Faculty Bibliography

OBJECTIVES: The American Gastroenterological Association fellowship curriculum identifies geriatric components for gastroenterology (GI) training; however, few tools are available for this purpose. Using an objective structured clinical examination (OSCE), we aimed to assess ACGME competencies of communication, professionalism, and geriatric-specific patient care among GI fellows. METHODS: We developed an informed-consent case involving a geriatric patient who needs surveillance colonoscopy. We used a validated faculty skills checklist to rate fellows across three competency domains. Fifteen fellows from four GI training programs participated. RESULTS: Although the fellows excelled at communication and professionalism, only 51% excelled at geriatric-specific patient-care skills. Fellows were least likely to demonstrate collaboration with the patient, to assess patient understanding, and to explain the limits of the test. Communication and geriatric-specific skills were correlated. CONCLUSIONS: OSCEs are a feasible method for assessing geriatric-related ACGME competencies for fellows. The results highlight the need for curriculum development.

OBJECTIVES: Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria. METHODS: We created two new scenarios: a handoff between a tired overnight senior fellow on call and a more junior fellow, and a telephone management case of an ulcerative colitis flare. Fellows wrote a progress notes documenting the encounters. To add educational value, we gave the participants references about handoff communication. Four OSCE stations-handoff communication, telephone management, informed consent, and delivering bad news-were completed by fellows and observed by faculty. RESULTS: Eight faculty members and eight fellows from four GI training programs participated. All the fellows agreed that handoffs can be important learning opportunities and can be improved if they are structured, and that handoff skills can improve with practice. CONCLUSIONS: OSCEs can serve as practicums for assessing complex skill sets such as handoff communication and telephone management.

BACKGROUND: The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use. METHODS: First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received. RESULTS: Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise-Assist knowledge for Web students (14% vs. -3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences. CONCLUSION: Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area

Background: Pediatric emergency medicine (PEM) fellows must acquire necessary knowledge and skills to lead a multidisci- plinary team under crisis conditions. Without consistent training in teamwork, however, many PEM fellows rely on mock codes or rare resuscitation events for experiential learning. In order to introduce and practice teamwork behaviors and skills, we organized a 2-day multi-institutional, multidisciplinary program, BASE Camp 2010: Basic Training for Pediatric Emergency Medicine. Objectives: To determine the skills PEM fellows identified as essential for effective teamwork, and to characterize potential barriers to integrating these principles in practice. Methods: Using qualitative methods, we conducted two focus group interviews (n = 16). Fellows described their teamwork experiences at BASE Camp, how they would integrate team principles into future practice, and prior resuscitation experiences. Responses to open-ended questions were recorded, transcribed, and analyzed by a constant comparative method in Atlas.ti (qualitative data analysis program). Data were cross-coded to ensure agreement. Themes were identified by content analysis. The study was IRB-approved, and all subjects consented. Results: Seventeen PEM fellows (12 first and 5 second year) from 10 fellowships in NY, CT, and RI participated in BASE Camp (Oct 23-24, 2010). Twenty-nine percent were male. Five themes reflecting five core teamwork principles were identified; in order of response frequency: role clarity (37%), communication (26%), leadership (17%), situational monitoring (13%), and mutual support (7%). A sixth theme emerged from an inductive interpretation of coded data segments. Barriers to integrating the five core principles are categorized by: Hierarchy (n = 16): discomfort asserting teamwork principles with more experienced multidisciplinary practitioners. Inexperience (n = 15): challenges to integrating teamwork principles when resuscitation events are rare. Communication (n = 8): difficulty implementing communication strategies with colleagues untrained in teamwork principles. Conclusion: Fellows acquired basic teamwork principles during BASE Camp training and are eager to incorporate these behaviors and skills into future practice despite the barriers identified. BASE Camp may be useful to overcome these challenges, and our results will help inform future iterations of our educational intervention