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Design and comparison of a hybrid to a traditional in-person point-of-care ultrasound course

Janjigian, Michael; Dembitzer, Anne; Srisarajivakul-Klein, Caroline; Mednick, Aron; Hardower, Khemraj; Cooke, Deborah; Zabar, Sondra; Sauthoff, Harald
BACKGROUND:Traditional introductory point-of-care ultrasound (POCUS) courses are resource intensive, typically requiring 2-3 days at a remote site, consisting of lectures and hands-on components. Social distancing requirements resulting from the COVID-19 pandemic led us to create a novel hybrid course curriculum consisting of virtual and in-person components. METHODS:Faculty, chief residents, fellows and advanced practice providers (APPs) in the Department of Medicine were invited to participate in the hybrid curriculum. The course structure included 4 modules of recorded lectures, quizzes, online image interpretation sessions, online case discussions, and hands-on sessions at the bedside of course participant's patients. The components of the course were delivered over approximately 8 months. Those participants who completed a minimum of 3 modules over the year were invited for final assessments. Results from the hybrid curriculum cohort were compared to the year-end data from a prior traditional in-person cohort. RESULTS:Participant knowledge scores were not different between traditional (n = 19) and hybrid (n = 24) groups (81% and 84%, respectively, P = 0.9). There was no change in POCUS skills as measured by the hands-on test from both groups at end-of-course (76% and 76%, respectively, P = 0.93). Confidence ratings were similar across groups from 2.73 traditional to 3.0 hybrid (out of possible 4, P = 0.46). Participants rated the course highly, with an average overall rating of 4.6 out 5. CONCLUSIONS:A hybrid virtual and in-person POCUS course was highly rated and as successful as a traditional course in improving learner knowledge, hands-on skill and confidence at 8 months after course initiation. These results support expanding virtual elements of POCUS educational curricula.
PMID: 35278145
ISSN: 2524-8987
CID: 5182382

Design and evaluation of the I-SCAN faculty POCUS program

Janjigian, Michael; Dembitzer, Anne; Srisarajivakul-Klein, Caroline; Hardower, Khemraj; Cooke, Deborah; Zabar, Sondra; Sauthoff, Harald
BACKGROUND:Point-of-care ultrasound (POCUS) is becoming widely adopted with increasing accessibility of courses. Little is known about the optimal design of the introductory course or longitudinal training programs targeting hospitalists that are critical to success. METHODS:Hospitalists at four academic sites participated in a two-day introductory course and a longitudinal phase comprising clinical POCUS practice, clip uploading with online feedback, hands-on teaching, and monthly ultrasound conferences. Assessments were performed immediately before and after the two-day course and after 1 year. RESULTS:Knowledge increased from baseline to post two-day course (median score 58 and 85%, respectively, p < 0.001) and decreased slightly at 1 year (median score 81%, p = 0.012). After the two-day introductory course, the median score for hands-on image acquisition skills, the principal metric of participant success, was 75%. After 1 year, scores were similar (median score 74%). Confidence increased from baseline to post two-day course (1.5 to 3.1 on a 4 point Likert scale from Not at all confident (1) to Very confident (4), p < 0.001), and remained unchanged after 1 year (2.73). Course elements correlating with a passing score on the final hands-on test included number of clip uploads (r = 0.85, p,0.001), attendance at hands-on sessions (r = 0.7, p = 0.001), and attendance at monthly conferences (r = 0.50, p = 0.03). CONCLUSIONS:The I-ScaN POCUS training program increased hospitalist knowledge, skill and confidence with maintained skill and confidence after 1 year. Uploading clips and attending hands-on teaching sessions were most correlative with participant success.
PMID: 33407431
ISSN: 1472-6920
CID: 4739032

The impact of the coronavirus pandemic on learning and using point-of-care ultrasound by internal medicine residents [Meeting Abstract]

