Volume 10

Abstract

Purpose: This study evaluates knowledge gaps in dermatology among Clinical Officers in Uganda and the effectiveness of Project ECHO (Extension for Community Healthcare Outcomes) as an educational intervention.

Background: The University of Utah partners with Ugandan organizations to train and support primary care providers in dermatology through monthly, interactive, case-based discussions.

Methods: The effectiveness of ECHO sessions was gauged using pre- and post-session surveys. The study focused on a convenience sample of Clinical Officers, and statistical analysis was performed to determine knowledge average change.

Results: Most respondents worked in urban out-patient (41%) and rural out-patient (34%) settings. Analysis of 5 months’ survey data revealed that the percentage of respondents reporting “very knowledgeable” of the session topic increased from 2% pre-survey to 51% post-survey. Ninety-four percent of respondents said they are “somewhat likely” or “very likely” to treat complex patients in their practice instead of referring to specialty care. Regarding the application of learned concepts, 68 participants indicated “Definitely Yes”, and 13 “Probably Yes”.

Conclusions: The ECHO sessions enhanced dermatological skills among Clinical Officers. The participants’ increased comfort level treating complex patients suggests a promising impact on dermatology healthcare accessibility and quality. These outcomes highlight ECHO’s effectiveness in resource-limited settings.

Abstract

Objective: To improve pediatrics intern comfort with primary care mental health concerns through peer-led mental health integration (MHI) education.

Background: Although pediatricians often provide mental health care for children, 65% of those surveyed by the American Academy of Pediatrics in 2013 felt underprepared to do so. Triple Board (TB; pediatrics, adult psychiatry, child/adolescent psychiatry) residents at our institution are uniquely suited to educate peers through interdisciplinary work.

Methods: An optional, anonymous needs assessment gauged interns’ baseline comfort with diagnosis and treatment of attention deficit-hyperactivity disorder (ADHD), depression, anxiety, behavior disorders, autism spectrum disorder (ASD), and trauma. During MHI half day, TB residents lead interns in an Intro to MHI lecture, patient visits, and small group learning.

Results: Survey response rate was 28/33 (85%) interns. Percentage reporting discomfort with diagnosis of: ADHD (32%), depression (14%), anxiety (14%), behavior disorders (71%), ASD (61%), trauma (68%). Percentage reporting discomfort with treatment of: ADHD (57%), depression (21%), anxiety (29%), behavior disorders (71%), ASD (75%), trauma (75%).

Conclusion: Interns had more comfort with mental health diagnoses than treatment; they had less comfort with ASD, trauma and behavior disorders. Our data confirm the value of pediatric trainee mental health didactic and clinical education and will shape curriculum interventions.

References

1. American Academy of Child & Adolescent Psychiatry. “A guide to building collaborative mental health care partnerships in pediatric primary care.” 2021. https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/guide_to_building_collaborative_mental_health_care_partnerships.pdf
2. Durette L, Oden C, Rudig N, Parikh N. “Clinicians’ Experience with a Graduate Medical Education Implemented Child Psychiatry Access Program.” Academic Psychiatry. 25 September 2023
3. Green C, Leyenaar JK, Nuncio B, Leslie LK. “Where Do Future Pediatricians Learn Behavioral and Mental Health Skills?” Academic Pediatrics. 2021;21:1288−1296
4. Green C, Leyenaar JK, Turner AL, et al. “Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems.” Pediatrics. 2020;146(1):e20192884
5. McMillan JA, Land M, Leslie LK. “Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action.” Pediatrics. 2017;139(1):e20162141

Abstract

Purpose: Cross-collaboration across units furthers the SOM mission. Background With the increase in class size & curriculum changes, SOM has more specialized departments & roles. Cross-collaboration is needed to pursue the SOM mission of social change. Design Staff in MSWP, OHEDI, EQI, SA, & Admissions implemented Skendall’s Seven C’s of Social Change to enhance the effectiveness of interdisciplinary collaboration in reviewing & revising educational policies. This group Collaborated; agreed upon a Common Purpose of promoting student mental health & education, was Conscious of their words & actions in discussions, presented with Congruence, engaged in discourse with Civility, & maintained drive toward Change.

Outcomes: Together, the group advocated for Student Handbook review by all SOM directors, & accomplished change within individual departments, including revising the GPA-MCAT Matrix (Admissions); implementation of DEIPAR principles to policies (MSWP); creating equity in application criteria for AOA (SA) & reviewing Promotions decisions & course surveys for trends of bias (EQI & OHEDI).

