-test and SPSS

software.

Results: Mean pre-test scores for the IPM and PM lectures were 56% (range 23-85%) and 50%

(range 31-85%) respectively. Significant improvement was seen between pre- and post-test

scores following attendance of the PM lecture, mean post-test score of 86% (range 38-100),

p<0.001. No improvement was seen between pre-test and post-test scores for the IPM lecture.

Questions related to discussing prognosis, hospice benefit and medical futility were answered

correctly in 5%, 14% and 42% of responses in the IPM pre-test. In the PM pre-test questions

related to equal analgesic doses of opiates, pharmacokinetics and opiate side effects were

answered correctly in 25%, 17% and 17% of responses. Questions related to opiate lock-out

intervals, adjuvant analgesics and prophylactic bowel regimens were the most commonly

correctly answered questions (82%, 66%, and 82% respectively) in the PM pre-test. Themes

related to patient confidentiality and communication with family were most commonly correctly

answered in the IPM pre-test (95% and 81%).

Conclusions and Implications: Palliative Medicine and pain management education is needed

for trainees in obstetrics and gynecology. Trainees scored higher on themes related to their daily

practices and scored lower on questions related to more complex components of Palliative

Medicine. Learners were able to score higher on post-tests related to pain management after

case-based learning. Further study is needed to evaluate the most effective educational tools.

Developing a Botanical Medicine Curriculum for Medicine Residents:

A Needs Assessment of Knowledge, Confidence, and Communication

Miriam Rahav, Sharon Leung, Darlene LeFrancois, Department of Medicine, Montefiore

Medical Center and Albert Einstein College of Medicine

Background and Goals: Complementary and alternative medicine (CAM) has grown in

the last decade with 2007 estimates placing CAM use prevalence at 38% of U.S. adults;

tallying $34 billion in national expenditures. As use of CAM grows so does the need for

healthcare providers to provide informed counsel on safe and relevant use. Of CAM

therapies botanicals are the most commonly used, but currently there is no formal

curriculum in this area for our housestaff (HS). To target learning needs, we conducted a

needs assessment survey focusing on knowledge, confidence, and communication

practices, domains considered necessary to achieve the overall goals of practicing and

teaching about botanicals at the point of care.

Methods: All categorical interns (n=38) and residents (n=76) were invited to participate

in an online survey. The survey evaluated participant demographics and exposure to BM

(botanical medicine) in addition to the 3 domains aforementioned.

Results: Of the 114 HS, 86 (75.4%) responded. Personal use of BM was reported by

25%, and 14.7% had received formal BM education in the past. In a MLR (multi linear

regression) analysis, knowledge was associated with personal use of BM after adjusted

for PGY level and exposure to formal teaching in BM. For the confidence score MLR

showed confidence was associated with use of BM and formal education after adjustment

for PGY level. For the CP scale, over 76% of the responders had no CP with their

patients over the past 30 days.

Despite high prevalence of BM usage by patients, categorical HS had knowledge

deficiencies relevant to the use of 10 common botanicals. In the communication domain,

a great majority of HS had not communicated with patients about the use of botanicals in

the last 30 days, nor did they feel confident in doing so. While history of personal use of

BM and prior formal education in BM predicted confidence, overall scores remained

quite low.

Conclusions and Implications: A BM curriculum is needed and has the potential to

impact knowledge, and enhance confidence by identification of resources for reference

and further study. A communication practice may follow, where the spectrum of patient

health practices is reflected inclusive of BM use.

Experiential Learning of Quality Improvement: Converting Resident

“Gripes” into Quality Improvement (QI) Projects

Kenneth Rivlin, Paul Sue, Daran Kaufman, Auxford Burks, Jeffery C. Gershel, Lewis M. Fraad

Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine

Background: A core ACGME competency is for residents to learn about QI through “practice

based improvement and learning.” However, there is no consensus as to the best educational

modality to achieve this goal. Current approaches include QI block rotations and modular QI

projects. While these approaches teach underlying principles and skills they are severely limited

in terms of developing both leadership and ownership of QI projects.

Goals: To improve the learning of practice based improvement by developing and

implementing projects initiated from resident complaints (i.e.,"gripes").

Methods: Chief residents supervised “gripe” sessions with residents with the goal of

discovering potential QI projects. Such gripes were used to identify system-wide problems in re:

patient care and quality of resident education. Chief residents functioned as project leaders,

educating residents on how to implement the Plan, Do, Study, and Act cycles. Regular meetings

were held to identify progress, report data and identify emerging obstacles and future cycles.

