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Phillips Z, Mitsumoto J, Fisher H, Wilhite J, Hardowar K, Robertson V, Paige J, Shahroudi J, Albert S, Li J, Hanley K, Gillespie C, Altshuler L, Zabar S. Using Unannounced Standardized Patients to Assess Clinician Telehealth and Communication Skills at an Urban Student Health Center. J Adolesc Health 2024; 74:1033-1038. [PMID: 38430075 DOI: 10.1016/j.jadohealth.2024.01.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 01/04/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE As the COVID-19 pandemic forced most colleges and universities to go online, student health centers rapidly shifted to telehealth platforms without frameworks for virtual care provision. An urban student health center implemented a needs assessment involving unannounced standardized patients (USPs) to evaluate the integration of a new telehealth workflow and clinicians' virtual communication skills. METHODS From April to May 2021, USPs conducted two video visits with 12 primary care and four women's health clinicians (N = 16 clinicians; 32 visits). Cases included (1) a 21-year-old female presenting for birth control with a positive Patient Health Questionaire-9 and (2) a 21-year-old male, who vapes regularly, with questions regarding safe sex with men. Clinicians were evaluated using a checklist completed by the USP immediately following the visit and a systematic chart review of the electronic health record. RESULTS USP feedback indicates most clinicians received high ratings for general communication skills but may benefit from educational intervention in several key telemedicine skills. Clinicians struggled with using nonverbal signals to enrich communication (47% well done), acknowledging emotions (34% well done), and using video for information gathering (34% well done). Low rates of standard screenings (e.g., 63% administered the PHQ-2, <50% asked about alcohol use) suggested protocols for in-person care were not easily incorporated into telehealth practices, and clinicians may benefit from enhanced care team support. Performance reports were shared with clinicians and leadership postvisit. DISCUSSION Results suggest project design and implementation is scalable and feasible for use at other institutions, offering a structured methodology that can improve general student health care.
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Affiliation(s)
- Zoe Phillips
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York.
| | - Jun Mitsumoto
- New York University Student Health Center, New York, New York
| | - Harriet Fisher
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Jeffrey Wilhite
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Khemraj Hardowar
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | | | - Joquetta Paige
- New York University Student Health Center, New York, New York
| | - Julie Shahroudi
- New York University Student Health Center, New York, New York
| | - Sharon Albert
- New York University Student Health Center, New York, New York
| | - Jacky Li
- New York University Student Health Center, New York, New York
| | - Kathleen Hanley
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Lisa Altshuler
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
| | - Sondra Zabar
- Department of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
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Eidlisz J, Hill-Whilton Z, Vizgan G, Cobos D, Chitale S, Gillespie C, Dib N, Gold-von Simson G. Sharing best practices for educational programs on venture creation and commercialization. Nat Biotechnol 2024; 42:675-681. [PMID: 38632442 DOI: 10.1038/s41587-024-02199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Jordan Eidlisz
- New York University Grossman School of Medicine, New York, NY, USA.
- SUNY Downstate College of Medicine, Brooklyn, NY, USA.
| | | | - Gabriel Vizgan
- New York University Grossman School of Medicine, New York, NY, USA
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Daniel Cobos
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sadhana Chitale
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Nabil Dib
- International Society for Cardiovascular Translational Research, Phoenix, AZ, USA
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Park A, Gillespie C, Triola M, Buckvar-Keltz L, Greene RE, Winkel AF. Scaffolding the Transition to Residency: A Qualitative Study of Coach and Resident Perspectives. Acad Med 2024; 99:91-97. [PMID: 37683265 DOI: 10.1097/acm.0000000000005446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
PURPOSE This study explores coaching during transition from medical school to residency through the perspectives of residents and faculty coaches participating in a coaching program from residency match through the first year of residency. METHOD From January to September 2020, 15 faculty coaches in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology participated in a synchronous, in-person coaching training course. All 94 postgraduate year 1 residents in these 5 training programs participated. Between November 2021 and March 2022, focus groups were held with interns from all residency programs participating in the program. Interviews were conducted with faculty coaches in February 2022. Faculty and residents discussed their experiences with and perceptions of coaching. De-identified transcripts were coded, and researchers organized these codes into broader categories, generated cross-cutting themes from the concepts described in both cohorts, and proposed a model for the potential of coaching to support the transition to residency. Descriptive themes were constructed and analytic themes developed by identifying concepts that crossed the data sets. RESULTS Seven focus groups were held with 39 residents (42%). Residents discussed the goals of a coaching program, coach attributes, program factors, resident attributes, and the role of the coach. Coaches focused on productivity of coaching, coaching skills and approach, professional development, and scaffolding the coaching experience. Three analytic themes were created: (1) coaching as creating an explicit curriculum for growth through the transition to residency, (2) factors contributing to successful coaching, and (3) ways in which these factors confront graduate medical education norms. CONCLUSIONS Learner and faculty perspectives on coaching through the transition to residency reveal the potential for coaching to make an explicit and modifiable curriculum for professional growth and development. Creating structures for coaching in graduate medical education may allow for individualized professional development, improved mindset, self-awareness, and self-directed learning.
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Winkel AF, Gillespie C, Park A, Branzetti J, Cocks P, Greene RE, Zabar S, Triola M. Bridging the Gap from Student to Doctor: Developing Coaches for the Transition to Residency. Med Educ Online 2023; 28:2145103. [PMID: 36351566 PMCID: PMC9662029 DOI: 10.1080/10872981.2022.2145103] [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: 10/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND A lack of educational continuity creates disorienting friction at the onset of residency. Few programs have harnessed the benefits of coaching, which can facilitate self-directed learning, competency development, and professional identity formation, to help ease this transition. OBJECTIVE To describe the process of training faculty Bridge Coaches for the Transition to Residency Advantage (TRA) program for interns. METHODS Nineteen graduate faculty educators participated in a coaching training course with formative skills assessment as part of a faculty development program starting in January 2020. Surveys (n = 15; 79%) and a focus group (n = 7; 37%) were conducted to explore the perceived impact of the training course on coaching skills, perceptions of coaching, and further program needs during the pilot year of the TRA program. RESULTS Faculty had strong skills around establishing trust, authentic listening, and supporting goal-setting. They required more practice around guiding self-discovery and following a coachee-led agenda. Faculty found the training course to be helpful for developing coaching skills. Faculty embraced their new roles as coaches and appreciated having a community of practice with other coaches. Suggestions for improvement included more opportunities to practice and receive feedback on skills and additional structures to further support TRA program encounters with coaches. CONCLUSIONS The faculty development program was feasible and had good acceptance among participants. Faculty were well-suited to serve as coaches and valued the coaching mindset. Adequate skills reinforcement and program structure were identified as needs to facilitate a coaching program in graduate medical education.
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Affiliation(s)
- Abigail Ford Winkel
- Department of Obstetrics and Gynecology, Assistant Director for Education Scholarship in the Institute of Innovations in Medical Education and Co-Director of the Transition to Residency Course at the NYU Grossman School of Medicine, New York
| | - Colleen Gillespie
- Department of Medicine and Director of the Division of Education Quality at the NYU, Grossman School of Medicine
| | - Agnes Park
- Department of Medicine at the NYU, Grossman School of Medicine
| | - Jeremy Branzetti
- Emergency Medicine Physician at Geisinger Community Medical Center, Geinsinger Health System, Danville, PA
| | - Patrick Cocks
- Department of Medicine and the Director of the Internal Medicine Residency Program at the NYU, Grossman School of Medicine
| | - Richard E. Greene
- Department of Medicine and the Director of the Division of Education Quality at the NYU, Grossman School of Medicine
| | - Sondra Zabar
- Department of Medicine, and Director of the Standardized Patient Program at the NYU Grossman School of Medicine
| | - Marc Triola
- Department of Medicine and Associate Dean for Educational Informatics and Director, Institute for Innovations in Medical Education at NYU Grossman School of Medicine
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Gillespie C, Wilhite JA, Hanley K, Hardowar K, Altshuler L, Fisher H, Porter B, Wallach A, Zabar S. Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs. BMJ Qual Saf 2023; 32:632-643. [PMID: 35623722 DOI: 10.1136/bmjqs-2021-013904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although efforts are underway to address social determinants of health (SDOH), little is known about physicians' SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs. METHODS Unannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a 'proxy' comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams. RESULTS 108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing issue increased for teams that received audit/feedback reports (46%-60%; p=0.045) and declined for the proxy comparison (61%-42%; p=0.174). Rates of responding to housing needs increased significantly for intervention teams (15%-41%; p=0.004) but not for the comparison team (21%-29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams. CONCLUSIONS Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response.
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Affiliation(s)
- Colleen Gillespie
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York, USA
| | - Jeffrey A Wilhite
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Kathleen Hanley
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Khemraj Hardowar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Harriet Fisher
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Barbara Porter
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
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Adams JE, Williams R, Gillespie C, Minsky M, LaPook J, Greene R, Ravenell J, Dennehy J, Gonzalez CM. Using an Animated Film to Foster Understanding of and Engagement in Addressing Implicit Bias Through Empathy Across the Health Care Continuum. Acad Med 2023; 98:S169. [PMID: 37983411 DOI: 10.1097/acm.0000000000005389] [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: 10/27/2023]
Affiliation(s)
- Jennifer E Adams
- Author affiliations: J.E. Adams, C. Gillespie, M. Minsky, J. LaPook, Center for Empathy in Medicine, Institute for Innovations in Medical Education, NYU Grossman School of Medicine; R. Williams, J. Dennehy, C.M. Gonzalez, Institute for Excellence in Health Equity, NYU Langone Health; R. Greene, J. Ravenell, Office of Diversity Affairs, NYU Grossman School of Medicine
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Paul CR, Poag M, Horlick M, Koscica N, Park A, Schaye V, Gillespie C. A Mixed Methods Analysis Using an Implementation Science Framework to Assess a New Workplace-Based Assessment Program for Medical Students. Acad Med 2023; 98:S213-S214. [PMID: 37983460 DOI: 10.1097/acm.0000000000005345] [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: 10/27/2023]
Affiliation(s)
- Caroline R Paul
- Author affiliations: C.R. Paul, M. Poag, M. Horlick, N. Koscica, A. Park, V. Schaye, C. Gillespie, NYU Grossman School of Medicine
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Altshuler L, Wilhite JA, Hardowar K, Crowe R, Hanley K, Kalet A, Zabar S, Gillespie C, Ark T. Understanding medical student paths to communication skills expertise using latent profile analysis. Med Teach 2023; 45:1140-1147. [PMID: 36961759 DOI: 10.1080/0142159x.2023.2193303] [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] [Indexed: 06/18/2023]
Abstract
PURPOSE To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. MATERIALS AND METHODS Performance data from 1182 consenting third year medical students in 9 cohorts (2011-2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. RESULTS Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner's skill profiles. CONCLUSION Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching.