Conclusions: In line with Skendall’s expectations, the group concluded cross-unit collaboration increases members’ abilities to see strengths, weaknesses, & unobserved potential within units; diversity of experience improves ability to identify gaps in policy; & multiple specialties working together provides the best chance to achieve “strategic recruitment, retention, & recognition of effort.”

References

1. Skendall, K. C. (2017). An overview of the social change model of leadership development. In S. R. Komives & W. Wagner (Eds.), Leadership for a better world: Understanding the social change model of leadership development (2nd ed., pp. 17–40). Jossey-Bass.

Abstract

Objective: To see if medical students report feeling more comfortable and prepared leading code status discussions (CSD) after a palliative care education session centered on holding CSD and CPR statistics.

Background and Rationale: There is minimal exposure to CSD content leading into the third year of medical school. Students are asked to independently perform these skills, without prior instruction (1). With the changing landscape of education at SFESOM, we wanted to develop a palliative care education session led by experts during intersession that made students more comfortable and prepared to lead CSD. We sought to aid in developing and designing a session that would address these issues and measure the impact on students.

Designs and Methods: We designed a session focused on CSD led by palliative care experts. To measure student-reported outcomes, we administered a pre and post-survey designed to measure students’ comfortability and preparedness around CSD. The session was conducted midway through the first clinical year.

Results: After the session, more people felt prepared and comfortable to lead CSD and felt comfortable discussing CPR statistics. Most students reported already having had a CSD with a patient, learning from a resident in FM or IM. Students appreciated learning statistics and valuable language from the session.

Conclusions: The session was successful at improving student-reported outcomes and should be repeated in pre-clinical spaces.

References

1. Rowe, K. A., Ouchi, K., Kennedy, M., Breu, A. C., Tolchin, D. W., & Schwartz, A. W. (2024). Preparing preclinical medical students for routine code status Discussions: A Mixed-Methods Study. Journal of Pain and Symptom Management, 67(2), 138–146. https://doi.org/10.1016/j.jpainsymman.2023.10.017

Abstract

Objective: The authors designed and implemented a new four-week core sub-internship for students applying into internal medicine-pediatrics (MP) residency programs. Background: Traditionally, students applying into MP residencies needed to complete a core sub-internship in both internal medicine and pediatrics. Students rarely worked with MP faculty members during these rotations and had difficulty obtaining MP specific letters of recommendation.

Design: The authors designed a four-week core sub-internship where students rotated for two weeks each on internal medicine and pediatric teams staffed with a MP attending. The course also had unique MP experiences customized to the student. The course was approved as a core sub-internship and run during block 2 of the 2023-2024 academic year.

Results: The course filled with a waitlist of three students. On post-course survey, the course was rated as “Excellent” by all students. Students specifically commented that they “received autonomy in a supportive environment” and that the course was well organized. On six month follow up survey, students continued to view the course positively, highlighting working with MP attendings and the MP specific experiences. Objectively, MP-specific letters of recommendation increased from 33% to 100%.

Conclusions: The core sub-internship was well-received by students and filled a unique gap in the previous fourth-year curriculum. The authors plan to continuing the course in the future.

Abstract

Objective: To characterize the frequency of carpal coalitions. Background: Carpal coalition is a rare congenital condition in which there is lack of segmentation of the carpal bones.¹ This study attempts to characterize the frequency of different coalitions in the wrist.

Methods : A search was performed in the University of Utah PACS for all studies with keywords “coalition” that were included the hand or wrist anatomy (xray, CT, and MRI modalities). Patients’ ethnicity/race was obtained from information available on Epic charting.

Results: A total of 232 coalitions were identified in 198 patients (105 females, 93). 86 coalitions were found in the left wrist and 78 coalitions were found in the right wrist. Coalitions occurred bilaterally in 34 patients. The following types of coalition were identified: lunotriquetral (189), capito-hamate (20), trapezoid-capitate (11), scapholunate (6), scaphoid-trapezium (4), triscaphe (4), scaphoid-trapezoid (3), trapezium-trapezoid (3), hamatopisiform (2), capitate-triquetrum (2), capitate-lunate-hamate (1), scapholunotriquetrum (1). Multiple coalitions occurred in 11 wrists. 127 of these patients identified with White, not Hispanic/Latino, 37 as Black (African-American), 18 as Hispanic/Latino, 4 as Black (African), 3 as Asian, 1 as Pacific Islander, 1 as other, and 7 did not disclose.

