Leaders' Perspectives on Resources for Academic Success: Defining Clinical Effort, Academic Time, and Faculty Support

INTRODUCTION

For academic promotion, clinical faculty are expected to excel in clinical care, teaching, and scholarship. Ensuring adequate protected time and resources to engage in scholarly work in the face of competing clinical responsibilities is critical. The authors examined academic leaders' perspectives across affiliate hospitals of a large medical school regarding the definition of clinical full-time effort and academic time, best practices to enable academic success, and barriers to faculty advancement.

METHODS

Open-ended, semistructured, individual interviews were conducted with a purposive sample of clinical department and division heads. Interview data were examined to illuminate the range and commonalities in practices and to identify successful approaches.

RESULTS

Interviews were conducted with 17 academic leaders across 6 affiliate hospitals. There was considerable variability in clinical full-time effort definition. "Academic time," more accurately characterized as "nonclinical time," was typically 1 day a week for nonshift specialties and mostly used for administrative work or completing clinical documentation. Certain departments were more explicit in designating and protecting time for academic pursuits; some had invested resources in intensive programs for academic advancement with built-in expectations for accountability. The impact of documentation burden was considerable in certain departments.

DISCUSSION AND CONCLUSION

Marked variability exists in time allocations for clinical and academic work, as well as in resources for academic success. This supports the potential value of establishing standards for defining and protecting academic time, motivating clinical faculty to engage in academic work, and building accountability expectations. Sharing best practices and setting standards may enhance academic advancement. Strategies to reduce documentation burden may enhance wellness.

A Call for Reform: Variability and Insufficiency in Radiation Oncology Resident Didactics-a Brief Report and National Survey of Program Directors

An informal needs assessment and lack of a national standardized curriculum suggest that there is tremendous variability in the formal teaching of radiation oncology resident throughout the USA. The goal of this study was to characterize formal radiation oncology resident education, in order to identify knowledge gaps and areas for improvement. We developed a 14-item survey consisting of the following domains: program characteristics, teaching faculty, formal teaching time, instructional approaches for formal teaching, curricular topics, and satisfaction with didactics. All 91 accredited US-based radiation oncology program directors received an invitation to complete the survey anonymously by email. Twenty-four (26% response rate) program directors responded. Programs used a variety of instructional methods; all programs reported using lecture-based teaching and only a minority using simulation (38%) or flipped classroom techniques (17%). Other than PowerPoint, the most common electronic resource utilized was quizzing/polling (67%), webinar (33%), and econtour.org (13%). The lack of a national, standardized, radiation oncology residency didactic curriculum promotes variability and insufficiency in resident training. Themes for improvement were diversity in didactic topics, incorporation of evidence-based teaching practices, increased faculty involvement, and sharing of resources across programs. Development of a national curriculum and increased electronic resource sharing may help address some of these areas of improvement.

A Resident-as-Leader Curriculum for Managing Inpatient Teams

PROBLEM

Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill.

INTERVENTION

We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching.

CONTEXT

Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team.

IMPACT

We trained 65 PGY1 residents and raters conducted 140 direct observations - 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2).

LESSONS LEARNED

A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.

Faculty Development and Infrastructure to Support Educational Scholarship: A Scoping Review on Author Development

PURPOSE

Medical educators are expected to produce educational scholarship, which can lead to career advancement and promotion. Institutions have developed author development programs, which vary in duration, instructional approach, and effectiveness. However, no summation of the evidence exists for academic medicine leaders to use as guidance for building similar programs. This scoping review characterizes faculty development programs that support educational scholarship and author development in academic medicine.

METHOD

The authors searched PubMed, Scopus, Google Scholar, and ProQuest (Healthcare Administration Database and Social Science Premium Collection) for articles published from inception to June 14, 2021. Articles that described formal instruction on scholarly writing for publishing were included. Data were analyzed by program participation, structure, content delivery, and outcomes.