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Affiliation(s)
- Lisa Altshuler
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Jeffrey A Wilhite
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Khemraj Hardowar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ruth Crowe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Kathleen Hanley
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Adina Kalet
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sondra Zabar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, NY, USA
| | - Tavinder Ark
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
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Triola MM, Reinstein I, Marin M, Gillespie C, Abramson S, Grossman RI, Rivera R. Artificial Intelligence Screening of Medical School Applications: Development and Validation of a Machine-Learning Algorithm. Acad Med 2023; 98:1036-1043. [PMID: 36888969 DOI: 10.1097/acm.0000000000005202] [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: 06/18/2023]
Abstract
PURPOSE To explore whether a machine-learning algorithm could accurately perform the initial screening of medical school applications. METHOD Using application data and faculty screening outcomes from the 2013 to 2017 application cycles (n = 14,555 applications), the authors created a virtual faculty screener algorithm. A retrospective validation using 2,910 applications from the 2013 to 2017 cycles and a prospective validation using 2,715 applications during the 2018 application cycle were performed. To test the validated algorithm, a randomized trial was performed in the 2019 cycle, with 1,827 eligible applications being reviewed by faculty and 1,873 by algorithm. RESULTS The retrospective validation yielded area under the receiver operating characteristic (AUROC) values of 0.83, 0.64, and 0.83 and area under the precision-recall curve (AUPRC) values of 0.61, 0.54, and 0.65 for the invite for interview, hold for review, and reject groups, respectively. The prospective validation yielded AUROC values of 0.83, 0.62, and 0.82 and AUPRC values of 0.66, 0.47, and 0.65 for the invite for interview, hold for review, and reject groups, respectively. The randomized trial found no significant differences in overall interview recommendation rates according to faculty or algorithm and among female or underrepresented in medicine applicants. In underrepresented in medicine applicants, there were no significant differences in the rates at which the admissions committee offered an interview (70 of 71 in the faculty reviewer arm and 61 of 65 in the algorithm arm; P = .14). No difference in the rate of the committee agreeing with the recommended interview was found among female applicants (224 of 229 in the faculty reviewer arm and 220 of 227 in the algorithm arm; P = .55). CONCLUSIONS The virtual faculty screener algorithm successfully replicated faculty screening of medical school applications and may aid in the consistent and reliable review of medical school applicants.
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Affiliation(s)
- Marc M Triola
- M.M. Triola is associate dean of educational informatics and director, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-6303-3112
| | - Ilan Reinstein
- I. Reinstein is a data scientist, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York
| | - Marina Marin
- M. Marin is director, Division of Academic Analytics, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- C. Gillespie is director, Division of Education Quality, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York
| | - Steven Abramson
- S. Abramson is vice dean for education, faculty, and academic affairs and chief academic officer, NYU Grossman School of Medicine, New York, New York
| | - Robert I Grossman
- R.I. Grossman is chief executive officer, NYU Langone Health, and dean, NYU Grossman School of Medicine, New York, New York
| | - Rafael Rivera
- R. Rivera Jr is associate dean for admission and financial aid, NYU Grossman School of Medicine, New York, New York
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Winkel AF, Chang LY, McGlone P, Gillespie C, Triola M. SMARTer Goalsetting: A Pilot Innovation for Coaches During the Transition to Residency. Acad Med 2023; 98:585-589. [PMID: 36652456 DOI: 10.1097/acm.0000000000005153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PROBLEM Ability to set goals and work with coaches can support individualized, self-directed learning. Understanding the focus and quality of graduating medical student and first-year resident goals and the influence of coaching on goal-setting can inform efforts to support learners through the transition from medical school to residency. APPROACH This observational study examined goal-setting among graduating medical students and first-year residents from April 2021 to March 2022. The medical students set goals while participating in a Transition to Residency elective. The residents in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology set goals through meeting 1:1 with coaches. Raters assessed goals using a 3-point rubric on domains of specific, measurable, attainable, relevant, and timely (i.e., SMART goal framework) and analyzed descriptive statistics, Mann-Whitney U tests, and linear regressions. OUTCOMES Among 48 medical students, 30 (62.5%) set 108 goals for early residency. Among 134 residents, 62 (46.3%) entered goals. Residents met with coaches 2.8 times on average (range 0-8 meetings, median = 3). Goal quality was higher in residents than medical students (average score for S: 2.71 vs 2.06, P < .001; M: 2.38 vs 1.66, P < .001; A: 2.92 vs 2.64, P < .001; R: 2.94 vs 2.86, P = .002; T: 1.71 vs 1.31, P < .001). The number of coaching meetings was associated with more specific, measurable goals (specific: F [1, 1.02] = 6.56, P = .01, R2 = .10; measurable: F [1, 1.49] = 4.74, P = .03, R2 = .07). NEXT STEPS Learners set realistic, attainable goals through the transition to residency, but the goals could be more specific, measurable, and timely. The residents set SMARTer goals, with coaching improving goal quality. Understanding how best to scaffold coaching and support goal-setting through this transition may improve trainees' self-directed learning and well-being.
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Affiliation(s)
- Abigail Ford Winkel
- A.F. Winkel is professor, Department of Obstetrics & Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Lucy Y Chang
- L.Y. Chang is clinical associate professor, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Pauline McGlone
- P. McGlone is program manager, Office of Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- C. Gillespie is director, Division of Education Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Marc Triola
- M. Triola is associate dean for educational informatics, director, Institute for Innovations in Medical Educationassociate professor, Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Cocco AM, Chai V, Read M, Ward S, Johnson MA, Chong L, Gillespie C, Hii MW. Percentage of intrathoracic stomach predicts operative and post-operative morbidity, persistent reflux and PPI requirement following laparoscopic hiatus hernia repair and fundoplication. Surg Endosc 2023; 37:1994-2002. [PMID: 36278994 PMCID: PMC10017603 DOI: 10.1007/s00464-022-09701-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Large hiatus hernias are relatively common and can be associated with adverse symptoms and serious complications. Operative repair is indicated in this patient group for symptom management and the prevention of morbidity. This study aimed to identify predictors of poor outcomes following laparoscopic hiatus hernia repair and fundoplication (LHHRaF) to aid in counselling potential surgical candidates. METHODOLOGY A retrospective analysis was performed from a prospectively maintained, multicentre database of patients who underwent LHHRaF between 2014 and 2020. Revision procedures were excluded. Hernia size was defined as the intraoperative percentage of intrathoracic stomach, estimated by the surgeon to the nearest 10%. Predictors of outcomes were determined using a prespecified multivariate logistic regression model. RESULTS 625 patients underwent LHHRaF between 2014 and 2020 with 443 patients included. Median age was 65 years, 62.9% were female and 42.7% of patients had ≥ 50% intrathoracic stomach. In a multivariate regression model, intrathoracic stomach percentage was predictive of operative complications (P = 0.014, OR 1.05), post-operative complications (P = 0.026, OR 1.01) and higher comprehensive complication index score (P = 0.023, OR 1.04). At 12 months it was predictive of failure to improve symptomatic reflux (P = 0.008, OR 1.02) and persistent PPI requirement (P = 0.047, OR 1.02). Operative duration and blood loss were predicted by BMI (P = 0.004 and < 0.001), Type III/IV hernias (P = 0.045 and P = 0.005) and intrathoracic stomach percentage (P = 0.009 and P < 0.001). Post-operative length of stay was predicted by age (P < 0.001) and emergency presentation (P = 0.003). CONCLUSION In a multivariate regression model, intrathoracic stomach percentage was predictive of operative and post-operative morbidity, PPI use, and failure to improve reflux symptoms at 12 months.
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Affiliation(s)
- A M Cocco
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia.
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia.
| | - V Chai
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - M Read
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - S Ward
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia
| | - M A Johnson
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - L Chong
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - C Gillespie
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - M W Hii
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, Eastern Health, Melbourne, Australia
- Upper GI and Hepatobiliary Surgical Unit, The Royal Melbourne Hospital, Melbourne, Australia
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12
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Vizgan G, Hill-Whilton Z, Achuonjei J, Schweickart T, Chitale S, Gillespie C, Gold-von Simson G. Longitudinal data support university-based biomedical entrepreneurship education programs. Nat Biotechnol 2023; 41:429-431. [PMID: 36922690 PMCID: PMC10122420 DOI: 10.1038/s41587-023-01701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Gabriel Vizgan
- New York University Grossman School of Medicine, New York, NY, USA. .,SUNY Downstate College of Medicine, Brooklyn, NY, USA.