Results: Two resident QI problems are summarized below in "storyboard" format:

1. Improving peripheral IV line (PIV) care and replacement

Gripe: Number of hours spent by residents maintaining and replacing PIV's.

Patient Care issue: Delays in care, time to admission, and reductions in time available for

patient care planning.

Outcome: Increased cooperation with nursing to manage PIV issues. Overall 32% mean

decrease in the time residents spent replacing PIVs on the inpatient service over a 1-year

period.

2. Improving hospital discharge follow-up process

Gripe: Amount of time spent by residents on phone making follow-up appointments.

Patient Care issues: Loss of resident time available for patient care planning.

Outcome: Initiation of an alternate system for discharge planning. Relative 45% decrease

in amount of working time spent by residents making follow-up appointments.

Conclusion and Implications: We found the conversion of resident gripes into QI projects to

be a powerful tool in providing experiential learning. For many of our residents, this approach

engendered feelings analogous to the pride felt when successfully managing a sick patient. In

addition, there was a personal investment in the QI projects.

A Faculty Development Program to Prepare Instructors to Observe and

Provide Effective Feedback on Clinical Skills to Internal Medicine Residents

Sheira Schlair, Larry Dyche, Felise Milan, Hillary Kunins, Julia Arnsten, Eric Holmboe

Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine

Background/Goals: Feedback on directly observed clinical encounters is essential to health

professional skill development, and the ACGME mandates direct observation in internal

medicine residencies via the mini-CEX (“clinical evaluation exercise”). Faculty training in direct

observation and feedback skills has been shown to be more important than the assessment

instrument used.

We have implemented a program to train internal medicine faculty to (1) Become familiar with

the evidence-based communication and feedback literature (2) Learn to accurately assess

resident interviewing skills and (3) Conduct behaviorally specific, learner-centered, emotionally

sensitive feedback sessions based on direct observation.

Methods: Interactive one-hour sessions were organized over an academic year. In the first

session, participants used the instrument to evaluate a trainee‟s clinical skills in a videotaped

clinical encounter and then gave real-time feedback to this trainee.

In a second session, facilitators enacted a scripted resident-patient encounter with deficient

rapport building. Faculty practiced feedback giving to this “pre-contemplative” resident using a

“qualities of good feedback” pocket-card and mini-CEX instrument. Themes in debriefing

included understanding residents‟ personal goals and time management. Subsequent quarterly

sessions will employ group discussions of videotaped faculty feedback encounters to explore

assessment accuracy.

Program impact will be assessed by pre-post feedback quality and satisfaction, as measured by

faculty and resident surveys and analyses of mini-CEX instrument data.

Results: Post-session faculty surveys had a response rate of 100% for session 1 (n=24/24) and

75% for session 2 (n=15/20). Faculty reported greatest improvement in the feedback skills

including “addressing learner emotions” (mean=1.3 vs. 2.8, p=0.19) and “collaborative”

feedback processing (mean=2.1 vs. 2.9, p=0.17). Data will be forthcoming from resident surveys

and analyses of mini-CEX instrument data. Preliminary qualitative analysis of faculty program

evaluation yielded curricular strengths: Interactive format, systematic approach to clinical

observation and feedback giving, facilitator style (“openness to criticism and discussion”) and

longitudinal nature of curriculum.

Conclusion: Managing emotions of the “pre-contemplative” resident is challenging but faculty

report growth after two program sessions. Allocated time, faculty attitudes and faculty efficiency

are critical factors to faculty satisfaction with this faculty development program and user

satisfaction with mini-CEX programming overall.

Evaluating Surgical Residents’ Cognitive and Functional Status

Assessment Skills Using a Standardized Patient Interview

Keerti Sharma, Amy R. Ehrlich, Laurie G. Jacobs, Deborah Greenberg, Kim Freeman,

Arnold Berlin, Departments of Medicine (Geriatrics) and Surgery, Montefiore Medical

Canter, Albert Einstein College of Medicine

Background: Surgeons often discuss the risks and benefits of elective surgery in the office

setting.

Goals: A standardized patient (SP) interview was designed to assess surgical residents‟

baseline competence in evaluating an older patient's cognitive and functional status prior to

the introduction of a geriatrics curriculum.

