Volume 10

Abstract

Purpose: Create a deliverable with national and local mental health resources to decrease suicide rates in Uinta County adolescents.

Background: Since 2018, Wyoming has held the highest suicide rate in the U.S. and Uinta County has the second-highest suicide rate in the state as of 2020. Uinta County has 1.5-fold more deaths by suicide than self-harm hospitalizations. There is a gap in care related to suicide awareness and prevention; people at risk for suicide are not being identified early for intervention.

Design: 250 stickers (80 Spanish, 170 English) with the national 988 crisis line, Wyoming crisis text line, and QR code to local mental health resources were created and provided to the Uinta County School District Superintendent and Project AWARE Manager to distribute to students. The stickers were promoted in a county public health meeting. The design was left with the Uinta County Suicide Prevention Task Force for further distribution.

 Learning outcomes: 

1. Provide adolescents with national and local mental health resources.
2. Establish the prevalence of suicide as a health crisis in Wyoming that is affecting adolescents significantly and deserves adequate attention in public health efforts.

Conclusion: Mental health is a highly stigmatized issue that has become a significant public health problem in Wyoming. Creating a resource for local adolescents utilizing a community-asset based approach will allow for a sustainable and substantial suicide prevention effort.

References  

1. Uinta County Human Services CSBG Tripartite Board. (2022). Uinta County, Wyoming 2022 Community Needs Assessment.
2. Szlyk, Berk, M., Peralta, A. O., & Miranda, R. (2020). COVID-19 Takes Adolescent Suicide Prevention to Less Charted Territory. Journal of Adolescent Health, 67(2), 161–163. https://doi.org/10.1016/j.jadohealth.2020.05.046
3. Blackstock, J., Chae, K. B., McDonald, A., & Mauk, G. W. (2018). Achieving Access to Mental Health Care for School-Aged Children in Rural Communities. The Rural Educator, 39(1), 12–25. https://doi.org/10.35608/ruraled.v39i1.212
4. Asarnow, & Mehlum, L. (2019). Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care. Journal of Child Psychology and Psychiatry, 60(10), 1046–1054. https://doi.org/10.1111/jcpp.13130

Abstract

Objectives: 1.) Offer an educational experience for medical trainees and patients through Fourth Street Clinic’s (4SC) skin cancer screening (SCS) events 2.) Expand the Department of Dermatology’s free eConsult service to 4SC while educating providers on dermatological conditions

Background: Dermatologic care is limited in rural and urban-underserved areas, causing disparities in patient outcomes. 4SC serves persons experiencing homelessness and offers dermatologic care through SCS events and a monthly, student-led dermatology clinic. U of U Health launched a store-and-forward teledermatology eConsult program in 2019, to increase access to care, and they are educational for referring providers.

Design: Expansion was done via trainings and opt-in referrals. Data was collected via retrospective chart review. Results At the 2023 SCS, trainees screened 24 patients for skin cancer and educated patients on prevention (clothing, SPF) and surveillance (skin checks). Data from 2019-2023 indicates the population seen via eConsult is younger, more male, higher proportion Medicaid, and higher proportion underserved racial and ethnic minorities compared to general dermatology ambulatory visits.

Conclusions: The SCS is an opportunity for medical students and residents to learn about treating skin cancer in resource-limited settings and to educate patients vulnerable to skin cancer. The eConsult service expansion increases underserved populations’ access to dermatologic care.

References

1. Glazer, A et al. Analysis of Trends in Geographic Distribution of US Dermatology Workforce Density JAMA Dermatol. 2017 May; 153(5): 472–473.
2. Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012 Jan;30(1):53-9, viii. doi: 10.1016/j.det.2011.08.002. PMID: 22117867; PMCID: PMC3742002.
3. Resneck JS Jr, Isenstein A, Kimball AB. Few Medicaid and uninsured patients are accessing dermatologists. J Am Acad Dermatol. 2006 Dec;55(6):1084-8. doi: 10.1016/j.jaad.2006.07.012. Epub 2006 Sep 6. PMID: 17097404.
4. Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL; Group for Research of Policy Dynamics in Dermatology. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol. 2020 Jul;83(1):299-307. doi: 10.1016/j.jaad.2020.01.065. Epub 2020 Feb 5. PMID: 32035106; PMCID: PMC7302990.
5. Wang RF, Trinidad J, Lawrence J, Pootrakul L, Forrest LA, Goist K, Levine E, Nair S, Rizer M, Thomas A, Wexler R, Kaffenberger BH. Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center. J Am Acad Dermatol. 2020 Dec;83(6):1633-1638. doi: 10.1016/j.jaad.2019.10.053. Epub 2019 Oct 31. PMID: 31678336.

Abstract

Objective: To evaluate the effectiveness of the Mentor Connection platform at the Spencer Fox Eccles School of Medicine (SFESOM) in supporting students with diverse identities and identify strategies for improving mentorship in medical education.

Background: Mentorship provides critical support for medical students. Most mentorship programs fail to account for the diverse identities of their students, despite the connection between identity and retention of those underrepresented in medicine (URiM). The SFESOM developed a mentorship platform to support medical students in the relationship-building process that facilitates student-mentor connections based on identity, experience, and specialties. We developed a survey to understand the relationship between the identity of medical students and their experiences with the mentorship platform and to identify strategies for improving the mentor connection platform.