RESULTS

Of 923 articles identified, 20 met inclusion criteria. The included studies covered 18 unique programs of which 1 was sponsored jointly by a university and professional society, 5 by professional societies, 5 by university or medical school organizations, and 7 by medical departments. Nine programs relied at least in part on volunteers. Instructional approaches included didactics (7 programs) and mentoring (5 programs) but mostly featured group-based work (11 programs). Expectations for participants ranged from participation to manuscript submission. The main funding sources were grants (8 programs) and internal funds (7 programs) from the sponsoring institution. Only 4 programs reported participation fees. The impact of these programs included scholarly work products, other measures of career advancement, and participant perceptions.

CONCLUSIONS

Author development programs require resource investment and a culture that values educational scholarship. Workshops, 1-on-1 mentoring, and peer writing groups are cornerstones of the experiential learning approach needed to build scholarship skills and can pay dividends in supporting the academic mission in medicine. These findings may benefit leaders in academic medicine who want to develop evidence-based programs in author development.

Advancing multi-level health communication research: A Delphi study on barriers and opportunities

Adopting a multi-level perspective that considers the many interrelated contexts influencing health could make health communication interventions more effective and equitable. However, despite increasing interest in the use of multi-level approaches, multi-level health communication (MLHC) interventions are infrequently utilized. We therefore sought to conduct a modified Delphi study to better understand how researchers conceptualize MLHC interventions and identify opportunities for advancing MLHC work. Communication and health behavior experts were invited to complete two rounds of surveys about the characteristics, benefits, pitfalls, best practices, barriers, and facilitators of MLHC interventions; the role of technology in facilitating MLHC interventions; and ways to advance MLHC intervention research (46 experts completed the first survey, 44 completed both surveys). Survey data were analyzed using a mixed-methods approach. Panelists reached consensus on two components of the proposed definition of MLHC interventions and also put forward a set of best practices for these interventions. Panelists felt that most health intervention research could benefit from a multi-level approach, and generally agreed that MLHC approaches offered certain advantages over single-level approaches. However, they also expressed concern related to the time, cost, and complexity of MLHC interventions. Although panelists felt that technology could potentially support MLHC interventions, they also recognized the potential for technology to exacerbate disparities. Finally, panelists prioritized a set of methodological advances and practical supports that would be needed to facilitate future MLHC intervention research. The results of this study point to several future directions for the field, including advancing how interactions between levels are assessed, increasing the empirical evidence base demonstrating the advantages of MLHC interventions, and identifying best practices for the use of technology. The findings also suggest that researchers may need additional support to overcome the perceived practical challenges of conducting MLHC interventions.

Cancer clinical trial providers' perspectives on communicating goals of care: A key informant study

Objectives

There has been limited research to date exploring provider communication in the context of cancer clinical trials. To elucidate multidisciplinary care providers' experiences, this qualitative study sought to understand their perspectives and communication patterns around goals of care discussions with patients enrolled in cancer clinical trials.

Methods

Semi-structured key informant interviews were conducted with a purposive sample of physicians, nurse practitioners, social workers, chaplains, nurses, and administrative staff in a cancer research hospital (N=19). Data were analyzed and interpreted using thematic analysis.

Results

Providers hold varied perspectives on goals of care in cancer clinical trials, highlighting the tension and potential for misalignment between scientific and clinical (patient-centered) goals. Inherent institutional hierarchies may impede some team members from initiating goal discussions. Care transitions (e.g., stopping treatment or initiating hospice) offer critical opportunities for goals of care discussions.

Conclusion

Conflicting perspectives among team members, perceptions of provider roles, and communication patterns could help explain some of the communication challenges previously documented in advanced cancer and clinical trial care.

Innovation

This qualitative study contributes to the literature on healthcare team communication in the clinical trial context and highlights tangible opportunities to better leverage providers' diverse experience and improve patient-centered care.

Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors

PURPOSE

Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural).

METHODS

This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017.

RESULTS

Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services.

CONCLUSION

Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.

Enhancing Clinical Teaching in Critical Thinking, High-Value Care, and Health Care Equity

INTRODUCTION

Faculty development in the clinical setting is challenging to implement and assess. This study evaluated an intervention (IG) to enhance bedside teaching in three content areas: critical thinking (CT), high-value care (HVC), and health care equity (HCE).