Methods: Six surgical residents were each given 20 minutes to complete a videotaped

interview of a SP. They were provided a scenario of an older adult coming for a pre-

operative visit to discuss an elective cholecystectomy. This exercise was a formative

evaluation and the residents had no prior cognitive and functional assessment training in their

residency. After the interview, the residents completed a structured self- assessment and the

SP completed a structured evaluation of the residents‟ interpersonal skills. A surgeon and a

geriatrician evaluated the residents‟ performance through videotape review using an

additional structured tool. An interactive feedback session was held with the residents, faculty

and SP. Brief video segments were reviewed to highlight successful approaches in eliciting

the SP‟s cognitive and functional status. This exercise will be repeated after the residents' are

exposed to a formal geriatrics curriculum.

Results: Five residents “somewhat agreed” that they were comfortable assessing the patient‟s

cognition; one resident “strongly agreed.” Half “strongly” and half “somewhat agreed” that

they were comfortable assessing function. There was strong correlation between the faculty

regarding the evaluation of the residents, and all six were assessed as “able to identify the

patient‟s cognitive and functional deficits.” Only one employed a standardized assessment

tool to reach this conclusion. The residents "strongly agreed" that this exercise was very

helpful.

Conclusion: Although all of the residents were able to identify cognitive and functional

deficits, they were not confident in their skills. Exposure to geriatric assessment tools, such

as the „Mini- Cog‟, through a formal geriatrics curriculum may improve the residents'

confidence in their skills. Use of this SP exercise prior to formal geriatrics training is a useful

teaching tool that was highly evaluated by surgical residents.

Support for this project provided by: John A. Hartford Foundation GSR grant

Observing the Teachers: Is Faculty Development Effective for

Preceptors Teaching Medical Students in a Physical Diagnosis Course?

Lisa Auerbach, Mimi McEvoy and Felise Milan, Departments of Medicine and

Pediatrics, Ruth L. Gottesman Clinical Skills Center, Albert Einstein College of Medicine

Background: Importance of student observation and feedback to enhance clinical skills

acquisition is well documented. Less well documented is the observation of preceptors‟

teaching skills. A myriad of faculty development venues exist in the literature;

effectiveness of these efforts hasn‟t been well studied.

Educational Objectives: Assess teaching skills of preceptors in a second-year physical

diagnosis course for: 1) conformity to course objectives/strategies/format; 2) various

teaching approaches, 3) observation and feedback technique; and 4) time management.

Methods: One experienced faculty observed 10 of 23 randomly selected preceptors

during 4 of 7 physical diagnosis sessions (vital signs/handling the instruments, HEENT,

abdomen and neuro) via remote observation (from a video control room) to determine if

objectives, strategies and format are being implemented as discussed in the 30 minute

faculty meetings prior to each session. All preceptors consented to being observed. A

12-item observation tool was crafted based on basic principles of group teaching (i.e.

coaching students who were practicing examination techniques) and course logistics (i.e.

not spending more than 30 minutes on pre-practice demonstrations/lectures, employing

the skills checklists in syllabus). General observations were also recorded.

Results: All preceptors conformed to session objectives and teaching strategies, except

in 2 cases where preceptors consistently lectured too long, minimizing hands-on practice.

Other teaching approaches observed included demonstration, observation, hands-on

corrections. All preceptors employed the PE skills practice checklists, but in different

ways. Preceptors consistently gave feedback on techniques despite variability on the

proportion of verbal explanation/demonstration. Length of sessions varied with some

preceptors ending before 2 ½ hours; 2 preceptors who lectured for greater than 30

minutes ended later.

Conclusions: Video observation confirmed that faculty do consistently meet course

objectives in a physical diagnosis course. Faculty development may be related to

achieving consistency of course objectives and strategies among preceptors despite a

variety of approaches and styles. Opportunities for specific preceptor feedback abound

with this observational method.

Health Disparities: Awareness to Action – A Curricular Innovation

Cristina M. Gonzalez, Aaron D. Fox, Department of Medicine, Montefiore Medical

Center, Albert Einstein College of Medicine

Background and Goals: The LCME mandates health disparities education. We

developed an innovative curriculum with the following objectives: (1) Define HD and list

examples of diseases where disparities are evident; (2) Demonstrate confidence in

utilizing skills targeting provider contributions to HD; (3) Demonstrate confidence in

developing advocacy skills targeting social contributions to HD.

