Patricia Tietjen Teaching Academy Academic Symposium 2023

2023 

ACADEMIC 

SYMPOSIUM 

JUNE 21, 2023

6 Pillars of Educational Activities 

Teaching 

Curriculum 

Development 

Advising and 

Mentoring 

Education 

Leadership and 

Administration 

Learner 

Assessment 

Scholarly 

Research 

and Writing

Tell me and I forget, teach me and 

I may remember, involve me and I 

learn. 

~Benjamin Franklin 

4 PATMDTA 2023

Contents 

Welcome to the Academic Symposium 6 

2022-2023 Scholar Profiles 

Lester Bussey, MD 10 

Meredith Clark, MD 12 

Cynthia Feher, MD 14 

Vicky Harisis, MD 16 

Marta Korytkowska, MS, CCC-SLP 18 

Susan Le, PA-C 20 

Stacie McLaughlin, PT 22 

Stephanie Midgley, MD 24 

Anthony Mohabir, MD 26 

Danielle Paravati, BSN, RN, CEN, TCRN 28 

Mary Pearson, CTRS, CDP 30 

Michael Pote, MSN, RN, CWCN 32 

Lisa Ricker, NP 34 

Ramanathan Seshadri, MD 36 

Barbara Spielman, BSN, RN 38 

Robert Storck, MPA, NRP, EMS-I 40 

Ellen Tangney, DNS, MS Ed, RN 42 

Academic Posters 44 

Closing 61 

Support the Teaching Academy 62 

PATMDTA 2023 

5

PATMDTA 2023

WELCOME 

Welcome to the 2023 Academic Symposium of the Patricia A. Tietjen, 

MD Teaching Academy. We invite you to learn more about each 

scholar’s individual educational project developed over the course of 

the 2022-2023 Teaching Academy curriculum. A bio, scholarly project 

abstract, and academic poster for each scholar follows. Please reach 

out directly to scholars with any questions you may have about their 

work, or, if you wish to collaborate. We know you will be as impressed 

and inspired by these passionate educators as we are. It has been our 

privilege to witness the scholarly projects take shape over the course 

of the past nine months. Read along, and we’ll catch up with you at 

the end of this publication... enjoy! 


7

MEET THE 2022-2023 SCHOLARS 

Lester Bussey, MD 

Vassar Brothers 

Meredith Clark, MD 

Danbury Hospital 

Cynthia Feher, MD, FACP 

Norwalk Hospital 

Vasiliki Harisis, MD, FACP 


Marta KorytkowskaK, PhD 

CCC-SLP 

Sacred Heart University 

Susan Le, PA-C 

Vassar Brothers 

Stacie McLaughlin, PT 

Western Connecticut Home Care 

Stephanie Midgley, MD 

Vassar Brothers Medical Center 

Anthony Mohabir, MD 

Hudson Valley Radiologists, PC 


Danielle Paravati, 

BSN, RN, CEN, TCRN 


Mary Pearson, CTRS, CDP 

Sharon Hospital 

Michael Pote, MSN, RN, CWCN 


Lisa Ricker, NP 


Ramanathan Seshadri, MD 

Danbury, New Milford and 

Norwalk Hospitals 

Barbara Spielman, BSN, RN 


Robert Storck, MPA, NRP, EMS-I 


Ellen Tangney, DNS, MS Ed, RN 

Northern Dutchess Hospital 


9

Lester Bussey, MD 


Lester.Bussey@nuvancehealth.org 

Lester Bussey is an obstetrician/gynecologist and is a hospitalist at 

Vassar Brothers Medical Center. He is a graduate of the University 

of Miami Miller School of Medicine. After completing a residency 

at The Mount Sinai School of Medicine at Queens Hospital Center, 

he worked for nine years at Harlem Hospital. While there, he 

organized and implemented the hospital’s 4-week Ob/Gyn rotation 

for the City University of New York physician assistant students. 

He joined the Vassar family in 2009, working with NP, PA, and 

CNM students. He continued to form bonds with his students that 

developed from mutual need and respect. Teaching has always 

been intuitive. Mentorship and preceptorship require other skills 

to be acquired to be effective. In 2019 he was selected to be an 

Associate Program Director of the new Ob/GYN residency program. 

