Faculty Bibliography

STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Can user-centered design (UCD) facilitate the development of novel and effective training tools for the virtual ambulatory learning environment LEARNING OBJECTIVES 1: To identify the needs, preferences, and concerns of resident trainees and attending preceptors regarding the current virtual ambulatory care learning environment. LEARNING OBJECTIVES 2: To apply user-centered design (UCD) strategies to the development of effective tools to enhance the virtual learning experience of trainees and preceptors. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The COVID-19 pandemic spurred a rapid transition to virtual learning environments, the design of which may impact learning experiences and competency development for trainees. User-centered design (UCD) offers a framework to iteratively and collaboratively incorporate needs, preferences, and concerns of users (e.g. trainees and preceptors) in the development of acceptable and effective educational tools. This study applied UCD strategies of empathize, define, ideate, prototype, and test among Internal Medicine residents and outpatient attending preceptors to develop innovations for the virtual ambulatory care learning environment. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVEMETRICSWHICHWILL BEUSEDTOEVALUATE PROGRAM/INTERVENTION): Using the UCD framework, we identified: 1) needs, preferences, and concerns of residents and preceptors in current virtual precepting practices (empathize) 2) key problem areas and pain points (define) 3) potential solutions (ideate) 4) specific products to develop (prototype), deploy, and evaluate (test) in practice FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Qualitative needs-assessment interviews were conducted among 8 residents and 10 preceptors, which identified key areas of learner need: technical and workflow competency; the virtual precepting experience; patient rapport-building and communication; and documentation requirements. Subsequently, a Design Thinking Workshop focusing on virtual precepting was developed, and 3 workshops were conducted with 12 participants (residents and attendings). Using a three-phase interactive sequence of explore, ideate, and create, participants were divided into 2-or 3-person virtual breakout groups and asked to 1) identify a key problem in current virtual precepting, 2) brainstorm possible solutions, and 3) design and present a low-fidelity prototype of one solution. Key problems identified included: management of technical issues, goal setting for precepting sessions, clinic-specific information dissemination practices, and the loss of shared learning space with colleagues. Potential solutions included: a digital shared-learning plan for residents, a real-time virtual clinical bulletin board, an integrated virtual team huddle, and just-in-time digital chalk talks. Two prototypes are being developed for testing in the live precepting environment. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY): User-centered design can be deployed as an effective strategy to engage learners and preceptors in the design and development of educational innovations for the virtual training environment. We recommend collaborating with residents, preceptors, and other stakeholders in the iterative design of virtual learning tools

BACKGROUND: The transition from medical school to residency is characterized by an abrupt transition of learning needs and goals. Coaching is a promising intervention to support individual learning and growth trajectories of learners. It is uncommon for medical school faculty to have undergone training as coaches. We explored our faculty's perceptions and skills after instituting a new coaching program.
METHOD(S): Faculty advisors (N=12) and GME (N=16) participated in a coaching development program and in community of practice meetings where challenging coaching scenarios were shared. GME faculty also participated in a Group Objective Structured Clinical Exam (GOSCE) to practice and receive feedback on their skills. Peer-faculty observers and resident raters used behaviorally grounded checklists to assess faculty performance. We conducted 2 focus groups: 1) UME advisors engaged in longitudinal coaching (n=9) and 2) GME faculty participating in the coaching development program (n=8) to better understand how faculty make sense of and put into practice these new coaching roles and skills.
RESULT(S): Simple thematic coding showed that both groups emphasized the blurring of the many roles they serve when interacting with trainees and struggled with recognizing both which hat to wear (role to adopt) and which skills to call upon in specific situations. UME advisors who have dedicated advising/coaching roles reported assuming multiple roles at different times with their same students. Many of the GME coaches serve as Associate Program Directors, and described adopting a coaching frame of reference (mentality) and requiring external reinforcement for coaching skills. Some reported realizing after the fact that coaching would have been a valuable approach. Faculty newer to their role felt more successful in engaging in coaching mindset and coaching. Faculty were curious about how trainees would feel about this approach and anticipated that some would appreciate this more than others. 12 faculty participated in a three station Coaching GOSCE. Both resident raters and faculty peer raters suggested faculty coaches were able to establish trust and engage in authentic listening. Coaches negotiated the tension between empathetic listening with supporting goal-setting. Residents provided slightly lower ratings than peer observers on coaches' ability to ask questions and assume a coachee- focused agenda.
CONCLUSION(S): Medical educators may benefit from obtaining coaching skills, but deliberate training in how these skills complement, and differ, from existing skills requires both didactic and experiential learning. Cultivating a community of practice and offering opportunities for deliberate practice, observation and feedback is essential for medical educators to achieve mastery as coaches. LEARNING OBJECTIVE #1: Identify and perform appropriate learning activities to guide personal and professional development (PBL) LEARNING OBJECTIVE #2: Understand and apply core longitudinal coaching skills (Professionalism)

