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Eighth Annual Davidoff Education Day
May 17, 2011
Poster Submissions
Medical Student Education
Author(s) Institution Poster Title
Garbern, Stephanie, Kate
Currie, Pablo Joo Einstein
Does Leadership in a Student-Run Free Clinic
Correlate with Selection of a Primary Care
Residency?
Grayson, Martha S., Dale A.
Newton, Lori Foster
Thompson
Einstein
Influence of Debt and Anticipated Income on
Medical Student Career Choice in Internal
Medicine
Gutwein, Andrew Jacobi/Einstein
How Much Competency Do Medical Students
Self-Report in the CDIM Medicine Sub-
internship Curriculum After a One-Month
Medicine Sub-internship?
Indyk, Diane, Darwin Deen,
Alice Fornari, Maria T.
Santos, Wei-Hsin Lu, Lisa
Rucker
Einstein
The Influence of Longitudinal Mentoring on
Medical Student Selection of Primary Care
Residencies
Kesselman, Amy, Christopher
Cimino, Linda Gillespie, Scott
Chudnoff, Penny Grossman,
Nadine Katz
Einstein/Montefiore
The Results of Implementing a Transparent
Clerkship Grading Policy Emphasizing Clinical
Performance
Kitsis, Elizabeth A., William
B. Burton, Hannah I. Lipman Einstein
Debate and Role-Play as Teaching Methods for
Preclinical Medical Students Learning to
Identify Ethical Issues in Clinical Cases: Work
in Progress
McEvoy, Mimi, Sheira
Schlair, Zsuzsanna Sidlo,
William Burton, Felise Milan
Einstein
Assessing Third-Year Medical Students’
Ability to Recognize and Address a Patient’s
Spiritual Distress During an Acute Medical
Crisis
Nosanchuk, Joshua, Liise-
anne Pirofski Einstein
Electronic Cases: Do They Have a Role in
Basic Science Courses?
Sparr, Steven A. Montefiore/Einstein
Creative Expression in a Neurology Clerkship:
A “Right Brain” Approach to Understanding
Neurologic Patients
ii
Resident or Fellowship Education
Author(s) Institution Poster Title
Bilotta, Federico, Apolonia
Elisabeth Abramowicz, Luca
Titi, Antonella Cianchi,
Giovanni Rosa, Ellise Delphin
Montefiore/Einstein Educating Anesthesiology Residents to
“Anesthesia” for Awake Craniotomy
Esteban-Cruciani, Nora, Peter
Cole, Catherine Skae, Alfin
Vicencio, Swapnil Rajpathak,
Laurie Bauman
Einstein/Montefiore
Implementation of a Departmental ACGME-
Compliant Core Curriculum for Pediatric
Subspecialty Fellows
Herbitter, Cara, Jason
Fletcher, Finn Schubert,
Megan Greenberg, Marji Gold
Montefiore/Einstein An Evaluation of an IUD Initiative at Family
Medicine Residency Programs
Kazimiroff, Julie, Karla
Alvarado, Nanice Regis Blay Montefiore/Einstein
Integrating the Chronic Care Model into a
Dental Residency Training Program
Muenzenmaier, Kristina, A.
Schneeberger, M. Abrams, L.
Ruberman, L. Antar, S. Leon,
S. Mouzon, J. Battaglia
BPC/Montefiore/
Einstein
Trauma Training Modular Curriculum: A New
Approach to Education of Psychiatry Residents
Nevadunsky, Nicole D., Serife
Eti, Enid Rivera, Peter
Selwyn, Kimala Harris, Gary
Goldberg
Montefiore/Einstein
Palliative Medicine Educational Initiative for
Trainees in the Department of Obstetrics,
Gynecology and Women’s Health
Rahav, Miriam, Sharon
Leung, Darlene LeFrancois Montefiore/Einstein
Developing a Botanical Medicine Curriculum
for Medicine Residents: A Needs Assessment
of Knowledge, Confidence, and
Communication
Rivlin, Kenneth, Paul Sue,
Daran Kaufman, Auxford
Burks, Jeffrey C. Gershel,
Lewis M. Fraad
Jacobi/Einstein
Experiential Learning of Quality Improvement:
Converting Resident “Gripes” into Quality
Improvement (QI) Projects
Schlair, Sheira, Larry Dyche,
Felise Milan, Hillary Kunins,
Julia Arnsten, Eric Holmboe
Montefiore/Einstein
A Faculty Development Program to Prepare
Instructors to Observe and Provide Effective
Feedback on Clinical Skills to Internal
Medicine Residents
Sharma, Keerti, Amy R.
Ehrlich, Laurie G. Jacobs,
Deborah Greenberg, Kim
Freeman, Arnold Berlin
Montefiore/Einstein
Evaluating Surgical Residents’ Cognitive and
Functional Status Assessment Skills Using a
Standardized Patient Interview
iii
Curriculum Development and/or Evaluation
Author(s) Institution Poster Title
Auerbach, Lisa, Mimi
McEvoy, Felise Milan Einstein
Observing the Teachers: Is Faculty
Development Effective for Preceptors Teaching
Medical Students in a Physical Diagnosis
Course?
Gonzalez, Cristina M., Aaron
D. Fox Montefiore/Einstein
Health Disparities: Awareness to Action – A
Curricular Innovation
Purcell, Jennifer M. Einstein
Psychometric Properties of the Team
Performance Scale in a Third-Year Medical
School Clerkship
Purcell, Jennifer M., Pablo
Joo Einstein
Evaluation of the Team-Based Learning
Curriculum in a Family Medicine Clerkship
Silbiger, Sharon, Darlene
LeFrancois, Penny Grossman,
William Burton, William Lee,
Eran Bellin
Einstein/Montefiore Incorporating a QI Exercise into the Einstein
Medicine Clerkship: A Pilot Study
Therattil, Maya R., Todd R.
Olson, Sherry A. Downie Montefiore/Einstein
Musculoskeletal Examination (MSKE) Pilot
Mini-Course: Increasing Medical Student
Exposure to the MSKE
Innovative Programs
Author(s) Institution Poster Title
Herron, Patrick D., Hannah I.
Lipman, Patricia (Tia) Powell,
Elizabeth A. Kitsis
Montefiore/Einstein
Video Recorded Simulations in Bioethics
Consultation Training: A Collaboration of the
Ruth L. Gottesman Clinical Skills Center and
the Einstein-Cardozo Masters of Science in
Bioethics Program
Katz-Sidlow, Rachel J.,
Allison Ludwig, Scott Miller,
Robert Sidlow
Jacobi/Einstein Smartphone Use During Inpatient Attending
Rounds: Help or Hindrance?
Morice, Karen, Michael D.
Skeels, Maya R. Therattil Montefiore/Einstein
Mastering Functional Independence Measures:
Comparison of Different Educational Strategies
Weinstein, Eleanor, Maria
Mendoza, Andrew Gutwein Jacobi/Einstein
Innovations in Resident Education:
Applications of Information Technology
Zuckerman, Tehila, Maria
Kassab, Anna Kochin, Dahlia
Rizk, Rebecca Calabrese
Beth Israel/Einstein Discharge Summary Quality Improvement
Project
Does Leadership in a Student-Run Free Clinic Correlate with Selection of a
Primary Care Residency?
Stephanie Garbern, Kate Currie, Pablo Joo, Department of Family and Social Medicine, Albert
Einstein College of Medicine
Background and Objectives: Declining student interest in primary care has prompted medical
educators to explore innovative methods to recruit students into the field. Over 49 American
medical schools operate student-run free clinics, providing medical students with broad exposure
to primary care settings. This study investigates whether students who served in a leadership
role at Einstein Community Health Outreach (ECHO), a student-run free clinic, were more likely
to match into a primary care specialty than their peers.
Methods: Residency match results for students who served in a leadership role at the ECHO
clinic were compared to their peers who did not serve in a leadership role at the clinic and to
nationwide data from the National Residency Match Program (NRMP) from 2007-2009. Chi-
square analysis was used to compare the results.
Results: Of the 59 students who served in a leadership role at the clinic, 38 students (64%)
matched into a primary care specialty of family medicine, general pediatrics, or internal
medicine as compared to 41.5% (188/453) of their classmates (p < 0.001). Students from the
medical school as a whole matched into primary care residencies at a similar proportion
(226/512, or 44.1%) as U.S. seniors nationwide (17,500/42,673, or 41.0%) (p = 0.148).
Conclusion: Our analysis shows that a high degree of involvement in a student-run free clinic
positively correlates with a greater likelihood of matching into a primary care residency.
Implications: Although self-selection almost certainly plays a role, serving in a student-run free
clinic may help to nurture an interest in primary care in those who are already considering the
field or to recruit students who would not otherwise be interested. Further study, such as
questionnaires or focus groups, is necessary to examine this relationship.
Influence of Debt and Anticipated Income on Medical Student Career Choice
in Internal Medicine
Martha S. Grayson, Dale A. Newton, Lori Foster Thompson, Albert Einstein College of
Medicine, New York Medical College, and Brody School of Medicine, East Carolina University
Background: Recent studies suggest that increasing debt and desire for higher incomes may be
influencing medical student career choice. This study examines career decisions of students who
begin medical school intending to pursue careers in Internal Medicine. The objectives were to
determine how debt, the self-rated importance placed on income, and future income projections
relate to intentions to pursue a subspecialty in Internal Medicine rather than General Internal
Medicine. The perceived salary increases associated with switching out of Internal Medicine
were also examined.