| | | | - Joy Achuonjei
- New York University Grossman School of Medicine, New York, NY, USA.,Hofstra University Zucker School of Medicine, Uniondale, NY, USA
| | - Tucker Schweickart
- New York University Grossman School of Medicine, New York, NY, USA.,University of Kentucky College of Medicine, Lexington, KY, USA
| | - Sadhana Chitale
- New York University Grossman School of Medicine, New York, NY, USA
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13
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Popeo DM, Gillespie C. You can teach students to give better feedback. Med Educ 2022; 56:1117-1118. [PMID: 35989363 DOI: 10.1111/medu.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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14
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Altshuler L, Ark T, Wilhite J, Hardowar K, Crowe R, Hanley K, L Kalet A, Zabar S, Gillespie C. Using Latent Profile Analysis to Describe and Understand Medical Student Paths to Communication Skills Expertise. Academic Medicine 2022; 97:S151. [PMID: 37838883 DOI: 10.1097/acm.0000000000004814] [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: 07/20/2023]
Affiliation(s)
- Lisa Altshuler
- Author affiliations: L. Altshuler, J. Wilhite, K. Hardowar, R. Crowe, K. Hanley, S. Zabar, C. Gillespie, NYU Grossman School of Medicine; T. Ark, A.L. Kalet, Medical College of Wisconsin
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15
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Wilhite JA, Phillips Z, Altshuler L, Fisher H, Gillespie C, Goldberg E, Wallach A, Hanley K, Zabar S. Does it get better? An ongoing exploration of physician experiences with and acceptance of telehealth utilization. J Telemed Telecare 2022:1357633X221131220. [PMID: 36221982 DOI: 10.1177/1357633x221131220] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION COVID-19 forced health systems to rapidly implement telehealth for routine practice, often without sufficient training or standards. We conducted a longitudinal survey of physicians to explore changes in their perceptions of the challenges and benefits of telehealth and identify recommendations for future practice. METHODS An anonymous online survey was distributed to a cohort of internal medicine physicians in May to June 2020 and March to June 2021. Changes in responses between 2020 and 2021 and by site (private vs. public) were described. These findings, along with those of a thematic analysis of open-ended responses to questions on telehealth experiences, informed a set of recommendations. RESULTS The survey response rate was 111/391 in 2021 compared to 122/378 in 2020. Fewer physicians reported that telehealth was more difficult than in person with regards to taking a history (49% in 2020, 33% in 2021, p= 0.015), maximizing patient adherence (33% in 2020, 19% in 2021, p = 0.028), and maintaining patient relationships (31%, 25%, p = 0.009) in 2021. Similar proportions of physicians reported continued challenges with building new patient relationships (75%, 77%, p = 0.075), educating patients (40%, 32%, p = 0.393), and working collaboratively with their team (38%, 41%, p = 0.794). Physicians reported increased satisfaction with tele-visits over in-person visits (13%, 27%, p = 0.006) and less worry over doing future tele-visits (45%, 31%, p = 0.027). Physicians' open-ended responses identified recommendations for further improving the design and use of telehealth. DISCUSSION Results suggest that physician experience with telehealth improved but opportunities for training and improved integration remain. Longitudinal assessment can deepen understanding of the evolution of telehealth care.
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Affiliation(s)
- Jeffrey A Wilhite
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Zoe Phillips
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Harriet Fisher
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Eric Goldberg
- 2012New York City Health+Hospitals, New York, NY, USA
| | | | - Kathleen Hanley
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, 12297NYU Langone Health, New York, NY, USA
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16
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Vizgan G, Hill-Whilton Z, Gillespie C, Cobos D, Johnson L, Dib N, Gold-von Simson G. Integrating medicine, engineering and business to educate early-stage researchers in cardiovascular device development. Nat Biotechnol 2022; 40:1528-1529. [PMID: 36207597 PMCID: PMC9743434 DOI: 10.1038/s41587-022-01498-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Device development is a burgeoning, innovative industry, yet early stage scientists have little knowledge of venture creation and the steps required to develop a device, likely contributing to the high failure rate of device technology. At present, there is no national program that provides specialty education for biomedical product development. In response to this critical problem, the Translational Pathways for Cardiovascular Devices course was developed with the goal of integrating medicine, engineering, and business education to targeted multidisciplinary early stage researchers. Pilot data show there was a greater than 300% increase in cardiac device translational practices competency; 67% of respondents indicated they planned to develop a cardiac device. The data highlight the need to develop a device development educational core to further enhance national, international and multidisciplinary innovation and collaboration in the biomedical device domain.
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Affiliation(s)
- Gabriel Vizgan
- New York University Grossman School of Medicine, New York, New York, USA. .,SUNY Downstate College of Medicine, Brooklyn, New York, USA.
| | | | | | - Daniel Cobos
- New York University Grossman School of Medicine, NY, USA
| | - LeAnn Johnson
- International Society for Cardiovascular Translational Research, Phoenix, AZ, USA
| | - Nabil Dib
- International Society for Cardiovascular Translational Research, Phoenix, AZ, USA
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17
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Cangiarella J, Eliasz K, Kalet A, Cohen E, Abramson S, Gillespie C. A Preliminary Evaluation of Students' Learning and Performance Outcomes in an Accelerated 3-Year MD Pathway Program. J Grad Med Educ 2022; 14:99-107. [PMID: 35222827 PMCID: PMC8848877 DOI: 10.4300/jgme-d-21-00284.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Little outcome data exist on 3-year MD (3YMD) programs to guide residency program directors (PDs) in deciding whether to select these graduates for their programs. OBJECTIVE To compare performance outcomes of 3YMD and 4-year MD (4YMD) students at New York University Grossman School of Medicine. METHODS In 2020, using the Kirkpatrick 4-level evaluation model, outcomes from 3 graduating cohorts of 3YMD students (2016-2018) were compared with the 4YMD counterparts. RESULTS Descriptive statistics compared outcomes among consented student cohorts: 92% (49 of 53) 3YMD, 87% (399 of 459) 4YMD-G, and 84% (367 of 437) 4YMD-S. Student survey response rates were 93% (14 of 15), 74% (14 of 19), and 89% (17 of 19) from 2016 to 2018. PDs' response rates were 58% (31 of 53, 3YMD) and 51% (225 of 441, 4YMD). Besides age, 3YMD and 4YMD cohorts did not differ significantly in admissions variables. Other than small statistically significant differences in the medicine shelf examination (3YMD mean 74.67, SD 7.81 vs 4YMD-G mean 78.18, SD 7.60; t test=3.02; P=.003) and USMLE Step 1 (3YMD mean 235.13, SD 17.61 vs 4YMD-S mean 241.70, SD 15.92; t test=2.644; P=.009 and vs 4YMD-G mean 242.39, SD 15.65; t test=2.97; P=.003) and Step 2 CK scores (3YMD mean 242.57, SD 15.58 vs 4YMD-S mean 248.55, SD 15.33; t test=2.55; P=.01 and vs 4YMD-G mean 247.83, SD 15.38; t test=2.97; P=.03), other metrics and overall intern ratings did not differ by pathway. CONCLUSIONS Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.
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Affiliation(s)
- Joan Cangiarella
- Joan Cangiarella, MD, is Associate Dean of Education and Faculty, Associate Professor of Pathology, and Director, Accelerated 3-Year MD Pathway, New York University Grossman School of Medicine
| | - Kinga Eliasz
- Kinga Eliasz, PhD, is a Postdoctoral Research Scientist, New York University Grossman School of Medicine
| | - Adina Kalet
- Adina Kalet, MD, MPH, is Director, Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin
| | - Elisabeth Cohen
- Elisabeth Cohen, MD, is Professor of Ophthalmology and Accelerated 3-Year MD Pathway Advisor, New York University Grossman School of Medicine
| | - Steven Abramson
- Steven Abramson, MD, is Vice Dean for Education, Faculty and Academic Affairs, New York University Grossman School of Medicine
| | - Colleen Gillespie
- Colleen Gillespie, PhD, is Director, Division of Education Quality, and Associate Professor of Medicine, New York University Grossman School of Medicine
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18
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Leong SL, Gillespie C, Jones B, Fancher T, Coe CL, Dodson L, Hunsaker M, Thompson BM, Dempsey A, Pallay R, Crump W, Cangiarella J. Accelerated 3-Year MD Pathway Programs: Graduates' Perspectives on Education Quality, the Learning Environment, Residency Readiness, Debt, Burnout, and Career Plans. Acad Med 2022; 97:254-261. [PMID: 34380931 PMCID: PMC8781222 DOI: 10.1097/acm.0000000000004332] [Citation(s) in RCA: 4] [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: 05/23/2023]
Abstract
PURPOSE To compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans. METHOD Customized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools. RESULTS GQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student-faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons). CONCLUSIONS These findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.
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Affiliation(s)
- Shou Ling Leong
- S.L. Leong is assistant dean, Pathways Innovation, and director, 3+ Accelerated Pathway, Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-2954-5381
| | - Colleen Gillespie
- C. Gillespie is director, Division of Education Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Betsy Jones
- B. Jones is chair, Department of Medical Education, and codirector, Family Medicine Accelerated Track, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Tonya Fancher
- T. Fancher is associate dean, Workforce Innovation and Community Engagement, University of California Davis School of Medicine, Sacramento, California
| | - Catherine L. Coe
- C.L. Coe is assistant professor of family medicine and director, Fully Integrated Readiness for Service Training (FIRST) Program, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Lisa Dodson
- L. Dodson is campus dean, Medical College of Wisconsin–Central Wisconsin, Wasau, Wisconsin
| | - Matthew Hunsaker
- M. Hunsaker is campus dean, Medical College of Wisconsin–Green Bay, Green Bay, Wisconsin
| | - Britta M. Thompson
- B.M. Thompson is associate dean, Assessment and Evaluation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Angela Dempsey
- A. Dempsey is associate dean, Curriculum in the Clinical Sciences, Medical University of South Carolina College of Medicine, Charleston, South Carolina
| | - Robert Pallay
- R. Pallay is chair and program director, Family Medicine, Mercer University School of Medicine, Macon, Georgia
| | - William Crump
- W. Crump is associate dean, Trover Campus, University of Louisville School of Medicine, Madisonville, Kentucky
| | - Joan Cangiarella
- J. Cangiarella is associate dean, Education, Faculty and Academic Affairs, and director, Accelerated Three Year MD Pathway, New York University Grossman School of Medicine, New York, New York
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19
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Wilhite JA, Altshuler L, Fisher H, Gillespie C, Hanley K, Goldberg E, Wallach A, Zabar S. The Telemedicine Takeover: Lessons Learned During an Emerging Pandemic. Telemed J E Health 2021; 28:353-361. [PMID: 34115538 DOI: 10.1089/tmj.2021.0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Health care systems rose to the challenges of COVID-19 by creating or expanding telehealth programs to ensure that patients could access care without an in-person appointment. Traditionally, physicians receive limited formal telemedicine training, making preparedness for this transition uneven. To describe challenges to and attitudes toward providing virtual patient care, we distributed a survey to physicians within our system who largely had no formal prior training/experience with telemedicine, but transitioned to routine telemedicine use. Data collected are then used to offer actionable recommendations for health system leaders and medical educators. Materials and Methods: Surveys were distributed to all faculty outpatient general internal medicine physicians working at any New York University Langone Health, New York City Health + Hospitals/Bellevue and Gouverneur, and the VA NY Harbor Health System (n = 378) in mid-2020. Survey items consisted of Likert and open-ended questions related to experience with televisits (13 items) and attitudes toward care (24 items). Results: Telehealth-related challenges varied by site and modality. Primary challenges included establishing a connection from the patient's (98%) or physician's end (84%) and difficulty in the following domains: working with team members (39%), physical examinations (95%), establishing new patient relationships (70%), and taking history (40%), among others. In thematic analysis, significant themes with illustrative qualitative commentary emerged related to technological challenges, new systems issues, and new patient/physician communication experiences. Discussion: Experience differences were rooted in the type of technology employed. Safety-net practices conducted mostly telephonic visits, whereas private outpatient sites utilized video, despite both using identical electronic medical records. As we consider a "new normal" and prolonged community transmission of COVID-19 infection, it is essential to establish telemedicine training, tools, and protocols that meet the needs of both patients and physicians.