BACKGROUND: On the road to becoming competent, compassionate and ethical physicians, trainees need to reflect on their experiences, understand the clinical and social contexts, and integrate cognitive and affective reactions in ways that build resilience and a coherent professional identity. Using a qualitative approach, this study seeks to identify medical residents' stressors and challenges, and to understand their experience of the internal and external factors of such situations. Such information can guide educators to develop curricula that better meet residents' needs.
METHOD(S): Primary Care residents at NYU School of Med have ongoing Psychosocial Rounds (PSR) throughout their 3 years, facilitated by a faculty member and Chief Resident, where residents present challenging cases or situations, framed by a specific question. Semi-structured notes taken by facilitators, including question, case description, process of discussion and teaching points were compiled into a deidentified database of 119 cases spanning 2010-2019. These notes were coded by three coders using iterative thematic analysis.
RESULT(S): Seventy four of the 119 cases have been coded to date. Four general themes emerged, with each comprised of 2 to 4 main codes. These themes were 1) Self (S): including management of medical uncertainty, emotional reactions, roles and responsibilities, self-care; 2) Teams (T): including relationship with peers, supervisors, other health professionals; 3) Understanding Patient and Families (PF): including social and cultural context, mental health issues, patient/ family and provider disagreements; and 4) Hospital, Healthcare and Societal issues (HHS). There was a high co- occurrence of themes within cases, 60% had 2 themes present, 24% had 3, and only 16% had one theme. Cases with 3 themes most often included S, T and PF.
CONCLUSION(S): This analysis of PSR cases identifies issues for which residents seek help and support in a safe, case-oriented problem-solving discussion group, and allows for in-depth reflection and exploration. The cooccurrences of themes indicate the complexity of issues faced, and the importance of integrating multiple domains when beginning to understand these issues. LEARNING OBJECTIVE #1: Professionalism: Coping with challenges of becoming resilient physician with emotional and cognitive capacity to deal with complex situations LEARNING OBJECTIVE #2: Interpersonal and Communication Skills: Develop awareness and skills to negotiate interpersonal situations

Psychosocial stressors are prevalent and linked to worse health outcomes, but are less frequently addressed than physically apparent medical conditions at primary care visits. Through a community-academic partnership between an art museum and a federally qualified health center, we developed an innovative museum-based intervention and evaluated its feasibility and acceptability among diverse, underserved patients and its perceived effects on psychosocial stressors. Guided by experiential learning and constructivist approaches, the intervention consisted of a single, three-hour session that incorporated group discussions and interactive components, including art-viewing, sketching, and object-handling. We used post-intervention focus groups to elicit feedback qualitatively. From July 2017 to January 2018, 25 patients participated. Focus groups revealed that the intervention exhibited therapeutic qualities, fostered self-reflection, catalyzed social connectivity, and functioned as a gateway to community resources. These findings can guide future research and development of community-based interventions to target the growing burden of psychosocial stressors among the underserved.

BACKGROUND: Patients who are immigrants, notably those with undocumented status, face challenges to equitable healthcare access. By understanding immigration status as a social determinant of health (SDOH), physicians can begin to address such disparities. However, few undergraduate medical curricula include formal longitudinal instruction addressing immigration. We conducted a needs assessment of a medical school's curricular content in teaching medical students to address immigration as a SDOH.
METHOD(S): MS1-3 students from a school in Bronx, NY where 35% of the patient population are immigrants, received a 13-question email survey via surveymonkey.com. Students were assessed on three primary areas based on a literature review on sanctuary doctoring and SDOH: 1) Knowledge of immigrants' barriers to care (4-point scale, strongly disagree to strongly agree); 2) Confidence in assessing patient immigration status, taking an immigration history, and advocating for patients at risk of deportation (3-point scale, not confident to very confident); and 3) Frequency of assessing patients' immigration status, identifying immigration status when presenting cases, and referring undocumented patients to social/legal resources (4-point scale, never to always). Outcomes were compared between pre-clinical (MS1-2) and clinical (MS3) students.
RESULT(S): Among 539 students, 159 (29.5%) responded, with 104 preclinical and 55 clinical students. 79.2% strongly agreed that undocumented immigration status limits healthcare access. Few students reported being very confident in asking about immigration status (8.8%), taking an immigration history (12.6%), providing legal information (2.5%) and advocating for patients at risk of deportation (6.3%). Compared to the pre-clinical cohort, clinical students were significantly more confident in taking an immigration history (p=0.04) but not in other skills. Few students endorsed frequently or always asking patients about immigration status (3.2%), identifying immigration status when presenting patients (4.5%), and referring undocumented patients to appropriate resources (8.3%). There were no significant differences in frequencies of use of clinical skills pertaining to care of immigrant patients in the pre- and clinical cohorts.
CONCLUSION(S): Students are aware of barriers that immigrant patients face but lack confidence and experience in identifying and supporting undocumented patients. Our results will inform a revision of the longitudinal curriculum, including didactics and practical activities. LEARNING OBJECTIVE #1: 1. Assess students' skills and confidence in identifying and advocating for undocumented immigrant patients in clinical practice LEARNING OBJECTIVE #2: 2. Assess students' knowledge of immigrants' barriers to care