Methods: Students at New York Medical College and Brody School of Medicine at East
Carolina University were surveyed annually at matriculation (M1) and just prior to graduation
(M4). The data set included 17 consecutive years of M1 surveys and 16 years of M4 data. The
overall response rate was 81%. The responses of students who expressed an interest in Internal
Medicine at either M1 or M4 were analyzed. Additional analyses focused on the subset of
students who expressed an interest in Internal Medicine at M1 and subsequently completed a
follow-up survey at M4, yielding paired data that enabled the investigation of trends over time.
Overall, the analyses examined the relationships among the following factors: reported debt (in
dollars), anticipated income 5 years after residency (in dollars), student reported
influence/importance of income on career choice (Likert scale rating), association of self-rated
importance of income with anticipated income, and stated career choice.
Results: 239 entering first year students identified an interest in General Internal Medicine and
404 expressed an interest in a subspecialty in Internal Medicine. By graduation, these numbers
changed to 277 and 343 respectively. The trends shown in Table 1 were identified. In addition,
changes in anticipated income over time were documented. Overall, students who entered
medical school with interests in Internal Medicine careers reported an expected income of $186K
at M4, which was $47K higher than the $139K they anticipated at M1 (p< .001). However, finer
grained analyses indicated significant (p<. 01) differences among subgroups of these students,
with those planning to enter GIM at M4 anticipating $139K (only $14K more than the $125K
they anticipated at M1), those planning to pursue a subspecialty in Internal Medicine anticipating
$179K ($43K more than the $136K they anticipated at M1), and those who switched out of
Internal Medicine altogether anticipating $207K at M4 ($62K more than the $145K they
anticipated at M1).
Conclusions: Both debt and expected income may push medical students initially interested in
General Internal Medicine towards a career in a subspecialty of medicine or to a career in
another specialty outside of Internal Medicine. Changes in the payment system to more properly
reimburse general internists may be needed to attract talented students whose financial concerns
may otherwise discourage them from pursuing a generalist career. Since concern about debt is
associated with career choice, new loan forgiveness programs linked to practice in General
Internal Medicine should also be developed as a method to assist in sustaining the numbers of
students choosing this career path.
How Much Competency Do Medical Students Self-Report in the CDIM
Medicine Sub-internship Curriculum After a One-Month Medicine Sub-
internship?
Andrew Gutwein, Department of Medicine, Jacobi Medical Center, Albert Einstein College of
Medicine
Background: The internal medicine sub-internship is commonly offered at medical schools
across the country. There is a curriculum for the sub-internship published by the Clerkship
Directors of Internal Medicine (CDIM). It is largely unknown whether sub-interns feel they are
improving in the areas laid out in this curriculum.
Objective: This study was undertaken to see if the sub-interns felt they had improved in the area
listed in the CDIM curriculum.
Methods: All sub-interns rotating through one major academic center during academic year
2004-2005 were given a pre-sub-internship and post-sub-internship questionnaire. The
questionnaire included the 20 topics, 17 scenarios and 6 procedures that are listed in the CDIM‟s
curriculum. Data were analyzed using SPSS software and the paired T-test.
Results: Thirteen of the 20 topics (65%), 14 of the 17 scenarios (82%) and 2 of the 6 procedures
(33%) showed a statistically significant improvement in sub-intern confidence over the 4-week
internal medicine sub-internship. The topics, scenarios and procedures that improved were:
Topic Case presentation
Coordinating care with other health care workers
Prioritizing scut list/ sign out list
Identifying adverse drug reactions/ interactions
Using electronic databases
Literature appraisal skills
Grief management
Composing discharge summaries
Communicating with difficult patients
Assessing suicide risk
Delivering bad news
Dealing with emotional abuse from patients or colleagues
Ethics of withdrawal/ withholding of care
Interpreting advance directives
Scenario
Respiratory distress
Chest pain
Altered mental status
Acute gastrointestinal bleeding
Fever
Acute pulmonary edema
Electrolyte disorders
Abdominal pain
Hypertensive emergencies
Glycemic control
Acute renal failure
Pain management
Drug withdrawal
Nausea and vomiting
Procedure
Arterial blood sampling
Nasogastric tube placement
Conclusions: While most areas showed improved sub-intern confidence, some did not. The
reason for this difference is likely related to the amount of exposure to that area in a one-month
setting. There may be ways to improve the sub-interns experience and make them more
confident.
The Influence of Longitudinal Mentoring on Medical Student Selection of
Primary Care Residencies
Diane Indyk, Darwin Deen, Alice Fornari, Maria T. Santos, Wei-Hsin Lu, Lisa Rucker,
Sophie Davis School of Biomedical Education, Hofstra University School of Medicine,
Stony Brook University School of Medicine, Albert Einstein College of Medicine
Background: The number of students selecting primary care has declined by 41% in the last
decade, resulting in anticipated shortages.
Goal: The “Generalist Career Program” (GCP) was designed to determine if early contact with a
mentor, specifically a primary care clinician, would influence medical student career choice.
Methods: This interdisciplinary program was designed to recruit first year medical students
(MS1) beginning in September 2005 and was funded through 2008. The grant supported four
core faculty, representing the primary care disciplines of FM, IM and PED, and a program
coordinator. Mentors were recruited from each of these disciplines. MS1 year students were
recruited for the GCP via e-mail, flyer, and an introduction to the program presented during
freshman student orientation. Students and faculty completed a database questionnaire, used for
the purpose of matching them both personally and professionally. Faculty attended an in-person
faculty development session The matching of mentors with mentees accommodated the mentee‟s
request (most commonly requesting a mentor by field of practice/gender/family), and was based
upon matched outside interests (most commonly hobbies and community involvements). The
GCP activities included: mentor-mentee meetings (monthly during the MS1&2 years and
quarterly during the clinical MS3 year); didactic conferences (monthly during MS1&2 years and
quarterly during the MS3 year); enhanced community-based primary care research opportunities
(summer between MS1&2 year); regional/national meeting attendance (any year) with a primary
care mentor or designated faculty; and participation in program evaluation. Mentors received a
small stipend ($30/month if meeting occurred) to compensate their time and defray the costs of
any activities shared. Mentors and students participated in focus groups at the end of each
academic year. Quantitative and qualitative results are presented.
Results: Students who remained in the mentoring program matched to primary care programs at
87.5% in the first year and 78.9% in the second year, compared to overall primary care match
rates of 55.8% and 35.9% respectively. Students reported a better understanding of the field of
primary care and appreciated a relationship with a mentor. We created "Best practices" guides
for mentors and mentees based on student and faculty feedback.
Conclusions: A longitudinal mentoring program can effectively support student interest in
primary care if it focuses on the needs of the students and is supportive of the mentors.
Implications: Medical schools that want to increase the number of graduates selecting primary
care can adopt a program like the GCP.
The Results of Implementing a Transparent Clerkship Grading Policy
Emphasizing Clinical Performance
Amy E. Kesselman, Christopher Cimino, Linda Gillespie, Scott Chudnoff, Penny Grossman,
Nadine T. Katz, Department of Obstetrics & Gynecology and Women‟s Health, Office of Student
Affairs, Office of Medical Education Albert Einstein College of Medicine – Montefiore Medical
Center
Background and Goals: Reliance on objective measures like written exams to assess clerkship
performance may penalize students who are not strong test takers and incentivize students to
prioritize studying for exams over clinical service duties. To address these concerns, our clerkship
implemented new criteria designed to motivate students to excel in all components of the clerkship
by emphasizing clinical and exam performance through a transparent grading process. The study‟s
goal was to measure whether our new policy achieved these objectives.
Methods: We invited 4th
year students from the class of 2010 (graded under the old policy) to
complete an online survey asking students to rate their agreement from “strongly disagree” to
“strongly agree” with 12 statements measuring satisfaction with and understanding of the grading
system that was applicable for them and whether it motivated them to succeed clinically and on
exams. Students from the class of 2011 (graded under the new policy) were asked to complete the
online questionnaire after their clerkship.
Results: We collected 44 and 52 responses from the class of 2010 and 2011, respectively. The
percentages of students who either agreed or strongly agreed with the statements were compared.
The new policy substantially increased students‟ motivation to excel clinically (85% for the class of
2011 versus 48% for 2010) without reducing motivation to excel on the written exam (89% for both
classes). The class of 2011 reported higher satisfaction with their clerkship experience (90% versus
77%) and a better understanding of how their grade was calculated (92% versus 70%). The class of
2011 also reported that their grade more accurately reflected their fund of knowledge (77% versus
43%) and their clinical skills (73% versus 43%).
Conclusions: The new grading system was transparent to students and encouraged them to excel
clinically while maintaining their incentive to excel on the written exam. It also provided a fairer
assessment of students who did not excel on the exam, but performed well clinically.
Implications: A transparent grading system that emphasizes both exams and clinical service duties
incentivizes students to develop clinical skills and teamwork in addition to excelling on their exams.