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Affiliation(s)
- Jeffrey A Wilhite
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Harriet Fisher
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Colleen Gillespie
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Kathleen Hanley
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.,New York City Health + Hospitals, New York, New York, USA
| | - Eric Goldberg
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrew Wallach
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.,New York City Health + Hospitals, New York, New York, USA
| | - Sondra Zabar
- Department of Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA.,New York City Health + Hospitals, New York, New York, USA
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20
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Bandyopadhyay S, Georgiou I, Baykeens B, Gillespie C, de Andres Crespo M, Bashir M, Handa A, Saunders K. 13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors. Br J Surg 2021. [PMCID: PMC8135683 DOI: 10.1093/bjs/znab135.035] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought. Method A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. Results A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p < 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university. Conclusions When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.
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Affiliation(s)
| | - I Georgiou
- University of Aberdeen, Aberdeen, United Kingdom
| | - B Baykeens
- Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
| | - C Gillespie
- University of Liverpool, Liverpool, United Kingdom
| | | | - M Bashir
- University of Aberdeen, Aberdeen, United Kingdom
| | - A Handa
- University of Oxford, Oxford, United Kingdom
| | - K Saunders
- University of Oxford, Oxford, United Kingdom
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21
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Taweel B, Gillespie C, Ali T, Islim A, Hannan C, Chavredakis E. 878 Comparing Treatment Outcomes for Unruptured Brain Arteriovenous Malformations: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.213] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Unruptured brain arteriovenous malformations (bAVMs) carry a lifetime risk of haemorrhage. Treatment strategies include conservative management, microsurgical excision, endovascular treatment (EVT) and radiosurgery (SRS). Optimal treatment selection remains unclear.
Method
A single-centre retrospective cohort study of adult unruptured bAVMs (2007-2019). Patients who underwent intervention were propensity matched using baseline features (age, sex, size, deep drainage, eloquence, and Spetzler-Martin grade) with patients conservatively managed. Rates of neurological disability and mortality due to intervention or bleed were compared.
Results
137 patients (mean age 48 years [SD = 16], males 64) were included; 34 (25%) EVT, 20 (15%) surgery, 31 (22%) SRS and 51 (37%) conservative. After a median follow-up of 49 months (IQR 23-75), rates of disability were as follows: surgery 35%, EVT 21%, SRS 13% and conservative 8%. Matched cohorts (intervention/conservative) were: surgery-19/18, SRS-30/22 and EVT-33/34. Comparison of disability rates across matched cohorts revealed no statistically significant differences (surgery p = 0.07, SRS p = 0.65 and EVT p = 0.11). Three conservatively managed patients died.
Conclusions
Unruptured bAVMs carry a significant risk of neurological morbidity, regardless of intervention choice. Treatment choice may have an impact on patient outcomes but requires investigation of stratified cohorts. Findings are consistent with the nuances of AVM treatment selection.
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Affiliation(s)
- B Taweel
- University of Liverpool, Liverpool, United Kingdom
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - C Gillespie
- University of Liverpool, Liverpool, United Kingdom
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - T Ali
- University of Liverpool, Liverpool, United Kingdom
| | - A Islim
- University of Liverpool, Liverpool, United Kingdom
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - C Hannan
- Walton Centre Foundation Trust, Liverpool, United Kingdom
| | - E Chavredakis
- University of Liverpool, Liverpool, United Kingdom
- Walton Centre Foundation Trust, Liverpool, United Kingdom
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22
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Gold-von Simson G, Gilon-Yanai M, Gillespie C, Chitale S, Achuonjei J, Cobos D. Cultivating a New Generation of Biomedical Entrepreneurs. Scientia (Bristol) 2021; 2021:90-93. [PMID: 34194817 DOI: 10.33548/scientia605] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent years, scientific and technological advances have brought great innovation within the life sciences industry, introducing the need for entrepreneurship training for medical and engineering graduates. With this in mind, Michal Gilon-Yanai, Dr Robert Schneider and their collaborators developed an academic program designed to provide students and faculty members with the skills they need to become successful entrepreneurs. The team of collaborators includes Dr Gabrielle Gold-von Simson, an expert in implementing academic programs, and Dr Colleen Gillespie, who specialises in education, evaluation and dissemination science. Their pioneering program trains students on how to bring new biomedical technologies to the market.
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Affiliation(s)
| | | | | | | | - Joy Achuonjei
- The Zucker School of Medicine at Hofstra/Northwell Hempstead, NY
| | - Daniel Cobos
- The NYU Grossman School of Medicine NYU Clinical and Translational Sciences Institute (CTSI) New York, NY
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Abstract
PURPOSE To describe the effect of transgender health-related objective structured clinical examination (THOSCE) case exposure on learner activation regarding gender-affirming care. METHOD A modified grounded theory approach was applied to identify the educational value of THOSCE cases. Focus groups with current and former primary care internal medicine residents who participated in THOSCE cases were conducted in 2018-2019. Transcripts were analyzed and coded until saturation to identify themes. RESULTS Eighteen (72%) eligible learners participated in the focus groups. Themes were identified relating to gender-affirming care, and modified grounded theory analysis was used as a framework to organize the themes into 4 stages of learner activation: (1) believing the learner role is important, (2) having the confidence and knowledge necessary to take action, (3) taking action to maintain and improve one's skills, and (4) staying the course even under stress. CONCLUSIONS Residents were grateful for the opportunity to practice the skills involved in transgender health in a simulation. Many felt unprepared and were concerned about how they were perceived by the standardized patient and faculty. Residents identified feeling more comfortable with gender-affirming language in the inpatient setting, which may provide an opportunity for learning in the future. Residents identified the psychosocial skills of gender-affirming care as more directly relevant while biomedical aspects of gender-affirming care seemed less accessible to residents, given the lack of outpatient experience. The authors propose a staged approach to teaching the skills of gender-affirming care using simulation to address learners of all levels.
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Affiliation(s)
- Richard E Greene
- R.E. Greene is associate professor of internal medicine and director, Health Disparities Education, Office of Diversity Affairs, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0001-8618-7723
| | - Gaines Blasdel
- G. Blasdel is research associate, Department of Urology, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-5431-6540
| | - Tiffany E Cook
- T.E. Cook is program manager, Training and Professional Development, Office of Diversity Affairs, New York University Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- C. Gillespie is associate professor, Department of Medicine, and director, Division of Educational Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
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24
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Wilhite JA, Fisher H, Altshuler L, Cannell E, Hardowar K, Hanley K, Gillespie C, Zabar S. Gasping for air: measuring patient education and activation skillsets in two clinical assessment contexts. BMJ Simul Technol Enhanc Learn 2020; 7:428-430. [DOI: 10.1136/bmjstel-2020-000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022]
Abstract
Objective structured clinical examinations (OSCEs) provide a controlled, simulated setting for competency assessments, while unannounced simulated patients (USPs) measure competency in situ or real-world settings. This exploratory study describes differences in primary care residents’ skills when caring for the same simulated patient case in OSCEs versus in a USP encounter. Data reported describe a group of residents (n=20) who were assessed following interaction with the same simulated patient case in two distinct settings: an OSCE and a USP visit at our safety-net clinic from 2009 to 2010. In both scenarios, the simulated patient presented as an asthmatic woman with limited understanding of illness management. Residents were rated through a behaviourally anchored checklist on visit completion. Summary scores (mean % well done) were calculated by domain and compared using paired sample t-tests. Residents performed significantly better with USPs on 7 of 10 items and in two of three aggregate assessment domains (p<0.05). OSCE structure may impede assessment of activation and treatment planning skills, which are better assessed in real-world settings. This exploration of outcomes from our two assessments using the same clinical case lays a foundation for future research on variation in situated performance. Using both assessments during residency will provide a more thorough understanding of learner competency.
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Wilhite JA, Altshuler L, Zabar S, Gillespie C, Kalet A. Development and maintenance of a medical education research registry. BMC Med Educ 2020; 20:199. [PMID: 32560652 PMCID: PMC7305610 DOI: 10.1186/s12909-020-02113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/20/2019] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Medical Education research suffers from several methodological limitations including too many single institution, small sample-sized studies, limited access to quality data, and insufficient institutional support. Increasing calls for medical education outcome data and quality improvement research have highlighted a critical need for uniformly clean and easily accessible data. Research registries may fill this gap. In 2006, the Research on Medical Education Outcomes (ROMEO) unit of the Program for Medical Innovations and Research (PrMEIR) at New York University's (NYU) Robert I. Grossman School of Medicine established the Database for Research on Academic Medicine (DREAM). DREAM is a database of routinely collected, de-identified undergraduate (UME, medical school leading up to the Medical Doctor degree) and graduate medical education (GME, residency also known as post graduate education leading to eligibility for specialty board certification) outcomes data available, through application, to researchers. Learners are added to our database through annual consent sessions conducted at the start of educational training. Based on experience, we describe our methods in creating and maintaining DREAM to serve as a guide for institutions looking to build a new or scale up their medical education registry. RESULTS At present, our UME and GME registries have consent rates of 90% (n = 1438/1598) and 76% (n = 1988/2627), respectively, with a combined rate of 81% (n = 3426/4225). 7% (n = 250/3426) of these learners completed both medical school and residency at our institution. DREAM has yielded a total of 61 individual studies conducted by medical education researchers and a total of 45 academic journal publications. CONCLUSION We have built a community of practice through the building of DREAM and hope, by persisting in this work the full potential of this tool and the community will be realized. While researchers with access to the registry have focused primarily on curricular/ program evaluation, learner competency assessment, and measure validation, we hope to expand the output of the registry to include patient outcomes by linking learner educational and clinical performance across the UME-GME continuum and into independent practice. Future publications will reflect our efforts in reaching this goal and will highlight the long-term impact of our collaborative work.
