Faculty Bibliography

INTRODUCTION/BACKGROUND:COVID-19 forced health systems to rapidly implement telehealth for routine practice, often without sufficient training or standards. We conducted a longitudinal survey of physicians to explore changes in their perceptions of the challenges and benefits of telehealth and identify recommendations for future practice. METHODS:An anonymous online survey was distributed to a cohort of internal medicine physicians in May to June 2020 and March to June 2021. Changes in responses between 2020 and 2021 and by site (private vs. public) were described. These findings, along with those of a thematic analysis of open-ended responses to questions on telehealth experiences, informed a set of recommendations. RESULTS: = 0.027). Physicians' open-ended responses identified recommendations for further improving the design and use of telehealth. DISCUSSION/CONCLUSIONS:Results suggest that physician experience with telehealth improved but opportunities for training and improved integration remain. Longitudinal assessment can deepen understanding of the evolution of telehealth care.

BACKGROUND:Vaccine hesitancy is challenging for clinicians and of increasing concern since COVID-19 vaccination rollout began. Standardized patients (SPs) provide an ideal method for assessing resident physicians' current skills, providing opportunity to practice and gain immediate feedback, while also informing evaluation of curriculum and training. As such, we designed and implemented an OSCE station where residents were tasked with engaging and educating a vaccine-hesitant patient. AIM/OBJECTIVE:Describe residents' vaccine counseling practices, core communication and interpersonal skills, and effectiveness in meeting the objectives of the case. Explore how effectiveness in overcoming vaccine hesitancy may be associated with communication and interpersonal skills in order to inform educational efforts. SETTING/METHODS:Annual OSCE at a simulation center. PARTICIPANTS/METHODS:106 internal medicine residents (51% PGY1, 49% PGY2). PROGRAM DESCRIPTION/METHODS:Residents participated in an annual residency-wide, multi-station OSCE, one of which included a Black, middle-aged, vaccine-hesitant male presenting for a routine video visit. Residents had 10 min to complete the encounter, during which they sought to educate, explore concerns, and make a recommendation. After each encounter, faculty gave residents feedback on their counseling skills and reviewed best practices for effective communication on the topic. SPs completed a behaviorally anchored checklist (30 items across 7 clinical skill domains and 2 measures of trust in the vaccine's safety and resident) which will inform future curriculum. PROGRAM EVALUATION/RESULTS:Fifty-five percent (SD: 43%) of the residents performed well on the vaccine-specific education domain. PGY2 residents scored significantly higher on two of the seven domains compared to PGY1s (patient education/counseling-PGY1: 35% (SD: 36%) vs. PGY2: 52% (SD: 41%), p = 0.044 and activation-PGY1: 37% (SD: 45%) vs. PGY2: 59% (SD: 46%), p = 0.016). In regression analyses, education/counseling and vaccine-specific communication skills were strongly, positively associated with trust in the resident and in the vaccine's safety. A review of qualitative data from the SPs' perspective suggested that low performers did not use patient-centered communication skills. DISCUSSION/CONCLUSIONS:This needs assessment suggests that many residents needed in-the-moment feedback, additional education, and vaccine-specific communication practice. Our program plans to reinforce evidence-based practices physicians can implement for vaccine hesitancy through ongoing curriculum, practice, and feedback. This type of needs assessment is replicable at other institutions and can be used, as we have, to ultimately shed light on next steps for programmatic improvement.

PURPOSE:To compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans. METHOD:Customized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools. RESULTS:GQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student-faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons). CONCLUSIONS:These findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.

Background/UNASSIGNED:Little outcome data exist on 3-year MD (3YMD) programs to guide residency program directors (PDs) in deciding whether to select these graduates for their programs. Objective/UNASSIGNED:To compare performance outcomes of 3YMD and 4-year MD (4YMD) students at New York University Grossman School of Medicine. Methods/UNASSIGNED:In 2020, using the Kirkpatrick 4-level evaluation model, outcomes from 3 graduating cohorts of 3YMD students (2016-2018) were compared with the 4YMD counterparts. Results/UNASSIGNED:=.03), other metrics and overall intern ratings did not differ by pathway. Conclusions/UNASSIGNED:Exploratory findings from a single institution suggest that 3YMD students performed similarly to 4YMD students in medical school and the first year of residency.

In recent years, scientific and technological advances have brought great innovation within the life sciences industry, introducing the need for entrepreneurship training for medical and engineering graduates. With this in mind, Michal Gilon-Yanai, Dr Robert Schneider and their collaborators developed an academic program designed to provide students and faculty members with the skills they need to become successful entrepreneurs. The team of collaborators includes Dr Gabrielle Gold-von Simson, an expert in implementing academic programs, and Dr Colleen Gillespie, who specialises in education, evaluation and dissemination science. Their pioneering program trains students on how to bring new biomedical technologies to the market.

BACKGROUND: Performance-based assessment & feedback during medical training is essential for a successful transition before moving onto residency and independent clinical practice. Learners at New York University's School of Medicine (NYUSOM) participate in a routine comprehensive clinical skills examination (CCSE) that takes place at the tail end of medical school. During this exam, learners interact with standardized patients (SPs) and are rated on specific skills using a standardized checklist, measuring important clinical skills domains. NYUSOM has utilized the same assessment tool since 2005. To date, there is limited evidence on the tool's validity and ability to differentiate among students. We sought to provide evidence for it's reliability, validity, and generalizability.
METHOD(S): 1157 learners participated in the CCSE from 2011-2019 and were included in the analysis. Communication domain items assessed included patient education (3 items), relationship development (4 items), information gathering (6 items) and organization/ time management (3 items). Items were scored using a 3-point behaviorally-anchored scale (not, partly, or well done). In order to determine the degree to which the data mapped onto our theoretically-informed communication domains, we conducted a four-factor confirmatory factor analysis (CFA) allowing for factors to correlate (oblique rotation) and using means and variance adjusted weighted-least squares estimation (WLSMV) in order to account for the ordered categorical nature of the communication items. Model fit was assessed using root mean square of approximation (RMSEA) < 0.08, comparative fit index (CFI) > 0.95, and standardized root mean square error (SRMR) <0.08.
RESULT(S): The model fit the data using RMSEA (0.04), CFI (0.98), and SRMR (0.05). All factors were significantly correlated with one another (p < 0.05), with the largest correlation between patient education and organization/ time management (0.86), and information gathering (0.77). The smallest correlation was between organization/ time management and information gathering (0.66). All items (factor loadings) significantly loaded on the factors they measured. Only one item had an insignificant threshold loading between partly and well done, suggesting this part of the response scale may be hard for SPs to differentiate between students with varying ability on this item. Each factor had at least one item that had a factor loading less than 0.7.
CONCLUSION(S): The analysis suggests each item on the communication checklist significantly measures domains they were designed to measure, and that items can be summated to compute overall scores. Domains had one item with a lower loading than the rest, suggesting these items may be measuring something different. Follow up measurement modeling and profile analysis is the next logical step in determining if there is an important sub-domain that identifies a student group operating differentially. LEARNING OBJECTIVE #1: Understand clinical communication LEARNING OBJECTIVE #2: Describe communication measures