Debate and Role-Play as Teaching Methods for Preclinical Medical Students
Learning to Identify Ethical Issues in Clinical Cases: Work in Progress
Elizabeth A. Kitsis, William B. Burton, Hannah I. Lipman, Departments of Epidemiology &
Population Health, Medicine, and Family & Social Medicine, Albert Einstein College of
Medicine
Background and Goals: The development of ethical sensitivity-- the ability to identify ethical
issues embedded in a case--is one of the goals of our bioethics curriculum. The purpose of this
study is to determine whether debate and role-play are effective methods for teaching ethical
sensitivity to medical students.
Methods: A total of 359 medical students will participate in the study, which is ongoing. The
study is being conducted in two parts. Part 1 has been completed; Part 2 will be conducted in
April 2011. For both parts, Bioethics faculty participate in a workshop on debate or role-play.
In Part 1, following a lecture on Bioethics Consultation, 191 second-year medical students were
randomly assigned to 12 groups, which were then randomly assigned to debate or role-play as
the teaching method to be used in the subsequent 75 minute small group session. In Part 2,
following a lecture on Ethical Issues at the End of Life, 168 first-year medical students will be
randomly assigned to 12 groups, which will then be randomly assigned to debate or role-play.
At the beginning of the small group session, students are provided with a written clinical case,
and asked to list the ethical issues relevant to the case. They then participate in either a role-play
or a debate. Following the role-play or debate, they are again asked to list the ethical issues in
the case.
The primary outcome measure is change in mean ethical sensitivity from baseline to completion
of the small group sessions. Ethical sensitivity is defined as percentage of ethical issues
correctly identified in a case. The correct list of ethical issues is determined using a modified
Delphi method. A multivariate analysis will be performed to determine whether additional
factors, such as gender, age, or previous bioethics courses are associated with study outcome.
Other outcome measures include a self-efficacy scale that measures students‟ perceptions of
confidence in their ability to identify ethical issues, and a student satisfaction survey.
Differences between the effectiveness of debate and role-play will be explored.
Assessing Third-Year Medical Students’ Ability to Recognize and
Address a Patient’s Spiritual Distress during an Acute Medical Crisis
Mimi McEvoy, Sheira Schlair, Zsuzsanna Sidlo, William Burton, Felise Milan,
Departments of Pediatrics and Medicine, Ruth L. Gottesman Clinical Skills Center,
Albert Einstein College of Medicine
Background: Assessment of students‟ ability to address spiritual distress is not well
studied.
Educational Objective: To inform curricular development, we explored: 1) How third-
year medical students (MS-3s) recognize/address a standardized patient‟s spiritual
distress during an acute medical crisis; and 2) The relationship between students‟
reported response to spiritual distress and clinical skills performance.
Method: Between March and April 2010, 170 MS-3s completed an 8-station videotaped
clinical skills assessment. One of the standardized patients (SP) is an older man with
acute chest pain who expresses fear of death, which he hopes to resolve by chaplain
consultation. After the encounter, students reported the nature of the patient‟s distress and
their response to it via a 4 question open-ended post-note. Separately, SPs assess
students‟ clinical skills performance, including history and communication. Mixed
methods analysis of the post-notes was conducted by 3 coders using NVivo 8 for
emergent themes. Analysis of inter-rater reliabilities using SAS revealed kappa
coefficients of > 0.6; codings with inter-rater reliability <0.8 were clarified by all coders
and fully adjudicated producing 34 codes. We also compared clinical skills performance
scores between students who reported making chaplain referral versus those who did not.
Results: 67% of students noted patient‟s fear of death. 49% of students reported
addressing patient‟s emotional state; 2% directly addressed his faith or spiritual beliefs.
64% of students reported chaplain referral. Students who reported chaplain referral had
slightly higher clinical skills performance scores than those who didn‟t on history
(mean=80.5 v. 78.7; p=0.23) and communication skills (mean=58.4 v. 56.4; p=0.11).
Conclusions/Implication: Most students report making a chaplain referral for a patient
in spiritual distress; yet few converse directly about the beliefs. Clinical skills
performance is not significantly correlated with report of chaplain referral. Hence,
teaching medical students to recognize/address a patient‟s religion/spirituality is a unique
domain and requires specific curriculum.
Electronic Cases: Do They Have a Role in Basic Science Courses?
Joshua Nosanchuk, Liise-anne Pirofski, Departments of Medicine and Microbiology and
Immunology, Albert Einstein College of Medicine
Background and Goals: We asked whether Einstein students in our second year Microbiology
and Infectious Diseases course would benefit from electronic cases designed to supplement
material presented in lecture.
Methods: Over three years (2009-2011), we refined our electronic case approach according to
student comments. The cases covered critical conditions in Infectious Diseases (e.g., meningitis)
and management processes (e.g., use of antibiotics). Cases were uploaded to “CobWeb” by the
Einstein Computer-Based Education staff and electronically assigned to students using
“MyAlbert”.
Results: The percent of students answering all questions in the cases ranged from 75-98%, and
>88% reported that the cases were educationally worthwhile. However, the students asked for
and were most satisfied by 1) cases that provided questions in multiple choice, single best answer
format rather than open ended questions and 2) immediate answer feedback for each question
rather than working through a case followed by a review. The most common complaint (85 of
180 students in 2011) was that there were not more electronic cases. The cases also allowed for
the delivery of uniform content for the entire class, which has not been achievable in the more
fluid setting of live small group sessions.
Conclusion: In conclusion, we found that electronic cases facilitated a deeper understanding of
difficult clinical processes (such as antibiotic management) and enhanced student satisfaction in
their learning experience.
Creative Expression in a Neurology Clerkship: A "Right Brain"
Approach to Understanding Neurologic Patients
Steven A. Sparr, Department of Neurology, Stern Stroke Center, Montefiore Medical
Center, Albert Einstein College of Medicine
Goals: Fostering "humanism" is a goal valued at all levels of medical education. One
technique that encourages and rewards the display of humanism is creative expression.
Methods: Since October 2003 all students rotating through the Neurology clerkship at
Montefiore Medical Center were given the following assignment: Neurology is not the
study of neurological diseases; it is the study of people with neurological diseases. Using
any form that you prefer (story, poem, musical piece, art work, etc.), discuss the impact
of a neurological disorder on the patient, family or the physician. The creative piece was
accepted in lieu of one the 3 required H & Ps. The pieces were not graded, but students
were required to present their creative project to their peers on the last day of the rotation.
Results: Well over 200 submissions were received. These included short stories about
patients, short stories about students‟ family members, fictional accounts (usually placing
the reader "in the shoes" of a person or family member of a patient with a neurological
disorder), philosophical essays, poetry/haiku, paintings/drawing, original musical
compositions/songs, video, crafts, puzzles and performance pieces. Many of the
submissions were poignant and moving to the audience and reflected a deep emotional
connection with the patient. Some students opted for less emotionally charged
presentations such as crossword puzzles or expository pieces. Feedback from the
students was overwhelming positive. Most appreciated the opportunity to express
themselves in a more creative/emotional manner and most felt that they would use the
technique in their teaching careers.
Conclusions: Emotional expression is an educational technique that fosters humanism
by valuing its expression. Most students are capable of creating emotionally powerful
pieces and the assignment was well received.
Implications: Both humanism and technical skills are required in the successful practice
of all medical disciplines. Encouraging the appreciation of the impact that illness has on
patients and family fosters empathy and also provides an emotional outlet for the
physician in training.
Educating Anesthesiology Residents for “Anesthesia” for Awake Craniotomy
Federico Bilotta, Apolonia Elisabeth Abramowicz, Luca Titi, Antonella Cianchi, Giovanni Rosa,
Ellise Delphin, Department of Anesthesiology, “Sapienza” University Rome, Italy, Montefiore
Medical Center, Albert Einstein College of Medicine
Background: Anesthesia for awake craniotomy is a technique used for functional neurosurgery and
resection of brain lesions in eloquent areas. In this study, we have designed a dedicated training
program to teach anesthesia for awake craniotomy to residents in anesthesiology, and have
evaluated their learning curve.
Methods: Seven anesthesia residents underwent a dedicated training program to learn anesthesia
for awake craniotomy based on three tasks: local anesthesia, sedation/analgesia, and intraoperative
hemodynamic management. Evaluation of the learning curve was based on residents‟ self-
assessment and attending anesthesiologist judgment using a modified Likert scale (12 points from
“very-poor” to “excellent”). Based on the actual "learning-curves" recorded up to the 10th
procedure and on calculated slope coefficients, the trend of the learning process after the 10th
procedure was extrapolated. Advice request was also recorded.
Results: Each task has a specific learning rate. Local anesthesia showed the lowest score at the first
procedure, but has the fastest progression rate with a slope coefficient of 1.1, suggesting that a
training experience of 10 procedures should be adequate to guarantee the achievement of a “good to
excellent” ability score. Sedation/analgesia has an intermediate starting score and a slope coefficient
of 0.7, suggesting that a training experience of 15-25 procedures should be adequate to guarantee
the achievement of a “good to excellent” ability score. Intraoperative hemodynamic management
has the slowest learning rate with a slope coefficient of 0.3, suggesting that a training program of
20-30 procedures should be adequate to guarantee the achievement of a “good to excellent” ability
score. Data were confirmed by the trend in the number of requests for advice.