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Affiliation(s)
- Jeffrey A Wilhite
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Robert I. Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA.
| | - Lisa Altshuler
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Robert I. Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Sondra Zabar
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Robert I. Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Colleen Gillespie
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Robert I. Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
- Institute for Innovations in Medical Education, Division of Education Quality, 550 First Avenue, Medical Science Building, Suite G107, New York, NY, 10016, USA
| | - Adina Kalet
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Robert I. Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
- Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, USA
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Cangiarella J, Cohen E, Rivera R, Gillespie C, Abramson S. Evolution of an Accelerated 3-Year Pathway to the MD Degree: The Experience of New York University Grossman School of Medicine. Acad Med 2020; 95:534-539. [PMID: 31577593 DOI: 10.1097/acm.0000000000003013] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The revision of the curriculum at New York University Grossman School of Medicine in 2010, with a reduction of the preclerkship curriculum to 18 months, made it possible to offer an accelerated 3-year pathway in 2013 for students who know their career path. The goals of the program include individualizing education, reducing student debt, and integrating undergraduate and graduate medical education. This accelerated 3-year doctor of medicine (3YMD) pathway is the first program of its kind in the United States to offer conditional acceptance to residency programs in all specialties through the National Resident Matching Program. Since inception of the pathway 6 years ago, 81 students have graduated. Critical components to successfully launch and implement the program are described.Unwavering commitment to the program as a high institutional priority by the dean and vice dean for education facilitated the support required by department chairs and residency program directors and the flexibility needed for success. Alignment between the 3- and 4-year pathways has made it possible to add points of entry into the 3-year pathway during the second and third years and to shift back into the 4-year pathway, as warranted. Modifications to how 3YMD students are mentored included changing the role of the departmental advisor and adding a dedicated 3YMD pathway advisor who serves as an advocate for both the students and the program. Having a relatively large number of 3YMD students has contributed to the success of the program and facilitated acceptance by the residencies.
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Affiliation(s)
- Joan Cangiarella
- J. Cangiarella is associate dean of education and faculty, associate professor of pathology, and director, Accelerated 3-Year MD Pathway, New York University Grossman School of Medicine, New York, New York. E. Cohen is professor of ophthalmology and 3-Year MD pathway advisor, New York University Grossman School of Medicine, New York, New York. R. Rivera is associate dean for admissions and financial aid and assistant professor of radiology, New York University Grossman School of Medicine, New York, New York. C. Gillespie is director, Division of Education Quality, and associate professor of medicine, New York University Grossman School of Medicine, New York, New York. S. Abramson is vice dean for education, faculty, and academic affairs and professor and chair of medicine, New York University Grossman School of Medicine, New York, New York
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Papademetriou M, Perrault G, Pitman M, Gillespie C, Zabar S, Weinshel E, Williams R. Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones. World J Gastroenterol 2020; 26:1221-1230. [PMID: 32231425 PMCID: PMC7093308 DOI: 10.3748/wjg.v26.i11.1221] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND System based practice (SBP) milestones require trainees to effectively navigate the larger health care system for optimal patient care. In gastroenterology training programs, the assessment of SBP is difficult due to high volume, high acuity inpatient care, as well as inconsistent direct supervision. Nevertheless, structured assessment is required for training programs. We hypothesized that objective structured clinical examination (OSCE) would be an effective tool for assessment of SBP.
AIM To develop a novel method for SBP milestone assessment of gastroenterology fellows using the OSCE.
METHODS For this observational study, we created 4 OSCE stations: Counseling an impaired colleague, handoff after overnight call, a feeding tube placement discussion, and giving feedback to a medical student on a progress note. Twenty-six first year fellows from 7 programs participated. All fellows encountered identical case presentations. Checklists were completed by trained standardized patients who interacted with each fellow participant. A report with individual and composite scores was generated and forwarded to program directors to utilize in formative assessment. Fellows also received immediate feedback from a faculty observer and completed a post-session program evaluation survey.
RESULTS Survey response rate was 100%. The average composite score across SBP milestones for all cases were 6.22 (SBP1), 4.34 (SBP2), 3.35 (SBP3), and 6.42 (SBP4) out of 9. The lowest composite score was in SBP 3, which asks fellows to advocate for cost effective care. This highest score was in patient care 2, which asks fellows to develop comprehensive management plans. Discrepancies were identified between the fellows’ perceived performance in their self-assessments and Standardized Patient checklist evaluations for each case. Eighty-seven percent of fellows agreed that OSCEs are an important component of their clinical training, and 83% stated that the cases were similar to actual clinical encounters. All participating fellows stated that the immediate feedback was “very useful.” One hundred percent of the fellows stated they would incorporate OSCE learning into their clinical practice.
CONCLUSION OSCEs may be used for standardized evaluation of SBP milestones. Trainees scored lower on SBP milestones than other more concrete milestones. Training programs should consider OSCEs for assessment of SBP.
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Affiliation(s)
- Marianna Papademetriou
- Division of Gastroenterology, Georgetown University Medical Center, Washington, DC 20007, United States
- Division of Gastroenterology, Washington DC VA Medical Center, Washington, DC 20422, United States
| | - Gabriel Perrault
- Department of Medicine, New York University Medical Center, New York, NY 10016, United States
| | - Max Pitman
- Division of Gastroenterology, New York University Medical Center, New York, NY 10016, United States
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, NY 10016, United States
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY 10016, United States
| | - Elizabeth Weinshel
- Department of Gastroenterology, VA New York Harbor Healthcare System, New York, NY 10010, United States
| | - Renee Williams
- Division of Gastroenterology, New York University Medical Center, New York, NY 10016, United States
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Murphy MC, Gibney B, Gillespie C, Hynes J, Bolster F. Gallstones top to toe: what the radiologist needs to know. Insights Imaging 2020; 11:13. [PMID: 32026025 PMCID: PMC7002643 DOI: 10.1186/s13244-019-0825-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/17/2019] [Accepted: 12/05/2019] [Indexed: 01/11/2023] Open
Abstract
Gallstone-related disease can have significant associated morbidity and mortality worldwide. The incidence of gallstone-related disease in the Western world is on the increase. There are multiple different pathological manifestations of gallstone disease: the presentation, diagnosis and associated complications of which vary significantly depending on anatomical location. The role of imaging in gallstone-related disease is broad with radiology playing an essential role in the diagnosis, management and follow-up of gallstone-related pathologies. This paper distills the broad range of gallstone-related pathologies into an anatomical map, discussing the disease processes involved at each point along the biliary tree and reviewing the strengths and weaknesses of different imaging modalities for each distinct disease process.
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Affiliation(s)
- M C Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - B Gibney
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - C Gillespie
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - J Hynes
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - F Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
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Zabar S, Hanley K, Wilhite JA, Altshuler L, Kalet A, Gillespie C. In the room where it happens: do physicians need feedback on their real-world communication skills? BMJ Qual Saf 2019; 29:182-184. [PMID: 31704892 DOI: 10.1136/bmjqs-2019-010384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Kathleen Hanley
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jeffrey A Wilhite
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Lisa Altshuler
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Adina Kalet
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York City, New York, USA
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Zabar S, Hanley K, Horlick M, Cocks P, Altshuler L, Watsula-Morley A, Berman R, Hochberg M, Phillips D, Kalet A, Gillespie C. "I Cannot Take This Any More!": Preparing Interns to Identify and Help a Struggling Colleague. J Gen Intern Med 2019; 34:773-777. [PMID: 30993628 PMCID: PMC6502915 DOI: 10.1007/s11606-019-04886-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few programs train residents in recognizing and responding to distressed colleagues at risk for suicide. AIM To assess interns' ability to identify a struggling colleague, describe resources, and recognize that physicians can and should help colleagues in trouble. SETTING Residency programs at an academic medical center. PARTICIPANTS One hundred forty-five interns. PROGRAM DESIGN An OSCE case was designed to give interns practice and feedback on their skills in recognizing a colleague in distress and recommending the appropriate course of action. Embedded in a patient "sign-out" case, standardized health professionals (SHP) portrayed a resident with depressed mood and an underlying drinking problem. The SHP assessed intern skills in assessing symptoms and directing the resident to seek help. PROGRAM EVALUATION Interns appreciated the opportunity to practice addressing this situation. Debriefing the case led to productive conversations between faculty and residents on available resources. Interns' skills require further development: while 60% of interns asked about their colleague's emotional state, only one-third screened for depression and just under half explored suicidal ideation. Only 32% directed the colleague to specific resources for his depression (higher among those that checked his emotional state, 54%, or screened for depression, 80%). DISCUSSION This OSCE case identified varying intern skill levels for identifying and assessing a struggling colleague while also providing experiential learning and supporting a culture of addressing peer wellness.