Srisarajivakul, N C; Janjigian, M; Dembitzer, A; Hardowar, K; Cooke, D; Sauthoff, H
LEARNING OBJECTIVES 1: Describe a longitudinal curriculum to train internal medicine (IM) residents in point-of-care ultrasound (POCUS). LEARNING OBJECTIVES 2: Recognize the impact of decreased patient contact on residents' retention of POCUS skills. SETTINGAND PARTICIPANTS:Despite thewell-documented benefits of POCUS, internal medicine residents receive little formal training. We implemented a curriculumin the 2019 academic year to train 55 PGY-2 IMresidents in POCUS across four urban teaching hospitals and a method to evaluate its efficacy. As the COVID pandemic hit, we additionally sought to understand the impact of COVID on the efficacy of our curriculum and to ascertain from IM residents their barriers to using POCUS during the COVID pandemic. DESCRIPTION: The curriculum was composed of three workshops, consisting of lectures and hands-on practice covering lung, cardiac, abdominal, and lower extremity vascular views. Following the workshops, we sought to consolidate learners' knowledge with a subsequent year-long skill building phase. The skill-building phase was truncated due to the pandemic.A hands-on assessment was performed prior to the course and not repeated at course conclusion due to social distancing concerns. An online knowledge test was administered before the course, immediately following the course, and at one year. A survey assessing attitudes and barriers to POCUS was administered before the course and at one year. EVALUATION: No resident passed the pre-course hands-on assessment. Prior to the course, the average resident score was 54% on the online knowledge quiz; directly after the workshop series, the average rose to 78%. At one year, the average score on the online knowledge quiz was 74%, a statistically significant decrease (p=0.04). Ninety-one percent of residents reported performing POCUS at least once/month prior to the pandemic. During the pandemic, scanning activity decreased; 67% residents reported they scanned rarely or never. DISCUSSION/ REFLECTION / LESSONS LEARNED: Our course led to significant improvement of knowledge regarding ultrasound technology and image interpretation, however this decayed at one year, likely due to lack of skill reinforcement. Though POCUS was widely used prior to the pandemic, usage dropped at the pandemic's peak, despite its utility as both a diagnostic and therapeutic tool. The most commonly cited reason for lack of use was concern regarding contamination and infectious exposure. While the COVID pandemic disrupted our curriculum, it also highlighted opportunities to incorporate POCUS into clinical practice and reinforced the importance of continued longitudinal practice to retain learned skills
ISSN: 1525-1497
CID: 4984882

Understanding clinician attitudes toward screening for social determinants of health in a primary care safety-net clinic [Meeting Abstract]

Altshuler, L; Fisher, H; Mari, A; Wilhite, J; Hardowar, K; Schwartz, M D; Holmes, I; Smith, R; Wallach, A; Greene, R E; Dembitzer, A; Hanley, K; Gillespie, C; Zabar, S R
BACKGROUND: Social determinants of health (SDoH) play a significant role in health outcomes, but little is known about care teams' attitudes about addressing SDoH. Our safety-net clinic has begun to implement SDoH screening and referral systems, but efforts to increase clinical responses to SDoH necessitates an understanding of how providers and clinical teams see their roles in responding to particular SDoH concerns.
METHOD(S): An annual survey was administered (anonymously) to clinical care teams in an urban safety-net clinic from 2017-2019, asking about ten SDoH conditions (mental health, health insurance, food, housing, transportation, finances, employment, child care, education and legal Aid). For each, respondents rated with a 4-point Likert-scale whether they agreed that health systems should address it (not at all, a little, somewhat, a great deal). They also indicated their agreement (using strongly disagree, somewhat disagree, somewhat agree, strongly agree) with two statements 1) resources are available for SDoH and 2) I can make appropriate referrals.
RESULT(S): 232 surveys were collected (103 residents, 125 faculty and staff (F/S), 5 unknown) over three years. Of note, mental health (84%) and health insurance (79%) were seen as very important for health systems to address, with other SDoH items seen as very important by fewer respondents. They reported little confidence that the health system had adequate resources (51%) and were unsure how to connect patients with services (39%). When these results were broken out by year, we found the following: In 2017 (n=77), approximately 35% of respondents thought the issues of employment, childcare, legal aid, and adult education should be addressed "a little," but in 2018 (n=81) and 2019 (n=74) respondents found the health system should be more responsible, with over 35% of respondents stating that these four issues should be addressed "somewhat" by health systems. In addition, half of respondents in 2019 felt that financial problems should be addressed "a great deal," up from 31% in 2017. Across all years, food, housing, mental health, and health insurance were seen as SDoH that should be addressed "a great deal". It is of note that respondents across all years reported limited understanding of referral methods and options available to their patients.
CONCLUSION(S): Many of the SDoH conditions were seen by respondents as outside the purview of health systems. However, over the three years, more members increased the number of SDoH conditions that should be addressed a "great deal." Responses also indicated that many of the team members do not feel prepared to deal with "unmet social needs". Additional examination of clinic SDoH coding, referral rates, resources, and team member perspectives will deepen our understanding of how we can cultivate a culture that enables team members to respond to SDoH in a way that is sensitive to their needs and patient needs
ISSN: 1525-1497
CID: 4803172

Assessing Clinician Educator Professional Identity at an Academic Medical Center [Meeting Abstract]

Dembitzer, Anne; Lusk, Penelope; Shapiro, Neil; Hauck, Kevin; Schaye, Verity E; Janjigian, Michael; Hardowar, Khemraj; Reiff, Stefanie; Zabar, Sondra
ISSN: 1525-1497
CID: 4610352


