Faculty Bibliography

BACKGROUND/UNASSIGNED:California adopted universal screening of adverse childhood experiences (ACEs) in January 2020 and dedicated significant financial and human resources to "ACES Aware," a statewide campaign to scale ACEs screening throughout the state. Provider perspectives after the roll-out of ACEs Aware have been understudied. The aim of this study was to understand provider perspectives on universal ACEs screening in primary care. We explored indicators of acceptability, utility, and barriers and facilitators of screening for ACEs. We also investigated treatments offered for disclosed ACEs. METHODS/UNASSIGNED:A cross-sectional survey with quantitative and qualitative components was distributed via Facebook, Twitter, and electronic listservs between March and April 2022, 2 years after the launch of ACEs Aware. The survey included the validated and reliable "Acceptability of Implementation Measure" and "Feasibility of Implementation Measure" as well as multiple choice, ranking, and free-text items to understand determinants of screening and treatment approaches. RESULTS/UNASSIGNED:Eighty two primary care providers in California, working primarily in pediatrics (84%), completed the survey. The majority (78%) received training on assessing ACEs and 60% reported using the Pediatric ACEs and Related Life-events Screener (PEARLS). About 22% "strongly agree" that PEARLS is acceptable and 32% "strongly agree" that PEARLS is feasible. Only 17% "strongly agree" that they like PEARLS. The top barriers were: (1) insufficient time; (2) unclear treatment pathway for detected ACEs; and (3) inadequate staffing to perform screening. The top facilitators for screening were: (1) financial incentives for providers to screen; (2) financial incentives for organizational leadership to implement screening; and (3) leadership support of screeners. The top approaches for addressing ACEs were: (1) behavioral therapy; (2) case navigation; and (3) trauma-informed care. CONCLUSION/UNASSIGNED:This study provided a first look at provider perspectives on ACEs screening and treatment in a sample of California providers. Most responding providers report currently screening for ACEs and using PEARLS. Perceptions of feasibility were slightly higher than for acceptability. Facilitators were largely top-down and organizational in nature, such as financial incentives and leadership support. Future directions could include an exploration into why some providers may find ACEs unappealing and research to identify effective and accessible treatment approaches for ACEs.

INTRODUCTION/UNASSIGNED:In response to accreditation bodies requiring health disparities curricula, medical educators are tasked with incorporating structural competency, the understanding of how social and structural barriers like structural racism impact health, into their teaching. Most have not received training in this area, yet there remains a scarcity of faculty development curricula to address this gap. We describe the creation, implementation, and evaluation of a faculty development workshop series rooted in the framework of structural competency. METHODS/UNASSIGNED:test. RESULTS/UNASSIGNED:< .001) incorporating structural competency. DISCUSSION/UNASSIGNED:Our application of structural competency to faculty workshops and teaching tools feasibly engages faculty in instruction to incorporate concepts of structural racism and the downstream effects of social determinants of health into clinical teaching. It represents an innovative tool as we seek to enhance clinical teaching to improve care for racially and ethnically minoritized communities.

The authors created Geriatrics Connect (GeriConnect), a program for first-year medical students at NYU Grossman School of Medicine to learn about healthy aging by developing a 7-month long telephonic relationship with an older adult living in the community. Background and Objectives: Early exposure to geriatrics and older adults is instrumental to preparing future physicians to care for the aging population. The objective of this study was to evaluate how the GeriConnect program affected students' attitudes on aging and ageism. Design: Paired students conducted monthly telephone or video calls with a geriatric patient recruited from the NYU Internal Medicine outpatient practice and wrote required reflections on ageism. Participants: 99 first-year medical students at NYU Grossman School of Medicine. Measurements: Student reflection essays were descriptively coded by five independent reviewers. Results: Thematic analysis revealed that many students had limited exposure to older adults prior to starting medical school, and suggested that the longitudinal relationships developed in the program improved students' understanding of aging and ageism. Conclusion: Establishing longitudinal telephonic relationships with older adults may be an effective method of enhancing student exposure to geriatrics and fostering more positive attitudes toward older adults.