Conclusion: Highest frequency was lunotriquetral (81%), capito-hamate (9%), trapezoid-capitate (5%) and in Whites (64%) and African/Americans (19%).

References

1. Resnik C, Grizzard JD, Simmons BP, Yaghmai I. Incomplete carpal coalition. AJR 1986; 147:301-304

Abstract

Objective: Establishment of a postgraduate program focusing on emergency medicine research to address the shortage of skilled researchers and advance clinical research in emergency medicine.

Background and Rationale: Emergency medicine faces shortage of experienced researchers.^1,2 Clinical experts may lack research methodology proficiency, while methodologically skilled individuals lack clinical insight. This highlights the need for a comprehensive training program bridging both domains, particularly in the USA, where life-threatening conditions are prevalent.³

Design: This is a two-year postgrad program integrating clinical knowledge with research methodology. The program attracts emergency medicine physicians and clinicians. Curriculum includes core courses and independent research projects, with integration into existing Master of Science in Clinical Investigation program at the University of Utah.

Anticipated Outcome: Enhanced research knowledge and skills, increased investigational capacity, producing high-quality research, the development of life-saving technologies, and improved emergency care outcomes.

Conclusion: The proposed two-year postgraduate program aims to bridge the gap in emergency medicine research expertise by integrating rigorous research methodology with clinical insights in a structured academic environment. This innovation is expected to improve emergency care quality through technology and scholarly efforts, ultimately saving more lives.

References

1. Gordon Guyatt, Drummond Rennie, Maureen O. Meade, et al. Users’ Guides to Medical Literature: Essentials of evidence-based clinical practice, Third Edition. McGraw Hill/ Medical; 2015.
2. Graham CA. Barriers to research in emergency medicine. European Journal of Emergency Medicine. 2019;26(3).
3. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. heart disease and stroke statistics—2022 Update: A Report from the American Heart Association. Circulation. 2022;145(8).

Abstract

Objective: To explore rural primary care providers’(PCPs) professional development (PD) needs and barriers through a national Veterans Health Administration (VHA) survey.

Background: PD opportunities—structured activities to improve professional knowledge, skills, or performance—bolsters PCP recruitment, satisfaction, and retention.^1,2,3 Improving recruitment and retention of a competitive workforce is paramount in rural VHA care settings. In 2022, turnover of rural PCPs reached the highest level observed in 20 years.

Methods: Using a systematic approach^4,5 a 40-item survey was developed and distributed nationally to 2163 VHA PCPs, defined as practicing in rural locations using RUCA codes of ≥50% rurality. Results We observed a response rate of 20% (n=446). No significant differences in mean responses for each interval suggests low risk of non-response bias. The majority were female (60%), either nurse practitioners (45%) or physicians (43%). Nearly half (46%) considered PD to be “extremely important” to professional satisfaction. One-third (34%) indicated PD to be critical in their decision to remain at VHA. Learning interests were broad and spanned multiple categories including clinical skills development, leadership, research, and preceptorship of health professions trainees.

Conclusions: Findings inform decision-making processes, responsible stewardship of limited resources, and strategic promotion/adaptation of existing VHA PD opportunities to rural settings.

References

1. Office of Rural Health Workforce Team Meeting Presentation (2021). Workforce Development. WMC Team: L. Pomeroy, P. Youngblood, L. Elliot, J. Marfield.
2. Rinne ST, Mohr DC, Swamy L, Blok AC, Wong ES, Charns MP. National Burnout Trends Among Physicians Working in the Department of Veterans Affairs. J Gen Intern Med. 2020;35(5):1382-1388. doi:10.1007/s11606-019-05582-7
3. Asghari S, Kirkland MC, Blackmore J, et al. A systematic review of reviews: Recruitment and retention of rural family physicians. Can J Rural Med. 2020;25(1):20-30. doi:10.4103/CJRM.CJRM_4_19
4. Gehlbach H, Artino AR Jr. The Survey Checklist (Manifesto). Acad Med. 2018;93(3):360-366. doi:10.1097/ACM.0000000000002083
5. Artino AR Jr, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research: AMEE Guide No. 87. Med Teach. 2014;36(6):463-474. doi:10.3109/0142159X.2014.889814

Abstract

Objective: Our objective is to gain a better understanding of the barriers and incentives that motivate pediatric providers in the state of Utah to precept PA students.

