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Disruptive behavior in the workplace: Challenges for gastroenterology fellows
Srisarajivakul, Nalinee; Lucero, Catherine; Wang, Xiao-Jing; Poles, Michael; Gillespie, Colleen; Zabar, Sondra; Weinshel, Elizabeth; Malter, Lisa
AIM: To assess first-year gastroenterology fellows' ability to address difficult interpersonal situations in the workplace using objective structured clinical examinations (OSCE). METHODS: Two OSCEs ("distracted care team" and "frazzled intern") were created to assess response to disruptive behavior. In case 1, a fellow used a colonoscopy simulator while interacting with a standardized patient (SP), nurse, and attending physician all played by actors. The nurse and attending were instructed to display specific disruptive behavior and disregard the fellow unless requested to stop the disruptive behavior and focus on the patient and procedure. In case 2, the fellow was to calm an intern managing a patient with massive gastrointestinal bleeding. The objective in both scenarios was to assess the fellows' ability to perform their duties while managing the disruptive behavior displayed by the actor. The SPs used checklists to rate fellows' performances. The fellows completed a self-assessment survey. RESULTS: Twelve fellows from four gastrointestinal fellowship training programs participated in the OSCE. In the "distracted care team" case, one-third of the fellows interrupted the conflict and refocused attention to the patient. Half of the fellows were able to display professionalism despite the heated discussion nearby. Fellows scored lowest in the interprofessionalism portion of post-OSCE surveys, measuring their ability to handle the conflict. In the "frazzled intern" case, 68% of fellows were able to establish a calm and professional relationship with the SP. Despite this success, only half of the fellows were successfully communicate a plan to the SP and only a third scored "well done" in a domain that focused on allowing the intern to think through the case with the fellow's guidance. CONCLUSION: Fellows must receive training on how to approach disruptive behavior. OSCEs are a tool that can assess fellow skills and set a culture for open discussion.
PMCID:5434438
PMID: 28566892
ISSN: 2219-2840
CID: 2581432
ESCALATION OF THERAPY IN INFLAMMATORY BOWEL DISEASE PATIENTS WITH CLOSTRIDIUM DIFFICILE INFECTION IS ASSOCIATED WITH BETTER OUTCOMES: AN IBD REMEDY STUDY [Meeting Abstract]
Lukin, Dana J.; Lawlor, Garrett; Feathers, Alexandra; Jen, Henry; Passi, Monica; Cavaliere, Kimberly; Axelrad, Jordan; Loftus, Michelle; Hudesman, David; Rosen, Melissa H.; Malter, Lisa; Swaminath, Arun
ISI:000403140302287
ISSN: 0016-5085
CID: 3182902
Using the Objective Structured Clinical Examination to Assess ACGME Competencies in Pediatric Gastroenterology Fellows
Solomon, Aliza B; Reed, Rachel; Benkov, Keith; Kingsbery, Joseph; Lusman, Sarah S; Malter, Lisa B; Levine, Jeremiah; Rabinowitz, Simon S; Wolff, Martin; Zabar, Sondra; Weinshel, Elizabeth
BACKGROUND:The Accreditation Council for Graduate Medical Education has described 6 core competencies with which trainees should demonstrate proficiency. Using the Objective Structured Clinical Examination (OSCE), we aimed to assess 4 of these competencies among Pediatric Gastrointestinal (GI) fellows (PGs). METHODS:Eight first-year PGs from 6 medical centers in the New York area participated in a 4-station OSCE with trained standardized patient (SP) actors. The cases included an emergency department (ED) consult, or "ED Consult" for lower gastrointestinal bleeding; "Breaking Bad News" focusing on CF nutritional complications; "Second Opinion" for abdominal pain; "Transition of Care" for inflammatory bowel disease. At each station, attending faculty observed the encounters behind a 1-way mirror. SPs and faculties provided immediate feedback to the examined fellows. Previously validated OSCE checklists were used to assess performance. On completion, fellows attended debriefing sessions and completed surveys about the educational value. RESULTS:Median overall milestone competency scores were 6.9 (PC1), 4.8 (PC2), 5.9 (MK1), 5.7 (MK2), 6.4 (ICS1), 6.9 (Prof1), and 6.7 (Prof3). Overall, fellows score highest (7/9) on the inflammatory bowel disease "Transition of Care" case, found the "Breaking Bad News" Cystic Fibrosis OSCE to be the most challenging, and were most comfortable with the "ED Consult" OSCE, as a commonly encountered scenario. Overall, the fellows rated the educational value of the program highly. CONCLUSIONS:To our knowledge, although the OSCE has been validated in other medical fields, this is the first OSCE program developed for PGs fellows. These OSCEs have included Accreditation Council for Graduate Medical Education competencies, serving to assess fellows' skills in these areas while exposing them to challenging medical and psychosocial cases that they may not frequently encounter.