It was the opportunity of a lifetime. The program, unfortunately, 

closed in 2022. The Patricia A. Tietjen Teaching Academy offered the 

ideal place to continue his journey in medical education. Thus far, 

the experience has been a whirlwind, often leaving more questions 

than answers, but he now has a purpose. His research interests are 

health infrastructure and learning systems, the science of teams 

and group learning, and web-based curriculum design. You will 

undoubtedly find him vibing on a beach somewhere in the world 

when he’s not working. If you see him, it costs nothing to say hello. 


The Humanist, The Humanities and the 

Practice of Empathy 

Lester F. Bussey, MD 

Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

This multi-phased, experimental, mixed-methods study aims to determine if the practice of 

empathy can improve HCAHPS survey scores and secondarily reduce clinician burnout. HCAHPS 

surveys are standardized tools often used by healthcare organizations to assess many aspects of 

the patient’s experience. 

Reimbursement from federal sources is HCAHPS performance dependent. Therefore, this study 

will evaluate the results of the six clinician-specific communication questions of the HCAHPS 

survey. The Listen, Explain, and Respect questions readily assess a patient’s receipt of empathetic 

care. Empathy can improve patient satisfaction (Riess,2012) and outcomes (Kelley,2014), reduce 

burnout (Krasner,2009), improve collaboration (Halper,2012), and improve reimbursement. Can 

empathy be taught? Briefly stated, it can be, but is this the right question to ask? Empathy can 

easily be taught in a classroom or with infographics but fully realized empathy and its practice are 

learned by observing and interacting with others. 

Phase one of the study is curriculum development. Situated learning theory provides the framework 

for a curriculum that allows learners to: 

• Explore using the Humanities to learn to practice empathy via didactics, small group 

discussions, and videotaped role-playing sessions. 

• Engage in the pillars of emotional intelligence. 

• Begin a journey of mindfulness. 

Phase two is curriculum implementation. The curriculum is multi-sessional and culminates in a oneday 

practicum. The delivery method is yet to be determined. The Jefferson Scale of Empathy will 

be administered to learners pre- and post-implementation. Chaitoff et al. (2017) found a positive 

association between physician empathy scores and CGCAHPS. Phase three begins with reviewing 

the results of a 12-month annual HCAHPS survey post-implementation. Furthermore, the delivery 

method will likely influence how the results are analyzed, as there could be an opportunity to study 

the benefits of interdisciplinary learning. 

A delivery method will materialize in the following weeks, and work will begin to establish concrete 

goals and objectives. Solutions to enhance patient experience/quality of service are complex 

and varied. Empathy is one of many variables in the equation. Attending the Disney Institute’s 

leadership and quality service workshops is hoped to offer greater insight into innovative solutions. 


11


Nuvance Health Medical Practice 

Meredith.Clark@nuvancehealth.org 

Meredith Clark, MD received her MD degree from New York 

Medical College in 2013 and was the recipient of the 2013 Geeta 

Mukhopadhyay Das, MD Memorial Award in Psychiatry. Meredith 

completed her psychiatric residency training at Montefiore Medical 

Center Department of Psychiatry and Behavioral Sciences in 2018 

during which time she served as chief resident. She was a copresenter 

at a workshop at the 2018 American Association of 

Directors of Residency Training, “Streaming through the Adolescent 

Mind: Brining Awareness to the Forefront of Our Training.” 

Meredith collaborated on a poster presented at the 2018 American 

Psychiatric Association Annual Meeting, “Home Visits: Where the 

Story Begins.” 

Meredith completed her child and adolescent fellowship training 

program at Montefiore Medical Center in 2020. She was the 

recipient of the Association of Family Psychiatrists’ 2019 Resident/ 

Fellow Recognition Award for Excellence in Family Care. She 

collaborated on a poster presented at the 2019 IPS: The Mental 

Health Services Conference“ When Politics Enters the Professional 

Realm: A Curriculum.” 

Meredith’s publications include an article published in the Journal 

of the American Academy of Child and Adolescent Psychiatry in 

2021,“Insidious Onset of Serotonin Syndrome in a 6-Year-Old 

Boy” and an article published in Academic Psychiatry in 2020 , 

“Trainees’ Attitudes Toward Prescribing and Managing Psychotropic 

Medications.” 

After completing her training, Dr. Clark joined Nuvance Health in 

2020 where she is an outpatient child and adolescent psychiatrist. 

She has recently taken on the role of Medical Student Clerkship 

Director which has become a highlight of her career. 

Dr. Clark has performed as a singer, dancer, and actor in community, 

regional, and summer stock theatre. She is passionate about 

exploring the world with her husband and 5 and 9 year old sons. 


