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Clarke L, O'Neill N, Patel B, Steeman S, Segal G, Merrell SB, Gisondi MA. Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis. BMC Med Educ 2024; 24:491. [PMID: 38702741 PMCID: PMC11067383 DOI: 10.1186/s12909-024-05449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities. METHODS In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results. RESULTS A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5). CONCLUSIONS Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.
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Affiliation(s)
- Lauren Clarke
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | | | - Binisha Patel
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Samantha Steeman
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Gabrielle Segal
- University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, USA
| | | | - Michael A Gisondi
- Department of Emergency Medicine and Principal, The Precision Education and Assessment Research Lab, Stanford University School of Medicine, Stanford, CA, USA
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Ruiz Colón GD, Bereknyei Merrell S, Poon DC, Mahaney KB, Maher CO, Prolo LM. Language-discordant care in pediatric neurosurgery: parent and provider perspectives on challenges and multilevel solutions to reduce disparities. J Neurosurg Pediatr 2024:1-7. [PMID: 38518279 DOI: 10.3171/2024.1.peds23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/24/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE In the United States, Spanish is the second most spoken language, with nearly 42 million individuals speaking Spanish at home. Spanish speakers have been noted to have higher rates of unfavorable neurosurgical outcomes; however, to the authors' knowledge, no study has explored the experiences of patients, caregivers, and providers receiving or delivering neurosurgical care in language-discordant settings. In this study, the authors sought to identify challenges faced by pediatric neurosurgery providers and Spanish-speaking parents communicating with a language barrier and propose solutions to address those challenges. METHODS Spanish-speaking parents and pediatric neurosurgery providers were invited to participate in semistructured interviews. Purposeful sampling was used to recruit Spanish-speaking parents whose child had recently undergone neurological surgery at the authors' institution and to identify pediatric neurosurgery clinical team members to interview, including physicians, advanced practice providers, and interpreters. Codes were inductively developed and applied to transcripts by two researchers. Thematic analysis was conducted to identify challenges faced by parents and providers. RESULTS Twenty individuals were interviewed, including parents (n = 8), advanced practice providers (n = 5), physicians (n = 3), interpreters (n = 2), a social worker (n = 1), and a nurse (n = 1). Three challenges were identified. 1) Compared with English-speaking parents, providers noted that Spanish-speaking parents were less likely to ask questions or raise new concerns. Concurrently, Spanish-speaking parents expressed a desire to better understand their child's future medical needs, care, and development. 2) There is a dearth of high-quality resources available in the Spanish language to supplement patient and parent neurosurgical education. 3) Both parents and providers invariably prefer in-person interpreters; however, their availability is limited. CONCLUSIONS Three challenges were identified by Spanish-speaking parents of pediatric neurosurgery patients and providers when receiving or delivering care through a language barrier. The authors discuss multilevel solutions that, if deployed, could directly address these shared challenges. Furthermore, optimizing communication may help mitigate the disparities experienced by non-English-speaking Hispanic/Latino individuals when receiving neurosurgical care.
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Affiliation(s)
| | - Sylvia Bereknyei Merrell
- 2Pediatrics, Stanford University School of Medicine, Stanford
- 3Office of Child Health Equity, Stanford University School of Medicine, Stanford; and
| | - Diana C Poon
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
| | - Kelly B Mahaney
- Departments of1Neurosurgery and
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
| | - Cormac O Maher
- Departments of1Neurosurgery and
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
| | - Laura M Prolo
- Departments of1Neurosurgery and
- 4Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford, California
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El-Banna G, Rezaei SJ, Chang M, Merrell SB, Bailey EE, Kibbi N. Perceptions of US-Based Muslim Patients of Their Dermatology Care. JAMA Dermatol 2024; 160:45-53. [PMID: 37966806 PMCID: PMC10652213 DOI: 10.1001/jamadermatol.2023.4439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Importance Cultural humility training is of growing interest, yet the religious and cultural accommodations of Muslim patients in dermatology have not been studied. Objective To explore the perceptions of Muslim patients of their dermatology care. Design, Setting, and Participants This qualitative mixed-methods study, consisting of surveys and semistructured interviews, recruited participants from 2 clinical sites within a large academic health care system in California. Participants were adult, English-speaking, Muslim patients who were evaluated at least once by a medical or surgical dermatologist between January 2022 and January 2023. Main Outcomes and Measures A survey obtained the following data: demographics, religious practices pertinent to dermatology care, and experiences of bias outside and inside the dermatology clinic. Semistructured interviews covered topics related to positive and negative experiences in the dermatology clinic, accommodation of cultural and religious needs in dermatology, and future interventions. Results A total of 21 patients (mean [SD] age, 36.4 [11.6] years; range, 26-71 years) participated in the study: 5 male individuals (24%) and 16 female individuals (76%), including 10 female individuals who wore hijab. Eleven participants identified as Middle Eastern (52%), 8 as South Asian (38%), 1 as North African (5%), and 1 as Pacific Islander (5%). Survey results showed variations in the impact of Islamic practices on dermatology care. Interviews showed that Muslim participants did not perceive dermatology care as a priority and expressed interest in community events focused on general dermatology education. They also experienced stigmatization of their skin disease and cosmetic care. Prior experiences with Islamophobia and colorism hindered the Muslim patient-dermatologist relationship and disclosure of the need for accommodations. There were instances when participants experienced bias and poor cultural humility from dermatologists. Finally, Muslim participants had unique religious and cultural needs pertinent to their care, including clinician gender concordance, medication timing adjustment while fasting, and halal medication ingredients. Conclusions and Relevance This qualitative mixed-methods study explored the experiences of Muslim patients in dermatology in the US. Recommendations supported by this study include incorporating religion into cultural humility training, increasing diversity in the dermatology workforce, implementing policies for clearer medication labeling, supporting dermatology research in subpopulations of Muslim individuals in the US, and partnering with community organizations for dermatology education.
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Affiliation(s)
- Ghida El-Banna
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Shawheen Justin Rezaei
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Michelle Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | | | - Elizabeth E. Bailey
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Nour Kibbi
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
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Lee MC, Melcer EF, Merrell SB, Wong LY, Shields S, Eddington H, Trickey AW, Tsai J, Korndorffer JR, Lin DT, Liebert CA. Usability of ENTRUST as an Assessment Tool for Entrustable Professional Activities (EPAs): A Mixed Methods Analysis. J Surg Educ 2023; 80:1693-1702. [PMID: 37821350 DOI: 10.1016/j.jsurg.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/19/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE As the American Board of Surgery transitions to a competency-based model of surgical education centered upon entrustable professional activities (EPAs), there is a growing need for objective tools to determine readiness for entrustment. This study evaluates the usability of ENTRUST, an innovative virtual patient simulation platform to assess surgical trainees' decision-making skills in preoperative, intra-operative, and post-operative settings. DESIGN This is a mixed-methods analysis of the usability of the ENTRUST platform. Quantitative data was collected using the system usability scale (SUS) and Likert responses. Analysis was performed with descriptive statistics, bivariate analysis, and multivariable linear regression. Qualitative analysis of open-ended responses was performed using the Nielsen-Shneiderman Heuristics framework. SETTING This study was conducted at an academic institution in a proctored exam setting. PARTICIPANTS The analysis includes n = 47 (PGY 1-5) surgical residents who completed an online usability survey following the ENTRUST Inguinal Hernia EPA Assessment. RESULTS The ENTRUST platform had a median SUS score of 82.5. On bivariate and multivariate analyses, there were no significant differences between usability based on demographic characteristics (all p > 0.05), and SUS score was independent of ENTRUST performance (r = 0.198, p = 0.18). Most participants agreed that the clinical workup of the patient was engaging (91.5%) and felt realistic (85.1%). The most frequent heuristics represented in the qualitative analysis included feedback, visibility, match, and control. Additional themes of educational value, enjoyment, and ease-of-use highlighted participants' perspectives on the usability of ENTRUST. CONCLUSIONS ENTRUST demonstrates high usability in this population. Usability was independent of ENTRUST score performance and there were no differences in usability identified in this analysis based on demographic subgroups. Qualitative analysis highlighted the acceptability of ENTRUST and will inform ongoing development of the platform. The ENTRUST platform holds potential as a tool for the assessment of EPAs in surgical residency programs.
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Affiliation(s)
- Melissa C Lee
- Stanford University School of Medicine, Stanford, California
| | - Edward F Melcer
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | | | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Samuel Shields
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | - Hyrum Eddington
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Palo Alto, California
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Palo Alto, California
| | - Jason Tsai
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California; Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Surgical Services, Palo Alto, California
| | - Dana T Lin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Cara A Liebert
- Department of Surgery, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Surgical Services, Palo Alto, California.
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Goyal T, Bereknyei Merrell S, Weimer-Elder B, Kline M, Rassbach CE, Gold CA. A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills. J Palliat Med 2023; 26:1180-1187. [PMID: 36952327 DOI: 10.1089/jpm.2022.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.
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Affiliation(s)
- Tarini Goyal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Barbette Weimer-Elder
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Merisa Kline
- Physician Partnership Program, Patient Experience, Stanford Health Care, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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Lin DT, Melcer EF, Keehl O, Eddington H, Trickey AW, Tsai J, Camacho F, Merrell SB, Korndorffer J, Liebert CA. ENTRUST: A Serious Game-Based Virtual Patient Platform to Assess Entrustable Professional Activities in Graduate Medical Education. J Grad Med Educ 2023; 15:228-236. [PMID: 37139206 PMCID: PMC10150817 DOI: 10.4300/jgme-d-22-00518.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/22/2022] [Accepted: 01/19/2023] [Indexed: 05/05/2023] Open
Abstract
Background As entrustable professional activities (EPAs) are implemented in graduate medical education, there is a great need for tools to efficiently and objectively evaluate clinical competence. Readiness for entrustment in surgery requires not only assessment of technical ability, but also the critical skill of clinical decision-making. Objective We report the development of ENTRUST, a serious game-based, virtual patient case creation and simulation platform to assess trainees' decision-making competence. A case scenario and corresponding scoring algorithm for the Inguinal Hernia EPA was iteratively developed and aligned with the description and essential functions outlined by the American Board of Surgery. In this study we report preliminary feasibility data and validity evidence. Methods In January 2021, the case scenario was deployed and piloted on ENTRUST with 19 participants of varying surgical expertise levels to demonstrate proof of concept and initial validity evidence. Total score, preoperative sub-score, and intraoperative sub-score were analyzed by training level and years of medical experience using Spearman rank correlations. Participants completed a Likert scale user acceptance survey (1=strongly agree to 7=strongly disagree). Results Median total score and intraoperative mode sub-score were higher with each progressive level of training (rho=0.79, P<.001 and rho=0.69, P=.001, respectively). There were significant correlations between performance and years of medical experience for total score (rho=0.82, P<.001) and intraoperative sub-scores (rho=0.70, P<.001). Participants reported high levels of platform engagement (mean 2.06) and ease of use (mean 1.88). Conclusions Our study demonstrates feasibility and early validity evidence for ENTRUST as an assessment platform for clinical decision-making.