METHODS

The Communities of Practice model and Theoretical Domains Framework informed IG development. Three multidepartmental working groups (WGs) (CT, HVC, HCE) developed three 2-hour sessions delivered over three months. Evaluation addressed faculty satisfaction, knowledge acquisition, and behavior change. Data collection included surveys and observations of teaching during patient care. Primary analyses compared counts of post-IG teaching behaviors per hour across intervention group (IG), comparison group (CG), and WG groups. Statistical analyses of counts were modeled with generalized linear models using the Poisson distribution.

RESULTS

Eighty-seven faculty members participated (IG n = 30, CG n = 28, WG n = 29). Sixty-eight (IG n = 28, CG n = 23, WG n = 17) were observed, with a median of 3 observation sessions and 5.2 hours each. Postintervention comparison of teaching (average counts/hour) showed statistically significant differences across groups: CT CG = 4.1, IG = 4.8, WG = 8.2; HVC CG = 0.6, IG = 0.9, WG = 1.6; and HCE CG = 0.2, IG = 0.4, WG = 1.4 ( P < .001).

DISCUSSION

A faculty development intervention focused on teaching in the context of providing clinical care resulted in more frequent teaching of CT, HVC, and HCE in the intervention group compared with controls. WG faculty demonstrated highest teaching counts and provide benchmarks to assess future interventions. With the creation of durable teaching materials and a cadre of trained faculty, this project sets a foundation for infusing substantive content into clinical teaching.

The DoCTRINE Guidelines: Defined Criteria To Report INnovations in Education

PURPOSE

Reporting guidelines assist authors in conducting and describing their research in alignment with evidence-based and expert-determined standards. However, published research-oriented guidelines do not capture all of the components that must be present in descriptions of educational innovations in health professions education. The authors aimed to create guidelines for educational innovations in curriculum development that would be easy for early-career educators to use, support reporting necessary details, and promote educational scholarship.

METHOD

Beginning in 2017, the authors systematically developed a reporting checklist for educational innovations in curriculum development, called Defined Criteria To Report INnovations in Education (DoCTRINE), and collected validity evidence for its use according to the 4 inferences of Kane's framework. They derived the items using a modified Delphi method, followed by pilot testing, cognitive interviewing, and interrater reliability testing. In May-November 2019, they implemented DoCTRINE for authors submitting to MedEdPORTAL, half of whom were randomized to receive the checklist (intervention group). The authors scored manuscripts using DoCTRINE while blinded to group assignment, and they collected data on final editorial decisions.

RESULTS

The final DoCTRINE checklist consists of 19 items, categorized into 5 components: introduction, curriculum development, curriculum implementation, results, and discussion. The overall interrater agreement was 0.91. Among the 108 manuscripts submitted to MedEdPORTAL during the study period, the mean (SD) total score was higher for accepted than rejected submissions (16.9 [1.73] vs 15.7 [2.24], P = .006). There were no significant differences in DoCTRINE scores between the intervention group, who received the checklist, and the control group, who did not.

CONCLUSIONS

The authors developed DoCTRINE, using systematic approaches, for the scholarly reporting of educational innovations in curriculum development. This checklist may be a useful tool for supporting the publishing efforts of early-career faculty.

Collaboration networks of the implementation science centers for cancer control: a social network analysis

BACKGROUND

Multi-center research initiatives offer opportunities to develop and strengthen connections among researchers. These initiatives often have goals of increased scientific collaboration which can be examined using social network analysis.

METHODS

The National Cancer Institute (NCI)-funded Implementation Science Centers in Cancer Control (ISC3) initiative conducted an online social network survey in its first year of funding (2020) to (1) establish baseline network measures including the extent of cross-center collaboration and (2) assess factors associated with a network member's access to the network such as one's implementation science (IS) expertise. Members of the seven funded centers and NCI program staff identified collaborations in planning/conducting research, capacity building, product development, scientific dissemination, and practice/policy dissemination.