Background and Rationale: Pediatrics is one of the most difficult specialties to find preceptors. With increased stresses from more programs needing placements and economic pressures for providers to increase productivity, understanding motivations is essential.

Design and Methods: We surveyed 54 pediatric providers in the state of Utah. We asked about barriers and common incentives. We also asked them to identify how precepting affects productivity, patient satisfaction, patient safety and workload. They ranked a list of 12 incentives on how those incentives might encourage them to precept and eleven factors that might be negatively affected by precepting.

Results: Providers ranked having more time per patient without a decrease in compensation as the most valued incentive.

Conclusions and/or Lessons Learned: The results indicate that working with employers to help preceptors have a manageable amount of time while precepting might be the most effective way to increase the number of providers willing to precept PA students.

References

1. Kayingo G, Gordes KL, Fleming S, Cawley JF. Thinking Outside the Box: Advancing Clinical Education in an Era of Preceptor Shortage. J Physician Assist Educ. 2023 Jun 1;34(2):135-141. doi: 10.1097/JPA.0000000000000500. Epub 2023 Apr 27. PMID: 37126204.
2. Evans TC, Wick KH, Andrilla CHA, Skaggs SA, Burgin T. A Method to Study the Effect of a Physician Assistant Student on Preceptor Productivity. J Physician Assist Educ. 2018 Dec;29(4):205-210. doi: 10.1097/JPA.0000000000000220. PMID: 30358652.
3. Hudak NM, Enking PJ, Gorney C, Gonzalez-Colaso R. Tales from the trenches: physician assistants’ perspectives about precepting students. J Physician Assist Educ. 2014;25(1):12-9. doi: 10.1097/01367895-201425010-00002. PMID: 24765805.
4. Theobald M, Everard KM, Morley CP. Changes in the Shortage and Quality of Family Medicine Clinical Training Sites. PRiMER. 2022 Mar 18;6:7. doi: 10.22454/PRiMER.2022.960678. PMID: 35481231; PMCID: PMC9037247.
5. Levy BT, Gjerde CL, Albrecht LA. The effects of precepting on and the support desired by community-based preceptors in Iowa. Acad Med. 1997 May;72(5):382-4. doi: 10.1097/00001888-199705000-00018. PMID: 9159585.

Abstract

Objective:
1) Identify from patients and their families the largest unmet language and cultural practice needs within Primary Children’s Hospital (PCH)
2) Identify from care providers at PCH areas in which they feel they both succeed in and struggle with meeting patients’ cultural needs and providing culturally humble care.

Background: Significant disparities persist in healthcare access and outcomes among minority patient populations, including heightened risks of experiencing adverse safety events, worsened health outcomes, and increased adverse medications reactions. These disparities are even more drastic for patients with limited English proficiency (LEP).

Design: We will conduct semi-structured interviews with both PCH patients’ parents/guardians (unless the patients are 18 or older) and caregivers at PCH. We will interview 10 English speaking, 10 Spanish speaking patients, and 20 care team members. The interviews will consist of 6 broad questions related to admission, language services, faith services, social work, and discharge education, with multiple more specific probes that interviewers can select based on participant answers.

Conclusions: We aim for this research to allow us to pinpoint specific areas in which we can propose systemic and individual changes to help PCH and Intermountain Health continue to improve in their mission to value and celebrate diversity in the care they provide at PCH.

References

1. Baker, D. W., Parker, R. M., Williams, M. V., Coates, W. C., & Pitkin, K. (1996). Use and effectiveness of interpreters in an emergency department. JAMA, 275(1), 783-788. https://doi.org/10.1001/jama.1996.03530340047028.
2. Chauhan, A., Walton, M., Manias, E., Walpola, R. L., Seale, H., Latanik, M., Leone, D., Mears, S., & Harrison, R. (2020). The safety of healthcare for ethnic minority patients: A systematic review. International Journal for Equity in Health, 19(118). https://doi.org/10.1186/s12939-020-0122302.
3. Hebb, J. H., Fitzgerald, D., & Fan, W. (2003). Healthcare disparities in disadvantaged Medicare beneficiaries: A national project overview. Journal of Health and Human Services Administration, 25(3). http://www.jstor.org/stable/41288035.
4. Wilson, E., Chen, A. H., Grumbach, K., Wang, F., & Fernandez, A. (2005). Effects of limited English proficiency and physician language on health care comprehension. Journal of General Internal Medicine, 20(9), 800-806. https://doi.org/10.1111/j.1525-1497.2005.0174.