Incorporating an Active Learning-Based Curriculum 

into a Psychiatry Clerkship: Impact on Student Grades 

and Satisfaction 



The didactic curriculum for medical students during their clinical years is associated with a number of 

challenges including limited faculty availability, sustaining student engagement in lectures conducted 

virtually, detracting from time spent in clinical encounters, and ensuring that lectures are relevant to 

the goal of preparing students for their end-of-rotation shelf examinations. A needs assessment has 

identified areas for improvement in the didactic curriculum for psychiatry clerkship. Students have 

voiced some dissatisfaction at the extent and nature of the current didactic curriculum. Students 

who are currently remotely joining lectures being conducted in-person describe feeling disengaged 

and reporting a suboptimal learning environment. Students have voiced frustration at the time that 

the extensive didactic curriculum takes away from clinical learning experiences. 

Several studies have found that medical student satisfaction improves with active learning.4 Active 

learning encourages critical thinking, discussion, and allows students and educators to interact 

and engage with the subject matter. 7 Problem-based learning (PBL) is an “instructional learnercentered 

approach that empowers learners to integrate theory and practice, and apply knowledge 

and skills to develop a solution to a defined problem.” Studies have found PBL has long term effects 

on undergraduate medical education including positive effects on physician’s competency after 

graduation. 

We plan to implement a curriculum based on active and problem-based learning in the psychiatry 

clerkship for the 3rd year University of Vermont medical students rotating at the Connecticut campus. 

We will streamline the psychiatric curriculum in order to optimize teaching of high yield information 

tested on the NBME shelf exam and minimize disruption to student’s clinical experiences. The 

proposed curriculum will consist of 5 case based sessions that incorporate high yield psychiatry 

topics in an active learning format. We hope to provide an improved learning environment that is 

engaging, more inclusive, tailored, and that creates a community of practice. We will then describe 

the effect of the curriculum changes on student grades and student satisfaction. 


13



Cynthia.Feher@nuvanceHealth.org 

Dr. Cynthia R. Feher MD, FACP is a physician, born in Vancouver, 

Canada and moved to Mercer Island, Washington at the age of 8. 

She went back to Canada to study physiology and anthropology 

at McGill University in Montreal, Canada. She studied medicine at 

St. George’s University in Grenada, did her clinicals in New Jersey 

and New York and completed residency in Internal Medicine at St. 

Luke’s Roosevelt University in 2007. She stayed as faculty at St. 

Luke’s Roosevelt Hospital (which is now Mt. Sinai St. Luke’s) and 

received the Empire State Research grant to study transfers of 

care. She has an interest in international medicine and has done 

rotations or worked in Czech Republic, Grenada, Canada, Kenya 

and New Zealand. 

Cynthia has been Associate Program Director at Norwalk Hospital, 

in charge of ambulatory medicine since 2014. She works out 

of the Norwalk Community Health Center, a Federally Qualified 

Health Center, and teaches medical students and residents. She 

has special interests in teaching quality improvement, mitigating 

health care disparity, cultural sensitivity, cost conscious care 

and preventive medicine. She is interested in supporting quality 

improvement research in ambulatory medicine. She is the chair 

of the Norwalk Hospital Internal Medicine Residency Clinical 

Competency Committee. 

Recently she has been involved in physician advocacy with the 

American College of Physicians Health & Public Policy group 

statewide and in her town. 

Cynthia is a mother of two elementary-aged children and was and 

will be again a competitive rower. She loves reading fantasy fiction 

and music. 


A New Population Panel Management Curriculum for Internal 

Medicine Residents 



It is estimated that only 55% of adults receive recommended preventative care. While traditional 

medical practice – with its individualized, visit-based approach – often struggles to reach some 

patients, population panel management allows primary care physicians to act more proactively, 

using staff support and IT tools to conduct outreach to patients. 

Panel management has been an informal part of the Norwalk Hospital Quality Improvement 

curriculum since 2017, when panel data was first made available to Norwalk Hospital Residents. 

A new electronic medical record (EMR) was implemented in May 2022, but panel data was not 

available until recently, and only partial data is currently available. 

We plan to implement a population panel management curriculum for Norwalk Hospital internal 

medicine residents. Residents will learn the importance of population panel management, 

understand how to interpret quality metrics regarding panels, and gain additional skills in teamwork 

and leadership. Norwalk Hospital Internal medicine residents will be surveyed to get a baseline 

understanding of their current attitude and comfort level with panel management, and then surveyed 

again one year later. 