RESULTS

Of the 192 invitees, 182 network members completed the survey (95%). The most prevalent roles were faculty (60%) and research staff (24%). Almost one-quarter (23%) of members reported advanced expertise in IS, 42% intermediate, and 35% beginner. Most members were female (69%) and white (79%). One-third (33%) of collaboration ties were among members from different centers. Across all collaboration activities, the network had a density of 14%, suggesting moderate cohesion. Degree centralization (0.33) and betweenness centralization (0.07) measures suggest a fairly dispersed network (no single or few central member(s) holding all connections). The most prevalent and densely connected collaboration was in planning/conducting research (1470 ties; 8% density). Practice/policy dissemination had the fewest collaboration, lowest density (284 ties' 3% density), and the largest number of non-connected members (n=43). Access to the ISC3 network varied significantly depending on members' level of IS expertise, role within the network, and racial/ethnic background. Across all collaboration activities, most connected members included those with advanced IS expertise, faculty and NCI staff, and Hispanic or Latino and white members.

CONCLUSIONS

Results establish a baseline for assessing the growth of cross-center collaborations, highlighting specific areas in need of particular growth in network collaborations such as increasing engagement of racial and ethnic minorities and trainees or those with less expertise in IS.

An Inside Look: Qualitative Study of Underrepresented in Medicine Recruitment Strategies used by OB-GYN Program Directors

INTRODUCTION

Since 2019, the Accreditation Council for Graduate Medical Education has mandated that all residency programs develop initiatives to recruit underrepresented in medicine (URiM) applicants to increase diversity among physicians. The literature has described a variety of recruitment strategies, but the underlying viewpoints of leaders most responsible for these efforts have not been characterized. We aimed to describe the experience and perspective of program directors around URiM recruitment.

METHODS

We conducted a qualitative analysis of 14 semi-structured interviews with OB-GYN program directors recruited electronically about their perspectives on URiM recruitment between August 2018 and October 2019. We coded audio transcripts from these interviews in an independent and iterative fashion. Using inductive content analysis, we derived several themes.

RESULTS

Fourteen OB-GYN program directors participated. Themes arising from data included an acknowledgement of the contextual nature of diversity, which included not just race but also other forms of self-identity; the visual nature of recruitment efforts; the lack of consistent support for programs despite shared goals in workforce diversity; the imperative of upending traditional approaches to recruitment (e.g., undue emphasis on Step 1 scores); and finally, the prerequisites of a critical mass of URiM residents, faculty diversity and supportive culture for successful URiM recruitment.

DISCUSSION

Our findings shed light on the motivations and obstacles that program directors face in URiM recruitment, underscoring a need for more broad-based initiatives to ensure that society is served by a healthcare workforce reflecting the diversity of our patients.

Abstract PO-017: The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data

The disruption of routine cancer screening during the COVID-19 pandemic is a public health priority given documented delays in the diagnosis and treatment of screening-eligible cancers, and future impacts on cancer mortality. Furthermore, COVID-19 has disproportionately affected historically underrepresented populations such as the Hispanic community, who already experience lower cancer screening rates compared to non-Hispanic whites. The purpose of this study was to examine inquiries about cancer screening among Spanish-speaking general public users before and during COVID-19, using data from the National Cancer Institute's Cancer Information Service (CIS). For this analysis, we examined cancer screening inquiries before (February 2019-March 2020) and during (March 2020-January 2021) COVID-19 among Spanish-speaking general public users. We analyzed CIS point of access (email, LiveHelp, social media, telephone), subjects of interaction, and referrals. Cancer sites with low cell sizes (e.g., lung) were combined into the category “other.” We conducted Chi-squared tests to compare counts for cancer screening inquiries before and during COVID-19 across these variables. There were 47.3% (n=691) cancer screening inquiries among English-speaking users before COVID-19 and 52.7% (n=770) during COVID-19. In comparison, among the 300 cancer screening inquiries from Spanish speakers, there were 57% (n=171) before COVID-19 compared to 43% (n=129) during COVID-19. There was a significant difference in patterns between these two groups (p&lt;.002). Cancer site inquiries among Spanish speakers included breast (n=66), general (n=108), and 17 other cancers combined (n=126). The proportion of breast and general cancer inquiries from Spanish speakers increased during COVID-19 compared to pre-COVID (p&lt;.001), whereas other cancer inquiries decreased. Additionally, Spanish-speaking telephone-based inquiries increased during COVID-19 whereas all other points of access decreased (p&lt;.001); subjects of interaction regarding general cancer questions increased, but those on finding healthcare services, screening tests, and other subjects decreased (p&lt;.01); and there was an increase in referrals to national/community organizations and to the CDC National Breast and Cervical Cancer Early Detection Program, although referrals to healthcare providers and other sources decreased during COVID-19 (p&lt;.001). We found that COVID-19 was associated with a significant decrease in cancer screening inquiries among Spanish speakers compared to English speakers using the CIS, with changes in point of access, referrals, subject of interaction, and cancer site for Spanish-speaking CIS users. It is critical to evaluate how these changes in information-seeking may affect screening behaviors post-COVID in Hispanic communities and may potentially widen existing disparities that have worsened during COVID-19. Despite overall inquiry reductions, there was an increase in some cancer screening referrals, hopefully resulting in increased screening behavior among Spanish-speaking CIS users.