Conclusions: Learning subspecialty anesthesia techniques such as “anesthesia” for awake
craniotomy requires adequate theoretical background knowledge, dedicated training and effective
mentoring. This is an increasingly used approach in the subspecialty of neuroanesthesia, suggesting
the need for specific training. Several factors can influence the learning process, including the time
span it takes. In our study the number of procedure needed to achieve a “good-excellent” ability for
2 of the 3 tested tasks (sedation/analgesia and hemodynamic management) is derived by
extrapolating the trend of the actual learning curves, thus assuming that the learning process is
constant over time. A dedicated training program can provide “good-excellent” ability and self-
confidence necessary to accomplish this procedure.
Bar-plot of the number of advice requests. The number of advice requests made to the
attending anesthesiologist by the 7 residents over the 10 procedures is represented as a bar-
plot for each of the three tasks
Implementation of a Departmental ACGME-Compliant Core Curriculum for
Pediatric Subspecialty Fellows
Nora Esteban-Cruciani, Peter Cole, Catherine Skae, Alfin Vicencio, Swapnil Rajpathak, Laurie
Bauman, Department of Pediatrics, Children‟s Hospital at Montefiore, and Department of
Epidemiology & Population Health, Albert Einstein College of Medicine
Background: The Accreditation Council for Graduate Medical Education (ACGME) sanctioned
new accreditation standards that define core competencies in research and other scholarly activities
in 2007. There are few descriptions of organizational models designed to address these mandates.
Objective: To implement a department-wide core curriculum for pediatric subspecialty fellows
addressing ACGME core competencies.
Design/Methods: In 1998, we implemented a Science Course for pediatric subspecialty fellows,
with continuous improvements in response to trainee evaluations, faculty feedback, and needs
assessments. In 2007, we revamped the course to meet the new mandated ACGME core
competencies. The current 3-year curriculum offers 2-hour monthly or bimonthly sessions; each
curriculum year is tailored to level of training. Attendance is required unless the trainee is involved
in alternate education programs. Content includes basic and clinical research, bioethics, research
design, biostatistics, quality improvement, career development, finding a research mentor, teaching
skills, and academic preparation. We use adult learning techniques, self-directed learning,
opportunities for critical thinking, and multidisciplinary interaction. We monitor fellows‟
participation, feedback and evaluation of didactic sessions, self-assessed knowledge and ACGME
review cycle-lengths.
Results: Fellows‟ participation quadrupled since 1998 (x=47 participants/year, 2007-10), currently
85% of fellows from 16 different subspecialties. Sessions‟ attendance: 78%. Evaluation of sessions
was high: 4.7 + 0.2 out of 5= excellent (n= 195); 60% of didactic material was considered “new”
knowledge; 95% recommended keeping each session. Self-assessed-knowledge and research skills
were evaluated using a 42-item survey; course entry-scores increased from 1st to 3
rd year of
fellowship (2.9, 3.4 and 4.0, out of 5, p<0.01). ACGME review cycle-length increased from 3.3+
1
to 4.5+
0.7 years p<0.001) compared to prior review cycle-lengths. Factors associated with success:
1) Support: Department Chair, Vice Chair and Fellowship Directors; Biostatistician; Administrative
assistance; 2) Process: mandatory attendance; content tailored to ACGME requirements;
progressive levels of training; evening sessions; timely electronic communication; continuous
interdisciplinary quality improvement; 3) Faculty: distinguished pediatric/non-pediatric educators;
collaborative course leadership that incorporates basic/clinical/social science perspectives.
Conclusion: We have developed and implemented a highly successful and widely accepted
organizational model that provides hands-on multidisciplinary learning for pediatric subspecialty
fellows using a 3-year department-wide curriculum. This model addresses fellows‟ needs and
current ACGME mandates while facilitating continuous feedback and program improvement.
An Evaluation of an IUD Initiative at Family Medicine Residency Programs
Cara Herbitter, Jason Fletcher, Finn Schubert, Megan Greenberg, Marji Gold, Department of
Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine
Background: Despite the safety and efficacy of intrauterine devices (IUDs), only 39% of family
physicians insert them and 2% of US women using contraction choose IUDs. Lay and professional
misconceptions about IUDs and inadequate clinical training likely account for these low rates.
Another barrier to greater IUD utilization is their prohibitive cost. The objective of this study is to
evaluate a program aimed at increasing IUD training for family medicine residents and providing
grand-funded IUDs to women.
Educational Goal: This initiative aims to increase resident training and patient access to IUDs.
Methods: Design: Pre- and post-surveys Setting: Ten family medicine residency programs
Participants: Residency programs that were previous or current abortion training funding grantees
were eligible to receive free IUDs and educational materials. All residents and precepting faculty at
participating residency programs were invited to complete the surveys. Intervention/Instrument:
Participating programs receive a free supply of copper and hormonal IUDs, which they can offer to
continuity clinic patients at no cost. These programs have also received educational resources to
distribute to faculty and residents. Online pre- and post- quantitative surveys are distributed at
baseline and at 6 months after starting the project to assess its impact on the knowledge and
experience of faculty and residents. Main Outcome Measures: Number of IUDs inserted in previous
6 months, willingness to insert IUDs in various patient scenarios, intent to insert (for residents).
Results: At baseline, the majority (81.3%) of responding residents had not inserted copper IUDs
and approximately half (54.7%) had not inserted hormonal IUDs in the previous six months.
Common misconceptions included guidelines for patients with a history of STI/PID or ectopic
pregnancy and those who have not had a recent Pap smear. Data analysis is in process and will be
limited to respondents who completed both a pre and a post survey.
Conclusions: We anticipate the post-survey results will demonstrate increased IUD insertions and
greater adherence to established guidelines among residents and faculty.
Implications: Interventions that seek to increase resident training with IUD insertions may reduce
misconceptions among and increase the number of IUD insertions by residents and faculty.
Integrating the Chronic Care Model into a Dental Residency Training Program
Julie Kazimiroff, Karla Alvarado, Nanice Regis Blay, Department of Dentistry, Montefiore Medical
Center, Albert Einstein College of Medicine
Background: One goal of our training program is to use medical/dental integration with the Chronic
Care Model to improve oral health outcomes for persons with diabetes.
Goal: To train General Practice (GP) dental residents working in urban health center-based dental
clinics and hospital environments to understand and practice comprehensive dental care across the
lifespan in dental patients with diabetes using the Chronic Care Model (CCM)
Methods: 1) Outreach: Oral health promotion to patients and medical primary care providers (PCPs)
at community-based programs including PCP waiting rooms, health fairs, senior centers, and dental
staff communication with medical staff by means of handouts, oral presentations and oral health
education classes 2) Interventions: Diabetes Collaborative - Train residents: i) in management and ii)
monitoring and analysis of cytokines in diabetic and overweight/obese patients as oral health
indicators. 3) Evaluation: Practice Teams (GP and dental faculty) became familiar with the
Assessment of Chronic Illness Care (ACIC) and Patient Assessment of Chronic Illness Care
(PACIC); completed the ACIC for one chronic condition (e.g., how well they are providing oral
health care for diabetes). Adherence to Chronic Care Model was evaluated quantitatively by a
numerical score given by the respondents (Teams, patients) in which they rated the degree to which
each component (e.g., partnerships with community organizations, patient treatment plans) is being
implemented for that chronic condition, using a scale ranging from 0 (not at all) to 11 (fully).
Results: When we started the enhanced program, the scores ranged over 85% between "0" and "2" =
limited support for chronic illness care; six month average moved to between "3" and "5" = basic
support for chronic illness care.
Conclusion: To improve, we will use Systems-Based Practice (SBP) and Practice-Based Learning
and Improvement (PBL&I) for Team development to achieve between "6" and "8" = reasonably good
support for chronic illness care; and between "9" and "11" = fully developed chronic illness care.
Implications: The enhanced dental residency curriculum will provide the dental resident with the
tools necessary to perform interventions that will improve patient self-management for their chronic
illness.
Funded by HRSA Grant Award No: D88HP20119-01-00
Trauma Training Modular Curriculum: A New Approach to Education of
Psychiatry Residents
Kristina Muenzenmaier, A. Schneeberger, M. Abrams, L. Ruberman, L. Antar, S. Leon, S. Mouzon,
J. Battaglia, Department of Psychiatry and Behavioral Sciences, Bronx Psychiatric Center,
Montefiore Medical Center, Albert Einstein College of Medicine
Background: As psychiatry residents progress through training, they have contact with traumatized
patients from the initial phases of assessment through recovery. Considering the specific challenges
trainees face during their postgraduate years, we decided to assess the need for more extensive
trauma training and as a result developed a Trauma Training Modular Curriculum (TTMC) at
MMC/AECOM psychiatry residency training program.
Goals: The purpose of this poster is to present the results of the needs assessment for specific
trauma training and report on the TTMC developed for use in residency training.