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Affiliation(s)
- Dana T. Lin
- Dana T. Lin, MD, FACS, is Clinical Associate Professor, Department of Surgery, Stanford University School of Medicine
| | - Edward F. Melcer
- Edward F. Melcer, PhD, is Assistant Professor and Director of the Alternative Learning Technologies and Games (ALT Games) Lab, Baskin School of Engineering, University of California, Santa Cruz
| | - Oleksandra Keehl
- Oleksandra Keehl, MS, is a PhD Student, Baskin School of Engineering, University of California, Santa Cruz
| | - Hyrum Eddington
- Hyrum Eddington, BS, is Data Manager and Data Analyst, Stanford-Surgery Policy Improvement Research and Education Center
| | - Amber W. Trickey
- Amber W. Trickey, PhD, MS, CPH, is Senior Biostatistician, Stanford-Surgery Policy Improvement Research and Education Center
| | - Jason Tsai
- Jason Tsai, MS, is a Master's Student, Baskin School of Engineering, University of California, Santa Cruz
| | - Fatyma Camacho
- Fatyma Camacho, MS, is a Master's Student, Baskin School of Engineering, University of California, Santa Cruz
| | - Sylvia Bereknyei Merrell
- Sylvia Bereknyei Merrell, DrPH, MS, is a Research Scholar, Department of Pediatrics, Stanford University School of Medicine
| | - James Korndorffer
- James Korndorffer Jr, MD, MHPE, FACS, is Vice Chair of Education and Associate Professor of Surgery, Department of Surgery, Stanford University School of Medicine
| | - Cara A. Liebert
- Cara A. Liebert, MD, FACS, is Clinical Assistant Professor, Department of Surgery, Stanford University School of Medicine
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Bruce JS, Lien TN, George E, Puri V, Ramirez M, Merrell SB. Examination of an Intergenerational Summer Meal Program for Children and Older Adults. J Community Health 2022; 47:902-913. [PMID: 35915322 DOI: 10.1007/s10900-022-01125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 12/26/2022]
Abstract
Unreliable access to a sufficient quantity of affordable, nutritious food in the U.S. is a persistent public health threat significantly impacting households with children (15%) and older adults (20%). Well-established nutrition assistance programs serve children and seniors independently, yet few programs utilize an intergenerational meal program model. The aim of this mixed methods study is to examine the impact of an intergenerational meal program administered through a partnership between a local school district and a county Senior Nutrition Program. Participating older adults completed surveys to assess food security and program attendance, and examine their understanding and utilization of community-based food resources. Interviews with a subsample of participants explored perceptions of the intergenerational meal program and community-level food security. Older adults (n = 83) completed surveys in English (59%), Spanish (25%), and Mandarin (16%). They identified primarily as Asian (44%), Latinx (30%), White (21%), and multi-racial (5%). Forty-eight percent of participants indicated low or very low food security at some time in the last 12 months. The subsample of interview participants (n = 24; Spanish 46% and English 54%) revealed key insights: 1) perceived benefits of an intergenerational meal program; 2) community-level food insecurity and struggles of older adults to make ends meet; and 3) importance and challenge of obtaining nutritious foods for those with limited budgets and medical comorbidities. Implementation of this intergenerational meal program highlights the opportunity to support the nutritional needs of children and older adults while leveraging a new interdisciplinary partnership and existing organizational capacity.
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Affiliation(s)
- Janine S Bruce
- Department of Pediatrics, Stanford School of Medicine, 453 Quarry Rd, Stanford, CA, 94304, USA.
| | - Tiffany N Lien
- University of Colorado School of Medicine, 13001 E. 17th Pl, Aurora, CO, 80045, USA
| | - Elizabeth George
- Department of Surgery, Division of Vascular & Endovascular Surgery, Stanford University School of Medicine, 780 Welch Road, Stanford, CA, 94305, USA
| | - Vandana Puri
- Department of Aging and Adult Services, Senior Nutrition Program, Santa Clara County, 353 W. Julian St, San Jose, CA, 95110, USA
| | - Melanie Ramirez
- Department of Pediatrics, Stanford School of Medicine, 453 Quarry Rd, Stanford, CA, 94304, USA
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Ariel D, Lau J, Osterberg L, Gesundheit N, Brar K, Merrell SB. The Student Guidance Program: Applying an Executive Coaching Model to Medical Student Remediation. Acad Med 2022; 97:S117. [PMID: 37838851 DOI: 10.1097/acm.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Danit Ariel
- Author affiliations: D. Ariel, L. Osterberg, N. Gesundheit, K. Brar, S.B. Merrell, Stanford University School of Medicine; J. Lau, Loyola University Chicago, Stritch School of Medicine
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Liebert CA, Melcer EF, Keehl O, Eddington H, Trickey AW, Lee M, Tsai J, Camacho F, Merrell SB, Korndorffer JR, Lin DT. Validity Evidence for ENTRUST as an Assessment of Surgical Decision-Making for the Inguinal Hernia Entrustable Professional Activity (EPA). J Surg Educ 2022; 79:e202-e212. [PMID: 35909070 DOI: 10.1016/j.jsurg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/02/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As the American Board of Surgery (ABS) moves toward implementation of Entrustable Professional Activities (EPAs), there is a growing need for objective evaluation of readiness for entrustment of residents. This requires not only assessment of technical skills and knowledge, but also surgical decision-making in preoperative, intraoperative, and postoperative settings. We developed and piloted an Inguinal Hernia EPA Assessment on ENTRUST, a serious game-based online virtual patient simulation platform to assess trainees' decision-making competence. DESIGN This is a prospective analysis of resident performance on the ENTRUST Inguinal Hernia EPA Assessment using bivariate analyses. SETTING This study was conducted at an academic institution in a proctored exam setting. PARTICIPANTS Forty-three surgical residents completed the ENTRUST Inguinal Hernia EPA Assessment. RESULTS Four case scenarios for the Inguinal Hernia EPA and corresponding scoring algorithms were iteratively developed by expert consensus aligned with ABS EPA descriptions and functions. ENTRUST Inguinal Hernia Grand Total Score was positively correlated with PGY-level (p < 0.0001). Preoperative, Intraoperative, and Postoperative Total Scores were also positively correlated with PGY-level (p = 0.001, p = 0.006, and p = 0.038, respectively). Total Case Scores were positively correlated with PGY-level for cases representing elective unilateral inguinal hernia (p = 0.0004), strangulated inguinal hernia (p < 0.0001), and elective bilateral inguinal hernia (p = 0.0003). Preoperative Sub-Scores were positively correlated with PGY-level for all cases (p < 0.01). Intraoperative Sub-Scores were positively correlated with PGY-level for strangulated inguinal hernia and bilateral inguinal hernia (p = 0.0007 and p = 0.0002, respectively). Grand Total Score and Intraoperative Sub-Score were correlated with prior operative experience (p < 0.0001). Prior video game experience did not correlate with performance on ENTRUST (p = 0.56). CONCLUSIONS Performance on the ENTRUST Inguinal Hernia EPA Assessment was positively correlated to PGY-level and prior inguinal hernia operative performance, providing initial validity evidence for its use as an objective assessment for surgical decision-making. The ENTRUST platform holds potential as tool for assessment of ABS EPAs in surgical residency programs.
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Affiliation(s)
- Cara A Liebert
- Department of Surgery, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Surgical Services, Palo Alto, California.
| | - Edward F Melcer
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | - Oleksandra Keehl
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | - Hyrum Eddington
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Melissa Lee
- Stanford University School of Medicine, Stanford, California
| | - Jason Tsai
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | - Fatyma Camacho
- Department of Computational Media, University of California-Santa Cruz, Baskin School of Engineering, Santa Cruz, California
| | | | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California; VA Palo Alto Health Care System, Surgical Services, Palo Alto, California
| | - Dana T Lin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Bidwell SS, Poles GC, Shelton AA, Staudenmayer K, Bereknyei Merrell S, Morris AM. Motivations and Barriers Toward Implementation of a Rectal Cancer Synoptic Operative Report: A Process Evaluation. Dis Colon Rectum 2022; 65:353-360. [PMID: 34711713 PMCID: PMC8823905 DOI: 10.1097/dcr.0000000000002202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of synoptic reporting has been shown to improve documentation of critical information and provide added value related to data access and extraction, data reliability, relevant detail, and completeness of information. Surgeon acceptance and adoption of synoptic reports has lagged behind other specialties. OBJECTIVE This study aimed to evaluate the process of implementing a synoptic operative report. DESIGN This study was a mixed-methods process evaluation including surveys and qualitative interviews. SETTINGS This study focused on colorectal surgery practices across the United States. PATIENTS Twenty-eight board-certified colorectal surgeons were included. INTERVENTIONS The synoptic operative report for rectal cancer was implemented. MAIN OUTCOME MEASURES Acceptability, feasibility, and usability were measured by Likert-type survey questions and followed up with individual interviews to elicit experiences with implementation as well as motivations and barriers to use. RESULTS Among all study participants, 28 surgeons completed the electronic survey (76% response rate) and 21 (57%) completed the telephone interview. Mean usability was 4.14 (range, 1-5; SE, 0.15), mean feasibility was 3.90 (SE, 0.15), and acceptability was 3.98 (SE, 0.18). Participants indicated that substantial administrative and technical support were necessary but not always available for implementation, and many were frustrated by the need to change their workflow. LIMITATIONS Most surgeon participants were male, white, had >12 years in practice, and used Epic electronic medical record systems. Therefore, they may not represent the perspectives of all US colon and rectal surgeons. In addition, as the synoptic operative report is implemented more broadly across the United States, it will be important to consider variations in the process by electronic medical record system. CONCLUSIONS The synoptic operative report for rectal cancer was easy to implement and incorporate into workflow, in general, but surgeons remained concerned about additional burden without immediate and tangible value. Despite recognizing benefits, many participants indicated they only implemented the synoptic operative report because it was mandated by the National Accreditation Program for Rectal Cancer. See Video Abstract at http://links.lww.com/DCR/B735MOTIVACIONES Y BARRERAS HACIA LA IMPLEMENTACIÓN DE UN INFORME OPERATIVO SINÓPTICO DE CÁNCER RECTAL: UNA EVALUACIÓN DEL PROCESOANTECEDENTES:Se ha demostrado que el uso de informes sinópticos mejora la documentación de información crítica y proporciona un valor agregado relacionado con el acceso y extracción de datos, la confiabilidad de los datos, los detalles relevantes y la integridad de la información. La aceptación y adopción de informes sinópticos por parte de los cirujanos se ha quedado rezagada con respecto a otras especialidades.OBJETIVO:Evaluar el proceso de implementación de un informe operativo sinóptico.DISEÑO:Evaluación de procesos de métodos mixtos que incluyen encuestas y entrevistas cualitativas.AJUSTES:Prácticas de cirugía colorrectal en los Estados Unidos.PACIENTES:Veintiocho cirujanos colorrectales certificados por la junta.INTERVENCIONES:Implementación del informe operatorio sinóptico de cáncer de recto.PRINCIPALES MEDIDAS DE RESULTADO:Aceptabilidad, viabilidad y usabilidad medidas por preguntas de encuestas tipo Likert y seguidas con entrevistas individuales para obtener experiencias con la implementación, así como motivaciones y barreras para el uso.RESULTADOS:Entre todos los participantes del estudio, 28 cirujanos completaron la encuesta electrónica (tasa de respuesta del 76%) y 21 (57%) completaron la entrevista telefónica. La usabilidad media fue 4,14 (rango = 1-5, error estándar (EE) = 0,15), la factibilidad media fue 3,90 (EE = 0,15) y la aceptabilidad fue 3,98 (EE = 0,18). Los participantes indicaron que se necesitaba un apoyo administrativo y técnico sustancial, pero que no siempre estaba disponible para la implementación y muchos se sintieron frustrados por la necesidad de cambiar su flujo de trabajo.LIMITACIONES:La mayoría de los cirujanos participantes eran hombres, blancos, tenían >12 años en la práctica y usaban sistemas de registros médicos electrónicos de Epic. Por lo tanto, es posible que no representen las perspectivas de todos los cirujanos de colon y recto de EE. UU. Además, a medida que el informe operativo sinóptico se implemente de manera más amplia en los EE. UU., Será importante considerar las variaciones en el proceso por sistema EMR.CONCLUSIONES:El informe quirúrgico sinóptico para el cáncer de recto fue en general fácil de implementar e incorporar en el flujo de trabajo, pero los cirujanos seguían preocupados por la carga adicional sin valor inmediato y tangible. A pesar de reconocer los beneficios, muchos participantes indicaron que solo implementaron el informe operativo sinóptico porque era un mandato del Programa Nacional de Acreditación para el Cáncer de Recto. Consulte Video Resumen en http://links.lww.com/DCR/B735 (Traducción-Dr. Xavier Delgadillo).