PMID: 27782961
ISSN: 1536-4801
CID: 2956102
Patterns and perceptions of self-prescribed antibiotic use in Guayaquil, Ecuador [Meeting Abstract]
Hall, O; Malter, L; Van, Der Linden E; Weinstein, J
Background: The rising incidence of antibiotic-resistant disease is partially attributable to the extensive use and misuse of antibiotics. Ecuador has the second highest rate of per-capita antibiotic consumption in Latin America. The purpose of this study is to identify factors that contribute to self-prescribed antibiotic use in a low-income neighborhood of Guayaquil, Ecuador's largest city, where antibiotics are frequently available over-the-counter. Methods: Qualitative, oral interviews were conducted with local residents who had seen a physician in the last two years (group A, 101 subjects) and those who had not for two years or more (group B, 100 subjects). Subjects were recruited at a local medical clinic and a nearby food market. Findings: Although 71% of subjects overall report that they believe antibiotics could be dangerous for them, 74% have self-medicated with antibiotics in their lifetime, and 43% have taken antibiotics in the last month. 73% of subjects report taking just one or two antibiotic pills when they self-medicate. There were no differences between groups for these findings, but subjects in group A were more than twice as likely to have spoken with a physician before starting antibiotics the last time they took them (56% vs. 25% p<0.001), and more than three times as likely to complete a full course of antibiotics that had been prescribed by a physician (41% vs. 13% p<0.001). Overall, 78% of subjects who had children under the age of 18 reported self-medicating with antibiotics, but 85% said they would not give antibiotics to their children without taking them to a physician first. Subjects in group B were more than twice as likely to give antibiotics to their children without seeking the advice of a physician (21% vs. 9% p=0.04). Interpretation: Lifetime patterns and perceptions of self-prescribed antibiotic use were generally the same between groups, but when looking at recent behavior, subjects who had seen a physi-cian in the last two years were more likely to get a prescription and take the full course as prescribed. Further studies should be conducted to determine whether improving healthcare access and/or enforc-ing regulations on antibiotic sales could reduce antibiotic misuse in the region
EMBASE:620060915
ISSN: 2214-9996
CID: 2924562
Perceptions of fecal microbiota transplantation for Clostridium difficile infection: factors that predict acceptance
Park, Leslie; Mone, Anjali; Price, Jennifer C; Tzimas, Demetrios; Hirsh, Jacqueline; Poles, Michael A; Malter, Lisa; Chen, Lea Ann
BACKGROUND: Despite the effectiveness of fecal microbiota transplantation (FMT) for treating recurrent Clostridium difficile (C. difficile) infection, some patients are reluctant to accept this therapy. Our study examined attitudes towards FMT and factors that contribute to patients' acceptance of this treatment. METHODS: We distributed patient surveys at a Veterans Affairs hospital, a public hospital, and an academic faculty practice. Multivariable logistic regression was performed, adjusting for factors associated with FMT acceptance on univariate analysis and prior experience with C. difficile infection. RESULTS: Of 267 patients, only 12% knew of FMT prior to the survey, but 77% would undergo the procedure if medically indicated. On multivariable analysis, those with children and with college degrees or higher were more likely to agree to FMT (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.02-4.35; OR 2.27, 95% CI 1.11-4.60 respectively). Sixty-five respondents (71%) chose colonoscopy as the preferred vehicle for FMT, while nasogastric tube was least preferred. Disease transmission was the most common concern (30%, n=242), and FMT success rate was the least selected concern (9.1%). CONCLUSIONS: Most patients in a diverse sample of gastroenterology clinics had no prior knowledge of FMT, but were receptive to the procedure. Having children and higher education levels were predictors for FMT acceptance. Our findings suggest that barriers to FMT utilization may be overcome with counseling about safety concerns. More data on the risk of transmitting diseases or clinical characteristics, such as obesity, through FMT are needed and will be important for the acceptance of this procedure.
PMCID:5198252
PMID: 28042242
ISSN: 1108-7471
CID: 2386482
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
Azathioprine Induced Sweet's Syndrome in Crohn's Disease: An Important Distinction [Meeting Abstract]
Papademetriou, Marianna; Kaplan, Alyson; Pomeranz, Miriam; Malter, Lisa
ISI:000395764603008
ISSN: 1572-0241
CID: 2492582
It's All in the History: Infectious Mimics of Inflammatory Bowel Disease [Meeting Abstract]
Quarta, Giulio; Lopatin, Sarah; Betesh, Andrea; Malter, Lisa; Gamagaris, Zoi
ISI:000395764603028
ISSN: 1572-0241
CID: 2492602
Using Humanized Germ-Free Mice to Understand Microbiome Variation in IBD Patients Who Respond to Anti-TNF Medications [Meeting Abstract]
Chen, Lea Ann; Ruiz, Victoria E; Battaglia, Thomas; Swaminath, Arun; Radin, Arielle; Tuen, Michael; Xu, Ruliang; Alvarez, Yelina; Bowcutt, Rowann; Lukin, Dana J; Lawlor, Garrett; Rosen, Melissa H; Hudesman, David; Malter, Lisa; Loke, P'ng; Sartor, RBalfour; Blaser, Martin J
ISI:000391783700785
ISSN: 1528-0012
CID: 2460562
A Longitudinal OSCE Experience: A Pilot of Progressive Testing to Assess Inflammatory Bowel Disease Training for Gastroenterology Fellows [Meeting Abstract]
Lopatin, Sarah; Balzora, Sophie; Shah, Brijen; Dikman, Andrew; Jones, Vicky; Gillespie, Colleen; Zabar, Sondra; Poles, Michael; Weinshel, Elizabeth; Malter, Lisa
ISI:000393896400114
ISSN: 1078-0998
CID: 2972132