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Affiliation(s)
- Sondra Zabar
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Kathleen Hanley
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Margaret Horlick
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Patrick Cocks
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lisa Altshuler
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Amanda Watsula-Morley
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Russell Berman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Mark Hochberg
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Donna Phillips
- Department of Orthopedic Surgery, NYU School of Medicine, New York, NY, USA
| | - Adina Kalet
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Colleen Gillespie
- Institute for Innovation in Medical Education, Division of Quality and Evaluation and Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
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Read KB, Larson C, Gillespie C, Oh SY, Surkis A. A two-tiered curriculum to improve data management practices for researchers. PLoS One 2019; 14:e0215509. [PMID: 31042776 PMCID: PMC6493725 DOI: 10.1371/journal.pone.0215509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/13/2019] [Accepted: 04/04/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Better research data management (RDM) provides the means to analyze data in new ways, effectively build on another researcher's results, and reproduce the results of an experiment. Librarians are recognized by many as a potential resource for assisting researchers in this area, however this potential has not been fully realized in the biomedical research community. While librarians possess the broad skill set needed to support RDM, they often lack specific knowledge and time to develop an appropriate curriculum for their research community. The goal of this project was to develop and pilot educational modules for librarians to learn RDM and a curriculum for them to subsequently use to train their own research communities. MATERIALS AND METHODS We created online modules for librarians that address RDM best practices, resources and regulations, as well as the culture and practice of biomedical research. Data was collected from librarians through questions embedded in the online modules on their self-reported changes in understanding of and comfort level with RDM using a retrospective pre-post design. We also developed a Teaching Toolkit which consists of slides, a script, and an evaluation form for librarians to use to teach an introductory RDM class to researchers at their own institutions. Researchers' satisfaction with the class and intent to use the material they had learned was collected. Actual changes in RDM practices by researchers who attended was assessed with a follow-up survey administered seven months after the class. RESULTS AND DISCUSSION The online curriculum increased librarians' self-reported understanding of and comfort level with RDM. The Teaching Toolkit, when employed by librarians to teach researchers in person, resulted in improved RDM practices. This two-tiered curriculum provides concise training and a ready-made curriculum that allows working librarians to quickly gain an understanding of RDM, and translate this knowledge to researchers through training at their own institutions.
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Affiliation(s)
- Kevin B. Read
- NYU Health Sciences Library, NYU Langone Health, New York, New York, United States of America
| | - Catherine Larson
- NYU Health Sciences Library, NYU Langone Health, New York, New York, United States of America
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, NYU Langone Health, New York, New York, United States of America
| | - So Young Oh
- Institute for Innovations in Medical Education, NYU Langone Health, New York, New York, United States of America
| | - Alisa Surkis
- NYU Health Sciences Library, NYU Langone Health, New York, New York, United States of America
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Williams T, Cornell A, Gillespie C, Hura A, Serota M. Effects of an introduced, novel prey on diet and reproduction in the diet-specialist European Starling ( Sturnus vulgaris). CAN J ZOOL 2019. [DOI: 10.1139/cjz-2018-0168] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diet specialization has important consequences for how individuals or species deal with environmental change that causes changes in availability of prey species. We took advantage of a “natural experiment” — establishment of a commercial insect farm — that introduced a novel prey item, black soldier flies (Hermetia illucens (Linnaeus, 1758)), to the diet-specialist European Starling (Sturnus vulgaris Linnaeus, 1758). We investigated evidence for individual diet specialization (IDS) and the consequences of diet specialization and exploitation of novel prey on breeding productivity. In all 4 years of our study, tipulid larvae were the most common prey item. Soldier flies were not recorded in diets in 2013–2014; however, coincident with the establishment of the commercial insect farming operation, they comprised 22% and 30% of all prey items in the diets of European Starling females and males, respectively, in 2015. There was marked individual variation in use of soldier flies (4%–48% and 2%–70% in females and males, respectively), but we found little evidence of dichotomous IDS, i.e., where only some individuals have a specialized diet. We found no evidence for negative effects of use of soldier flies on breeding productivity: brood size at fledging and chick quality (mass, tarsus length) were independent of the number and proportion (%) of soldier flies returned to the nest.
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Affiliation(s)
- T.D. Williams
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - A. Cornell
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - C. Gillespie
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - A. Hura
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - M. Serota
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
- Department of Biological Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
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Fang V, Gillespie C, Crowe R, Popeo D, Jay M. Associations between medical students' beliefs about obesity and clinical counseling proficiency. BMC Obes 2019; 6:5. [PMID: 30766687 PMCID: PMC6360739 DOI: 10.1186/s40608-018-0222-4] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/12/2018] [Indexed: 12/19/2022]
Abstract
Background Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person’s control. We evaluated whether medical school students’ beliefs about obesity correlate with ability to effectively counsel patients with obesity. Methods Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity. We surveyed these students to evaluate their beliefs about the causes of obesity and their attitudes towards people with obesity. We analyzed correlations between student beliefs, negative obesity attitudes, and OSCE performance. Results The response rate was 60.7% (n = 71). When asked to rate the importance of individual factors, students rated controllable factors such as unhealthy diet, physical inactivity, and overeating as more important than genetics or biological factors (p < 0.01). Believing obesity is caused by uncontrollable factors was negatively correlated with obesity bias (r = − 0.447; p < 0.0001). Believing that obesity is caused by factors within a person’s control was negatively correlated with counseling skills (r = − 0.235; p < 0.05). Conclusions Attribution of obesity to external factors correlated with greater ability to counsel patients with obesity, suggesting that educating providers on the biological causes of obesity could help reduce bias and improve provider care.
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Affiliation(s)
- Victoria Fang
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Colleen Gillespie
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Ruth Crowe
- 1Department of Medicine, New York University School of Medicine, New York, NY USA
| | - Dennis Popeo
- 2Department of Psychiatry, New York University School of Medicine, New York, NY USA
| | - Melanie Jay
- 3Departments of Medicine and Population Health, New York University School of Medicine, New York, NY USA.,New York Harbor Veterans Health Affairs, New York, NY USA
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Hanley K, Gillespie C, Zabar S, Adams J, Kalet A. Monitoring communication skills progress of medical students: Establishing a baseline has value, predicting the future is difficult. Patient Educ Couns 2019; 102:309-315. [PMID: 30318384 DOI: 10.1016/j.pec.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/18/2017] [Revised: 07/26/2018] [Accepted: 09/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide evidence for the validity of an Introductory Clinical Experience (ICE) that was implemented as a baseline assessment of medical students' clinical communication skills to support progression of skills over time. METHODS In this longitudinal study of communication skills, medical students completed the ICE, then a Practice of Medicine (POM) Objective Structured Clinical Exam 8 months later, and the Comprehensive Clinical Skills Exam (CCSE) 25 months later. At each experience, trained Standardized Patients assessed students, using the same behaviorally anchored checklist in 3 domains: Information Gathering, Relationship Development, and Patient Education and Counseling (PEC) with good internal reliability (.70-.87). Skills development patterns were described. ICE as a predictor of later performance was explored. Students' perspectives were elicited. RESULTS 140 (80%) medical students consented to include their data in this study. Overall communication scores increased over time (eta2 = .17, medium effect) mostly attributable to increase in PEC skills (eta2 = .48, large effect), in 4 patterns. ICE and POM scores predicted future communication skills. Most students recognized the educational value of ICE. CONCLUSION Entering medical students' clinical communication skills increase over time on average and may predict future performance. PRACTICE IMPLICATIONS Implementing an ICE is likely a valid strategy for monitoring progress and facilitating communication skills development.
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Affiliation(s)
- Kathleen Hanley
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, USA; Institute for Innovations in Medical Education, New York University School of Medicine, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Jennifer Adams
- Department of Medicine, New York University School of Medicine, New York, USA
| | - Adina Kalet
- Department of Medicine, New York University School of Medicine, New York, USA.
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Colder Carras M, Kalbarczyk A, Wells K, Banks J, Kowert R, Gillespie C, Latkin C. Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. Soc Sci Med 2018; 216:124-132. [PMID: 30257787 DOI: 10.1016/j.socscimed.2018.08.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 03/31/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 12/17/2022]
Abstract
RATIONALE Mental and behavioral health recovery includes concepts related not just to symptom improvement, but also to participating in activities that contribute to wellness and a meaningful life. Video game play can relieve stress and provide a way to connect, which may be especially important for military veterans. OBJECTIVE We examined how military veterans used video game play to further their mental and behavioral health recovery by conducting an exploratory thematic analysis of the gaming habits of 20 United States military veterans who were in treatment for mental or behavioral health problems. METHOD We conducted semi-structured interviews in 2016 and used a framework analytic approach to determine salient themes linking video gaming to mental and behavioral health recovery. RESULTS Veteran participants reported that video games helped not only with managing moods and stress, but also with three areas related to other aspects of recovery: adaptive coping (e.g. distraction, control, symptom substitution); eudaimonic well-being (confidence, insight, role functioning); and socializing (participation, support, brotherhood). Meaning derived from game narratives and characters, exciting or calming gameplay, and opportunities to connect, talk, and lead others were credited as benefits of gaming. Responses often related closely to military or veteran experiences. At times, excessive use of games led to life problems or feeling addicted, but some veterans with disabilities felt the advantages of extreme play outweighed these problems. CONCLUSION Video games seem to provide some veterans with a potent form of "personal medicine" that can promote recovery. Although reasons and results of gaming may vary within and among individuals, clinicians may wish to discuss video game play with their patients to help patients optimize their use of games to support recovery.
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Affiliation(s)
- Michelle Colder Carras
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD, 21205, USA; A Department of Veterans Affairs Medical Center Within the 'VA Healthcare' Veterans Integrated Service Network 4, USA.
| | - Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Kurrie Wells
- A Department of Veterans Affairs Medical Center Within the 'VA Healthcare' Veterans Integrated Service Network 4, USA.
| | - Jaime Banks
- Department of Communication Studies, West Virginia University, Armstrong Hall, 94 Beechurst Ave #108, Morgantown, WV, 26505, USA.
| | | | - Colleen Gillespie
- A Department of Veterans Affairs Medical Center Within the 'VA Healthcare' Veterans Integrated Service Network 4, USA.
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway St., Baltimore, MD, 21205, USA.