Methods: The survey comprises 3 sections: (1) mentorship experiences, (2) utilization of platform, and (3) relationships between student identities, and the use of the mentorship platform. Results: 227/530 responded, and ~60% felt that they had identified at least one or more mentors during their medical school experience. 78% identified as URiM. Early analysis suggests that Mentor Connection has both strengths and areas for improvement.

Conclusion: Stratifying data is vital for assessing the Mentor Connection Platform’s impact on students, particularly URiM individuals.

References

1. Bhatnagar, V., Diaz, S., & Bucur, P. A. (2020). The Need for More Mentorship in Medical School. Cureus, 12(5), e7984. https://doi.org/10.7759/cureus.7984 
2. Physician Mentorship: Why It’s Important, and How to Find and Sustain Relationships. https://resources.nejmcareercenter.org/article/physician-mentorship-why-its-important-and-how-to-find-and-sustain-relationships/ 
3. Find a Mentor in Medicine. https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/finding-a-mentor.html

Abstract

Authors: Yingri Li¹, Zachary J Moore¹, Adam Katz¹

Affiliations:
¹Spencer Fox Eccles School of Medicine at the University of Utah, Midvale Community Building Community Clinic

Objective/Purpose: Quantify the effect of the new Mission-Driven (MD) curriculum on MS1 clinical training through involvement in student-led clinics compared to the Legacy curriculum.

Background & Rationale: The new MD program incorporates MS1 student-led clinics to increase patient care experience during Pre-clerkship Education. This project investigates the amount of clinic time MS1s spend at Midvale CBC Clinic and compares total clinic time under the new curriculum against clinic time in the legacy curriculum.

Design/Methods: Five unique roles were assigned to students each week on a rotating schedule: Each clinic, four students were assigned to indirect patient care duties, and four students were assigned to direct patient care. Using this schedule, the total clinic time for each student was calculated, along with a breakdown of time spent by students in each clinic role. To compare opportunities for student involvement in clinics, the total number of clinic shifts was compared between 2022 and 2023.

Results: Each MS1 at Midvale CBC Clinic will receive 80 hours of patient care in Phase One alone and will attend over 40 clinics at Midvale CBC.

Conclusions: The new clinical education structure has substantially increased first-year medical students’ clinical experience. Integration between the Midvale CBC Clinic and the MD curriculum has provided students with significant opportunities that will better prepare them for both clerkships and medical practice.

References:

1. Mission-Driven MD Program (2023) | School of Medicine | University of Utah Health. medicine.utah.edu. Published March 16, 2023. https://medicine.utah.edu/programs/md/2023
2. Midvale Community Building Community, Inc. | United States. 2023 Website Update, www.midvalecommunityclinic.com/. Accessed 27 Feb. 2024.

Abstract

Objective: EM LEADS prepares medical students to succeed during their EM clerkship, sub-internship, residency, and beyond. It serves as a platform to develop leadership skills, connect with faculty, engage in research, and mentor peers.

Background: The School of Medicine has a required EM clerkship but limited early opportunities for building EM skills¹, inspiring the creation of EM LEADS. Graduates of a similar 1-year program reported feeling well-equipped to start residency and stated that additional EM training benefited their careers¹. Further, more hours spent practicing EM-specific skills is shown to improve performance in residency³.

Design: EM LEADS has activities tailored to each participating class year. The certificate has four categories: Dedication to EM, Leadership, Education, and Scholarship. Students will present their research at an annual EM Research Symposium and will be honored upon completion of the program. The certificate can be a prominent experience on the ERAS application.

Results: EM LEADS received support from the Department of Emergency Medicine, and students participating in the program have expressed appreciation to have a dedicated program to nurture their passion for EM.

Conclusions: EM LEADS enables early exposure to EM, focused training, and mentorship. It can be a template for medical schools to integrate specialty training into undergraduate medical education and students can highlight the program in one experience on ERAS.

References

1. https://medicine.utah.edu/programs/md/curriculum
2. Kman NE, Bernard AW, Martin DR, Bahner D, Gorgas D, Nagel R, Khandelwal S. Advanced topics in emergency medicine: curriculum development and initial evaluation. West J Emerg Med. 2011 Nov;12(4):543-50. doi: 10.5811/westjem.2011.2.2095. PMID: 22224157; PMCID: PMC3236174.
3. Costantino TG, Satz WA, Stahmer SA, Dean AJ. Predictors of success in emergency medicine ultrasound education. Acad Emerg Med. 2003 Feb;10(2):180-3. doi: 10.1111/j.1553-2712.2003.tb00038. PMID: 12574018.

Abstract

Purpose: 1. Describe the Safe Zone LGBTQ+ identity curriculum implemented at SFESOM 2. Discuss data collection for program evaluation and improvement Background and rationale:  Safe Zone is a national education framework on LGBTQ+ identity, sexuality, and gender. In partnership with OHEDI, this curriculum has been adapted into interactive sessions that guide students to examine their biases and privileges while building awareness around LGBTQ+ experiences.