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Affiliation(s)
- Serena S. Bidwell
- University of Michigan Medical School, Ann Arbor, Michigan
- S-SPIRE Center, Stanford University, Stanford, California
| | - Gabriela C. Poles
- Department of Surgery, University of Rochester Medical School, Rochester, New York
| | | | | | | | - Arden M. Morris
- S-SPIRE Center, Stanford University, Stanford, California
- Department of Surgery, Stanford University, Stanford, California
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Yelorda K, Bidwell S, Fu S, Miller MO, Merrell SB, Koshy S, Morris AM. Self-efficacy Toward a Healthcare Career Among Minority High School Students in a Surgical Pipeline Program: A Mixed Methods Study. J Surg Educ 2021; 78:1896-1904. [PMID: 34011476 PMCID: PMC8856596 DOI: 10.1016/j.jsurg.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/22/2021] [Accepted: 04/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE While many barriers to healthcare careers exist for URM students, a strong sense of self-efficacy may help mitigate these obstacles. This study explores how URM high school students describe their academic challenges and compares their descriptions across self-efficacy scores. DESIGN We conducted a convergent mixed methods study of URM high school students. Students completed a validated self-efficacy questionnaire and participated in semi-structured focus group interviews to discuss their approach to academic challenges, goal setting, and achievement. The primary outcome was academic, social, and emotional self-efficacy, measured using the Self-Efficacy Questionnaire for Children. We separated participants into high and low self-efficacy groups based on scores in each domain. Using thematic analysis, we identified and compared common themes associated with academic challenges and goal setting. SETTING Surgical exposure pipeline program sponsored by Stanford University Department of Surgery PARTICIPANTS: Low-income, high academic achieving URM high school students interested in science, technology, engineering and mathematics, and/or healthcare careers. RESULTS Thirty-one high school students completed the focus groups and self-efficacy questionnaire. Most students scored in the high self-efficacy group for at least one domain: 65% for academic self-efficacy, 56% for social self-efficacy, and 19% for emotional self-efficacy. Four emergent themes highlighted participants' perspectives toward educational success: fulfillment in academic challenges, focus on future goals, failing forward, and asking for help. Compared to students with low self-efficacy scores, students in the high-scoring self-efficacy groups more often discussed strategies and concrete behaviors such as the importance of seeking support from teachers and peers and learning from failure. CONCLUSIONS Students in high self-efficacy groups were more comfortable utilizing approaches that helped them succeed academically. Additional efforts are needed to bolster student self-efficacy, particularly in students from URM backgrounds, to increase diversity in medical schools.
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Affiliation(s)
- Kirbi Yelorda
- Department of Surgery, Stanford University School of Medicine, Stanford, California; S-SPIRE Center, Palo Alto, California
| | - Serena Bidwell
- S-SPIRE Center, Palo Alto, California; University of Michigan Medical School, Ann Arbor, Michigan
| | - Sue Fu
- Department of Surgery, Stanford University School of Medicine, Stanford, California; S-SPIRE Center, Palo Alto, California
| | - Miquell O Miller
- Department of Surgery, Stanford University School of Medicine, Stanford, California; S-SPIRE Center, Palo Alto, California
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12
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Sasnal M, Miller-Kuhlmann R, Merrell SB, Beres S, Kipp L, Lee S, Threlkeld Z, Nassar AK, Gold CA. Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study. BMC Med Educ 2021; 21:513. [PMID: 34583691 PMCID: PMC8478605 DOI: 10.1186/s12909-021-02936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual). METHODS We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed. RESULTS Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future. CONCLUSIONS In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.
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Affiliation(s)
- Marzena Sasnal
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Rebecca Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Shannon Beres
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Lucas Kipp
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sarah Lee
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Zachary Threlkeld
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA.
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13
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Wise CE, Bereknyei Merrell S, Sasnal M, Forrester JD, Hawn MT, Lau JN, Lin DT, Schmiederer IS, Spain DA, Nassar AK, Knowlton LM. COVID-19 Impact on Surgical Resident Education and Coping. J Surg Res 2021; 264:534-543. [PMID: 33862581 PMCID: PMC7877215 DOI: 10.1016/j.jss.2021.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare systems and surgical residency training programs have been significantly affected by the novel coronavirus disease 2019 (COVID-19) pandemic. A shelter-in-place and social distancing mandate went into effect in our county on March 16, 2020, considerably altering clinical and educational operations. Along with the suspension of elective procedures, resident academic curricula transitioned to an entirely virtual platform. We aimed to evaluate the impact of these modifications on surgical training and resident concerns about COVID-19. MATERIALS AND METHODS We surveyed residents and fellows from all eight surgical specialties at our institution regarding their COVID-19 experiences from March to May 2020. Residents completed the survey via a secure Qualtrics link. A total of 38 questions addressed demographic information and perspectives regarding the impact of the COVID-19 pandemic on surgical training, education, and general coping during the pandemic. RESULTS Of 256 eligible participants across surgical specialties, 146 completed the survey (57.0%). Junior residents comprised 43.6% (n = 61), compared to seniors 37.1% (n = 52) and fellows 19.3% (n = 27). Most participants, 97.9% (n = 138), anticipated being able to complete their academic year on time, and 75.2% (n = 100) perceived virtual learning to be the same as or better than in-person didactic sessions. Participants were most concerned about their ability to have sufficient knowledge and skills to care for patients with COVID-19, and the possibility of exposure to COVID-19. CONCLUSIONS Although COVID-19 impacted residents' overall teaching and clinical volume, residency programs may identify novel virtual opportunities to meet their educational and research milestones during these challenging times.
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Affiliation(s)
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California
| | - Marzena Sasnal
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California
| | - Joseph D Forrester
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Mary T Hawn
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California; Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - James N Lau
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Dana T Lin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Ingrid S Schmiederer
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - David A Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa Marie Knowlton
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford, California; Department of Surgery, Stanford University School of Medicine, Stanford, California.
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14
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Coughran AJ, Merrell SB, Pineda C, Sceats LA, Yang GP, Morris AM. Local and Visiting Physician Perspectives on Short Term Surgical Missions in Guatemala: A Qualitative Study. Ann Surg 2021; 273:606-612. [PMID: 31009390 DOI: 10.1097/sla.0000000000003292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the impact of short-term surgical missions (STMs) on medical practice in Guatemala as perceived by Guatemalan and foreign physicians. SUMMARY BACKGROUND DATA STMs send physicians from high-income countries to low and middle-income countries to address unmet surgical needs. Although participation among foreign surgeons has grown, little is known of the impact on the practice of foreign or local physicians. METHODS Using snowball sampling, we interviewed 22 local Guatemalan and 13 visiting foreign physicians regarding their perceptions of the impact of Guatemalan STMs. Interviews were transcribed verbatim, iteratively coded, and analyzed to identify emergent themes. Findings were validated through triangulation and searching for disconfirming evidence. RESULTS We identified 2 overarching domains. First, the delivery of surgical care by both Guatemalan and foreign physicians was affected by practice in the STM setting. Differences from usual practice manifested as occasionally inappropriate utilization of skills, management of postoperative complications, the practice of perioperative care versus "pure surgery," and the effect on patient-physician communication and trust. Second, both groups noted professional and financial implications of participation in the STM. CONCLUSIONS While Guatemalan physicians reported a net benefit of STMs on their careers, they perceived STMs as an imperfect solution to unmet surgical needs. They described missed opportunities for developing local capacity, for example through education and optimal resource planning. Foreign physicians described costs that were manageable and high personal satisfaction with STM work. STMs could enhance their impact by strengthening working relationships with local physicians and prioritizing sustainable educational efforts.
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Affiliation(s)
- Alanna J Coughran
- Department of Surgery, Stanford University, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford University, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA
| | | | - Lindsay A Sceats
- Department of Surgery, Stanford University, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA
| | - George P Yang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
- Birmingham VA Medical Center, Birmingham, AL
| | - Arden M Morris
- Department of Surgery, Stanford University, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA
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15
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Ayakta N, Sceats LA, Merrell SB, Kin C. "It's Like Learning by the Seat of Your Pants": Surgeons Lack Formal Training in Opioid Prescribing. J Surg Educ 2021; 78:160-167. [PMID: 32917541 DOI: 10.1016/j.jsurg.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/07/2020] [Accepted: 07/03/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To determine the training surgical residents and faculty receive on opioid prescribing, and to identify opportunities for curricula development to fill training gaps. DESIGN We conducted qualitative semi-structured interviews and surveys. After applying an overarching organizational framework, we used an iterative, team-based process to develop relevant inductive codes. We then performed thematic analyses to identify and catalogue critical domains related to surgeons' education about opioid prescribing. SETTING Tertiary care academic medical center. PARTICIPANTS Maximum variation purposive sampling was used to recruit general surgery residents and surgical faculty members. RESULTS We interviewed 21 attending surgeons and 20 surgical residents. Surgeons reported minimal formal training on pain management and prescribing opioids. A minority of individuals described receiving opioid training in the form of continuing medical education, intern boot camp sessions, and medical school classes. Participants compensated for the lack of formal training during residency by informally learning from senior residents, consulting pain specialists, and seeking external learning resources. Increased surgical experience was correlated with increased comfort with pain management. A majority of surgeons desired formal training. The most commonly requested educational resources were opioid prescribing guidelines for common operations and recommendations for treating chronic pain patients. Residents requested that training occur early in residency to maximize the benefits received. Based on these findings, we developed a conceptual framework to explain how surgeons learn to prescribe opioids and to highlight opportunities for improvement. CONCLUSIONS Although surgeons routinely prescribe opioids and desire education on opioids, a majority of them do not receive any training. Instituting formal educational programs is critical for improving opioid prescribing practices among surgeons.These programs should include standard prescribing guidelines and address management of acute postoperative pain in patients with chronic pain.