Methods: In order to assess the current needs regarding trauma training of psychiatric residents in
different stages of their postgraduate training we developed a semi-structured questionnaire, which
was distributed to residents (n=29). Additionally information was elicited on a 4-point Likert scale
about three major areas (trauma assessment, barriers, level of comfort).
Results: Needs assessment: First and second year residents stated that the perceived barriers include a lack
of knowledge and skills, discomfort, and lack of appropriate setting; Third year residents‟ answers
focused on discomfort, timing, fear of re-traumatizing, and lack of rapport with patients; Fourth
year residents mentioned difficulties around their own shame, embarrassment and fear regarding the
topic, as well as cultural differences between patient and therapist. Recommendations on how to
improve training included the request for more lectures, protocols, and screening tools, more
evidence based information, structured interviews, sample questions, and more practice, and
requests for more specific training in interviewing and age-specific assessments, guidelines, and
role-plays.
Development of the TTMC: We have created the TTMC that can be adapted to the needs of each
postgraduate year. Each module is structured and has specific teaching goals and objectives, which
focus on conveying attitudes, knowledge and skills. From a teaching perspective, a multimodal,
multimedia, and multisensory approach elicits active participation.
Conclusion: Results of the written questionnaire shows the need for more specific trauma training,
which we addressed with the development of the TTMC. Next steps include program evaluation at
AECOM psychiatric residency training sites as well as collaboration with other residency training
programs on a national level.
Palliative Medicine Educational Initiative for Trainees in the Department of
Obstetrics, Gynecology and Women’s Health
Nicole S. Nevadunsky, Serife Eti, Enid Rivera, Peter Selwyn, Kimala Harris, Gary Goldberg,
Departments of Obstetrics & Gynecology and Women‟s Health (Gynecologic Oncology) and
Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine
Background and Goals: Women with gynecologic malignancies are confronted with pain,
debilitating symptoms and end-of-life decision making. Trainees in obstetrics, gynecology and
women‟s health may deliver improved care by implementing principles of Palliative Medicine.
Our goal was to evaluate baseline knowledge and the efficacy of a training program.
Methods: Fifty-six trainees participated in two interdisciplinary lectures that were themed an
Introduction to Palliative Medicine (IPM) and Pain Management (PM). Lectures were structured
on published curricula from the End of Life Palliative Education Resource Center (EPERC).
Participants completed a pre-test and post-test. The PM lecture included a case-based
component. Learner‟s level of training ranged from medical and physician assistant students to
fourth year residents. Statistical analysis was performed using Students T-test and SPSS
software.
Results: Mean pre-test scores for the IPM and PM lectures were 56% (range 23-85%) and 50%
(range 31-85%) respectively. Significant improvement was seen between pre- and post-test
scores following attendance of the PM lecture, mean post-test score of 86% (range 38-100),
p<0.001. No improvement was seen between pre-test and post-test scores for the IPM lecture.
Questions related to discussing prognosis, hospice benefit and medical futility were answered
correctly in 5%, 14% and 42% of responses in the IPM pre-test. In the PM pre-test questions
related to equal analgesic doses of opiates, pharmacokinetics and opiate side effects were
answered correctly in 25%, 17% and 17% of responses. Questions related to opiate lock-out
intervals, adjuvant analgesics and prophylactic bowel regimens were the most commonly
correctly answered questions (82%, 66%, and 82% respectively) in the PM pre-test. Themes
related to patient confidentiality and communication with family were most commonly correctly
answered in the IPM pre-test (95% and 81%).
Conclusions and Implications: Palliative Medicine and pain management education is needed
for trainees in obstetrics and gynecology. Trainees scored higher on themes related to their daily
practices and scored lower on questions related to more complex components of Palliative
Medicine. Learners were able to score higher on post-tests related to pain management after
case-based learning. Further study is needed to evaluate the most effective educational tools.
Developing a Botanical Medicine Curriculum for Medicine Residents:
A Needs Assessment of Knowledge, Confidence, and Communication
Miriam Rahav, Sharon Leung, Darlene LeFrancois, Department of Medicine, Montefiore
Medical Center and Albert Einstein College of Medicine
Background and Goals: Complementary and alternative medicine (CAM) has grown in
the last decade with 2007 estimates placing CAM use prevalence at 38% of U.S. adults;
tallying $34 billion in national expenditures. As use of CAM grows so does the need for
healthcare providers to provide informed counsel on safe and relevant use. Of CAM
therapies botanicals are the most commonly used, but currently there is no formal
curriculum in this area for our housestaff (HS). To target learning needs, we conducted a
needs assessment survey focusing on knowledge, confidence, and communication
practices, domains considered necessary to achieve the overall goals of practicing and
teaching about botanicals at the point of care.
Methods: All categorical interns (n=38) and residents (n=76) were invited to participate
in an online survey. The survey evaluated participant demographics and exposure to BM
(botanical medicine) in addition to the 3 domains aforementioned.
Results: Of the 114 HS, 86 (75.4%) responded. Personal use of BM was reported by
25%, and 14.7% had received formal BM education in the past. In a MLR (multi linear
regression) analysis, knowledge was associated with personal use of BM after adjusted
for PGY level and exposure to formal teaching in BM. For the confidence score MLR
showed confidence was associated with use of BM and formal education after adjustment
for PGY level. For the CP scale, over 76% of the responders had no CP with their
patients over the past 30 days.
Despite high prevalence of BM usage by patients, categorical HS had knowledge
deficiencies relevant to the use of 10 common botanicals. In the communication domain,
a great majority of HS had not communicated with patients about the use of botanicals in
the last 30 days, nor did they feel confident in doing so. While history of personal use of
BM and prior formal education in BM predicted confidence, overall scores remained
quite low.
Conclusions and Implications: A BM curriculum is needed and has the potential to
impact knowledge, and enhance confidence by identification of resources for reference
and further study. A communication practice may follow, where the spectrum of patient
health practices is reflected inclusive of BM use.
Experiential Learning of Quality Improvement: Converting Resident
“Gripes” into Quality Improvement (QI) Projects
Kenneth Rivlin, Paul Sue, Daran Kaufman, Auxford Burks, Jeffery C. Gershel, Lewis M. Fraad
Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine
Background: A core ACGME competency is for residents to learn about QI through “practice
based improvement and learning.” However, there is no consensus as to the best educational
modality to achieve this goal. Current approaches include QI block rotations and modular QI
projects. While these approaches teach underlying principles and skills they are severely limited
in terms of developing both leadership and ownership of QI projects.
Goals: To improve the learning of practice based improvement by developing and
implementing projects initiated from resident complaints (i.e.,"gripes").
Methods: Chief residents supervised “gripe” sessions with residents with the goal of
discovering potential QI projects. Such gripes were used to identify system-wide problems in re:
patient care and quality of resident education. Chief residents functioned as project leaders,
educating residents on how to implement the Plan, Do, Study, and Act cycles. Regular meetings
were held to identify progress, report data and identify emerging obstacles and future cycles.
Results: Two resident QI problems are summarized below in "storyboard" format:
1. Improving peripheral IV line (PIV) care and replacement
Gripe: Number of hours spent by residents maintaining and replacing PIV's.
Patient Care issue: Delays in care, time to admission, and reductions in time available for
patient care planning.
Outcome: Increased cooperation with nursing to manage PIV issues. Overall 32% mean
decrease in the time residents spent replacing PIVs on the inpatient service over a 1-year
period.
2. Improving hospital discharge follow-up process
Gripe: Amount of time spent by residents on phone making follow-up appointments.
Patient Care issues: Loss of resident time available for patient care planning.
Outcome: Initiation of an alternate system for discharge planning. Relative 45% decrease
in amount of working time spent by residents making follow-up appointments.
Conclusion and Implications: We found the conversion of resident gripes into QI projects to
be a powerful tool in providing experiential learning. For many of our residents, this approach
engendered feelings analogous to the pride felt when successfully managing a sick patient. In
addition, there was a personal investment in the QI projects.
A Faculty Development Program to Prepare Instructors to Observe and
Provide Effective Feedback on Clinical Skills to Internal Medicine Residents
Sheira Schlair, Larry Dyche, Felise Milan, Hillary Kunins, Julia Arnsten, Eric Holmboe
Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine
Background/Goals: Feedback on directly observed clinical encounters is essential to health
professional skill development, and the ACGME mandates direct observation in internal
medicine residencies via the mini-CEX (“clinical evaluation exercise”). Faculty training in direct
observation and feedback skills has been shown to be more important than the assessment
instrument used.
We have implemented a program to train internal medicine faculty to (1) Become familiar with
the evidence-based communication and feedback literature (2) Learn to accurately assess
resident interviewing skills and (3) Conduct behaviorally specific, learner-centered, emotionally
sensitive feedback sessions based on direct observation.
Methods: Interactive one-hour sessions were organized over an academic year. In the first
session, participants used the instrument to evaluate a trainee‟s clinical skills in a videotaped
clinical encounter and then gave real-time feedback to this trainee.
In a second session, facilitators enacted a scripted resident-patient encounter with deficient
rapport building. Faculty practiced feedback giving to this “pre-contemplative” resident using a
“qualities of good feedback” pocket-card and mini-CEX instrument. Themes in debriefing
included understanding residents‟ personal goals and time management. Subsequent quarterly
sessions will employ group discussions of videotaped faculty feedback encounters to explore
assessment accuracy.