Design: Monthly, one hour, student-led sessions address: language best practices; clinical cases; self-reflection on identity; privilege, discrimination and access to care. Experts in the care of LGBTQ+ patients provide their perspectives and practical recommendations for providing inclusive care. Learner satisfaction and feedback are assessed each session through opt-in, qualitative surveys.

Learning Outcomes: 1. Build and utilize foundational vocabulary to create affirming spaces for LGBTQ+ individuals.  2. Explore lived experiences of LGBTQ+ individuals to better understand inequities and inclusivity opportunities. 3. Understand nuances of biological sex, gender identity, gender expression, and attraction. 4. Continuously assess and improve curriculum based on learner feedback. 

Conclusions: Healthcare providers take part in sensitive conversations with communities who have been historically harmed by the medical system. Safe Zone empowers medical students to engage with LGBTQ+ patients thoughtfully.

Abstract

Objective: This initiative standardizes the medical student precepting practice among residents in the Department of Physical Medicine and Rehabilitation at the University of Utah, enhancing their proficiency and comfort as medical educators. We aim to provide a consistent, comprehensive educational experience for medical students.

Background: In our department, ensuring uniform educational experiences for medical students is challenged by a lack of structured resident preceptor training, clear expectations for diverse medical student levels, and accessible resources across various clinical settings.

Design: Our approach includes a one-hour training on best practices in medical education and evaluation.^1,2 We have established an educational checklist for each rotation including foundational PM&R experiences, readings, and resources for active learning. Medical students will be evaluated by residents on a presentation and an OCSE. Residents will perform self-assessments on their perceived ability to teach and assess medical students.³ End-of-rotation surveys will be collected from medical students.

Results: Outcomes are pending but will reflect perceived resident comfort in teaching and evaluating learners as well as medical student satisfaction.

Conclusions: Our goal is to improve the skills and confidence level of our residents in providing quality education to medical students through establishing a framework for residents to precept medical students in various clinical settings.

References

1. The T-E-A-C-H Model: An Approach to Guide Residents as Teachers. https://www.stfm.org/publicationsresearch/publications/educationcolumns/2021/january/.
2. Saucier, A. et al. Exploring Family Medicine Residents’ Experiences Teaching Medical Students. PRiMER 5, (2021).
3. Brink, D., Power, D. & Leppink, E. Results of a Preceptor Improvement Project. Fam. Med. 52, 647–652 (2020).

Objective: This project aims to evaluate areas for improvement in the informed consent process for peripheral nerve blocks (PNB) performed by the department of anesthesiology faculty and residents.

Background and Rationale: Ideal informed consent for PNBs should occur in the pre-operative period prior to the administration of sedating medications and general anesthesia while patients have adequate decision-making capacity. Yet the intraoperative anesthesiologist typically preforms informed consent despite not being a part of the regional anesthesia (RA) team. As such, there is concern that patients are not engaged in an adequate expectation setting and risk-benefit discussion preoperatively.

Design and Methods: We surveyed the RA faculty, general anesthesia faculty and anesthesia residents to assess what is currently being included in informed consent for PNB vs. what the RA experts would describe as critical to the consent process. Results and

Learning Outcomes: We found gaps in two main areas: (1) general faculty and residents can improve their risk discussion for PNB, specifically as it pertains to pre-existing nerve damage; and (2) improve accurate expectations regarding when/if a patient will safely qualify for a PNB.

Conclusions and/or Lessons Learned: In response to these findings, we provided residents and faculty with resources and education, including an exemplary PNB consent script, to aid in comprehensive and accurate informed consent.

Abstract

Purpose: This interdisciplinary educational training program empowers health professions learners (students and trainees) to confidently conduct comprehensive skin exams, utilize dermoscopy, and perform biopsies, to improve earlier melanoma detection in veterans.

Background: Within the George E Wahlen Veteran Affairs (VA) Medical Center in Salt Lake City, UT predominantly Caucasian males aged 65+ represent a prime target for skin cancer intervention. Unfortunately, minimal dermatology training in primary care leaves providers ill-equipped to address this need1. Our program aims to bridge this gap, saving lives and reducing costs associated with late-stage diagnoses.

Methods: This pilot training, held at the Salt Lake City VA (affiliated with the University of Utah), equips health professions learners with the skills to detect melanoma in high-risk veterans. The 4-day program combines group learning with hands-on skills training in a cadaver lab and finishes in clinical practice with dermatology specialists in our innovative Primary Care Dermatology clinic. Diagnosis of melanoma in clinic will be collected.

Learning Outcomes: The effectiveness of this program will be evaluated by pre- and post-self-assessments gauging respondents’ knowledge, comfort with assessments and conditions, and skin examination skills.

Conclusions: This educational initiative appears feasible for faculty, is well received by learners, and has resulted in expanded clinical services to veterans.

References

1. AM Drucker, RB Cavalcanti, BM Wong, S.R.A. Walsh Teaching dermatology to internal medicine residents: needs assessment survey and possible directions. J Cutan Med Surg, 17 (1) (2013), pp. 39-45.