Citation Format: Heather N. Platter, Adaora Ezeani, Travis Hyams, Grace C. Huang, Robin C. Vanderpool, William M.P. Klein. The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-017.

The MedEdPORTAL Infinity Mirror: Conducting an Interactive Workshop on How to Develop an Educational Summary Report for MedEdPORTAL

INTRODUCTION

MedEdPORTAL is an open-access journal for health professions educators to publish their educational activities. The Educational Summary Report (ESR) is the manuscript that represents scholarly expression of those activities, aligned with Glassick's criteria for scholarship; however, prospective authors face challenges in writing ESRs, which can lead to rejection.

METHODS

We developed a conference workshop to teach health professions educators how to write an ESR by reviewing a sample ESR in small groups. The workshop began with a didactic on best practices in crafting each section of an ESR. We then divided participants into small groups to review an assigned section of a sample ESR using a reviewer's checklist and completing a templated flip chart. Each small group then reported out in a large-group discussion. A conference evaluation was distributed online to solicit perceptions of the workshop's effectiveness.

RESULTS

The 90-minute workshop was presented by separate teams of two facilitators at three national conferences. Approximately 35 participants attended the first workshop, and 50 attended the second and third workshops. Survey feedback from 19 respondents (38%) to the evaluation survey at the third workshop was representative of the previous two iterations and demonstrated that workshop content and materials were helpful.

DISCUSSION

A workshop enabling educators to serve as group peer reviewers of a sample ESR for a MedEdPORTAL submission was well received. Associate editors, faculty mentors, and other experienced faculty development leaders can use these materials to support future authors in submitting to MedEdPORTAL while providing opportunities for national presentations.

Striving for Diversity: National Survey of OB-GYN Program Directors Reporting Residency Recruitment Strategies for Underrepresented Minorities

OBJECTIVE

To characterize strategies among OB-GYN residency programs to recruit underrepresented minorities in medicine, the relative effectiveness of these approaches, and the associated barriers to recruitment.

DESIGN

We conducted a survey to solicit strategies from OB-GYN PDs at 253 United States (U.S.) accredited programs for recruiting underrepresented minorities in medicine (URiM) applicants. We also sought their relative effectiveness and barriers to recruitment.

SETTING

A national survey of U.S. accredited residency programs in OB-GYN in 2017-2018.

RESULTS

A total of 56 (22% response rate) PDs responded. Programs reported either "some" or "significant emphasis" on URiM recruitment (77%), with only 32% employing specific recruitment strategies. Fifteen (83%) reported using race and/or ethnicity data in the U.S.'s centralized electronic residency application service, 10 (56%) recruiting applicants from URiM association events, 9 (50%) meeting with potential URiMs prior to official interviews, and 5 (28%) offering a second visit. Efforts perceived to be most effective were second visits (39%), identifying race/ethnicity in electronic residency application service (33%), URiM recruitment events (28%), and individual phone calls (22%). Barriers included the lack of applicant pool (32%), lack of department diversity (29%) and lack of institutional diversity (30%).

CONCLUSIONS

This systematic collation of URiM recruitment practices and perceptions of their effectiveness represents a toolbox of options for residency programs to consider in diversifying their workforce.