Methods: Eleven first-year medical students participated in the elective at Einstein. The

curriculum was divided into three areas with the final session for evaluation:

1. Background (four sessions): Included computer based modules summarizing the

HD literature, videos introducing the social determinants of health, and discussion

with community health advocates.

2. Provider Contributions (three sessions): Sessions prepared learners to recognize

implicit biases and minimize their influence on patient care. Learners completed

the Implicit Association Test (IAT), participated in case based discussion groups,

and practiced interviewing techniques.

3. Advocacy Skills (five sessions): Skill building sessions prepared learners to

address the social determinants of health through advocacy and social change.

Sessions included strategy for advocacy campaigns, outreach, physicians‟

organizations, media, and legislative advocacy.

Results: Pretests and posttests items were rated on a four-point Likert

scale. Changes in confidence were examined using paired T-tests. Learners

demonstrated increased comfort in defining HD, social determinants of health, and

implicit bias, and increased awareness of mistrust, communication, and physician

contribution to HD. Learners also increased confidence in their advocacy skills.

Perception of personal implicit bias did not change.

Student‟s identified positive aspects of the course that facilitated learning: the small

group environment, enthusiasm of faculty, and skill development. Suggestions for

improvement included: additional experiential learning and integration into the

compulsory curriculum.

Conclusions and Implications: Our students enjoyed the HD elective and felt confident

in their knowledge gains. The IAT is provocative, but may not convey the intended

lesson that implicit bias is natural and can be managed in clinical practice. Methods to

recognize and overcome implicit bias are needed. While physician advocacy is often

discussed in the context of professionalism, teaching advocacy skills as part of HD

coursework may empower students to address social contributions to HD and reduce HD

in the future.

Psychometric Properties of the Team Performance Scale in a Third-

Year Medical School Clerkship

Jennifer M. Purcell, Department of Family and Social Medicine, Albert Einstein College

of Medicine

Background and Goals: Research and evaluation are critical components of any

educational initiative, and selecting appropriate tools to measure the construct of interest

is important to ensure reliability of data and validity of results. The purpose of this poster

is two-fold: 1) review the psychometric properties of the Team Performance Scale (TPS)

with third year medical students, and 2) test the feasibility of using a subsample of items

without impacting the psychometric results.

Methods: The Department of Family and Social Medicine recently introduced four team-

based learning (TBL) sessions to its clerkship curriculum. As part of a comprehensive

evaluation process, faculty are collecting data from multiple sources to measure

knowledge, higher-order thinking, and quality of team performance.

Students were asked to complete the TPS, developed by Thompson and colleagues

(2009), as part of their end-of-rotation clerkship evaluation. Using a similar method

described in the Thompson et al. article, we examined the internal consistency,

proportion of explained item variance, and ability to distinguish among teams for the full

scale and 12 shortened scales created through random item generators.

Results: Preliminary results using data from eight rotations (n = 122) show similar

psychometric properties for both the original TPS and a 6-item subscale to those reported

by the scale‟s authors.

Conclusions and Implications: There is evidence of reliability and validity when using

the TPS with a group of 3rd

year medical students. Researchers may also consider the use

of a shortened scale when administering multiple construct questionnaires without

compromising validity or increasing response burden.

Evaluation of the Team-Based Learning Curriculum in a Family

Medicine Clerkship

Jennifer M. Purcell, Pablo Joo, Department of Family and Social Medicine, Albert

Einstein College of Medicine

Background and Goals: The use of team-based learning (TBL) in medical education has

grown steadily over the past decade. However, its effectiveness in clinical clerkships is

not often reported. This poster will present quantitative outcome data from the first eight

months of the new TBL curriculum in the Family Medicine clerkship.

Methods: After completing a six-month iterative design process, the Department of

Family and Social Medicine implemented a series of TBL sessions in its 3rd

-year

clerkship. Four 2-hour sessions replaced one standard health promotion lecture and three

case-based sessions covering asthma, hypertension and hyperlipidemia, and diabetes.

Exam scores (20 items) of students in TBL were compared with students who

participated in the lecture and case-based sessions the previous year. Additionally,

responses to four self-report survey items on knowledge change, student interaction, and

the opportunity to apply content to clinical questions were considered. These data

represent only two of multiple evaluation measures.