Program impact will be assessed by pre-post feedback quality and satisfaction, as measured by
faculty and resident surveys and analyses of mini-CEX instrument data.
Results: Post-session faculty surveys had a response rate of 100% for session 1 (n=24/24) and
75% for session 2 (n=15/20). Faculty reported greatest improvement in the feedback skills
including “addressing learner emotions” (mean=1.3 vs. 2.8, p=0.19) and “collaborative”
feedback processing (mean=2.1 vs. 2.9, p=0.17). Data will be forthcoming from resident surveys
and analyses of mini-CEX instrument data. Preliminary qualitative analysis of faculty program
evaluation yielded curricular strengths: Interactive format, systematic approach to clinical
observation and feedback giving, facilitator style (“openness to criticism and discussion”) and
longitudinal nature of curriculum.
Conclusion: Managing emotions of the “pre-contemplative” resident is challenging but faculty
report growth after two program sessions. Allocated time, faculty attitudes and faculty efficiency
are critical factors to faculty satisfaction with this faculty development program and user
satisfaction with mini-CEX programming overall.
Evaluating Surgical Residents’ Cognitive and Functional Status
Assessment Skills Using a Standardized Patient Interview
Keerti Sharma, Amy R. Ehrlich, Laurie G. Jacobs, Deborah Greenberg, Kim Freeman,
Arnold Berlin, Departments of Medicine (Geriatrics) and Surgery, Montefiore Medical
Canter, Albert Einstein College of Medicine
Background: Surgeons often discuss the risks and benefits of elective surgery in the office
setting.
Goals: A standardized patient (SP) interview was designed to assess surgical residents‟
baseline competence in evaluating an older patient's cognitive and functional status prior to
the introduction of a geriatrics curriculum.
Methods: Six surgical residents were each given 20 minutes to complete a videotaped
interview of a SP. They were provided a scenario of an older adult coming for a pre-
operative visit to discuss an elective cholecystectomy. This exercise was a formative
evaluation and the residents had no prior cognitive and functional assessment training in their
residency. After the interview, the residents completed a structured self- assessment and the
SP completed a structured evaluation of the residents‟ interpersonal skills. A surgeon and a
geriatrician evaluated the residents‟ performance through videotape review using an
additional structured tool. An interactive feedback session was held with the residents, faculty
and SP. Brief video segments were reviewed to highlight successful approaches in eliciting
the SP‟s cognitive and functional status. This exercise will be repeated after the residents' are
exposed to a formal geriatrics curriculum.
Results: Five residents “somewhat agreed” that they were comfortable assessing the patient‟s
cognition; one resident “strongly agreed.” Half “strongly” and half “somewhat agreed” that
they were comfortable assessing function. There was strong correlation between the faculty
regarding the evaluation of the residents, and all six were assessed as “able to identify the
patient‟s cognitive and functional deficits.” Only one employed a standardized assessment
tool to reach this conclusion. The residents "strongly agreed" that this exercise was very
helpful.
Conclusion: Although all of the residents were able to identify cognitive and functional
deficits, they were not confident in their skills. Exposure to geriatric assessment tools, such
as the „Mini- Cog‟, through a formal geriatrics curriculum may improve the residents'
confidence in their skills. Use of this SP exercise prior to formal geriatrics training is a useful
teaching tool that was highly evaluated by surgical residents.
Support for this project provided by: John A. Hartford Foundation GSR grant
Observing the Teachers: Is Faculty Development Effective for
Preceptors Teaching Medical Students in a Physical Diagnosis Course?
Lisa Auerbach, Mimi McEvoy and Felise Milan, Departments of Medicine and
Pediatrics, Ruth L. Gottesman Clinical Skills Center, Albert Einstein College of Medicine
Background: Importance of student observation and feedback to enhance clinical skills
acquisition is well documented. Less well documented is the observation of preceptors‟
teaching skills. A myriad of faculty development venues exist in the literature;
effectiveness of these efforts hasn‟t been well studied.
Educational Objectives: Assess teaching skills of preceptors in a second-year physical
diagnosis course for: 1) conformity to course objectives/strategies/format; 2) various
teaching approaches, 3) observation and feedback technique; and 4) time management.
Methods: One experienced faculty observed 10 of 23 randomly selected preceptors
during 4 of 7 physical diagnosis sessions (vital signs/handling the instruments, HEENT,
abdomen and neuro) via remote observation (from a video control room) to determine if
objectives, strategies and format are being implemented as discussed in the 30 minute
faculty meetings prior to each session. All preceptors consented to being observed. A
12-item observation tool was crafted based on basic principles of group teaching (i.e.
coaching students who were practicing examination techniques) and course logistics (i.e.
not spending more than 30 minutes on pre-practice demonstrations/lectures, employing
the skills checklists in syllabus). General observations were also recorded.
Results: All preceptors conformed to session objectives and teaching strategies, except
in 2 cases where preceptors consistently lectured too long, minimizing hands-on practice.
Other teaching approaches observed included demonstration, observation, hands-on
corrections. All preceptors employed the PE skills practice checklists, but in different
ways. Preceptors consistently gave feedback on techniques despite variability on the
proportion of verbal explanation/demonstration. Length of sessions varied with some
preceptors ending before 2 ½ hours; 2 preceptors who lectured for greater than 30
minutes ended later.
Conclusions: Video observation confirmed that faculty do consistently meet course
objectives in a physical diagnosis course. Faculty development may be related to
achieving consistency of course objectives and strategies among preceptors despite a
variety of approaches and styles. Opportunities for specific preceptor feedback abound
with this observational method.
Health Disparities: Awareness to Action – A Curricular Innovation
Cristina M. Gonzalez, Aaron D. Fox, Department of Medicine, Montefiore Medical
Center, Albert Einstein College of Medicine
Background and Goals: The LCME mandates health disparities education. We
developed an innovative curriculum with the following objectives: (1) Define HD and list
examples of diseases where disparities are evident; (2) Demonstrate confidence in
utilizing skills targeting provider contributions to HD; (3) Demonstrate confidence in
developing advocacy skills targeting social contributions to HD.
Methods: Eleven first-year medical students participated in the elective at Einstein. The
curriculum was divided into three areas with the final session for evaluation:
1. Background (four sessions): Included computer based modules summarizing the
HD literature, videos introducing the social determinants of health, and discussion
with community health advocates.
2. Provider Contributions (three sessions): Sessions prepared learners to recognize
implicit biases and minimize their influence on patient care. Learners completed
the Implicit Association Test (IAT), participated in case based discussion groups,
and practiced interviewing techniques.
3. Advocacy Skills (five sessions): Skill building sessions prepared learners to
address the social determinants of health through advocacy and social change.
Sessions included strategy for advocacy campaigns, outreach, physicians‟
organizations, media, and legislative advocacy.
Results: Pretests and posttests items were rated on a four-point Likert
scale. Changes in confidence were examined using paired T-tests. Learners
demonstrated increased comfort in defining HD, social determinants of health, and
implicit bias, and increased awareness of mistrust, communication, and physician
contribution to HD. Learners also increased confidence in their advocacy skills.
Perception of personal implicit bias did not change.
Student‟s identified positive aspects of the course that facilitated learning: the small
group environment, enthusiasm of faculty, and skill development. Suggestions for
improvement included: additional experiential learning and integration into the
compulsory curriculum.
Conclusions and Implications: Our students enjoyed the HD elective and felt confident
in their knowledge gains. The IAT is provocative, but may not convey the intended
lesson that implicit bias is natural and can be managed in clinical practice. Methods to
recognize and overcome implicit bias are needed. While physician advocacy is often
discussed in the context of professionalism, teaching advocacy skills as part of HD
coursework may empower students to address social contributions to HD and reduce HD
in the future.
Psychometric Properties of the Team Performance Scale in a Third-
Year Medical School Clerkship
Jennifer M. Purcell, Department of Family and Social Medicine, Albert Einstein College
of Medicine
Background and Goals: Research and evaluation are critical components of any
educational initiative, and selecting appropriate tools to measure the construct of interest
is important to ensure reliability of data and validity of results. The purpose of this poster
is two-fold: 1) review the psychometric properties of the Team Performance Scale (TPS)
with third year medical students, and 2) test the feasibility of using a subsample of items
without impacting the psychometric results.
Methods: The Department of Family and Social Medicine recently introduced four team-
based learning (TBL) sessions to its clerkship curriculum. As part of a comprehensive
evaluation process, faculty are collecting data from multiple sources to measure
knowledge, higher-order thinking, and quality of team performance.
Students were asked to complete the TPS, developed by Thompson and colleagues
(2009), as part of their end-of-rotation clerkship evaluation. Using a similar method
described in the Thompson et al. article, we examined the internal consistency,
proportion of explained item variance, and ability to distinguish among teams for the full
scale and 12 shortened scales created through random item generators.
Results: Preliminary results using data from eight rotations (n = 122) show similar
psychometric properties for both the original TPS and a 6-item subscale to those reported
by the scale‟s authors.