Srisarajivakul, Nalinee C.; Janjigian, Michael; Dembitzer, Anne; Sartori, Daniel; Hardowar, Khemraj; Cooke, Deborah; Sauthoff, Harald
ISSN: 0884-8734
CID: 4799392


Janjigian, Michael; Dembitzer, Anne; Srisarajivakul-Klein, Caroline; Hardowar, Khemraj; Cooke, Deborah; Sauthoff, Harald
ISSN: 0884-8734
CID: 4800092

Faculty development and the growth mindset

Shapiro, Neil; Dembitzer, Anne
PMID: 31509287
ISSN: 1365-2923
CID: 4101282

A workshop to train medicine faculty to teach clinical reasoning

Schaye, Verity; Janjigian, Michael; Hauck, Kevin; Shapiro, Neil; Becker, Daniel; Lusk, Penelope; Hardowar, Khemraj; Zabar, Sondra; Dembitzer, Anne
Background Clinical reasoning (CR) is a core competency in medical education. Few studies have examined efforts to train faculty to teach CR and lead CR curricula in medical schools and residencies. In this report, we describe the development and preliminary evaluation of a faculty development workshop to teach CR grounded in CR theory. Methods Twenty-six medicine faculty (nine hospitalists and 17 subspecialists) participated in a workshop that introduced a framework to teach CR using an interactive, case-based didactic followed by role-play exercises. Faculty participated in pre- and post-Group Observed Structured Teaching Exercises (GOSTE), completed retrospective pre-post assessments (RPPs), and made commitment to change statements (CTCs). Results In the post-GOSTE, participants significantly improved in their use of problem representation and illness scripts to teach CR. RPPs revealed that faculty were more confident in their ability and more likely to teach CR using educational strategies grounded in CR educational theory. At 2-month follow-up, 81% of participants reported partially implementing these teaching techniques. Conclusions After participating in this 3-h workshop, faculty demonstrated increased ability to use these teaching techniques and expressed greater confidence and an increased likelihood to teach CR. The majority of faculty reported implementing these newly learned educational strategies into practice.
PMID: 30849044
ISSN: 2194-802x
CID: 3724222

Mastering co-management: A curriculum for hospitalists [Meeting Abstract]

Mednick, A; Dembitzer, A; Nelson, A; Trivedi, S P; Viswanathan, A
Needs and Objectives: The U.S. surgical population is becoming increasingly medically complex, increasing the risk of post-operative complications. Surgeons have traditionally consulted internists and sub-specialists for medical management during inpatient admissions, but this has failed to decrease complications or healthcare costs. To address this issue hospitalists have taken on the role of co-managing patients admitted to surgical services. However, internal medicine residencies don't adequately prepare trainees for this role. Safe and effective modern medical care requires training in medical co-management (MCM), yet there exists no robust theory-and evidence-based curricula to teach these competencies. We designed a curriculum to fill this need. Setting and Participants: Thirteen hospitalists with 0-7 years' clinical experience in an academic medical center in New York, NY. Hospitalists spend 50% of their clinical time on an MCM service covering general surgery, vascular surgery, neurosurgery, general neurology/epilepsy, and orthopedic surgery. Description: We developed a yearlong curriculum based on the Society for Hospital Medicine's guidelines on creating MCM teams and other published frameworks. We applied evidence-based learning theories including: Adult Learning Theory, Cognitivism, Constructivism, and Ericsson's Theory of Expertise. We developed a conceptual framework incorporating key stakeholders in MCM (medical attending, surgical attending, PCP, mid-levels, and patients/families) and 6 core content topics (Roles & Responsibilities, Communication Strategies, Trust & Respect, Common Complications, Transitions of Care, and Deliberate Practice). The curriculum includes two parts: a week-long intensive orientation with Objective Structured Clinical Examinations (OSCEs) and workshops in the main content areas, and a series of monthly continuing professional development (CPD) sessions to facilitate deliberate practice and improve skills needed to manage niche patients on surgical services. These CPD skills are based upon needs identified by the hospitalists and surgical teams. Evaluation: Effectiveness will be measured at the program and hospitalist level. The program will be assessed by patient quality metrics (eg, LOS and readmission rates) and satisfaction by the surgical teams yearly. We will evaluate the impact on hospitalists using retrospective pre-post surveys to measure changes in clinical knowledge, confidence and engagement. Assessments will be collected using Qualtrics survey software. Discussion/Reflection/Lessons Learned: In the early stages of this curriculum, 79% of participants found the CPD sessions "very or extremely helpful." Participants have shown increasing engagement in the curriculum as evidenced by proposals of future session topics and attendance. Data collection is ongoing
ISSN: 1525-1497
CID: 4052682