Results: Exam scores and survey responses from 122 TBL students were compared with

119 students from last academic year. Exam scores were not significantly different by

topic area and no trends in item difficulty occurred over time. TBL students rated self-

perceived knowledge both prior to and after the sessions lower than the previous group,

yet changes in knowledge were not significantly different. There were significant

differences, however, in the opportunity to apply content to clinical questions.

Conclusions and Implications: Curriculum evaluation is an ongoing process and is

especially important when implementing any curricular change. Although preliminary

results support the use of TBL in the Family Medicine clerkship, measures of student

satisfaction, team performance, and faculty feedback will be reviewed to create a more

robust evaluation.

Incorporating a QI Exercise into the Einstein Medicine Clerkship: A Pilot

Study

Sharon Silbiger, Darlene LeFrancois, Penny Grossman, William Burton, William Lee, Eran

Bellin, Department of Medicine, Office of Educational Resources, Emerging Health Information

Technology, Albert Einstein College of Medicine/Montefiore Medical Center

Background: Based on the AAMC 2010 GQ Medical School Graduation Survey, over 37% of

Einstein students felt that their instruction in and exposure to “Health Care Quality

Improvement” was inadequate. Montefiore Medical Center (MMC) has developed longitudinal

analytic software, called Clinical Looking Glass (CLG), which allows users to query the health

information system and answer clinical questions based on cohort data, thereby supporting QI

efforts.

Objectives: 1) Conduct a Needs Assessment of current 3rd

year Einstein medical students

regarding familiarity with QI concepts. 2) Pilot a QI exercise in the Medicine Clerkship.

Methods: 1) 11 question “Needs Assessment” survey distributed to all Einstein 3rd

year

medical students who had completed Medicine Clerkship in current academic year (N=89). 2)

Tool development: a) 2011 Standards of Care (Standards of Care) Guidelines summary for

Diabetes Mellitus (DM), b) Pre-test on DM Standards of Care, c) Medical chart abstraction form,

3) Pilot QI exercise: a) Student clerks rotating on in-patient medical service of MMC

participated. b) Pre-test administered to students. c) Standards of Care Guidelines for DM

reviewed with students. c) Each student reviewed medical chart of diabetic in-patient. d)

Students trained in CLG, developed a clinical question regarding care of patients in the MMC

system and ran query. 4) Program evaluation performed using focus group.

Results: 1) Needs assessment survey response rate: 52%. Students reported either a vague idea

or unclear understanding of QI (74%); Standards of Care (54.5%); PBL (26.2%). 98% of

students felt it was important for medical students to know about monitoring patient outcomes.

Over 50% of students had no experience with chart review.

2) 11 students successfully participated in the pilot QI program. a) Few students were

familiar with Standards of Care in DM. b) Chart review challenges noted: indecipherable

handwriting and poor documentation. c) Sample CLG student query: What percentage of

patients with 2 HBA1C levels > 6.5 in the past year and a systolic BP>130 and diastolic >80 are

on ACEI or ARB?

3) Based on focus group, most students enjoyed discussing their QI queries and using

CLG, but felt that other aspects of the QI exercise should be truncated. Some students felt that

the QI exercise required a large time commitment and took them away from patient care during

the clerkship. Student comments regarding the overall benefit of practice based learning and

improvement and self reflective practice varied, with some students commenting: “I think it

makes me a better physician” and “It show us how we can test ourselves”.

Summary/Conclusions: A QI exercise was successfully instituted during the medicine

clerkship block. Further development and expansion of this curriculum is planned.

Musculoskeletal Examination (MSKE) Pilot Mini-Course: Increasing Medical

Student Exposure to the MSKE

Maya R. Therattil, Todd R. Olson, Sherry A. Downie, Departments of Physical Medicine and

Rehabilitation and Anatomy and Structural Biology, Montefiore Medical Center, Albert Einstein

College of Medicine

Background and Goals: Medical students are inadequately prepared to undertake careers in

musculoskeletal medicine (Day et al., 2007). They lack anatomic knowledge, basic exam skills,

and confidence to perform musculoskeletal exams (MSKE). To address this, we developed a

pilot course integrating anatomical knowledge and MSKE skills using cadaver review and hands-

on workshops.