Cohort study of hospitalists' procedural skills: baseline competence and durability after simulation-based training

OBJECTIVES

Hospitalists are expected to be competent in performing bedside procedures, which are associated with significant morbidity and mortality. A national decline in procedures performed by hospitalists has prompted questions about their procedural competency. Additionally, though simulation-based mastery learning (SBML) has been shown to be effective among trainees whether this approach has enduring benefits for independent practitioners who already have experience is unknown. We aimed to assess the baseline procedural skill of hospitalists already credentialed to perform procedures. We hypothesised that simulation-based training of hospitalists would result in durable skill gains after several months.

DESIGN

Prospective cohort study with pretraining and post-training measurements.

SETTING

Single, large, urban academic medical centre in the USA.

PARTICIPANTS

Twenty-two out of 38 eligible participants defined as hospitalists working on teaching services where they would supervise trainees performing procedures.

INTERVENTIONS

One-on-one, 60 min SBML of lumbar puncture (LP) and abdominal paracentesis (AP).

PRIMARY AND SECONDARY OUTCOME MEASURES

Our primary outcome was the percentage of hospitalists obtaining minimum passing scores (MPS) on LP and AP checklists; our secondary outcomes were average checklist scores and self-reported confidence.

RESULTS

At baseline, only 16% hospitalists met or exceeded the MPS for LP and 32% for AP. Immediately after SBML, 100% of hospitalists reached this threshold. Reassessment an average of 7 months later revealed that only 40% of hospitalists achieved the MPS. Confidence increased initially after training but declined over time.

CONCLUSIONS

Hospitalists may be performing invasive bedside procedures without demonstration of adequate skill. A single evidence-based training intervention was insufficient to sustain skills for the majority of hospitalists over a short period of time. More stringent practices for certifying hospitalists who perform risky procedures are warranted, as well as mechanisms to support skill maintenance, such as periodic simulation-based training and assessment.

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

BACKGROUND

As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience.

METHODS

We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures.

RESULTS

Our synthesis of the literature characterizes contributors to hospitalists' procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists.

CONCLUSION

We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.

Cancer Information-seeking in an Age of COVID-19: Findings from the National Cancer Institute's Cancer Information Service

Seeking cancer information is recognized as an important, life-saving behavior under normal circumstances. However, given the significant impact of COVID-19 on society, the healthcare system, and individuals and their families, it is important to understand how the pandemic has affected cancer information needs in a crisis context and, in turn, how public health agencies have responded to meeting the information needs of various audiences. Using data from the National Cancer Institute's Cancer Information Service (CIS) - a long-standing, multi-channel resource for trusted cancer information in English and Spanish - this descriptive analysis explored differences in cancer information-seeking among cancer survivors, caregivers, tobacco users, and members of the general public during the onset and continuation of the COVID-19 pandemic (February - September 2020), specifically comparing interactions that involved a discussion of COVID-19 to those that did not. During the study period, COVID-19 discussions were more likely to involve survivors or caregivers compared to tobacco users and the general public. Specific patterns emerged across the four user types and their respective discussions of COVID-19 related to language of service, point of CIS access, stage on the cancer continuum, subject of interaction, cancer site discussed, and referrals provided by the CIS. These results provide insights that may help public health agencies deliver, prioritize, and tailor their messaging and response to specific audiences based on heightened health information needs during a crisis.

The Mindful Manager: Validation of a Rounding Leadership Instrument for Residents

BACKGROUND

In the context of inpatient general medicine, "rounding" refers to the process of seeing, assessing, and caring for patients as a team. The clinical leadership skills required of residents to lead rounds are essential to inpatient care and clinical education. Assessment of these skills has relevance to developing competent physicians; however, there is an absence of widely accepted tools to specifically measure this competency.

OBJECTIVE

To develop and collect validity evidence for a direct observation instrument of internal medicine residents' leadership skills during daily inpatient care rounds for future formative assessment.

DESIGN

Prospective observational study.

PARTICIPANTS

PGY2 and PGY3 internal medicine residents.

MAIN MEASURES

The authors collected inferences of validity evidence according to Kane's validity model. They performed direct observations of PGY2 and PGY3 residents by individual faculty and trained raters and measured inter-rater reliability, using the kappa statistic. Mixed linear regression models were used to compare PGY2 and PGY3 residents. Surveys captured faculty perceptions about value of the instrument.