Conclusions and Implications: There is evidence of reliability and validity when using
the TPS with a group of 3rd
year medical students. Researchers may also consider the use
of a shortened scale when administering multiple construct questionnaires without
compromising validity or increasing response burden.
Evaluation of the Team-Based Learning Curriculum in a Family
Medicine Clerkship
Jennifer M. Purcell, Pablo Joo, Department of Family and Social Medicine, Albert
Einstein College of Medicine
Background and Goals: The use of team-based learning (TBL) in medical education has
grown steadily over the past decade. However, its effectiveness in clinical clerkships is
not often reported. This poster will present quantitative outcome data from the first eight
months of the new TBL curriculum in the Family Medicine clerkship.
Methods: After completing a six-month iterative design process, the Department of
Family and Social Medicine implemented a series of TBL sessions in its 3rd
-year
clerkship. Four 2-hour sessions replaced one standard health promotion lecture and three
case-based sessions covering asthma, hypertension and hyperlipidemia, and diabetes.
Exam scores (20 items) of students in TBL were compared with students who
participated in the lecture and case-based sessions the previous year. Additionally,
responses to four self-report survey items on knowledge change, student interaction, and
the opportunity to apply content to clinical questions were considered. These data
represent only two of multiple evaluation measures.
Results: Exam scores and survey responses from 122 TBL students were compared with
119 students from last academic year. Exam scores were not significantly different by
topic area and no trends in item difficulty occurred over time. TBL students rated self-
perceived knowledge both prior to and after the sessions lower than the previous group,
yet changes in knowledge were not significantly different. There were significant
differences, however, in the opportunity to apply content to clinical questions.
Conclusions and Implications: Curriculum evaluation is an ongoing process and is
especially important when implementing any curricular change. Although preliminary
results support the use of TBL in the Family Medicine clerkship, measures of student
satisfaction, team performance, and faculty feedback will be reviewed to create a more
robust evaluation.
Incorporating a QI Exercise into the Einstein Medicine Clerkship: A Pilot
Study
Sharon Silbiger, Darlene LeFrancois, Penny Grossman, William Burton, William Lee, Eran
Bellin, Department of Medicine, Office of Educational Resources, Emerging Health Information
Technology, Albert Einstein College of Medicine/Montefiore Medical Center
Background: Based on the AAMC 2010 GQ Medical School Graduation Survey, over 37% of
Einstein students felt that their instruction in and exposure to “Health Care Quality
Improvement” was inadequate. Montefiore Medical Center (MMC) has developed longitudinal
analytic software, called Clinical Looking Glass (CLG), which allows users to query the health
information system and answer clinical questions based on cohort data, thereby supporting QI
efforts.
Objectives: 1) Conduct a Needs Assessment of current 3rd
year Einstein medical students
regarding familiarity with QI concepts. 2) Pilot a QI exercise in the Medicine Clerkship.
Methods: 1) 11 question “Needs Assessment” survey distributed to all Einstein 3rd
year
medical students who had completed Medicine Clerkship in current academic year (N=89). 2)
Tool development: a) 2011 Standards of Care (Standards of Care) Guidelines summary for
Diabetes Mellitus (DM), b) Pre-test on DM Standards of Care, c) Medical chart abstraction form,
3) Pilot QI exercise: a) Student clerks rotating on in-patient medical service of MMC
participated. b) Pre-test administered to students. c) Standards of Care Guidelines for DM
reviewed with students. c) Each student reviewed medical chart of diabetic in-patient. d)
Students trained in CLG, developed a clinical question regarding care of patients in the MMC
system and ran query. 4) Program evaluation performed using focus group.
Results: 1) Needs assessment survey response rate: 52%. Students reported either a vague idea
or unclear understanding of QI (74%); Standards of Care (54.5%); PBL (26.2%). 98% of
students felt it was important for medical students to know about monitoring patient outcomes.
Over 50% of students had no experience with chart review.
2) 11 students successfully participated in the pilot QI program. a) Few students were
familiar with Standards of Care in DM. b) Chart review challenges noted: indecipherable
handwriting and poor documentation. c) Sample CLG student query: What percentage of
patients with 2 HBA1C levels > 6.5 in the past year and a systolic BP>130 and diastolic >80 are
on ACEI or ARB?
3) Based on focus group, most students enjoyed discussing their QI queries and using
CLG, but felt that other aspects of the QI exercise should be truncated. Some students felt that
the QI exercise required a large time commitment and took them away from patient care during
the clerkship. Student comments regarding the overall benefit of practice based learning and
improvement and self reflective practice varied, with some students commenting: “I think it
makes me a better physician” and “It show us how we can test ourselves”.
Summary/Conclusions: A QI exercise was successfully instituted during the medicine
clerkship block. Further development and expansion of this curriculum is planned.
Musculoskeletal Examination (MSKE) Pilot Mini-Course: Increasing Medical
Student Exposure to the MSKE
Maya R. Therattil, Todd R. Olson, Sherry A. Downie, Departments of Physical Medicine and
Rehabilitation and Anatomy and Structural Biology, Montefiore Medical Center, Albert Einstein
College of Medicine
Background and Goals: Medical students are inadequately prepared to undertake careers in
musculoskeletal medicine (Day et al., 2007). They lack anatomic knowledge, basic exam skills,
and confidence to perform musculoskeletal exams (MSKE). To address this, we developed a
pilot course integrating anatomical knowledge and MSKE skills using cadaver review and hands-
on workshops.
At Einstein, students are introduced to musculoskeletal medicine through first-year Clinical and
Developmental Anatomy and second-year Musculoskeletal System courses. During anatomy,
students dissect the back, upper and lower extremities, and discuss clinical cases with Physical
Medicine and Rehabilitation faculty. In the Musculoskeletal System course common pathologies
are studied. This exposure to musculoskeletal medicine is equal to or less than the exposure in
institutions where deficiencies were reported (Schmale, 2005). We hypothesize that additional
opportunities for students to learn fundamental concepts and practice MSKE techniques will
result in measurable improvement in student knowledge, confidence, and competency.
Methods: The MSKE Pilot Mini-Course (limited to 23 MS1-4 students) consisted of the pre-
course quiz, three 2-hour evening sessions, and a follow-up meeting to administer the post-test
quiz and course evaluation. Data were analyzed statistically using paired t-tests. Each session
included an introduction to body planes and positioning, clinically relevant concepts of
movement (e.g. scapulohumeral rhythm), cadaver-based anatomy review of the selected region,
and hands-on sessions to learn and practice such common MSKE techniques as range of motion,
Spurling‟s test, Lhermitte‟s test, straight leg raise, impingement tests, and tests for tendonitis,
carpal tunnel syndrome, arthritis, ligamentous and meniscal knee injuries, and ankle sprains.
Results: Confidence levels in performing MSKEs increased significantly and 100% of students
felt that integration of anatomy with MSKE practice was useful. An increase in knowledge was
documented (10.19% MS1; 18.10% MS2-4). Skills were not tested.
Conclusion: Integration of cadaveric anatomy review with MSKE practice helps medical
students synthesize what they have learned in first- and second-year courses and provides a
framework for adding and retaining new information.
Future plans: Develop MSKE OSCEs for use in the 2012 Mini-Course and develop a fourth-
year elective curriculum that expands on this pilot program and incorporates cadaveric anatomy
review, hands-on MSKE practice, and clinical experience.
Funded by Grants for Excellence in Medical Education, Albert Einstein College of Medicine,
2010.
Video Recorded Simulations in Bioethics Consultation Training: A
Collaboration of the Ruth L. Gottesman Clinical Skills Center and the
Einstein-Cardozo Masters of Science in Bioethics Program
Patrick D. Herron, Hannah I. Lipman, Patricia (Tia) Powell, Elizabeth A. Kitsis, Departments of
Family & Social Medicine, Medicine (Geriatrics), Epidemiology & Population Health,
Psychiatry and Behavioral Sciences, Medicine (Rheumatology), Montefiore Medical Center,
Albert Einstein College of Medicine
Background: In the spring of 2011, the Montefiore-Einstein Center for Bioethics and Ruth L.
Gottesman Clinical Skills Center (CSC) collaborated on the development of a graduate course in
Bioethics Consultation. The course was offered as professional development and/or towards the
Einstein-Cardozo M.S. in Bioethics, a degree program of the Albert Einstein College of
Medicine and the Benjamin Cardozo School of Law of Yeshiva University in collaboration with
Montefiore Medical Center. Ten students representing the fields of medicine, nursing, law, and
pastoral care participated over four days covering two weekends in March and April.
Goals/Objectives: The goal of the course was to design an effective training program for
bioethics consultants using a variety of educational techniques including interactive lecture, case
discussion, literature review, role play and video recorded simulations.
Methods: Learners had the opportunity to apply techniques learned through a variety of
scenarios created by faculty that address common themes and challenges in bioethics
consultation. Recorded simulations were accessible to participants via the Internet utilizing the
CSC‟s web based data management system. This provided an opportunity for self-assessment by
the participants. Faculty assessed and provided feedback to all participants as well as using
recordings for teaching points to help illustrate interpersonal/communication skills, bioethics
mediation skills and bioethics knowledge as demonstrated in recorded consultation encounters.