At Einstein, students are introduced to musculoskeletal medicine through first-year Clinical and

Developmental Anatomy and second-year Musculoskeletal System courses. During anatomy,

students dissect the back, upper and lower extremities, and discuss clinical cases with Physical

Medicine and Rehabilitation faculty. In the Musculoskeletal System course common pathologies

are studied. This exposure to musculoskeletal medicine is equal to or less than the exposure in

institutions where deficiencies were reported (Schmale, 2005). We hypothesize that additional

opportunities for students to learn fundamental concepts and practice MSKE techniques will

result in measurable improvement in student knowledge, confidence, and competency.

Methods: The MSKE Pilot Mini-Course (limited to 23 MS1-4 students) consisted of the pre-

course quiz, three 2-hour evening sessions, and a follow-up meeting to administer the post-test

quiz and course evaluation. Data were analyzed statistically using paired t-tests. Each session

included an introduction to body planes and positioning, clinically relevant concepts of

movement (e.g. scapulohumeral rhythm), cadaver-based anatomy review of the selected region,

and hands-on sessions to learn and practice such common MSKE techniques as range of motion,

Spurling‟s test, Lhermitte‟s test, straight leg raise, impingement tests, and tests for tendonitis,

carpal tunnel syndrome, arthritis, ligamentous and meniscal knee injuries, and ankle sprains.

Results: Confidence levels in performing MSKEs increased significantly and 100% of students

felt that integration of anatomy with MSKE practice was useful. An increase in knowledge was

documented (10.19% MS1; 18.10% MS2-4). Skills were not tested.

Conclusion: Integration of cadaveric anatomy review with MSKE practice helps medical

students synthesize what they have learned in first- and second-year courses and provides a

framework for adding and retaining new information.

Future plans: Develop MSKE OSCEs for use in the 2012 Mini-Course and develop a fourth-

year elective curriculum that expands on this pilot program and incorporates cadaveric anatomy

review, hands-on MSKE practice, and clinical experience.

Funded by Grants for Excellence in Medical Education, Albert Einstein College of Medicine,

2010.

Video Recorded Simulations in Bioethics Consultation Training: A

Collaboration of the Ruth L. Gottesman Clinical Skills Center and the

Einstein-Cardozo Masters of Science in Bioethics Program

Patrick D. Herron, Hannah I. Lipman, Patricia (Tia) Powell, Elizabeth A. Kitsis, Departments of

Family & Social Medicine, Medicine (Geriatrics), Epidemiology & Population Health,

Psychiatry and Behavioral Sciences, Medicine (Rheumatology), Montefiore Medical Center,

Albert Einstein College of Medicine

Background: In the spring of 2011, the Montefiore-Einstein Center for Bioethics and Ruth L.

Gottesman Clinical Skills Center (CSC) collaborated on the development of a graduate course in

Bioethics Consultation. The course was offered as professional development and/or towards the

Einstein-Cardozo M.S. in Bioethics, a degree program of the Albert Einstein College of

Medicine and the Benjamin Cardozo School of Law of Yeshiva University in collaboration with

Montefiore Medical Center. Ten students representing the fields of medicine, nursing, law, and

pastoral care participated over four days covering two weekends in March and April.

Goals/Objectives: The goal of the course was to design an effective training program for

bioethics consultants using a variety of educational techniques including interactive lecture, case

discussion, literature review, role play and video recorded simulations.

Methods: Learners had the opportunity to apply techniques learned through a variety of

scenarios created by faculty that address common themes and challenges in bioethics

consultation. Recorded simulations were accessible to participants via the Internet utilizing the

CSC‟s web based data management system. This provided an opportunity for self-assessment by

the participants. Faculty assessed and provided feedback to all participants as well as using

recordings for teaching points to help illustrate interpersonal/communication skills, bioethics

mediation skills and bioethics knowledge as demonstrated in recorded consultation encounters.

Evaluation: Faculty provided learners with Ethics Consultant Proficiency Assessment Tool as a

pre/post assessment to evaluate course objectives. It was developed by the Veteran‟s Health

Administration‟s Integrated Ethics program through the National Center for Health Care Ethics.

Faculty also utilized an adaptation of Einstein‟s Introduction to Clinical Medicine program‟s

Communication/Interpersonal Skills checklist for medical students. Preliminary results of the

course and teaching methods will be completed by the end of April 2011.

Conclusion/Implications: The faculty, representing the Gottesman Clinical Skills Center and

Center for Bioethics, include experts in bioethics consultation and education and use of video in

medical education. Their collaboration to design an interactive curriculum teaching core content

and skills for bioethics consultation demonstrates the benefits of collaboration and partnership of

the Ruth L. Gottesman Clinical Skills Center with institutional partners throughout the Einstein-

Montefiore community.

Smartphone Use During Inpatient Attending Rounds: Help or Hindrance?

Rachel J. Katz-Sidlow, Allison Ludwig, Scott Miller, Robert Sidlow, Departments of Medicine

and Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine

Background: Healthcare market research has found that 72% of US physicians currently own a

smartphone (e.g. iPhone, Android, Blackberry, iPad). These devices offer numerous benefits for

physicians, including applications that assist in patient diagnosis and management. Nevertheless,

research from the psychology and traffic safety fields has raised concerns about the potential for

smartphone user distraction while multitasking.

Objective: To assess resident and faculty smartphone use during inpatient attending rounds and

its potential as a source of distraction during important clinical information transfer.

Methods: We surveyed all housestaff and inpatient faculty in the departments of Medicine and

Pediatrics at our institution regarding smartphone ownership and usage patterns during attending

rounds. Respondents were also asked whether they had ever missed, or had seen others miss,

clinically important data during rounds due to distraction from smartphones. Attendings were

asked whether policies should be established for smartphone use during rounds.

Results: Survey response rates were 81% (116/143) for housestaff and 56% (40/71) for faculty.

Smartphone ownership rates were 89% for residents and 98% for faculty, with 57% of housestaff

and 28% of attendings reporting “frequent” personal use of smartphones on attending rounds.

Respondents noted that they used their smartphones at least occasionally during attending rounds

for: 1) patient care (85% residents, 48% faculty, p<.001), 2) reading/responding to personal

texts/emails (36% residents, 12% faculty, p<.001), and 3) other non-patient care uses (15%

residents, 0% faculty, p<.001). Of concern, 19% of residents reported that they missed important

clinical information due to smartphone distraction, as did 12% of attendings. Interestingly,

respondents reported observing other team members using smartphones and missing important

clinical data at higher rates than they reported for themselves. A majority of both residents and

faculty agreed that smartphones “can be a serious distraction during attending rounds” and 77%

of attendings affirmed that "smartphone use codes of conduct" are needed.

Conclusions: Smartphone ownership and use during attending rounds is highly prevalent among

both faculty and residents and can distract users during these periods of important information

transfer. A vast majority of attendings favor the institution of formal policies governing

appropriate smartphone use during inpatient rounds.

Mastering Functional Independence Measures: Comparison of

Different Educational Strategies

Karen Morice, Michael D. Skeels, Maya R. Therattil, Department of Physical Medicine

and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine

Background: The Functional Independence Measure (FIM) instrument is a scoring

system, developed to provide data on severity of disability and rehabilitation outcomes.

The FIM is an 18-item ordinal scale used universally in outcome studies and in

rehabilitation hospitals to measure a patient‟s improvement during their inpatient stay.

Physical Medicine and Rehabilitation (PMR) residents spend a minimum of one year in

inpatient rehabilitation training and undertake careers in managing inpatient rehabilitation

units. Understanding how to correctly assess a patient‟s FIM is important as it helps

predict length of stay, discharge destination and services required. Resident education on

using the FIM instrument has not been reported in the PMR literature despite the

importance and daily use in inpatient rehabilitation.

Goals: To compare the efficacy of two different strategies to educate residents in the use

of the FIM instrument.

Methods: Twenty-two residents, who took a standardized FIM pre-test, underwent a

didactic session taught by physical, occupational and speech therapists who are experts in

the various domains of the FIM instrument. Eleven residents (intervention group) from

this group would use the FIM instrument to score the function of one patient admitted to

the acute rehabilitation unit. This process is ongoing. A standardized post-test will be

administered to all twenty-two residents after a period of four months. The scores of the

intervention group will be compared to the scores of the non-intervention group (the

eleven residents who only attended the didactic session and did not FIM score any

patients) would be compared.

Results: The average score on the Pretest was 6.02, maximum score being18. The post-

test score is not available as this is a study in progress.

Conclusions: Our hypothesis is that residents who evaluated a patient and calculated the

FIM score, in addition to attending the standard didactic session on FIM scoring, would

score higher on the standardized post-test.

Implications: The results of this study may determine the inclusion of practical FIM

scoring sessions with actual patients, to the resident education, in addition to a didactic

session, by experts in FIM scoring.