KEY RESULTS

A total of 223 observations were performed in 92 unique individuals. Twenty-four faculty used the observation instrument, of which 18 (75%) completed the post-survey, and 100% agreed that the instrument represented the resident's global leadership abilities. Inter-rater reliability was strong, with an overall kappa statistic equaling 0.82. The mean performance for PGY2 and PGY3 residents was 15.9 (SD 5.1) and 17.7 (SD 4.1), respectively. Adjusting for repeated measures, there was no statistically significant difference between groups.

CONCLUSIONS

The authors reported evidence for all four stages of validity and use of the instrument in clinical practice. Their work provides a codification of best practices of rounding leadership, which directly impacts the education of trainees, care of hospitalized patients, and use for formative assessment. The instrument also has the potential to be used for summative assessment.

Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers

INTRODUCTION

The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners' development of critical thinking.

METHODS

We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions.

RESULTS

Three major themes emerged regarding participants' descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning).

DISCUSSION

An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.

The science of team science: A review of the empirical evidence and research gaps on collaboration in science

Collaborations among researchers and across disciplinary, organizational, and cultural boundaries are vital to address increasingly complex challenges and opportunities in science and society. In addition, unprecedented technological advances create new opportunities to capitalize on a broader range of expertise and information in scientific collaborations. Yet rapid increases in the demand for scientific collaborations have outpaced changes in the factors needed to support teams in science, such as institutional structures and policies, scientific culture, and funding opportunities. The Science of Team Science (SciTS) field arose with the goal of empirically addressing questions from funding agencies, administrators, and scientists regarding the value of team science (TS) and strategies for successfully leading, engaging in, facilitating, and supporting science teams. Closely related fields have rich histories studying teams, groups, organizations, and management and have built a body of evidence for effective teaming in contexts such as industry and the military. Yet few studies had focused on science teams. Unique contextual factors within the scientific enterprise create an imperative to study these teams in context, and provide opportunities to advance understanding of other complex forms of collaboration. This review summarizes the empirical findings from the SciTS literature, which center around five key themes: the value of TS, team composition and its influence on TS performance, formation of science teams, team processes central to effective team functioning, and institutional influences on TS. Cross-cutting issues are discussed in the context of new research opportunities to further advance SciTS evidence and better inform policies and practices for effective TS. (PsycINFO Database Record

Adapting Maslow's Hierarchy of Needs as a Framework for Resident Wellness

ISSUE

Burnout in graduate medical education is pervasive and has a deleterious impact on career satisfaction, personal well-being, and patient outcomes. Interventions in residency programs have often addressed isolated contributors to burnout; however, a more comprehensive framework for conceptualizing wellness is needed.

EVIDENCE

In this article the authors propose Maslow's hierarchy of human needs (physiologic, safety, love/belonging, esteem, and self-actualization) as a potential framework for addressing wellness initiatives. There are numerous contributors to burnout among physician-trainees, and programs to combat burnout must be equally multifaceted. A holistic approach, considering both the trainees personal and professional needs, is recommended. Maslow's Needs can be adapted to create such a framework in graduate medical education. The authors review current evidence to support this model.

IMPLICATIONS

This work surveys current interventions to mitigate burnout and organizes them into a scaffold that can be used by residency programs interested in a complete framework to supporting wellness.

Teaching Genomic Pathology: Translating Team-Based Learning to a Virtual Environment Using Computer-Based Simulation

CONTEXT.—

Developing skills related to use of computer-based tools is critical for practicing genomic pathology. However, given the relative novelty of genomics education, residency programs may lack faculty members with adequate expertise and/or time to implement training. A virtual team-based learning (TBL) environment would make genomic pathology education available to more trainees.

OBJECTIVE.—

To translate an extensively implemented in-person TBL genomic pathology workshop into a virtual environment and to evaluate both knowledge and skill acquisition.

DESIGN.—

Using a novel interactive simulation approach, online modules were developed translating aspects of the TBL experience into the virtual environment with a goal of acquisition of necessary computer-related skills. The modules were evaluated at 10 postgraduate pathology training programs using a pre-post test design with participants deidentified. A postmodule anonymous survey obtained participant feedback on module quality and efficacy.