Evaluation: Faculty provided learners with Ethics Consultant Proficiency Assessment Tool as a
pre/post assessment to evaluate course objectives. It was developed by the Veteran‟s Health
Administration‟s Integrated Ethics program through the National Center for Health Care Ethics.
Faculty also utilized an adaptation of Einstein‟s Introduction to Clinical Medicine program‟s
Communication/Interpersonal Skills checklist for medical students. Preliminary results of the
course and teaching methods will be completed by the end of April 2011.
Conclusion/Implications: The faculty, representing the Gottesman Clinical Skills Center and
Center for Bioethics, include experts in bioethics consultation and education and use of video in
medical education. Their collaboration to design an interactive curriculum teaching core content
and skills for bioethics consultation demonstrates the benefits of collaboration and partnership of
the Ruth L. Gottesman Clinical Skills Center with institutional partners throughout the Einstein-
Montefiore community.
Smartphone Use During Inpatient Attending Rounds: Help or Hindrance?
Rachel J. Katz-Sidlow, Allison Ludwig, Scott Miller, Robert Sidlow, Departments of Medicine
and Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine
Background: Healthcare market research has found that 72% of US physicians currently own a
smartphone (e.g. iPhone, Android, Blackberry, iPad). These devices offer numerous benefits for
physicians, including applications that assist in patient diagnosis and management. Nevertheless,
research from the psychology and traffic safety fields has raised concerns about the potential for
smartphone user distraction while multitasking.
Objective: To assess resident and faculty smartphone use during inpatient attending rounds and
its potential as a source of distraction during important clinical information transfer.
Methods: We surveyed all housestaff and inpatient faculty in the departments of Medicine and
Pediatrics at our institution regarding smartphone ownership and usage patterns during attending
rounds. Respondents were also asked whether they had ever missed, or had seen others miss,
clinically important data during rounds due to distraction from smartphones. Attendings were
asked whether policies should be established for smartphone use during rounds.
Results: Survey response rates were 81% (116/143) for housestaff and 56% (40/71) for faculty.
Smartphone ownership rates were 89% for residents and 98% for faculty, with 57% of housestaff
and 28% of attendings reporting “frequent” personal use of smartphones on attending rounds.
Respondents noted that they used their smartphones at least occasionally during attending rounds
for: 1) patient care (85% residents, 48% faculty, p<.001), 2) reading/responding to personal
texts/emails (36% residents, 12% faculty, p<.001), and 3) other non-patient care uses (15%
residents, 0% faculty, p<.001). Of concern, 19% of residents reported that they missed important
clinical information due to smartphone distraction, as did 12% of attendings. Interestingly,
respondents reported observing other team members using smartphones and missing important
clinical data at higher rates than they reported for themselves. A majority of both residents and
faculty agreed that smartphones “can be a serious distraction during attending rounds” and 77%
of attendings affirmed that "smartphone use codes of conduct" are needed.
Conclusions: Smartphone ownership and use during attending rounds is highly prevalent among
both faculty and residents and can distract users during these periods of important information
transfer. A vast majority of attendings favor the institution of formal policies governing
appropriate smartphone use during inpatient rounds.
Mastering Functional Independence Measures: Comparison of
Different Educational Strategies
Karen Morice, Michael D. Skeels, Maya R. Therattil, Department of Physical Medicine
and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine
Background: The Functional Independence Measure (FIM) instrument is a scoring
system, developed to provide data on severity of disability and rehabilitation outcomes.
The FIM is an 18-item ordinal scale used universally in outcome studies and in
rehabilitation hospitals to measure a patient‟s improvement during their inpatient stay.
Physical Medicine and Rehabilitation (PMR) residents spend a minimum of one year in
inpatient rehabilitation training and undertake careers in managing inpatient rehabilitation
units. Understanding how to correctly assess a patient‟s FIM is important as it helps
predict length of stay, discharge destination and services required. Resident education on
using the FIM instrument has not been reported in the PMR literature despite the
importance and daily use in inpatient rehabilitation.
Goals: To compare the efficacy of two different strategies to educate residents in the use
of the FIM instrument.
Methods: Twenty-two residents, who took a standardized FIM pre-test, underwent a
didactic session taught by physical, occupational and speech therapists who are experts in
the various domains of the FIM instrument. Eleven residents (intervention group) from
this group would use the FIM instrument to score the function of one patient admitted to
the acute rehabilitation unit. This process is ongoing. A standardized post-test will be
administered to all twenty-two residents after a period of four months. The scores of the
intervention group will be compared to the scores of the non-intervention group (the
eleven residents who only attended the didactic session and did not FIM score any
patients) would be compared.
Results: The average score on the Pretest was 6.02, maximum score being18. The post-
test score is not available as this is a study in progress.
Conclusions: Our hypothesis is that residents who evaluated a patient and calculated the
FIM score, in addition to attending the standard didactic session on FIM scoring, would
score higher on the standardized post-test.
Implications: The results of this study may determine the inclusion of practical FIM
scoring sessions with actual patients, to the resident education, in addition to a didactic
session, by experts in FIM scoring.
Innovations in Resident Education: Applications of Information Technology
Eleanor Weinstein, Maria Mendoza, Andrew Gutwein, Department of Medicine, Jacobi Medical
Center, Albert Einstein College of Medicine
Background and Goals: The goal of this project is for Jacobi Medical Center (JMC) Internal
Medicine residents to achieve competency in Practice - Based Learning and Improvement in
their ambulatory care education through the use of a Diabetes Registry. Additionally, they will
gain an understanding of the chronic disease model of care resulting in improved quality of care
for their patients.
The Diabetes Registry is a web-based tool using the electronic medical record (EMR)
information to provide an overall snapshot of longitudinal patient care. It is useful to monitor
trends in compliance with evidence-based practice and, residents can use it to self-identify areas
needing improvement. Residents can continually monitor their own performance and identify
patients not meeting established targets for clinical care.
The JMC Internal Medicine categorical training program currently consists of 93 residents.
About 40 % of the 4200 diabetic patients at JMC are assigned to residents for ongoing care.
These patients pose particular challenges as continuity of care and close follow up, vital in
diabetes management, are more difficult given erratic resident schedules.
Methods: The Diabetes Registry function at JMC was adjusted this academic year to allow each
resident to have his/her own personal registry. Patients are assigned as they are seen by a
resident, building patient panels within the Registry for residents to follow over the 3 years of
residency. We hypothesize this will improve engagement of residents with their patients, allow
residents to continually evaluate the care being provided and improve continuity of care,
outcomes and quality. Through effective use of the Registry, competency in Practice Based
Learning and Improvement will be achieved.
Plans for studying the effectiveness of the Diabetes Registry in resident education include:
Monitoring patient outcomes by following clinical indicators via the individual
Registries
Monitoring continuity of care of the patients assigned to the resident Registry
Monitoring the residents‟ use of their Registry via the built in log - in audit
function
Surveying the residents every 6 months throughout their residency training to
assess attitudes and confidence in using the Registry
Surveying the residents every 6 months to assess knowledge and confidence in
caring for patients with chronic disease
Discharge Summary Quality Improvement Project
Tehila Zuckerman, Maria Kassab, Anna Kochin, Dahlia Rizk, Rebecca Calabrese
Department of Medicine, Beth Israel Medical Center, and Albert Einstein College of
Medicine
Background and Objectives: Discharge summaries are used by clinicians for
communication with colleagues and patients. Studies demonstrate summary quality
impacts patient morbidity and mortality. This study aimed to evaluate the quality of
discharge summaries written by internal medicine house officers, whether an educational
intervention could improve quality, and the perception of the intervention.
Methods: The study took place at an urban academic medical center over a one-month
period. Discharge summaries of 29 house officers assigned to a medical ward were
evaluated. Survey participants included internal medicine house officers, hospitalists,
and primary care physicians. The educational intervention was a noon conference for
house officers.
Description: An anonymous pre-intervention survey asked house officers and faculty
physicians to rate current discharge summary quality and their interest in education on
quality improvement. Thereafter, 30 randomly selected, de-indentified summaries were
scored using an 18-item discharge summary quality scoring tool. Approximately 65
house officers attended a lecture highlighting those items identified as needing
improvement. Then, 30 randomly selected, de-identified summaries written by the same
group were scored to evaluate impact. A score of 80% or greater was considered
adequate quality. An anonymous post-intervention survey of house officers solicited
feedback.
Results: The pre-intervention survey yielded responses from 50/121 house officers and
24/39 faculty physicians. Both groups thought 60% of summaries were of high quality.
86% of house officers and 87.5% of faculty favored an educational intervention. The
discharge summary scoring tool found overall pre-intervention quality to be 87%, but
identified 9 of 18 individual items scored as having an average quality <80%. The
overall post-intervention quality score improved to 93.9%, with only 1 of 18 individual
items scored having a quality score <80%. The post-intervention survey of house officers
yielded 42/121 responses. 96% recommended adopting the intervention into the academic
curriculum.
Conclusions and Implications: House officers and faculty agreed regarding the need for
improvement in discharge summary quality. Nearly all individual summary items in
need of improvement achieved adequate quality after the intervention. The educational
intervention was well received. Our study demonstrates the value of incorporating
education on discharge summary quality into the academic curriculum.