Innovations in Resident Education: Applications of Information Technology

Eleanor Weinstein, Maria Mendoza, Andrew Gutwein, Department of Medicine, Jacobi Medical

Center, Albert Einstein College of Medicine

Background and Goals: The goal of this project is for Jacobi Medical Center (JMC) Internal

Medicine residents to achieve competency in Practice - Based Learning and Improvement in

their ambulatory care education through the use of a Diabetes Registry. Additionally, they will

gain an understanding of the chronic disease model of care resulting in improved quality of care

for their patients.

The Diabetes Registry is a web-based tool using the electronic medical record (EMR)

information to provide an overall snapshot of longitudinal patient care. It is useful to monitor

trends in compliance with evidence-based practice and, residents can use it to self-identify areas

needing improvement. Residents can continually monitor their own performance and identify

patients not meeting established targets for clinical care.

The JMC Internal Medicine categorical training program currently consists of 93 residents.

About 40 % of the 4200 diabetic patients at JMC are assigned to residents for ongoing care.

These patients pose particular challenges as continuity of care and close follow up, vital in

diabetes management, are more difficult given erratic resident schedules.

Methods: The Diabetes Registry function at JMC was adjusted this academic year to allow each

resident to have his/her own personal registry. Patients are assigned as they are seen by a

resident, building patient panels within the Registry for residents to follow over the 3 years of

residency. We hypothesize this will improve engagement of residents with their patients, allow

residents to continually evaluate the care being provided and improve continuity of care,

outcomes and quality. Through effective use of the Registry, competency in Practice Based

Learning and Improvement will be achieved.

Plans for studying the effectiveness of the Diabetes Registry in resident education include:

Monitoring patient outcomes by following clinical indicators via the individual

Registries

Monitoring continuity of care of the patients assigned to the resident Registry

Monitoring the residents‟ use of their Registry via the built in log - in audit

function

Surveying the residents every 6 months throughout their residency training to

assess attitudes and confidence in using the Registry

Surveying the residents every 6 months to assess knowledge and confidence in

caring for patients with chronic disease

Discharge Summary Quality Improvement Project

Tehila Zuckerman, Maria Kassab, Anna Kochin, Dahlia Rizk, Rebecca Calabrese

Department of Medicine, Beth Israel Medical Center, and Albert Einstein College of

Medicine

Background and Objectives: Discharge summaries are used by clinicians for

communication with colleagues and patients. Studies demonstrate summary quality

impacts patient morbidity and mortality. This study aimed to evaluate the quality of

discharge summaries written by internal medicine house officers, whether an educational

intervention could improve quality, and the perception of the intervention.

Methods: The study took place at an urban academic medical center over a one-month

period. Discharge summaries of 29 house officers assigned to a medical ward were

evaluated. Survey participants included internal medicine house officers, hospitalists,

and primary care physicians. The educational intervention was a noon conference for

house officers.

Description: An anonymous pre-intervention survey asked house officers and faculty

physicians to rate current discharge summary quality and their interest in education on

quality improvement. Thereafter, 30 randomly selected, de-indentified summaries were

scored using an 18-item discharge summary quality scoring tool. Approximately 65

house officers attended a lecture highlighting those items identified as needing

improvement. Then, 30 randomly selected, de-identified summaries written by the same

group were scored to evaluate impact. A score of 80% or greater was considered

adequate quality. An anonymous post-intervention survey of house officers solicited

feedback.

Results: The pre-intervention survey yielded responses from 50/121 house officers and

24/39 faculty physicians. Both groups thought 60% of summaries were of high quality.

86% of house officers and 87.5% of faculty favored an educational intervention. The

discharge summary scoring tool found overall pre-intervention quality to be 87%, but

identified 9 of 18 individual items scored as having an average quality <80%. The

overall post-intervention quality score improved to 93.9%, with only 1 of 18 individual

items scored having a quality score <80%. The post-intervention survey of house officers

yielded 42/121 responses. 96% recommended adopting the intervention into the academic

curriculum.

Conclusions and Implications: House officers and faculty agreed regarding the need for

improvement in discharge summary quality. Nearly all individual summary items in

need of improvement achieved adequate quality after the intervention. The educational

intervention was well received. Our study demonstrates the value of incorporating

education on discharge summary quality into the academic curriculum.