RESULTS.—

There were 147 trainees who received an email request to voluntarily participate in the study. Of these, 43 trainees completed the pretest and 15 (35%) subsequently completed the posttest. Mean overall scores were 45% on the pretest compared with 70% on the posttest ( P < .001; effect size = 1.4). Posttest improvement of results was similar for questions testing acquisition of knowledge versus skills. Regarding the 19 participants who took the survey, 18 (95%) would recommend the modules to others and believed they met the stated objectives.

CONCLUSIONS.—

A simulation-based approach allows motivated pathology trainees to acquire computer-related skills for practicing genomic pathology. Future work can explore efficacy in a nonvoluntary setting and adaptation to different specialties, learners, and computer tools.

Developing internal medicine subspecialty fellows' teaching skills: a needs assessment

BACKGROUND

For academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows' needs for programs to improve teaching skills have been largely unexplored.

METHODS

We conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills.

RESULTS

One hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills.

CONCLUSIONS

The majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.

A health professions education editors' open letter to our community

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Perspectives on Palliative Care in Cancer Clinical Trials: Diverse Meanings from Multidisciplinary Cancer Care Providers

BACKGROUND

Palliative care (PC) is often misunderstood as exclusively pertaining to end-of-life care, which may be consequential for its delivery. There is little research on how PC is operationalized and delivered to cancer patients enrolled in clinical trials.

OBJECTIVE

We sought to understand the diverse perspectives of multidisciplinary oncology care providers caring for such patients in a teaching hospital.

METHODS

We conducted qualitative semistructured interviews with 19 key informants, including clinical trial principal investigators, oncology fellows, research nurses, inpatient and outpatient nurses, spiritual care providers, and PC fellows. Questions elicited information about the meaning providers assigned to the term "palliative care," as well as their experiences with the delivery of PC in the clinical trial context. Using grounded theory, a team-based coding method was employed to identify major themes.

RESULTS

Four main themes emerged regarding the meaning of PC: (1) the holistic nature of PC, (2) the importance of symptom care, (3) conflict between PC and curative care, and (4) conflation between PC and end-of-life care. Three key themes emerged with regard to the delivery of PC: (1) dynamics among providers, (2) discussing PC with patients and family, and (3) the timing of PC delivery.

CONCLUSION

There was great variability in personal meanings of PC, conflation with hospice/end-of-life care, and appropriateness of PC delivery and timing, particularly within cancer clinical trials. A standard and acceptable model for integrating PC concurrently with treatment in clinical trials is needed.

Implementation of diagnostic pauses in the ambulatory setting

BACKGROUND

Diagnostic errors result in preventable morbidity and mortality. The outpatient setting may be at increased risk, where time constraints, the indolent nature of outpatient complaints and single decision-maker practice models predominate.

METHODS

We developed a self-administered diagnostic pause to address diagnostic error. Clinicians (physicians and nurse practitioners) in an academic primary care setting received the tool if they were seeing urgent care patients who had previously been seen in the past two weeks in urgent care. We used pre-post-intervention surveys, focus groups and chart audits 6 months after the urgent care visit to assess the impact of the intervention on participant perceptions and actions.

RESULTS

We piloted diagnostic pauses in two phases (3 months and 6 months, respectively); 9 physicians participated in the first phase, and 16 physicians and 2 nurse practitioners in the second phase. Subjects received 135 alerts for diagnostic pauses and responded to 82 (61% response). Thirteen per cent of alerts resulted in clinicians reporting new actions as a result of the diagnostic pauses. Thirteen per cent of cases at a 6-month chart audit resulted in diagnostic discrepancies, defined as differences in diagnosis from the initial working diagnosis. Focus groups reported that the diagnostic pauses were brief and fairly well integrated into the overall workflow for evaluation but would have benefited as a real-time application for patients at higher risk for diagnostic error.

CONCLUSION

This pilot represents the first known examination of diagnostic pauses in the outpatient setting, and this work potentially paves the way for more broad-based systems and/or electronic interventions to address diagnostic error.

When Old Habits Train a New Generation: Findings From a National Survey of Internal Medicine Program Directors on Procedural Training

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk.