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Using an inflammatory bowel disease objective structured clinical examination to assess acgme milestones in gastroenterology fellows [Meeting Abstract]

Zalkin, D; Malter, L; Balzora, S; Weinshel, E; Zabar, S; Gillespie, C
Background: Te Accreditation Council for Graduate Medical Education (ACGME) has identifed six core competencies in which trainees are expected to demonstrate profciency. Milestones have been developed to provide a framework for evaluating trainee performance within these competencies. We used an objective structured clinical examination (OSCE) focused on inflammatory bowel disease (IBD) to assess the milestones in gastroenterology (GI) fellows. METHODS: Ten second-year fellows from six GI fellowship programs participated in a four case OSCE. In the "Transition of CareTM case the fellow was to assess a patient's readiness on the planned transition from child-centered to adult-centered care. In the "Shared Decision MakingTM case the fellow was to evaluate a patient with Crohn's disease who would beneft from combination therapy. In the "ER FlareTM case the fellow was to triage and suggest management of a flaring ulcerative colitis patient. In the "IBS in IBDTM case the fellow was asked to discuss irritable bowel syndrome in the context of quiescent IBD. Previously validated OSCE checklists were used to assess the GI fellows' performance using a 3-and 5-point behaviorally-anchored Likert Scale. Checklists were scored by the standardized patient. Checklist items were mapped to appropriate ACGME milestones by a GI medical educator. Scores within each milestone were normalized on a scale from 0-9 as utilized by the ACGME in the Next Accreditation System milestone initiative. Fellows were provided feedback on their performance. RESULTS: Te majority of fellows scored between 6 and 9 in the milestones assessing patient care (PC), medical knowledge (MK), interpersonal and communication skills (ICS), professionalism (Prof), and systems-based practice (SBP). Composite average scores for all participants were as follows: PC1 7. 7, PC2 6. 9, MK1 6. 9, MK2 7. 0, ICS1 7. 4, Prof1 7. 6, Prof3 6. 9, and SBP4 6. 4. Fellows scored highest in the "Shared Decision MakingTM case and scored lowest in the "Transitions of CareTM case. CONCLUSION(S): In this OSCE GI fellows performed well in the majority of milestones evaluated, however areas of less optimal performance were identifed, providing areas for future focus in fellow training. Te OSCE is a well-validated standardized tool for evaluating trainees, and with appropriate mapping of checklists to ACGME milestones, it can serve as an objective method to assess GI fellows' progress in the core competencies
EMBASE:621501484
ISSN: 1572-0241
CID: 3113162

What do i need to know about feeding tubes? Assessing the effect of a multi-modal educational effort on internal medicine residents' competence in discussing feeding tube placement [Meeting Abstract]

Betesh, A; Zalkin, D; Liang, P S; Perskin, M H; Malter, L B
Introduction: Patients and families are often asked to make decisions regarding feeding tube placement during a medical crisis. The risks, benefits, and alternative treatment choices are not communicated by a standard method, and the consultants placing the tubes are often invited to join the discussion at a late stage. Our aim is to improve this process with a focus on patient and family preferences and patient safety, by educating medicine residents about feeding tubes and providing them with a shared decision making tool utilizing an electronic book (iBook). Methods: We created a one hour noon conference program for residents in which we reviewed information about enteral feeding, including types of tubes, placement methods, indications, contraindications, complications, and feeding tube use in selected medical conditions, with a focus on dementia. During this session the iBook was introduced for use in discussions with patients and families. Pre- and postintervention surveys were given to the residents to determine their knowledge and comfort level with the content. Gastroenterology fellows were also surveyed to determine if there was a difference in the nature of the feeding tube consults before and after the intervention. We used the chi-squared or Fisher's exact test to compare dichotomous outcomes in the pre- and post- intervention groups. Results: Among residents, there was a statistically significant increase in the proportion of individuals who answered that they were very comfortable/competent in all six questions regarding feeding tube placement after the intervention (p < 0.01 for all). Among fellows, there was perceived improvement in resident and patient knowledge regarding feeding tube placement as well as appropriateness of consults after the intervention, however these were not statistically significant due to the small sample size. There was a perceived decrease in the frequency of appropriate feeding tube placements after the intervention, which was also statistically non-significant. None of the residents reported that they had used the iBook with patients. Conclusion: Residents are often the first physicians to discuss feeding tube placement with patients and families in the acute inpatient setting, however many report that they are not equipped to lead this discussion. Formal education about feeding tubes improves resident comfort/competence in this area and should be incorporated into medicine housestaff curricula
EMBASE:620839085
ISSN: 1572-0241
CID: 2968262

Irritable Bowel Syndrome and Inflammatory Bowel Disease Overlap: Optimizing Management Through the Use of an Observed Structured Clinical Examination [Meeting Abstract]

Zalkin, Dana; Cohen, Cynthia; Zabar, Sondra; Kingsbery, Joseph; Weinshel, Elizabeth; Malter, Lisa
ISI:000395764601060
ISSN: 1572-0241
CID: 2492452

ACUTE LIVER INJURY IN A PATIENT WITH METASTATIC PHEOCHROMOCYTOMA [Meeting Abstract]

Zalkin, Dana; McNeill, Matthew
ISI:000392201602051
ISSN: 0884-8734
CID: 3214082