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Affiliation(s)
- Nagehan Ayakta
- School of Medicine, Stanford University, Stanford, California
| | - Lindsay A Sceats
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery (S-SPIRE), Stanford University, Stanford, California
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery (S-SPIRE), Stanford University, Stanford, California
| | - Cindy Kin
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery (S-SPIRE), Stanford University, Stanford, California.
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16
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Goldhaber-Fiebert SN, Bereknyei Merrell S, Agarwala AV, De La Cruz MM, Cooper JB, Howard SK, Asch SM, Gaba DM. Clinical Uses and Impacts of Emergency Manuals During Perioperative Crises. Anesth Analg 2020; 131:1815-1826. [PMID: 33197160 DOI: 10.1213/ane.0000000000005012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Performing key actions efficiently during crises can determine clinical outcomes, yet even expert clinicians omit key actions. Simulation-based studies of crises show that correct performance of key actions dramatically increases when emergency manuals (EMs) are used. Despite widespread dissemination of EMs, there is a need to understand in clinical contexts, when, how, and how often EMs are used and not used, along with perceived impacts. METHODS We conducted interviews with the anesthesia professionals involved in perioperative crises, identified with criterion-based sampling, occurring between October 2014 and May 2016 at 2 large academic medical centers with a history of EM training and implementation. Our convergent, mixed-methods study of the interview data extracted quantitative counts and qualitative themes of EM use and nonuse during clinical crises. RESULTS Interviews with 53 anesthesia professionals yielded 80 descriptions of applicable clinical crises, with varying durations and event types. Of 69 unique patients whose cases involved crises, the EM was used during 37 (54%; 95% confidence interval [CI], 41-66). Impacts on clinician team members included decreased stress for individual anesthesia professionals (95%), enabled teamwork (73%), and calmed atmosphere (46%). Impacts on delivery of patient care included specific action improvements, including catching errors of omission, for example, turning off anesthetic during cardiac arrest, only after EM use (59%); process improvements, for example, double-checking all actions were completed (41%); and impediments (0%). In 8% of crises, EM use was associated with potential distractions, although none were perceived to harm delivery of patient care. For 32 EM nonuses (46%; 95% CI, 34-59), participants self-identified errors of omission or delays in key actions (56%), all key actions performed (13%), and crisis too brief for EM to be used (31%). CONCLUSIONS This study provides evidence that EMs in operating rooms are being used during many applicable crises and that clinicians perceive EM use to add value. The reported negative effects were minimal and potentially offset by positive effects.
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Affiliation(s)
- Sara N Goldhaber-Fiebert
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Aalok V Agarwala
- Department of Anesthesia, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica M De La Cruz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jeffrey B Cooper
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven K Howard
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Steven M Asch
- Division of Primary Care and Population Health, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Stanford, California
| | - David M Gaba
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Carroll AL, Garcia D, Cassells SJ, Bruce JS, Bereknyei Merrell S, Schillinger E. "Making It Work": A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico. Cureus 2020; 12:e11143. [PMID: 33251053 PMCID: PMC7685818 DOI: 10.7759/cureus.11143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles. Materials and Methods We conducted an explanatory mixed methods study by creating geospatial maps of New Mexico’s trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles. Results Geospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systems-based issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions. Conclusions In addressing rural patients’ needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.
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Affiliation(s)
- Anna L Carroll
- Medicine, Stanford University School of Medicine, Stanford, USA
| | - Deanna Garcia
- Computer Science, Stanford University, Stanford, USA
| | | | - Janine S Bruce
- Pediatrics, Stanford University School of Medicine, Stanford, USA
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Bessoff KE, Choi J, Bereknyei Merrell S, Nassar AK, Spain D, Knowlton LM. Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions. Trauma Surg Acute Care Open 2020; 5:e000552. [PMID: 32953998 PMCID: PMC7481073 DOI: 10.1136/tsaco-2020-000552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/01/2020] [Accepted: 08/16/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Emergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care. Methods The grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption. Results We identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow. Conclusions The uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it. Level of evidence Level III.
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Affiliation(s)
- Kovi E Bessoff
- General Surgery, Stanford University, Stanford, California, USA
- Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Jeff Choi
- General Surgery, Stanford University, Stanford, California, USA
- Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Aussama Khalaf Nassar
- Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - David Spain
- Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Lisa Marie Knowlton
- General Surgery, Stanford University, Stanford, California, USA
- Students and Surgeons writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
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Bryant TS, Carroll AL, Steinberg JR, Marin-Nevarez P, Anderson TN, Merrell SB, Lau JN. Implementation and Evaluation of an Educational Program for Increasing Diversity and Inclusion in Surgery for Preclinical Students. JAMA Netw Open 2020; 3:e2015675. [PMID: 32870310 PMCID: PMC7489849 DOI: 10.1001/jamanetworkopen.2020.15675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This survey study assesses the student-led Service Through Surgery model for increasing diversity and inclusion in surgical education.
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Affiliation(s)
- Tyler S. Bryant
- Stanford University School of Medicine, Stanford, California
| | - Anna L. Carroll
- Stanford University School of Medicine, Stanford, California
| | | | | | - Tiffany N. Anderson
- Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, California
| | - James N. Lau
- Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Department of Surgery, Stanford University, Stanford, California
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Carroll AL, Chan A, Steinberg JR, Bryant TS, Marin-Nevarez P, Anderson TN, Bereknyei Merrell S, Lau JN. Medical Student Values Inform Career Plans in Service & Surgery-A Qualitative Focus Group Analysis. J Surg Res 2020; 256:636-644. [PMID: 32810664 DOI: 10.1016/j.jss.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diversifying the surgical workforce is a critical component of improving care for underserved patients. To recruit surgeons from diverse backgrounds, we must understand how medical students choose their specialty. We investigate how preclinical students contemplate entering a surgical field. MATERIALS AND METHODS We conducted semistructured focus groups during two iterations of a seminar class called Service Through Surgery. Discussion goals included identifying student values and assessing how they inform early career decisions. We used a systematic, collaborative, and iterative process for transcript analysis, including developing a codebook, assessing inter-rater reliability, and analyzing themes. RESULTS Twenty-four preclinical medical students from diverse backgrounds participated in seven focus groups; most were women (16; 67%), in their first year of medical school (19; 79%), and interested in surgery (17; 71%). Participants ranked professional fulfillment, spending time with family, and serving their communities and/or underserved populations among their most important values and agreed that conducting groundbreaking research, working long hours, and finding time for leisure activities were the least important. We constructed a framework to describe student responses surrounding their diverse visions for service in future surgical careers through individual doctoring interactions, roles in academia, and broader public service. CONCLUSIONS Our framework provides a basis for greater understanding and study of the ways in which preclinical medical students think about their personal values and visions for service in potential future surgical careers. This research can guide early interventions in medical education to promote diversity and care for the underserved in surgery.
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Affiliation(s)
- Anna L Carroll
- Stanford University School of Medicine, Stanford, California.
| | - Antonia Chan
- Stanford University School of Medicine, Stanford, California
| | | | - Tyler S Bryant
- Stanford University School of Medicine, Stanford, California
| | | | - Tiffany N Anderson
- Department of Surgery, Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Stanford University, Stanford, California
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Palo Alto, California
| | - James N Lau
- Stanford University School of Medicine, Stanford, California; Department of Surgery, Stanford Surgery ACS Education Institute/Goodman Surgical Education Center, Stanford University, Stanford, California
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Jacobs KG, Kugler J, Chi J, Stuart E, Bereknyei Merrell S, Rassbach C. A Mixed Methods Approach to Understanding Curricular Impact of a Capstone Course on the Self-Efficacy of Fourth-Year Medical Students. Cureus 2020; 12:e9537. [PMID: 32905172 PMCID: PMC7465827 DOI: 10.7759/cureus.9537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Capstone, or bootcamp, courses have been shown to increase the knowledge, skills, and self-efficacy of students prior to starting intern year and have been recommended by the Alliance for Clinical Education (ACE) to be incorporated into the fourth-year medical school curricula. However, a paucity of research exists regarding the exploration of the student perspective on critical curricular content and teaching strategies in a capstone course. Self-efficacy, one's subjective task-specific judgment of capability, has served in the literature as a framework for capstone outcomes and is derived from four sources of experiences: practice, observation of others, feedback, and one's emotional reaction to difficult situations. Utilizing this framework, we aimed to evaluate the impact of our capstone curriculum on students' self-efficacy and to identify critical curricular content and teaching strategies that affected students' self-efficacy and their transition into residency. Methods We designed a mixed methods study of our institution's capstone course in May 2019. Students were invited to participate in the retrospective pre- and post- self-efficacy survey and focus group immediately after the capstone and in semi-structured interviews four months after they began the intern year. Themes were identified via qualitative analysis using inductive coding to allow participants' voices to guide code development and deductive analysis using codes derived from the self-efficacy framework. Results Nine enrolled students participated in the study (surveys n=8, focus group n=7, follow-up interview n=6). Students reported the capstone was a very valuable educational experience (median 4.5 [interquartile range, or IQR 4-5]), increased their preparedness for intern year (median 5 [IQR 4.25-5]) and increased self-efficacy in multiple domains. Qualitative analysis revealed the critical curricular elements that most impacted students' self-efficacy were practical and communication skills to which students previously had limited exposure, in particular managing acute clinical needs, overnight cross-cover pages, inpatient pharmacology, daily intern communication (handoffs, consults, consenting), and end-of-life communication (goals of care, code status, pronouncing death). While all four sources contributed to self-efficacy, students reported that instructor and peer feedback were fundamental to providing context and substance to their performance. Students preferred practice-based learning via high-fidelity simulation and small groups for familiar tasks (daily intern communication, overnight pages, pharmacology) and observation of peers for new tasks (end-of-life communication and acute clinical deterioration). Conclusions This is the first study describing students' perspectives on critical curricular content and teaching strategies for a capstone course derived from qualitative analysis. Practical and communication skills with previously limited clerkship exposure and task-specific learning strategies increased the students' self-efficacy. Constructive feedback provided an important source of self-efficacy for all tasks, augmenting the benefits of practice and observation. This data provides preliminary groundwork for future research as multi-institutional studies are necessary to better understand students' needs around the curriculum to address residency transition.