Access to an academic clinical research center (CRC) in health professional shortage areas (HPSA) can help address healthcare disparities and increase research accessibility and enrollment. Here we describe the development of a community-centered CRC in the underserved area of Sunset Park, Brooklyn, New York, centered within a larger academic health network and the evaluation of its outcomes within the first two years. In addition to resources and space, establishment of the CRC required a culturally competent and multilingual team of healthcare professionals and researchers and buy-in from the community. Between 1/2022 and 12/2023, the CRC opened 21 new trials (10 interventional and 11 noninterventional) with greater than 500 participant visits that reflect the racial and ethnic diversity of the community. These participants represent 110 distinct zip codes; 76% of these zip codes are underserved and designated HPSA. 60% self-identified as non-White and 20% identified as Hispanic, with 12 other distinct ethnicities represented. 28% of participants speak 11 languages other than English. Community-based CRCs can be created with sustainable growth to align with the mission of the National Institutes of Health and U.S. Food and Drug Administration to meet the ever-growing clinical, social, and research needs of the communities they serve.

This report describes a delayed recognition of mpox in a patient admitted to an inpatient psychiatry unit, resulting in potential exposures to staff and patients. We detail the investigation and risk mitigation efforts and emphasize the importance of prompt identification and isolation in congregate healthcare settings to prevent transmission.

INTRODUCTION/BACKGROUND:An important component of internal medicine resident education is morning (attending) rounds. Effective aspects of medical education include involving all team members, minimizing distractions, asking questions, and having ready access to data, all of which may not be present during rounds. There is limited information on learner-centered rounds or resident perspectives about education during rounds. To inform a learner-centered approach to rounds, the investigators conducted a focus group study of Internal Medicine residents exploring their perceived strengths and weaknesses of rounds, and how rounds could be better used as a teaching tool. METHODS:Three 60-min focus groups were conducted with N = 21 postgraduate year 2/3 Internal Medicine Residents at Montefiore Medical Center in Bronx, NY, USA in 2021-2022. Two resident investigators led the focus groups using a semistructured interview guide. Questions included defining types of rounds, benefits and pitfalls of various rounding styles, their impact on resident education, and recommendations to improve education on morning rounds. The sessions were audio recorded, transcribed verbatim, and de-identified. Transcripts were analyzed through inductive thematic analysis. RESULTS:Rounding styles identified were bedside, table rounds, and a hybrid approach. Three themes emerged through analysis of the data: (1) A hybrid model offers an optimal balance of education; (2) full bedside rounds have unintended pitfalls; and (3) Attending preparation affects the quality of rounds. CONCLUSIONS:Residents' perceptions of the education on attending rounds are impacted by both attending rounding style and advanced preparation. Our participants' insights could inform a rounding approach that optimizes both patient- and learner-centeredness.

to characterize and describe the spatial and temporal distribution of nursing care establishments in Brazil according to the National Registry of Health Establishments. ecological study, using secondary data from the National Register of Health Establishments, aggregated by year, state and region. The variables extracted were: year of registration, gender of the nurse manager or administrator, number of nurses per establishment, type of establishment, main activity, level of care, legal nature and agreement. Descriptive statistics and temporal analysis were carried out using the Jointpoint program. between 2003 and 2023, 340 nursing establishments were found with active registrations. The South and Southeast concentrated most of the establishments. There was a predominance of practices, specialized clinics and home care services. The temporal analysis indicated that between 2003 and 2021, there was an annual growth of 30.07% (p= 0.00). Considering the total period (2003-2023), there was an annual growth of 25.01%, indicating an upward trend in businesses over the years. formalization and registration reflect the professionalization of nursing management. There has been an increase in registrations following the publication of resolutions by the Federal Nursing Council that support autonomous and/or liberal practice.