2011 - UCSF School of Medicine - University of California, San ...

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UCSF Education Day 2011There were only rare differences in distributions ofthemes across gender, year in school, size of school, orschool nationality.Discussion: Healer’s Art medical students identify coreissues and values that they may repress or feel unableto sustain in medical training. According to the dataanalyzed here, medical training involves not onlyprofessional formation, but personal deformation as well.Medical educators must attend to both gains inprofessional competence and the personal qualities andvalues that are at risk as students progress throughmedical training.Reflective critique: Judith Wrubel, PhD, anaccomplished qualitative researcher, helped design thestudy and analytic methods.References:1. Rabow MW, Remen RN, Parmelee DX, Inui TS. Professionalformation: extending medicine's lineage of service into the nextcentury. Acad Med. 2010;85:310-17.Teaching and Assessing MedicalStudents’ Skills in Counseling forBehavior Change: A SystematicReviewKaren E. Hauer, MD, UCSF, karen.hauer@ucsf.edu;Patricia Carney, PhD, Oregon Health SciencesUniversity, carneyp@ohsu.edu; Anna Chang, MD,UCSF, anna.chang2@med.va.gov; Jason Satterfield,PhD, UCSF, jsatter@medicine.ucsf.eduAreas abstract covers: UME, GMEDomain(s) addressed: Clinical Instruction andPerformance, Evaluation of Programs and Curricula,Patient CarePurpose: To characterize published curricularinterventions to teach medical trainees to counselpatients for behavior change and identify curricularformats that enhance patient outcomes.Background: Unhealthy lifestyle behaviors contribute toapproximately half of United States (US) deaths.However, physicians infrequently address importantbehavioral science topics during clinical visits and lacksufficient skill in counseling patients to implementbehavior change.Methods: We conducted a systematic literature searchof studies published 1965-2010 evaluating curricula oncounseling for behavior change for medial trainees.Included studies described: (1) behavior changecounseling, (2) a teaching intervention for medicaltrainees, and (3) assessment of the intervention. Weextracted eligible articles and rated impact on learnersand patients using Kirkpatrick’s hierarchy.Results: Of 2,758 initial citations, 106 met inclusioncriteria. 75 studies described interventions for medicalstudents, and 88 for residents/fellows. Most studiesoccurred in the US (94) at single institutions (91). Themajority (77) occurred in primary care disciplines:internal medicine (36), family medicine (30) andpediatrics (13). The most prevalent study design waspre-post comparison; only 22 studies used a randomizedcontrolled design.The most commonly addressedcurricular topic for counseling for behavior change wassmoking (65 studies) followed by nutrition (27),alcohol/drug use (26), and exercise (20). Theoreticalframeworks uncommonly justified curricularinterventions, although 28 studies used thetranstheoretical model of change. 58 studies involved 8or fewer hours of curricular time, and 48 spanned 4 orfewer weeks. Outcome measures related to learnerattitudes, knowledge or skills were common; only 8studies showed benefit to patients or organizationalpractice.Discussion: Multi-institutional research on methods ofteaching trainees counseling for behavior change thatinfluence patients’ health outcomes are urgently neededto ensure trainees’ clinical competence and improvedpatient care.Reflective critique: We will present our manuscript draftat ESCape 3/1/11 for feedback.The Educational Value of OvernightCall Amid Resident Duty HoursRestrictionsOren K. Fix, MD, MSc, UCSF Medical Center,oren.fix@ucsf.eduAreas abstract covers: GMEDomain(s) addressed: Competencies, Health Systems,Patient Care, Quality ImprovementPurpose: To compare faculty perception of theeducational value of a rotation with overnight call to onewithout overnight call.Background: The implementation of new ACGME dutyhours regulations in July 2011 will place new restrictionson post-graduate year (PGY)-1 trainees, primarily byrestricting consecutive duty hours to 16. Theseregulations limit PGY-1 residents from staying overnightfollowing a normal workday. Residency programs mustconsider the relative educational value of overnight callversus alternative duties that provide a similar learningexperience.University of California, San Francisco • School of Medicine 39
UCSF Education Day 2011Methods: An anonymous, 5-item Web-based surveywas e-mailed to clinical faculty of a liver transplantrotation. Items solicited opinions about the educationalvalue of overnight call, adequacy of supervision and thevalue of a rotation without overnight call. Answer choiceswere yes/no or multiple choice and includedopportunities for comment. Analyses were descriptiveand qualitative.Results: 10/15 (67%) faculty completed the survey. Allrespondents answered that overnight call waseducationally important for the PGY-1 resident and allfelt that adequate supervision was available. In a rotationwithout overnight call, 90% of respondents answeredthat weekend coverage remained educationallyimportant but most felt this did not replace theeducational value of overnight call. Respondentsidentified the following competencies learned fromovernight call: development of independence,confidence, responsibility, decision-making, prioritizationand communication; cross-covering; and the opportunityto work-up new admissions.Discussion: Despite the scheduling difficulties imposedby new duty hours regulations, overnight call maintains aunique learning experience that should be preservedwhere possible in the training of PGY-1 residents.Reflective critique: Survey results were reported to theInternal Medicine Residency Program with a proposal tomaintain overnight call if possible, with weekend day asan educationally important, although qualitatively inferior,alternative.References:1. Nasca TJ, Day SH, Amis ES. The new recommendations on dutyhours from the ACGME task force. N Engl J Med 2010;363(2):e3.The UCSF Geriatric CommunityResources Clinical Algorithm andGuideChristopher A. Bautista, Christopher.Bautista@ucsf.edu;Louise Aronson, MD, aronsonl@medicine.ucsf.eduBackground: Roughly half of current physician visits inmany specialties are from patients >65 years old, andthe population aged >60 is expected to double by 2050.As states increasingly cut services keeping elderlypatients healthy and independent, healthcare providersmust be aware of, refer to, and lobby for these vitalgeriatric community resources.Methods: Following a literature review, internetsearches and interprofessional expert focus groups, wedeveloped an algorithm and related guide detailingservices, eligibility, coverage and cost, provider role andlocal contacts. Validity was established through surveysof students, residents, faculty and local communityproviders as well as feedback from over 30interprofessional national leaders in Geriatrics. Casebasedpre/post-tests with medical students and residentswere used to evaluate the educational utility of the toolsafter a brief introduction.Results: 58% (37/64) of survey respondents said thatthey were “somewhat likely” or “very likely” to use thesetools in their clinical practice and teaching. 63% (26/41)of learners “agreed” or “strongly agreed” that the toolsmade them more comfortable referring elderly patients tocommunity resources. 64% (9/14) of medical studentsand 90% (4/5) of residents who completed the pre/posttestscored higher after brief training with the tools.Discussion: The Geriatric Community ResourcesClinical Algorithm and Guide providers a validated andeducationally effective framework to help cliniciansappropriately refer elderly patients to vital communityservices. The tool alone does not help all trainees, someof whom may require a dedicated educational sessionon the purpose and uses of certain resources.Reflective critique: Presentations at ESCAPE,Geriatrics WIP and dissemination to local and nationalgeriatrics leaders for review led to additional resourcesand refined structure.Areas abstract covers: UME, GME, CME, IPHEDomain(s) addressed: Community Medicine,Evaluation of Programs and Curricula, Patient Care,Primary CarePurpose: To develop a tool that gives providers apractical conceptual framework for approaching themyriad resources necessary to keep elderly patientshealthy and independent in the community.40 The Haile T. Debas Academy of Medical Educators
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