Faculty Bibliography

This study sought to understand how individuals experienced participating in a Housing First (HF) program, which is designed to operate along principles of permanent housing, consumer choice, and harm reduction, while simultaneously participating in an alternative to incarceration (ATI) program that incorporates treatment mandates, abstinence monitoring, and court reporting which tend to be in tension with the HF model. Analysis of semi-structured qualitative interviews with 20 participants suggests that though participants recognized the constraints of the ATI program and legal mandates, they somewhat surprisingly experienced the HF program in accordance with the model's stated principles. The majority of participants remained in the HF program after four years and reported positive outcomes, which many attributed to having a home of their own. Having the ATI program serve as a mediator with the criminal justice system may have allowed the HF program to have a buffer between the participant and the legal system and helped keep the housing and consumer-driven services separate from explicit legal requirements.

NEEDS AND OBJECTIVES: Despite an increasing need for physicians trained in Internal Medicine (IM), the number of medical students entering residencies in IM has declined. Misconceptions about careers in IM, pay differentials between disciplines, student debt and work hours are thought to contribute to this decline. We developed an "IM Speed Dating Event" to increase first year medical student's awareness of the breadth and richness of IM training and careers. SETTING AND PARTICIPANTS: Faculty members from each Division within the Department of Medicine at our institution were asked to participate to emphasize the diversity of careers paths after IM training. Medical Students were recruited via email, flyers and word-of-mouth. Over 3 years of the event (2009-2011), 51 medical students participated (14-19/year). DESCRIPTION: This "speed dating" event was structured so that students rotated, in timed, five-minute blocks, speaking to a total of 10 faculty. Faculty members were organized to optimize diversity of disciplines to which students were exposed. Students asked questions about faculty members' career and training paths, current roles/responsibilities, work life, and work/life balance. The event was very informal, easy to set up and organize, and the speed dating format encouraged friendly, compelling and direct, but brief, discussions. EVALUATION: All 51 participants (n=18 in 2009, 19 in 2010, and 14 in 2011), completed a pre-event anonymous assessment of their attitudes toward and understanding of IM residency and career pathways and practices as well as their specialty and career intentions. After the event, 47 completed an evaluation of the "Speed Dating" event including listing 3 things they learned and the degree to which the event led them to become more interested in exploring IM. Pre-event assessment results suggest that medical students are quite unsure about IM careers (e.g., 45% reported being not sure whether faculty within IM Departments have all done IM residencies and 58% rep!

STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): To determine how adding a non-clinical member to primary care teams can improve hypertension and smoking cessation outcomes in Veteran Affairs New York Harbor Healthcare System's (VA NYHHS) implementation of the VA's Patient Centered Medical Home (PCMH) model, known as Patient Aligned Care Teams (PACT). OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): As part of the Program for Research on Outcomes of VA Education (PROVE) study, we sought to define a toolkit of panel management strategies that Panel Management Assistants (PMAs) will use to improve outcomes in smoking cessation and hypertension across patient panels. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENTVS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Coincident with the nation-wide implementation of PACT across the VA system, PROVE explores the incremental impact of panel management and clinical microsystem education on hypertension and smoking outcomes. Two-thirds of randomly selected PACT teams in ambulatory care clinics at the Brooklyn and Manhattan campuses of the VA NYHHS had a PMA added to the team. Based on literature review and qualitative interviews of clinicians and key stakeholders at VA NYHHS, we developed a core toolkit of strategies utilizing clinical databases to target subsets of smokers and hypertensive patients that could benefit from specialized panel management interventions outside of the patient visit, such as identifying smokers who have not recently received tobacco cessation medications. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVEMETRICSWHICH WILL BE USED TOEVALUATE PROGRAM/INTERVENTION): Prior to PROVE's intervention, we determined baseline rates of hypertension (uncontrolled and controlled) and smoking for all PACT panels. To assess PROVE's effectiveness of integrating panel management strategies by PACT teams, we will survey providers and nurses at baseline, 6 and 12 months to me!

OBJECTIVE: To evaluate a nutrition curriculum and explore the influence of medical students' own nutrition practices on its impact. METHODS: An anonymous survey was given to first-year medical students attending a required course immediately prior to and 2 weeks after a 2-hour interactive nutrition curriculum intervention in a large private urban medical school in New York, New York. Main outcomes included self-reported nutrition counseling confidence, ability to assess diet, and nutrition knowledge measured using 4-point Likert scales. RESULTS: One hundred eleven students completed surveys pre-curriculum (69%) and 121 completed them post-curriculum (75%). The authors found overall pre-post differences in dietary assessment ability (2.65 vs 3.05, P < .001) and counseling confidence (1.86 vs 2.22, P < .001). In addition to the curricular impact, students' nutrition-related behaviors and attitudes were positively associated with outcomes. CONCLUSIONS AND IMPLICATIONS: A nutrition curriculum for medical students improves students' nutrition counseling-related confidence, knowledge, and skills even when controlling for personal nutrition-related behaviors.