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Affiliation(s)
| | - John Kugler
- Internal Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Jeffrey Chi
- Internal Medicine, Stanford University School of Medicine, Stanford, USA
| | - Elizabeth Stuart
- Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
| | | | - Caroline Rassbach
- Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
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Anderson TN, Aalami LR, Lee EW, Merrell SB, Sgroi MD, Lin DT, Lau JN. Perception and confidence of medical students in informed consent: A core EPA. Surgery 2020; 167:712-716. [DOI: 10.1016/j.surg.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/17/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
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23
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Sceats LA, Ayakta N, Merrell SB, Kin C. Drivers, Beliefs, and Barriers Surrounding Surgical Opioid Prescribing: A Qualitative Study of Surgeons’ Opioid Prescribing Habits. J Surg Res 2020; 247:86-94. [DOI: 10.1016/j.jss.2019.10.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/30/2019] [Accepted: 10/19/2019] [Indexed: 02/02/2023]
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Rosenberg G, Zion SR, Shearer E, Bereknyei Merrell S, Abadilla N, Spain DA, Crum AJ, Weiser TG. What constitutes a 'successful' recovery? Patient perceptions of the recovery process after a traumatic injury. Trauma Surg Acute Care Open 2020; 5:e000427. [PMID: 32154383 PMCID: PMC7046981 DOI: 10.1136/tsaco-2019-000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background As the number of patients surviving traumatic injuries has grown, understanding the factors that shape the recovery process has become increasingly important. However, the psychosocial factors affecting recovery from trauma have received limited attention. We conducted an exploratory qualitative study to better understand how patients view recovery after traumatic injury. Methods This qualitative, descriptive study was conducted at a Level One university trauma center. Participants 1–3 years postinjury were purposefully sampled to include common blunt-force mechanisms of injuries and a range of ages, socioeconomic backgrounds and injury severities. Semi-structured interviews explored participants’ perceptions of self and the recovery process after traumatic injury. Interviews were transcribed verbatim; the data were inductively coded and thematically analyzed. Results We conducted 15 interviews, 13 of which were with male participants (87%); average hospital length of stay was 8.9 days and mean injury severity score was 18.3. An essential aspect of the patient experience centered around the recovery of both the body and the ‘self’, a composite of one’s roles, values, identities and beliefs. The process of regaining a sound sense of self was essential to achieving favorable subjective outcomes. Participants expressed varying levels of engagement in their recovery process, with those on the high end of the engagement spectrum tending to speak more positively about their outcomes. Participants described their own subjective interpretations of their recovery as most important, which was primarily influenced by their engagement in the recovery process and ability to recover their sense of self. Discussion Patients who are able to maintain or regain a cohesive sense of self after injury and who are highly engaged in the recovery process have more positive assessments of their outcomes. Our findings offer a novel framework for healthcare providers and researchers to use as they approach the issue of recovery after injury with patients. Level of evidence III—descriptive, exploratory study.
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Affiliation(s)
- Graeme Rosenberg
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Sean R Zion
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Emily Shearer
- School of Medicine, Stanford University, Stanford, California, USA
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford University, Stanford, California, USA.,Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA, United States
| | - Natasha Abadilla
- School of Medicine, Stanford University, Stanford, California, USA
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA.,Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University, Stanford, CA, United States
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25
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Hasty BN, Lau JN, Tekian A, Miller SE, Shipper ES, Bereknyei Merrell S, Lee EW, Park YS. Validity Evidence for a Knowledge Assessment Tool for a Mastery Learning Scrub Training Curriculum. Acad Med 2020; 95:129-135. [PMID: 31577588 DOI: 10.1097/acm.0000000000003007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum. METHOD Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017 to June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre curriculum, post curriculum, and 6 months after the curriculum. RESULTS From April 2017 to June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and postcurriculum knowledge scores were 74.4% (standard deviation [SD] = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen's d = 1.10, P < .001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the precurriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs 67.0% [SD = 14.9]; P < .001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%. CONCLUSIONS This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.
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Affiliation(s)
- Brittany N Hasty
- B.N. Hasty was a surgical education fellow, Department of Surgery, Stanford University School of Medicine, Stanford, California, at the time of writing. She is currently a resident in general surgery, Loyola University Medical Center, Maywood, Illinois. J.N. Lau is professor of surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California. A. Tekian is professor and associate dean for international affairs, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-9252-1588. S.E. Miller was a fourth-year medical student, Stanford University School of Medicine, Stanford, California, at the time of writing. She is currently a resident in obstetrics and gynecology, Stanford University School of Medicine, Stanford, California. E.S. Shipper was a general surgery resident, University of Texas Health Science Center at San Antonio, San Antonio, Texas, at the time of writing. He is currently a research fellow, National Trauma Institute, San Antonio, Texas. S. Bereknyei Merrell is director of research, Goodman Surgical Education Center, and research scholar, Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, California. E.W. Lee was a surgical education fellow, Department of Surgery, Stanford University School of Medicine, Stanford, California. He is currently a resident in general surgery, Inova Fairfax Medical Campus, Falls Church, Virginia. Y.S. Park is associate professor and associate head, Department of Medical Education, University of Illinois, Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
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Anderson TN, Lee EW, Merrell SB, Korndorffer JR. Tracking Surgical Education Survey Research Through the APDS Listserv. J Surg Educ 2019; 76:e41-e48. [PMID: 31383613 DOI: 10.1016/j.jsurg.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Survey-based studies are cornerstones in medical education research. The Association of Program Directors in Surgery (APDS) listserv offers a method to contact program directors (PD) and residents for such research. To facilitate research beneficial to the APDS, improve the quality of survey-based research and minimize survey fatigue, the APDS research committee (ARC) developed a survey review process to grant access to the listserv for research. This study was conducted to determine the impact of the review process on the quality of survey-based research and eventual publication. DESIGN This log was systematically reviewed identifying publications resulting from accepted surveys. Publications were categorically analyzed to determine the components of their survey tool methodology, response rate (RR), and medical education research study quality instrument (MERSQI) score. SETTING The ARC used a 2-reviewer peer-review process for survey distribution requests. The request was either accepted, rejected, or returned for revision. Accepted surveys were distributed through the listserv with an ARC attestation of approval. PARTICIPANTS A log of all survey requests maintained from 2014 to 2017 and subsequent publications. RESULTS Thirty-five requests were accepted (40%), 30 were reviewed discovering 10 surveys that led to 12 publications (publication rate of 33%). The average RR was 60% (SD = 29%). Detailed explanations of survey development strategies were reported in 5 (42%), consisting of methods building validity evidence such as expert consensus, modified Delphi method, and pilot group sampling. Half of study participants were PD (50%). MERSQI scores averaged 10 (SD = 1.6). CONCLUSION Based on those survey research published to date, the ARC survey peer-review process has enabled most accepted surveys to achieve adequate RR. Although the pool of accepted requests is small, it does highlight areas of improvement. With further refinement of the process, including questioning the survey development methods, the process and listserv can be a powerful tool for further research.
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Affiliation(s)
- Tiffany N Anderson
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Edmund W Lee
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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27
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Lund AJ, Sam MM, Sy AB, Sow OW, Ali S, Sokolow SH, Bereknyei Merrell S, Bruce J, Jouanard N, Senghor S, Riveau G, Lopez-Carr D, De Leo GA. Unavoidable Risks: Local Perspectives on Water Contact Behavior and Implications for Schistosomiasis Control in an Agricultural Region of Northern Senegal. Am J Trop Med Hyg 2019; 101:837-847. [PMID: 31452497 PMCID: PMC6779182 DOI: 10.4269/ajtmh.19-0099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Human schistosomiasis is a snail-borne parasitic disease affecting more than 200 million people worldwide. Direct contact with snail-infested freshwater is the primary route of exposure. Water management infrastructure, including dams and irrigation schemes, expands snail habitat, increasing the risk across the landscape. The Diama Dam, built on the lower basin of the Senegal River to prevent saltwater intrusion and promote year-round agriculture in the drought-prone Sahel, is a paradigmatic case. Since dam completion in 1986, the rural population-whose livelihoods rely mostly on agriculture-has suffered high rates of schistosome infection. The region remains one of the most hyperendemic regions in the world. Because of the convergence between livelihoods and environmental conditions favorable to transmission, schistosomiasis is considered an illustrative case of a disease-driven poverty trap (DDPT). The literature to date on the topic, however, remains largely theoretical. With qualitative data generated from 12 focus groups in four villages, we conducted team-based theme analysis to investigate how perception of schistosomiasis risk and reported preventive behaviors may suggest the presence of a DDPT. Our analysis reveals three key findings: 1) rural villagers understand schistosomiasis risk (i.e., where and when infections occur), 2) accordingly, they adopt some preventive behaviors, but ultimately, 3) exposure persists, because of circumstances characteristic of rural livelihoods. These findings highlight the capacity of local populations to participate actively in schistosomiasis control programs and the limitations of widespread drug treatment campaigns. Interventions that target the environmental reservoir of disease may provide opportunities to reduce exposure while maintaining resource-dependent livelihoods.
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Affiliation(s)
- Andrea J. Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California
| | | | - Alioune Badara Sy
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | | | - Sofia Ali
- Stanford University, Stanford, California
| | | | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford Surgery Policy Improvement Research & Education Center (S-SPIRE), School of Medicine, Stanford University, Stanford, California
| | - Janine Bruce
- Pediatric Advocacy Program, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Nicolas Jouanard
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
- Station d’Innovation Aquacole, Saint Louis, Senegal
| | - Simon Senghor
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | - Gilles Riveau
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | - David Lopez-Carr
- Department of Geography, University of California, Santa Barbara, Santa Barbara, California
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, California
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Goyal T, Hasty BN, Bereknyei Merrell S, Gold CA. Education Research: Understanding barriers to goals of care communication for neurology trainees. Neurology 2019; 93:362-366. [DOI: 10.1212/wnl.0000000000007975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo describe the perspectives of neurology residents regarding barriers to effective goals of care discussions and to identify residents' current and desired educational strategies to improve goals of care communication.MethodsAll neurology residents at our institution were invited to voluntarily participate in focus groups. Residents were organized into 3 focus groups by year of training. Moderators asked residents open-ended questions about current goals of care communication practice and ideas for improving the frequency and effectiveness of goals of care discussions. All responses were audiorecorded, transcribed, and de-identified. Transcripts of the focus groups were independently read and coded by members of the research team. We performed thematic analysis to identify and systematize relationships across coded data.ResultsTwenty out of 29 neurology residents participated in the focus groups. We identified 3 overarching domains impeding goals of care communication: patient factors, resident factors, and systems factors. Residents proposed specific desired strategies to address these 3 domains with the goal of improving the frequency and efficacy of goals of care communication. The desired strategies included receiving feedback from patients and families, developing resident-focused educational opportunities through direct observation and coaching, and systems changes by documenting goals of care discussions.ConclusionsNeurology residents identify multiple barriers to effective goals of care communication and propose specific desired strategies for improvement. This detailed input from residents will be incorporated into future curricular interventions to improve confidence and skill in leading goals of care discussions.
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Mattingly AS, Starr N, Bitew S, Forrester JA, Negussie T, Bereknyei Merrell S, Weiser TG. Qualitative outcomes of Clean Cut: implementation lessons from reducing surgical infections in Ethiopia. BMC Health Serv Res 2019; 19:579. [PMID: 31419972 PMCID: PMC6698005 DOI: 10.1186/s12913-019-4383-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clean Cut is a six month, multi-modal, adaptive intervention aimed at reducing surgical infections through improving six critical perioperative processes: 1) handwashing/skin preparation, 2) surgical gown/drape integrity, 3) antibiotic administration, 4) instrument sterility, 5) gauze counts, and 6) WHO Surgical Safety Checklist use. The aim of this study was to elucidate themes across Clean Cut implementation sites in Ethiopia to improve implementation at future hospitals. METHODS We conducted semi-structured interviews of 20 clinicians involved in Clean Cut at four hospitals. Participation was limited to Clean Cut team members and included surgeons, anesthetists, operating room (OR) nurses, ward nurses, OR managers, quality improvement personnel, and hospital administrators. Audio recordings were transcribed and coded using qualitative software. A codebook was inductively and iteratively derived between two researchers, tested for inter-rater reliability, and applied to all transcripts. We conducted thematic analysis to derive our final qualitative results. RESULTS The interviews revealed barriers and facilitators to the implementation of Clean Cut, as well as strategies for future implementation sites. Key barriers included material resource limitations, feelings of job burden, existing gaps in infection prevention education, and communication errors during data collection. Common facilitators included strong hospital leadership support, commitment to improved patient outcomes, and organized Clean Cut training sessions. Future strategies include resource assessments, creating a sense of responsibility among staff, targeted training sessions, and incorporating new standards into daily routine. CONCLUSIONS The findings of this study highlight the importance of engaging hospital leadership, providers and staff in quality improvement programs, and understanding their work contexts. The identified barriers and facilitators will inform future initiatives in the field of perioperative infection prevention.
