Faculty Bibliography

The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.

Background/UNASSIGNED:Telemedicine holds promise to bridge the transition of care between inpatient and outpatient settings. Despite this, the unique communication and technical skills required for virtual encounters are not routinely taught or practiced in graduate medical education (GME) programs. Objective/UNASSIGNED:To develop an objective structured clinical examination (OSCE) case to assess residents' telemedicine-specific skills and identify potential gaps in our residency program's curriculum. Methods/UNASSIGNED:As part of a multi-station OSCE in 2019, we developed a case simulating a remote encounter between a resident and a recently discharged standardized patient. We developed an assessment tool comprising specific behaviors anchored to "not done," "partly done," and "well done" descriptors to evaluate core communication and telemedicine-specific skills. Results/UNASSIGNED:Seventy-eight NYU internal medicine residents participated in the case. Evaluations from 100% of participants were obtained. Residents performed well in Information Gathering and Relationship Development domains. A mean 95% (SD 3.3%) and 91% (SD 4.9%) of residents received "well done" evaluations across these domains. A mean 78% (SD 14%) received "well done" within Education/Counseling domain. However, only 46% (SD 45%) received "well done" evaluations within the Telemedicine domain; specific weak areas included performing a virtual physical examination (18% well done) and leveraging video to augment history gathering (17% well done). There were no differences in telemedicine-specific skill evaluations when stratified by training track or postgraduate year. Conclusions/UNASSIGNED:We simulate a post-discharge virtual encounter and present a novel assessment tool that uncovers telemedicine-specific knowledge gaps in GME trainees.

Needs and Objectives: In the changing landscape of healthcare, physicians must be adaptive, visionary and evidence-based in their approach to care Medical education must be adjusted to allow learners to gain skills that prepare them to function effectively in this new paradigm. In order to meet these needs, we developed a community based curriculum with emphasis on transitions of care, population health and innovation of care. Setting and Participants: Curriculum was developed as part of a new NYU Internal Medicine Residency Community Health Track, housed at NYU Langone Hospital-Brooklyn, a community based, academic teaching hospital. Ambulatory training is based at the Family Health Centers at NYU Langone, a network of FQHCs. Both the hospital and FQHCs serve a vulnerable, diverse community in south Brooklyn. To date we have recruited one class of 10 interns. As of July 2020 we anticipate having a full track consisting of 30 residents. Description: Our first year curriculum aims to develop a framework for thinking about community health introducing key concepts such as population-based care, novel delivery of care, and interdisciplinary collaboration. Early in their training, residents completed a community assessment using observational data, interviews and census track data. These assessments paired with collaboration with CHW and community organizations gave them first hand exposure to our area's specific challenges and gaps in care. The residents began to develop skills in home care by working with an interdisciplinary team of doctors, nurses and CHWs. Additionally, they participated in a transitions of care workshop, examining their own hospital patients who had been readmitted and identifying best practices for hospital discharge. Evaluation: A multi-method evaluation plan is essential as we evaluate and strengthen the curriculum. Qualitative feedback is gathered at regular intervals throughout the year along with surveys of trainees. Initial Results suggest that curricula is well-received by residents. Aggregated longitudinal educational data including resident self-report, 360^oevaluations and performance-based assessment, (OSCEs, USP visits) will contribute to program evaluation. The most important outcome will be how these trainees practice once they have graduated. We plan to use postgraduate surveys to judge the impact of the curriculum. Discussion/Reflection/Lessons Learned: We adapted curriculum to focus on our particular community and created innovative programs to improve the population's health. Essential to these accomplishments was our partnership with learners and our reliance on their feedback to guide curriculum development. Allowing trainees to explore their interests has lead to visionary projects. We have learned that by being flexible and adapting to the learners' needs and interests we can serve our community in deeper ways than we had initially anticipated. However, structural limitations of the clinic coupled with institutional changes resulted in a slower time frame for clinical adaptations