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Gordon AC, Gillespie C, Son J, Polhill T, Leibman S, Smith GS. Long-term outcomes of laparoscopic large hiatus hernia repair with nonabsorbable mesh. Dis Esophagus 2018; 31:4850447. [PMID: 29444215 DOI: 10.1093/dote/dox156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/07/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
The use of mesh to augment suture repair of large hiatus hernias remains controversial. Repair with mesh may help reduce the recurrence rate of primary repair, but concerns about the potential for serious complications, such as mesh erosion or stricturing, continue to limit its use. We aim to evaluate the long-term outcome of primary hiatus hernia repair with lightweight polypropylene mesh (TiMesh) specifically looking at rates of clinical recurrence, dysphagia, and mesh-related complications. From a prospectively maintained database, 50 consecutive patients who underwent elective primary laparoscopic hiatal hernia repair with TiMesh between January 2005 and December 2007 were identified. Case notes and postoperative endoscopy reports were reviewed. Clinical outcomes were evaluated using a structured questionnaire, including a validated dysphagia score. Of the 50 patients identified, 36 (72%) were contactable for follow-up. At a median follow-up of 9 years, the majority of patients (97%) regarded their surgery as successful. Twelve patients (33%) reported a recurrence of their symptoms, but only 4 (11%) reported that their symptoms were as severe as prior to the surgery. There was no significant difference between pre- and postoperative dysphagia scores. Postoperative endoscopy reports were available for 32 patients at a median time point of 4 years postoperatively, none of which revealed any mesh-related complications. One patient had undergone a revision procedure for a recurrent hernia at another institution. In this series, primary repair of large hiatus hernia with nonabsorbable mesh was not associated with any adverse effects over time. Patient satisfaction with symptomatic outcome remained high in the long term.
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Affiliation(s)
- A C Gordon
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - C Gillespie
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - J Son
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - T Polhill
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - S Leibman
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - G S Smith
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Lewis A, Howard J, Watsula-Morley A, Gillespie C. An educational initiative to improve medical student awareness about brain death. Clin Neurol Neurosurg 2018; 167:99-105. [DOI: 10.1016/j.clineuro.2018.01.036] [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: 11/02/2017] [Revised: 01/27/2018] [Accepted: 01/28/2018] [Indexed: 01/09/2023]
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Ley A, Jeffery D, Ruiz J, McLaren S, Gillespie C. Underdetection of comorbid drug use at acute psychiatric admission. Psychiatr bull 2018. [DOI: 10.1192/pb.26.7.248] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThe ability of routine clinical practice to detect drug use at acute psychiatric admission was assessed by comparing the results of urinalysis with information on drug use extracted from patient records (n=112).ResultsUrinalysis detected drug use in 23% of the sample. Cannabis was the drug most frequently found. Of the cases of drug use positively identified by urinalysis, 54% were not identified in the notes. Some information on drug use proximal to admission was found in 40% of patient records. Patients asked about proximal drug use were younger than those not asked.Clinical ImplicationsAll patients should be asked about drug use.
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Li YX, Gautam V, Brüstle A, Cockburn IA, Daria VR, Gillespie C, Gaus K, Alt C, Lee WM. Flexible polygon-mirror based laser scanning microscope platform for multiphoton in-vivo imaging. J Biophotonics 2017; 10:1526-1537. [PMID: 28164461 DOI: 10.1002/jbio.201600289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/11/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 05/18/2023]
Abstract
Commercial microscopy systems make use of tandem scanning i.e. either slow or fast scanning. We constructed, for the first time, an advanced control system capable of delivering a dynamic line scanning speed ranging from 2.7 kHz to 27 kHz and achieve variable frame rates from 5 Hz to 50 Hz (512 × 512). The dynamic scanning ability is digitally controlled by a new customized open-source software named PScan1.0. This permits manipulation of scanning rates either to gain higher fluorescence signal at slow frame rate without increasing laser power or increase frame rates to capture high speed events. By adjusting imaging speed from 40 Hz to 160 Hz, we capture a range of calcium waves and transient peaks from soma and dendrite of single fluorescence neuron (CAL-520AM). Motion artifacts arising from respiratory and cardiac motion in small animal imaging reduce quality of real-time images of single cells in-vivo. An image registration algorithm, integrated with PScan1.0, was shown to perform both real time and post-processed motion correction. The improvement is verified by quantification of blood flow rates. This work describes all the steps necessary to develop a high performance and flexible polygon-mirror based multiphoton microscope system for in-vivo biological imaging.
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Affiliation(s)
- Y X Li
- Research School of Engineering, College of Engineering and Computer Science, Australia National University, North Road, Canberra ACT, 2601, Australia
| | - V Gautam
- John Curtin School of Medical Research, Australian National University, Garran Road, Canberra ACT, 2601, Australia
| | - A Brüstle
- John Curtin School of Medical Research, Australian National University, Garran Road, Canberra ACT, 2601, Australia
| | - I A Cockburn
- John Curtin School of Medical Research, Australian National University, Garran Road, Canberra ACT, 2601, Australia
| | - V R Daria
- John Curtin School of Medical Research, Australian National University, Garran Road, Canberra ACT, 2601, Australia
| | - C Gillespie
- John Curtin School of Medical Research, Australian National University, Garran Road, Canberra ACT, 2601, Australia
| | - K Gaus
- Australia- EMBL Node in Single Molecule Science, School of Medical Sciences, University of New South Wales, Sydney NSW, 2052, Australia
- Australia Research Council Centre of Excellence in Advanced Molecular Imaging, University of New South Wales, Australia
| | - C Alt
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114, USA
| | - W M Lee
- Research School of Engineering, College of Engineering and Computer Science, Australia National University, North Road, Canberra ACT, 2601, Australia
- Australia Research Council Centre of Excellence in Advanced Molecular Imaging, Australian National University, Australia
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Rogers ES, Gillespie C, Smelson D, Sherman SE. A Qualitative Evaluation of Mental Health Clinic Staff Perceptions of Barriers and Facilitators to Treating Tobacco Use. Nicotine Tob Res 2017; 20:1223-1230. [DOI: 10.1093/ntr/ntx204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/05/2017] [Indexed: 11/14/2022]
Affiliation(s)
- Erin S Rogers
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
| | - Colleen Gillespie
- New York University School of Medicine, Department of Medicine, New York, NY
| | - David Smelson
- University of Massachusetts Medical School, Department of Psychiatry, Worcestor, MA
| | - Scott E Sherman
- New York University School of Medicine, Department of Population Health, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY
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Chaudhary N, Lucero C, Villanueva G, Poles M, Gillespie C, Zabar S, Weinshel E. Assessment of Abilities of Gastroenterology Fellows to Provide Information to Patients With Liver Disease. Clin Gastroenterol Hepatol 2017; 15:1095-1123.e3. [PMID: 28111335 DOI: 10.1016/j.cgh.2016.12.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/07/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patient education is critical in ensuring patient compliance and good health outcomes. Fellows must be able to effectively communicate with their patients, delivering enough information for the patient to understand their medical problem and maximize patient compliance. We created an objective structured clinical examination (OSCE) with 4 liver disease cases to assess fellows' knowledge and ability to inform standardized patients (SPs) about their clinical condition. METHODS We developed 4 cases highlighting different aspects of liver disease and created a 4-station OSCE: hepatitis B, acute hepatitis C, new diagnosis of cirrhosis, and an end-stage cirrhotic nontransplant candidate. The SP with hepatitis B was minimizing the fact that she could not read English. The acute hepatitis C SP was a nursing student who is afraid that having hepatitis C might jeopardize her career. The SP with the new diagnosis of alcoholic cirrhosis needed to stop drinking, and the end-stage liver disease patient had to grapple with his advanced directives. Twelve fellows from 4 GI training programs participated. Our focus was to assess the fellows' knowledge about liver diseases and the Accreditation Council for Graduate Medical Education competencies of health literacy, shared decision making, advanced directives, and goals of care. The goal for the fellows was to communicate effectively with the SPs, and acknowledge that each patient had an emotionally charged issue to overcome. The SPs used a checklist to rate fellows' performance. Faculty and the SPs observed the cases and provided feedback. The fellows were surveyed on their performance regarding the case. RESULTS The majority of fellows were able to successfully summarize findings and discuss a plan with the patient in the new diagnosis of cirrhosis (76.92%) and hepatitis C case (100%), but were less successful in the hepatitis B case (30.77%) and the end-of-life case (41.67%). Overall, a small percentage of fellows reflected that they did a good job (22%-33%), except at the end-of-life case (67%). The fellows' greatest challenge was trying to cover a lot of information in a single outpatient visit. CONCLUSIONS Caring for patients with liver diseases can be complex and time consuming. The patients and fellows' observations were discordant in several areas: for example, the fellows believed they excelled in the end-of-life case, but the SP thought only a small percentage of fellows were able to successfully summarize and discuss the plan. This discrepancy and others highlight important areas of focus in training programs. OSCEs are important to help the fellows facilitate striking the right balance of information delivery and empathy, and this will lead to better patient education, compliance, rapport, and satisfaction.
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Affiliation(s)
- Noami Chaudhary
- Department of Medicine, New York University School of Medicine, New York, NY.
| | - Catherine Lucero
- Department of Gastroenterology, New York University School of Medicine, New York, New York
| | - Gerald Villanueva
- Department of Gastroenterology, New York University School of Medicine, New York, New York
| | - Michael Poles
- Department of Gastroenterology, New York University School of Medicine, New York, New York
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Sondra Zabar
- Department of Medicine, New York University School of Medicine, New York, NY
| | - Elizabeth Weinshel
- Department of Gastroenterology, New York University School of Medicine, New York, New York
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Hanley K, Zabar S, Altshuler L, Lee H, Ross J, Rivera N, Marvilli C, Gillespie C. Opioid vs nonopioid prescribers: Variations in care for a standardized acute back pain case. Subst Abus 2017; 38:324-329. [DOI: 10.1080/08897077.2017.1319894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kathleen Hanley
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Sondra Zabar
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Hillary Lee
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Jasmine Ross
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Nicomedes Rivera
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Christian Marvilli
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Colleen Gillespie
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, New York, USA
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Srisarajivakul N, Lucero C, Wang XJ, Poles M, Gillespie C, Zabar S, Weinshel E, Malter L. Disruptive behavior in the workplace: Challenges for gastroenterology fellows. World J Gastroenterol 2017; 23:3315-3321. [PMID: 28566892 PMCID: PMC5434438 DOI: 10.3748/wjg.v23.i18.3315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/04/2017] [Accepted: 04/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess first-year gastroenterology fellows’ ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE).
METHODS Two OSCEs (“distracted care team” and “frazzled intern”) were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows’ ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows’ performances. The fellows completed a self-assessment survey.
RESULTS Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the “distracted care team” case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the “frazzled intern” case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored “well done” in a domain that focused on allowing the intern to think through the case with the fellow’s guidance.