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Affiliation(s)
| | - Nichole Starr
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.,Lifebox Foundation, London, UK and Brooklyn, NY, USA
| | - Senait Bitew
- Lifebox Foundation, London, UK and Brooklyn, NY, USA
| | - Jared A Forrester
- Department of Surgery, Division of General Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tihitena Negussie
- Department of Pediatric Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Palo Alto, CA, USA
| | - Thomas G Weiser
- Lifebox Foundation, London, UK and Brooklyn, NY, USA. .,Department of Surgery, Division of General Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine, Palo Alto, CA, USA.
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30
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Liker K, Black L, Weil J, Bruce J, Bereknyei Merrell S, Bivona S, Ormond KE. Challenges of infertility genetic counseling: Impact on counselors' personal and professional lives. J Genet Couns 2019; 28:626-640. [PMID: 30821877 DOI: 10.1002/jgc4.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/07/2022]
Abstract
Infertility genetic counselors (GCs) work with patients struggling to become pregnant who desire genetic testing of embryos and preconception genetic testing or carrier screening. Because personal and professional challenges have not been examined in this relatively new genetic counseling specialty, we investigated the difficulties infertility GCs face in their professional roles. Past and present infertility GCs in patient-facing roles were recruited through the National Society of Genetic Counselors. Purposive sampling ensured participants were diverse in clinical setting, reproductive history, and other demographics. Nineteen participants completed a semi-structured interview, at which time data saturation occurred. Thematic analysis revealed infertility GCs consider their patients more emotionally stressed than patients in other specialties. Infertility GCs relate easily to patients, build long-term patient relationships, and feel invested in the reproductive successes of patients. Participants reported heightened concern for their own fertility, leading to high personal uptake of preconception genetic and fertility tests. Participants described discomfort when counseling while visibly pregnant and reluctance to disclose their own reproductive histories. Further research is needed on the complex interactions of GCs' personal and professional lives. Peer support groups and professional dialogue about the personal effects of the role may be beneficial for infertility GCs.
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Affiliation(s)
- Karina Liker
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Lauri Black
- Pacific Reproductive Genetic Counseling, Pacifica, California
| | - Jon Weil
- Department of Biological Sciences, California State University Stanislaus, Turlock, California
| | - Janine Bruce
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, California
| | - Stephanie Bivona
- Department of Genetics, Stanford University School of Medicine, Stanford, California
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, California
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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Waliany S, Caceres W, Merrell SB, Thadaney S, Johnstone N, Osterberg L. Preclinical curriculum of prospective case-based teaching with faculty- and student-blinded approach. BMC Med Educ 2019; 19:31. [PMID: 30674302 PMCID: PMC6343267 DOI: 10.1186/s12909-019-1453-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/04/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Case-based teaching with real patient cases provides benefit of simulating real-world cognition. However, while clinical practice involves a prospective approach to cases, preclinical instruction typically involves full disclosure of case content to faculty, introducing hindsight bias into faculty teaching in medical curricula. METHODS During 2015-2018, we piloted an optional medical school curriculum involving 6-7 one-hour sessions over a 3-month period each year. New groups enrolled each year from first- and second-year classes. A facilitator provided a blinded physician discussant and blinded students with case information during and not in advance of each session, allowing prospective case-based discussions. Cases were based on real patients treated in the Department of Medicine. Clinical material was presented in the chronologic sequence encountered by treating physicians. Content covered a median of 5 patient visits/case (range: 2-10) spanning over months. A 14-item survey addressing components of the reporter-interpreter-manager-educator (RIME) scheme was developed and used to compare self-reported clinical skills between course participants and non-participant controls during the 2016 course iteration. RESULTS This elective curriculum at Stanford School of Medicine involved 170 preclinical students (22.7% of 750 eligible). During the 2016 course iteration, a quasi-experimental study compared self-reported clinical skills between 29 course participants (response rate: 29/49 [59.2%]) and 35 non-participant controls (response rate: 35/132 [26.5%]); students self-assessed clinical skills via the RIME-based survey developed for the course. Two-sample t-tests compared the change in pre- and post-course skills between course participants and non-participants. Of 15 Department of Medicine faculty members invited as discussants, 12 (80%) consented to participate. Compared with controls, first-year participants self-assessed significantly greater improvement in understanding how clinicians reason through cases step-by-step to arrive at diagnoses (P = 0.049), work through cases in longitudinal settings (P = 0.049), and share information with patients (P = 0.047). Compared with controls, second-year participants self-assessed significantly greater improvement (P = 0.040) in understanding how clinicians reason through cases step-by-step to arrive at diagnoses. CONCLUSIONS Prospective case-based discussions with blinding of faculty and students to clinical content circumvents hindsight bias and may impart real-world cognitive skills as determined by student self-report.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
| | - Wendy Caceres
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
| | | | - Sonoo Thadaney
- Program for Bedside Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Noelle Johnstone
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Lars Osterberg
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
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Miller S, Shipper E, Hasty B, Bereknyei Merrell S, Lee EW, Lin D, Lau JN. Introductory Surgical Skills Course: Technical Training and Preparation for the Surgical Environment. MedEdPORTAL 2018; 14:10775. [PMID: 30800975 PMCID: PMC6342345 DOI: 10.15766/mep_2374-8265.10775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
Introduction Early exposure to surgery in a positive learning environment can contribute to increased student interest. The primary objectives of this study included developing increased comfort in the operating room (OR) environment, confidence in surgical skills, and mentorship for students interested in surgery. Methods The course comprised seven 2-hour sessions covering both nontechnical and technical skills facilitated by attending and resident surgeons. Sessions included nontechnical skills training, basic knot tying and suturing, laparoscopic surgical skills, and high-fidelity operative simulations on animal and cadaver models. The curriculum also matched students with faculty mentors in order to scrub into operative cases. Surveys assessing self-reported comfort in the OR, confidence levels in surgical skills, and whether students had mentors in surgery were distributed before and after the course. Results Thirty preclinical medical students were enrolled in the course in 2016 and an additional 41 students in 2017. Results showed increased confidence in all skills and in comfort in the OR, as well as increased surgeon mentorship. Thirty-two students who completed the course entered clinical rotations in 2018 and, when surveyed, reported increased confidence in the aforementioned domains and in their preparedness for their surgery clerkship, compared to 49 peers who had not completed the course. Discussion The course successfully increased comfort in the OR, increased confidence in performing surgical skills, and provided students with mentors in surgery, all of which will hopefully foster positive experiences during their surgery clerkship and ultimately increase their consideration of surgery as a career.
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Affiliation(s)
- Sarah Miller
- Medical Student, Stanford University School of Medicine
| | - Edward Shipper
- Surgical Education Fellow, Goodman Surgical Education Center, Stanford University School of Medicine
| | - Brittany Hasty
- Surgical Education Fellow, Goodman Surgical Education Center, Stanford University School of Medicine
| | | | - Edmund W. Lee
- Surgical Education Fellow, Goodman Surgical Education Center, Stanford University School of Medicine
| | - Dana Lin
- Clinical Assistant Professor, Department of Surgery, Stanford University School of Medicine
| | - James N. Lau
- Clinical Professor, Department of Surgery, Stanford University School of Medicine
- Director, Goodman Surgical Education Center, Stanford University School of Medicine
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Lin DT, Qiu W, Lai C, Post LI, Merrell SB, Lau JN, Salles A, Mueller CM. Psychologist-Facilitated Group Sessions for Residents: A Worthwhile Investment? J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hasty BN, Merrell SB, Brandford EC, Lee EW, Lau JN. Medical Student Mistreatment: Coping Strategies and Resilience on the Surgery Clerkship. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee EW, Hasty BN, Lau JN, Merrell SB, Hawn MT, Shanafelt T, Salles A, Lin DT. Emotional Intelligence as a Possible Safeguard to Surgeon Wellness. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu EY, Batten JN, Merrell SB, Shafer A. The long-term impact of a comprehensive scholarly concentration program in biomedical ethics and medical humanities. BMC Med Educ 2018; 18:204. [PMID: 30153822 PMCID: PMC6114241 DOI: 10.1186/s12909-018-1311-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 08/15/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is a strong and growing interest in biomedical ethics and medical humanities (BEMH) within medical education for facilitating key components of medical professionalism and ethics, clinical communication and observational skills, and self-care and reflective practices. Consequently, United States (US) medical institutions have begun to incorporate BEMH through formal Scholarly Concentrations (SCs). This is the first study to examine the impact of a US BEMH SC, from student experience in medical school to post-graduate development, as perceived by graduate physicians. METHODS Graduated students who participated in the BEMH SC or did extensive BEMH research prior to the BEMH SC's establishment (n = 57) were sampled for maximum variation across graduating years. In telephone surveys and interviews, participants discussed the perceived impact of the BEMH SC on (a.) student experience during medical school and (b.) post-graduate development. Interviews were audiotaped, transcribed, and de-identified. The authors iteratively generated a codebook; two raters coded independently, adjudicated codes, and completed inter-rater reliability (IRR) tests. The authors subsequently conducted a team-based thematic analysis, identifying emergent themes. RESULTS Nineteen BEMH graduates were interviewed. Results were analyzed according to (a.) student experience and (b.) post-graduate development. Overall, respondents perceived impacts in reinforcing knowledge and skills in clinical ethics; solidifying self-care and reflective practices; refining a sense of professional identity and integrity for ethically challenging situations; and promoting student skills, productivity, and later careers involving BEMH. CONCLUSION A comprehensive US BEMH SC achieved the purported aims of BEMH in medical education, with graduate physicians perceiving persisting effects into clinical practice. Furthermore, the structure and format of a SC may offer additional advantages in promoting student scholarly skill and productivity, career development, and professional identity formation-core competencies identified across clinical training and ethics programs. Our findings indicate that a BEMH SC is effective in achieving a range of desired immediate and post-graduate effects and represent a particularly promising venue for BEMH in medical education. We believe these findings to be of critical significance to medical educators and administrators when considering how best to incorporate BEMH into SCs and medical curricula.
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Affiliation(s)
- Emily Yang Liu
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Jason Neil Batten
- Stanford School of Medicine, 291 Campus Drive, Palo Alto, CA 94305 USA
| | | | - Audrey Shafer
- VA Palo Alto Healthcare System, 3801 Miranda Avenue, Anesthesia 112A, Palo Alto, CA 94304 USA
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Abstract
IMPORTANCE Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care. OBJECTIVE To document the published programmatic and curricular attempts to decrease the incidence of mistreatment. DATA SOURCES PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017. STUDY SELECTION Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded. DATA EXTRACTION AND SYNTHESIS Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education. MAIN OUTCOMES AND MEASURES A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted. RESULTS Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data. CONCLUSIONS AND RELEVANCE There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.
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Affiliation(s)
- Laura M. Mazer
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sylvia Bereknyei Merrell
- Goodman Surgical Education Center, Stanford–Surgery Policy Improvement Research & Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brittany N. Hasty
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Christopher Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, California
| | - James N. Lau
- Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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Zapata AML, Beaudreau SA, O'Hara R, Bereknyei Merrell S, Bruce J, Garrison-Diehn C, Gould CE. Information-Seeking about Anxiety and Perceptions about Technology to Teach Coping Skills in Older Veterans. Clin Gerontol 2018; 41:346-356. [PMID: 28967837 DOI: 10.1080/07317115.2017.1359716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills. METHODS Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology. RESULTS Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability. CONCLUSION Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans. CLINICAL IMPLICATIONS Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.
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Affiliation(s)
- Aimee Marie L Zapata
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,b Pacific Graduate School of Psychology , Palo Alto University , Palo Alto , California , USA
| | - Sherry A Beaudreau
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Ruth O'Hara
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Sylvia Bereknyei Merrell
- e Department of Medicine, Division of General Medical Disciplines , Stanford University School of Medicine , Stanford , California , USA
| | - Janine Bruce
- f Department of Pediatrics, Division of General Pediatrics , Stanford University School of Medicine , Stanford , California , USA
| | - Christina Garrison-Diehn
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Christine E Gould
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
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Bereknyei Merrell S, Gaba DM, Agarwala AV, Cooper JB, Nevedal AL, Asch SM, Howard SK, Goldhaber-Fiebert SN. Use of an Emergency Manual During an Intraoperative Cardiac Arrest by an Interprofessional Team: A Positive-Exemplar Case Study of a New Patient Safety Tool. Jt Comm J Qual Patient Saf 2018; 44:477-484. [PMID: 30071967 DOI: 10.1016/j.jcjq.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An emergency manual (EM) is a set of evidence-based crisis checklists, or cognitive aids, that can improve team performance. EMs are used in other safety-critical industries, and health care simulation studies have shown their efficacy, but use in clinical settings is nascent. A case study was conducted on the use of an EM during one intraoperative crisis, which entailed the assessment of the impact of the EM's use on teamwork and patient care and the identification of lessons for effectively using EMs during future clinical crises. METHODS In a case study of a single crisis, an EM was used during a cardiac arrest at a tertiary care hospital that had systematically implemented perioperative EMs. Semistructured interviews were conducted with all six clinicians present, interview transcripts were iteratively coded, and thematic analysis was performed. RESULTS All clinician participants stated that EM use enabled effective team functioning via reducing stress of individual clinicians, fostering a calm work environment, and improving teamwork and communication. These impacts in turn improved the delivery of patient care during a clinical crisis and influenced participants' intended EM use during future appropriate crises. CONCLUSION In this positive-exemplar case study, an EM was used to improve delivery of evidence-based patient care through effective clinical team functioning. EM use must complement rather than replace good clinician education, judgment, and teamwork. More broadly, understanding why and how things go well via analyzing positive-exemplar case studies, as a converse of root cause analyses for negative events, can be used to identify effective applications of safety innovations.
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Affiliation(s)
| | - David M Gaba
- Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Aalok V Agarwala
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, and Assistant Professor, Harvard Medical School
| | - Jeffrey B Cooper
- Harvard Medical School, and Founder, Center for Medical Simulation, Boston
| | - Andrea L Nevedal
- Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California
| | - Steven M Asch
- Department of Medicine, Stanford University School of Medicine
| | - Steven K Howard
- Perioperative and Pain Medicine, Stanford University School of Medicine
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Chandrasekar H, Gesundheit N, Nevins AB, Pompei P, Bruce J, Merrell SB. Promoting student case creation to enhance instruction of clinical reasoning skills: a pilot feasibility study. Adv Med Educ Pract 2018; 9:249-257. [PMID: 29692641 PMCID: PMC5903478 DOI: 10.2147/amep.s155481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND It is a common educational practice for medical students to engage in case-based learning (CBL) exercises by working through clinical cases that have been developed by faculty. While such faculty-developed exercises have educational strengths, there are at least two major drawbacks to learning by this method: the number and diversity of cases is often limited; and students decrease their engagement with CBL cases as they grow accustomed to the teaching method. We sought to explore whether student case creation can address both of these limitations. We also compared student case creation to traditional clinical reasoning sessions in regard to tutorial group effectiveness, perceived gains in clinical reasoning, and quality of student-faculty interaction. METHODS Ten first-year medical students participated in a feasibility study wherein they worked in small groups to develop their own patient case around a preassigned diagnosis. Faculty provided feedback on case quality afterwards. Students completed pre- and post-self-assessment surveys. Students and faculty also participated in separate focus groups to compare their case creation experience to traditional CBL sessions. RESULTS Students reported high levels of team engagement and peer learning, as well as increased ownership over case content and understanding of clinical reasoning nuances. However, students also reported decreases in student-faculty interaction and the use of visual aids (P < 0.05). CONCLUSION The results of our feasibility study suggest that student-generated cases can be a valuable adjunct to traditional clinical reasoning instruction by increasing content ownership, encouraging student-directed learning, and providing opportunities to explore clinical nuances. However, these gains may reduce student-faculty interaction. Future studies may be able to identify an improved model of faculty participation, the ideal timing for incorporation of this method in a medical curriculum, and a more rigorous assessment of the impact of student case creation on the development of clinical reasoning skills.
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Affiliation(s)
| | - Neil Gesundheit
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew B Nevins
- Department of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Pompei
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Janine Bruce
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Hamilton KV, Ormond KE, Moscarello T, Bruce JS, Bereknyei Merrell S, Chang KW, Bernstein JA. Exploring the Medical and Psychosocial Concerns of Adolescents and Young Adults With Craniofacial Microsomia: A Qualitative Study. Cleft Palate Craniofac J 2018; 55:1430-1439. [PMID: 29634364 DOI: 10.1177/1055665618768542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study explores the experiences of adolescents and young adults with craniofacial microsomia, including the impact of growing up with this craniofacial condition on daily life and sense of self. The results may guide future research on optimally supporting individuals with craniofacial microsomia during this critical life phase. DESIGN AND SETTING Participants were recruited through a craniofacial center, online patient support groups, and social media sites. Eleven individual semistructured interviews with participants between 12 and 22 years old were conducted by a single interviewer, transcribed, iteratively coded, and thematically analyzed. RESULTS Five themes were evident in the data: (1) impact on personal growth and character development, (2) negative psychosocial impact, (3) deciding to hide or reveal the condition, (4) desire to make personal surgical decisions, and (5) struggles with hearing loss. CONCLUSIONS We identified both medical and psychosocial concerns prevalent among adolescents with craniofacial microsomia. Although adolescents with craniofacial microsomia exhibit considerable resilience, the challenges they face impact their sense of self and should be addressed through psychosocial support and counseling. Further research should investigate the potential benefit of the wider use of hearing aids, as well as the involvement of patients in decision-making about reconstructive ear surgery.
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Affiliation(s)
- Kayla V Hamilton
- 1 Department of Genetics, Stanford, Stanford University School of Medicine, CA, USA.,Hamilton is now with Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kelly E Ormond
- 1 Department of Genetics, Stanford, Stanford University School of Medicine, CA, USA
| | - Tia Moscarello
- 2 Department of Cardiovascular Medicine, Stanford Health Care, Stanford, CA, USA
| | - Janine S Bruce
- 3 Department of Pediatrics, Stanford University School of Medicine, CA, USA
| | | | - Kay W Chang
- 5 Department of Otolaryngology, Stanford University School of Medicine, CA, USA
| | - Jonathan A Bernstein
- 6 Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, CA, USA.,7 Stanford Children's Health-Lucile Packard Children's Hospital, Stanford, CA, USA
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Hasty BN, Miller SE, Bereknyei Merrell S, Lin DT, Shipper ES, Lau JN. Medical student perceptions of a mistreatment program during the surgery clerkship. Am J Surg 2018; 215:761-766. [DOI: 10.1016/j.amjsurg.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/05/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
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Rope R, Merrell SB, Stedman M, Young B. Education in consultation: A comparative survey-based assessment of perceived educational effectiveness within a university and community-based internal medicine residency. MedEdPublish (2016) 2017; 6:153. [PMID: 38406436 PMCID: PMC10885288 DOI: 10.15694/mep.2017.000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Education in consultation is a potentially valuable, but understudied, element of medical education. Inpatient consultation is an opportunity for significant subspecialist contact for resident trainees and an avenue for improving their knowledge and patient care across content areas. We evaluated the perceived educational effectiveness of education in consultation among internal medicine residents, within a university and a community-based program, as well as the role of barriers in medical training that may limit education. Methods: We used a web-based survey expanded from a previously published survey consisting of 12 questions, including one free-response, on education in consultation. Data were analyzed descriptively and qualitatively. We surveyed residents from two internal medicine programs in 2016. One within a large university-based hospital and the second within a smaller community-based safety-net hospital. Results: 91/198 (46%) of residents responded. Overall results from both programs were similar despite their structural differences. Residents viewed education in consultation as a priority and the majority felt it was at least moderately effective but underutilized. Importantly, educational interactions are largely dependent on outreach from residents. While in-person teaching interactions were the most effective, key barriers to these interactions include a lack of time, difficulty locating residents, and the perception of residents as being too busy. Conclusions: Inpatient consultation offers a unique opportunity for specialist-led education for internal medicine residents. It is potentially effective but constrained extensively in modern training environments. Interventions aimed at emphasizing education in consultation within fellowships and residencies, increasing in-person resident-specialist interactions, and addressing structural barriers, may improve resident knowledge across specialties and strengthen patient care.