CONCLUSION Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
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Munro A, Gillespie C, Cotton S, Busby-Earle C, Kavanagh K, Cuschieri K, Cubie H, Robertson C, Smart L, Pollock K, Moore C, Palmer T, Cruickshank ME. The impact of human papillomavirus type on colposcopy performance in women offered HPV immunisation in a catch-up vaccine programme: a two-centre observational study. BJOG 2017; 124:1394-1401. [PMID: 28102931 DOI: 10.1111/1471-0528.14563] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy. DESIGN A two-centre observational study including vaccinated and unvaccinated women. SETTING Colposcopy clinics serving two health regions in Scotland, UK. POPULATION A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening. METHODS Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features. MAIN OUTCOME MEASURES Colposcopic features, HPV genotypes, mRNA expression, and cervical histology. RESULTS The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated). CONCLUSIONS In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines. TWEETABLE ABSTRACT Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+.
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Affiliation(s)
- A Munro
- University of Aberdeen, Aberdeen, UK
| | | | - S Cotton
- University of Aberdeen, Aberdeen, UK
| | | | | | - K Cuschieri
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | - H Cubie
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | | | | | - K Pollock
- Health Protection Scotland, Glasgow, UK
| | - C Moore
- Scottish Human Papillomavirus Reference Laboratory, Edinburgh, UK
| | - T Palmer
- University of Edinburgh, Edinburgh, UK
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Buckvar-Keltz L, Robinson E, Gillespie C, Hopkins M. How do international health electives impact medical students in their
long term career paths? Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.351] [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: 10/21/2022] Open
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Zabar S, Adams J, Kurland S, Shaker-Brown A, Porter B, Horlick M, Hanley K, Altshuler L, Kalet A, Gillespie C. Charting a Key Competency Domain: Understanding Resident Physician Interprofessional Collaboration (IPC) Skills. J Gen Intern Med 2016; 31:846-53. [PMID: 27121308 PMCID: PMC4945565 DOI: 10.1007/s11606-016-3690-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/04/2016] [Accepted: 03/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Interprofessional collaboration (IPC) is essential for quality care. Understanding residents' level of competence is a critical first step to designing targeted curricula and workplace learning activities. In this needs assessment, we measured residents' IPC competence using specifically designed Objective Structured Clinical Exam (OSCE) cases and surveyed residents regarding training needs. METHODS We developed three cases to capture IPC competence in the context of physician-nurse collaboration. A trained actor played the role of the nurse (Standardized Nurse - SN). The Interprofessional Education Collaborative (IPEC) framework was used to create a ten-item behaviorally anchored IPC performance checklist (scored on a three-point scale: done, partially done, well done) measuring four generic domains: values/ethics; roles/responsibilities; interprofessional communication; and teamwork. Specific skills required for each scenario were also assessed, including teamwork communication (SBAR and CUS) and patient-care-focused tasks. In addition to evaluating IPC skills, the SN assessed communication, history-taking and physical exam skills. IPC scores were computed as percent of items rated well done in each domain (Cronbach's alpha > 0.77). Analyses include item frequencies, comparison of mean domain scores, correlation between IPC and other skills, and content analysis of SN comments and resident training needs. RESULTS One hundred and seventy-eight residents (of 199 total) completed an IPC case and results are reported for the 162 who participated in our medical education research registry. IPC domain scores were: Roles/responsibilities mean = 37 % well done (SD 37 %); Values/ethics mean = 49 % (SD 40 %); Interprofessional communication mean = 27 % (SD 36 %); Teamwork mean = 47 % (SD 29 %). IPC was not significantly correlated with other core clinical skills. SNs' comments focused on respect and IPC as a distinct skill set. Residents described needs for greater clarification of roles and more workplace-based opportunities structured to support interprofessional education/learning. CONCLUSIONS The IPC cases and competence checklist are a practical method for conducting needs assessments and evaluating IPC training/curriculum that provides rich and actionable data at both the individual and program levels.
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Affiliation(s)
- Sondra Zabar
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA.
| | - Jennifer Adams
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Sienna Kurland
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Amara Shaker-Brown
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Barbara Porter
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Margaret Horlick
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Kathleen Hanley
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Lisa Altshuler
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Adina Kalet
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
| | - Colleen Gillespie
- Division of General Internal Medicine and Clinical Innovations, New York University School of Medicine, 550 First Avenue, CD401, New York, NY, 10016, USA
- Institute for Innovations in Medical Education, New York University School of Medicine, New York, NY, USA
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Thayer EK, Rathkey D, Miller MF, Palmer R, Mejicano GC, Pusic M, Kalet A, Gillespie C, Carney PA. Applying the institutional review board data repository approach to manage ethical considerations in evaluating and studying medical education. Med Educ Online 2016; 21:32021. [PMID: 27443407 PMCID: PMC4956727 DOI: 10.3402/meo.v21.32021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/21/2016] [Accepted: 06/10/2016] [Indexed: 05/29/2023]
Abstract
ISSUE Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. APPROACH IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. IMPLICATIONS Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data.
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Affiliation(s)
- Erin K Thayer
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA;
| | - Daniel Rathkey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Marissa Fuqua Miller
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Palmer
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - George C Mejicano
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martin Pusic
- Division of Learning Analytics, Institute for Innovations in Medical Education, NYU School of Medicine, New York, NY, USA
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
| | - Adina Kalet
- Medical Education Outcomes Unit, Program for Medical Education Innovation and Research, NYU School of Medicine, New York, NY, USA
| | - Colleen Gillespie
- Division of Evaluation and Outcomes, Institute for Innovations in Medical Education, NYU School of Medicine, New York, NY, USA
- Department of Medicine, Institute for Innovations in Medical Education, NYU School of Medicine, New York, NY, USA
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Cangiarella J, Gillespie C, Shea JA, Morrison G, Abramson SB. Accelerating medical education: a survey of deans and program directors. Med Educ Online 2016; 21:31794. [PMID: 27301381 PMCID: PMC4908065 DOI: 10.3402/meo.v21.31794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 05/15/2023]
Abstract
BACKGROUND A handful of medical schools in the U.S. are awarding medical degrees after three years. While the number of three-year pathway programs is slowly increasing there is little data on the opinions of medical education leaders on the need for shortening training. PURPOSE To survey deans and program directors (PDs) to understand the current status of 3-year medical degree programs and to elicit perceptions of the need for shortening medical school and the benefits and liabilities of 3-year pathway programs (3YPP). METHODS Online surveys were emailed to the academic deans of all U.S. medical schools and to a convenience sample of residency and fellowship PDs. Frequency distributions are reported for key survey items and content analysis was used to describe open-ended responses. RESULTS Of the respondents, 7% have a 3YPP, 4% were developing one, and 35% were considering development. In 2014, 47% of educational deans and 32% of PDs agreed that there may be a need to shorten medical school. From a list of benefits, both deans and PDs agreed that the greatest benefit to a 3YPP was debt reduction (68%). PDs and deans felt reduced readiness for independence, reduced exposure to complementary curricula regarding safety and quality improvement, premature commitment to a specialty, and burnout were all potential liabilities. From a list of concerns, PDs were concerned about depth of clinical exposure, direct patient care experience, ability to assume increased responsibility, level of maturity, and certainty regarding career choice. CONCLUSIONS Over one-third of medical schools are considering the development of a 3YPP. While there may be benefits for a select group of students, concerns regarding maturity, depth of clinical exposure, and competency must be addressed for these programs to be well received.
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Affiliation(s)
- Joan Cangiarella
- Department of Pathology, New York University School of Medicine, New York, NY, USA;
| | - Colleen Gillespie
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gail Morrison
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven B Abramson
- Department of Medicine, New York University School of Medicine, New York, NY, USA
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Howard Tripp N, Tarn J, Gillespie C, Lendrem D, Ng WF. FRI0026 A Cytokine-Mediated Biological Basis for Fatigue in Primary Sjögren's Syndrome. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2980] [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: 11/03/2022]
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50
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Gillespie C, Zabar S, Altshuler L, Fox J, Pusic M, Xu J, Kalet A. The Research on Medical Education Outcomes (ROMEO) Registry: Addressing Ethical and Practical Challenges of Using "Bigger," Longitudinal Educational Data. Acad Med 2016; 91:690-5. [PMID: 26466377 DOI: 10.1097/acm.0000000000000920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PROBLEM Efforts to evaluate and optimize the effectiveness of medical education have been limited by the difficulty of designing medical education research. Longitudinal, epidemiological views of educational outcomes can help overcome limitations, but these approaches require "bigger data"-more learners, sources, and time points. The rich data institutions collect on students and residents can be mined, however, ethical and practical barriers to using these data must first be overcome. APPROACH In 2008, the authors established the Research on Medical Education Outcomes (ROMEO) Registry, an educational data registry modeled after patient registries. New York University School of Medicine students, residents, and fellows provide consent for routinely collected educational, performance, quality improvement, and clinical practice data to be compiled into a deidentified, longitudinal database. As of January 2015, this registry included 1,225 residents and fellows across 12 programs (71% consent rate) and 841 medical students (86% consent rate). Procedures ensuring voluntary informed consent are essential to ethical enrollment and data use. Substantial resources are required to provide access to and manage the data. OUTCOMES The registry supports educational scholarship. Seventy-two studies using registry data have been presented or published. These focus on evaluating the curriculum, quality of care, and measurement quality and on assessing needs, competencies, skills development, transfer of skills to practice, remediation patterns, and links between education and patient outcomes. NEXT STEPS The authors are working to integrate assessment of relevant outcomes into the curriculum, maximize both the quantity and quality of the data, and expand the registry across institutions.
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Affiliation(s)
- Colleen Gillespie
- C. Gillespie is assistant professor, Department of Medicine, and director, Division of Educational Quality, New York University School of Medicine, New York, New York. S. Zabar is professor, Department of Medicine, New York University School of Medicine, New York, New York. L. Altshuler is assistant professor, Department of Medicine, New York University School of Medicine, New York, New York. J. Fox is research coordinator, Department of Medicine, New York University School of Medicine, New York, New York. M. Pusic is assistant professor, Department of Emergency Medicine, New York University School of Medicine, New York, New York. J. Xu is ontology manager, NYU Health Sciences Library, New York University School of Medicine, New York, New York. A. Kalet is professor, Departments of Medicine and Surgery, New York University School of Medicine, New York, New York
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