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Affiliation(s)
- Robert Rope
- Oregon Health and Science University Division of Nephrology and Hypertension
| | | | | | - Brian Young
- University of California at Davis School of Medicine Division of Nephrology
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Tanaka P, Bereknyei Merrell S, Walker K, Zocca J, Scotto L, Bogetz AL, Macario A. Implementation of a Needs-Based, Online Feedback Tool for Anesthesia Residents With Subsequent Mapping of the Feedback to the ACGME Milestones. Anesth Analg 2017; 124:627-635. [PMID: 28099326 DOI: 10.1213/ane.0000000000001647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Optimizing feedback that residents receive from faculty is important for learning. The goals of this study were to (1) conduct focus groups of anesthesia residents to define what constitutes optimal feedback; (2) develop, test, and implement a web-based feedback tool; and (3) then map the contents of the written comments collected on the feedback tool to the Accreditation Council for Graduate Medical Education (ACGME) anesthesiology milestones. METHODS All 72 anesthesia residents in the program were invited to participate in 1 of 5 focus groups scheduled over a 2-month period. Thirty-seven (51%) participated in the focus groups and completed a written survey on previous feedback experiences. On the basis of the focus group input, an initial online feedback tool was pilot-tested with 20 residents and 62 feedback sessions, and then a final feedback tool was deployed to the entire residency to facilitate the feedback process. The completed feedback written entries were mapped onto the 25 ACGME anesthesiology milestones. RESULTS Focus groups revealed 3 major barriers to good feedback: (1) too late such as, for example, at the end of month-long clinical rotations, which was not useful because the feedback was delayed; (2) too general and not specific enough to immediately remedy behavior; and (3) too many in that the large number of evaluations that existed that were unhelpful such as those with unclear behavioral anchors compromised the overall feedback culture. Thirty residents (42% of 72 residents in the program) used the final online feedback tool with 121 feedback sessions with 61 attendings on 15 rotations at 3 hospital sites. The number of feedback tool uses per resident averaged 4.03 (standard deviation 5.08, median 2, range 1-21, 25th-75th % quartile 1-4). Feedback tool uses per faculty averaged 1.98 (standard deviation 3.2, median 1, range 1-25, 25th-75th % quartile 1-2). For the feedback question item "specific learning objective demonstrated well by the resident," this yielded 296 milestone-specific responses. The majority (71.3%) were related to the patient care competency, most commonly the anesthetic plan and conduct (35.8%) and airway management (11.1%) milestones; 10.5% were related to the interpersonal and communication skills competency, most commonly the milestones communication with other professionals (4.4%) or with patients and families (4.4%); and 8.4% were related to the practice-based learning and improvement competency, most commonly self-directed learning (6.1%). For the feedback tool item "specific learning objective that resident may improve," 67.0% were related to patient care, most commonly anesthetic plan and conduct (33.5%) followed by use/interpretation of monitoring and equipment (8.5%) and airway management (8.5%); 10.2% were related to practice-based learning and improvement, most commonly self-directed learning (6.8%); and 9.7% were related to the systems-based practice competency. CONCLUSIONS Resident focus groups recommended that feedback be timely and specific and be structured around a tool. A customized online feedback tool was developed and implemented. Mapping of the free-text feedback comments may assist in assessing milestones. Use of the feedback tool was lower than expected, which may indicate that it is just 1 of many implementation steps required for behavioral and culture change to support a learning environment with frequent and useful feedback.
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Affiliation(s)
- Pedro Tanaka
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California; †Stanford University School of Medicine, Stanford, California; ‡Department of Anesthesia, New York Presbyterian Hospital, Weill-Cornell University, New York, New York; and §Department of Pediatrics and ‖Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Sattler AL, Merrell SB, Lin SY, Schillinger E. Actual and Standardized Patient Evaluations of Medical Students' Skills. Fam Med 2017; 49:548-552. [PMID: 28724153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Physicians must communicate effectively with patients. Actual patients (APs) rarely evaluate medical students' clinical skills; instead, standardized patients (SPs) provide proxy ratings. It is unclear how well SP ratings mirror AP experiences. The aim of this study was to compare AP and SP assessments of medical students' communication skills and professionalism. We hypothesized that their perspectives would be similar, but distinct, and offer insight about how to more reliably include the patient's voice in medical education. METHODS Using a mixed methods design, data were gathered from both APs and SPs using a modified SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter) framework. Authors analyzed Likert-scale surveys using Spearman's rho (ρ) correlations, and qualitatively analyzed open-ended comments about students' interpersonal skills and professionalism. RESULTS For APs, the domains of "trusted the student," "discussed treatment," and "reviewed next steps" were positively correlated with whether they would recommend the student to others (ρ.89, ρ.89, ρ.88, respectively, all P<.001). For SPs, feeling like they "trusted the student," "student appeared professionally competent," and "made personal connection" were most highly correlated with recommending the student to others (ρ.86, ρ.86, ρ.76, respectively, all P<.001). CONCLUSIONS Feedback from APs provides unique perspectives, complementing those of SPs, and prompts insights into incorporating patients' voices and values into training. Students may benefit from learning experiences focused on sharing and clarifying information. Providing opportunities for deliberate practice and feedback during both AP and SP encounters may enhance mastery of these skills.
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Lau JN, Mazer LM, Liebert CA, Bereknyei Merrell S, Lin DT, Harris I. A Mixed-Methods Analysis of a Novel Mistreatment Program for the Surgery Core Clerkship. Acad Med 2017; 92:1028-1034. [PMID: 28121657 DOI: 10.1097/acm.0000000000001575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To review mistreatment reports from before and after implementation of a mistreatment program, and student ratings of and qualitative responses to the program to evaluate the short-term impact on students. METHOD In January 2014, a video- and discussion-based mistreatment program was implemented for the surgery clerkship at the Stanford University School of Medicine. The program aims to help students establish expectations for the learning environment; create a shared and personal definition of mistreatment; and promote advocacy and empower ment to address mistreatment. Counts and types of mistreatment were compared from a year before (January-December 2013) and two years after (January 2014-December 2015) implementation. Students' end-of-clerkship ratings and responses to open-ended questions were analyzed. RESULTS From March 2014-December 2015, 141/164 (86%) students completed ratings, and all 47 (100%) students enrolled from January-August 2014 provided qualitative program evaluations. Most students rated the initial (108/141 [77%]) and final (120/141 [85%]) sessions as excellent or outstanding. In the qualitative analysis, students valued that the program helped establish expectations; allowed for sharing experiences; provided formal resources; and provided a supportive environment. Students felt the learning environment and culture were improved and reported increased interest in surgery. There were 14 mistreatment reports the year before the program, 9 in the program's first year, and 4 in the second year. CONCLUSIONS The authors found a rotation-specific mistreatment program, focused on creating shared understanding about mistreatment, was well received among surgery clerkship students, and the number of mistreatment reports decreased each year following implementation.
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Affiliation(s)
- James N Lau
- J.N. Lau is clinical associate professor, Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California. L.M. Mazer is a surgical resident, Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California. C.A. Liebert is a surgical resident, Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California. S. Bereknyei Merrell is research scholar, Goodman Surgical Education Center, Departments of Surgery and of Research and Evaluation, Office of Medical Education, Stanford University School of Medicine, Stanford, California. D.T. Lin is clinical assistant professor, Goodman Surgical Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California. I. Harris is professor, Department of Medical Education, University of Illinois-Chicago College of Medicine, Chicago, Illinois
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Shipper ES, Mazer LM, Merrell SB, Lin DT, Lau JN, Melcher ML. Pilot evaluation of the Computer-Based Assessment for Sampling Personal Characteristics test. J Surg Res 2017; 215:211-218. [DOI: 10.1016/j.jss.2017.03.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/12/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
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Boggiano VL, Wu Y, Bruce JS, Merrell SB, Schillinger E. Patient-Centered Care Challenges and Surprises: Through the Clerkship Students' Eyes. Fam Med 2017; 49:57-61. [PMID: 28166582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The patient-centered care model for health care delivery encourages medical providers to respect patients' preferences and give patients more autonomy over their health care decisions. This approach has gained importance within US medical school curricula. Yet, little is known about student perspectives on both patient-centered care and the benefits and challenges that lie therein. This manuscript explores the greatest impediments to, as well as the benefits from, student engagement in patient-centered care from the perspectives of students participating in their family medicine outpatient clerkship. METHODS Clerkship students on their core family medicine clerkship at Stanford University School of Medicine were provided the following open-ended prompt: "Describe a patient-centered care challenge or surprise in the family medicine core clerkship." Free-text responses were collected and analyzed using content and thematic analysis. RESULTS A total of 326 responses from 216 students were analyzed for frequency and patient-centered themes. Nine final themes emerged and were grouped into three domains: student definitions of patient-centered care, patient-centered care impact on patients, and patient-centered care impact on medical professionals. CONCLUSIONS Our study suggests that students find the patient-centered care model for health care delivery to be challenging but worthwhile. We highlight that students find communication with patients in a patient-centered manner challenging and discuss the need for improved medical education about patient-centered care in order to better prepare students to implement the model in a variety of psychosocial and medical contexts.
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Braverman G, Bereknyei Merrell S, Bruce JS, Makoul G, Schillinger E. Finding the Words: Medical Students' Reflections on Communication Challenges in Clinic. Fam Med 2016; 48:775-783. [PMID: 27875600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Interpersonal communication is essential to providing excellent patient care and requires ongoing development. Although aspects of medical student interpersonal communication may degrade throughout career progression, it is unknown what specific elements pose challenges. We aimed to characterize clerkship students' perspectives on communication challenges in the outpatient setting to help inform curricular development. METHODS Third-year medical students in a required family medicine clerkship were asked to describe a communication challenge they encountered. Open-ended written responses were collected through a mandatory post-clerkship survey. Responses were qualitatively coded using an a priori framework for teaching and assessing communication skills (The SEGUE Framework for Teaching and Assessing Communication Skills) with data-derived additions to the framework, followed by a team-based thematic analysis. RESULTS We collected 799 reflections written by 518 students from 2007-2014. Three dominant themes emerged from the analysis: challenges with (1) effectively exchanging information with patients, (2) managing emotional aspects of the patient encounter, and (3) negotiating terms of the encounter. CONCLUSIONS Communication curricula focus on content and process of the medical interview, but insufficient time and energy are devoted to psychosocial factors, including aspects of the encounter that are emotionally charged or conflicting. While gaps in students' communication skillsets may be anticipated or observed by educators, this study offers an analysis of students' own perceptions of the challenges they face.
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Liebert CA, Mazer L, Bereknyei Merrell S, Lin DT, Lau JN. Student perceptions of a simulation-based flipped classroom for the surgery clerkship: A mixed-methods study. Surgery 2016; 160:591-8. [PMID: 27262534 DOI: 10.1016/j.surg.2016.03.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/25/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The flipped classroom, a blended learning paradigm that uses pre-session online videos reinforced with interactive sessions, has been proposed as an alternative to traditional lectures. This article investigates medical students' perceptions of a simulation-based, flipped classroom for the surgery clerkship and suggests best practices for implementation in this setting. METHODS A prospective cohort of students (n = 89), who were enrolled in the surgery clerkship during a 1-year period, was taught via a simulation-based, flipped classroom approach. Students completed an anonymous, end-of-clerkship survey regarding their perceptions of the curriculum. Quantitative analysis of Likert responses and qualitative analysis of narrative responses were performed. RESULTS Students' perceptions of the curriculum were positive, with 90% rating it excellent or outstanding. The majority reported the curriculum should be continued (95%) and applied to other clerkships (84%). The component received most favorably by the students was the simulation-based skill sessions. Students rated the effectiveness of the Khan Academy-style videos the highest compared with other video formats (P < .001). Qualitative analysis identified 21 subthemes in 4 domains: general positive feedback, educational content, learning environment, and specific benefits to medical students. The students reported that the learning environment fostered accountability and self-directed learning. Specific perceived benefits included preparation for the clinical rotation and the National Board of Medical Examiners shelf exam, decreased class time, socialization with peers, and faculty interaction. CONCLUSION Medical students' perceptions of a simulation-based, flipped classroom in the surgery clerkship were overwhelmingly positive. The flipped classroom approach can be applied successfully in a surgery clerkship setting and may offer additional benefits compared with traditional lecture-based curricula.
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Affiliation(s)
- Cara A Liebert
- Goodman Surgical Education Center, Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
| | - Laura Mazer
- Goodman Surgical Education Center, Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sylvia Bereknyei Merrell
- Goodman Surgical Education Center, Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Dana T Lin
- Goodman Surgical Education Center, Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - James N Lau
- Goodman Surgical Education Center, Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
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