Residents and faculty will receive instruction on population panel management, which will include 

understanding the importance of panel management, knowing key terms, understanding how to 

access panel data, strategies and workflows around panel management, and understanding the 

team-based approach. Training will take place during noon conference, small group instruction, 

academic half days, and quality improvement sessions. Individual instruction and support will take 

place as part of scheduled quality improvement sessions and during administrative time. Resident 

physician champions will be identified to lead specific projects. 

Residents will be expected to do panel management during administrative time in clinic blocks and 

will be supervised by ambulatory faculty. 

Residents will be divided into 4 care groups: 3 chronic disease management groups (hypertension, 

diabetes, and hepatitis C) and 1 preventative care group (colorectal cancer screening). Residents will 

help determine measures, goals and interventions, and will be encouraged to collaborate with the 

research department in creating studies, with the aim of improving the health of specific populations. 


15



Vasiliki.Harisis@nuvancehealth.org 

Vasiliki Harisis, MD, FACP is a Hospitalist Clinician Educator and 

Associate Program Director of the Internal Medicine Residency 

Program at Norwalk Hospital. Dr. Harisis was born and raised 

in Rochester, New York and identifies as both a first-generation 

student and physician. She completed her undergraduate training 

at Cornell University in 2003, where she received her Bachelor of 

Arts in Psychology. As a true “Upstater,” she attended medical 

school at SUNY Upstate Medical University in Syracuse, New York, and subsequently completed her 

residency training in Internal Medicine at the University of Rochester. 

After graduating in 2010, Dr. Harisis began her career at Norwalk Hospital as a Hospitalist Clinician 

Educator, and later assumed the role of clerkship director for the internal medicine sub-internship 

rotation. Dr. Harisis has a keen interest in medical education and the patient experience. She has 

developed the Objective Structured Clinical Examinations (OSCEs) program which utilizes simulation 

to both assess and teach communication skills that facilitate patient-centered communication, a 

cornerstone of the Nuvance Health mission. 

Dr. Harisis recognizes the competing interests that have resulted in the steady ‘creep’ away from the 

bedside. In her most recent appointment as Associate Program Director, her professional goals include 

promoting the “Back to the Bedside” initiative, as endorsed by the Accreditation Council for Graduate 

Medical Education. Further, as a PATMDTA scholar, she has an emerging interest in cultivating interprofessional 

collaboration to build a community of practice that benefits students, trainees, patients, 

and the Nuvance Health community at large. 

Outside of work, Dr. Harisis enjoys spending time with her husband and 2 children, and the rest of 

her “Big Fat Greek [Family].” She is an active member of the Greek Orthodox community and enjoys 

celebrating Greek culture and promoting cultural fellowship and hospitality. 

On a final note, through reflection on this experience as a PATMDTA scholar, Dr. Harisis is grateful for 

the support she has received from the leadership at Norwalk Hospital, who have not only provided 

mentorship, but have also afforded her the opportunity to define and pursue her career goals. 


“Talk the Talk and Walk the Walk”: A Resident 

Communications Curriculum Revamp 



Effective communication is an essential component of high value healthcare. Interpersonal and 

Communication skills (ICS) is an Accreditation Council of Graduate Medical Education (ACGME) 

core competency, and its integration into program curriculum is an ACGME common program 

requirement (CPR). Our goal is to create a comprehensive, longitudinal, structured ICS curriculum 

using multimodal pedagogical techniques. We hypothesize that a spaced learning approach to the 

ICS curriculum with reinforcement from a program-wide bedside rounding initiative will improve 

residents’ self-efficacy and performance in ICS, with resultant positive impact on patient experience 

and patient outcomes. 

Medication counseling was chosen as the first component of ICS curricular development. An interprofessional 

working group including pharmacy and residency program leadership contributed to 

the development of the workshop content, guided by ACGME CPR review and an informal program 

needs assessment. Three 1-hour interactive workshops were created, each focusing on one high risk 

medication. Forty-five internal medicine residents were eligible for participation. The workshops 

were case-based and experiential, and were comprised of a didactic component, video review, and 

small-group role play. The workshops were held in-person and occurred at four-week intervals 

from February 2023 to May 2023. The residents completed pre-workshop surveys, assessing 

their previous experience and self-confidence in counseling on each high-risk medication. They 

subsequently completed post-workshop evaluations. Two weeks after the final workshop, residents 

will complete an Objective Structured Clinical Examination (OSCE) to assess their performance in a 

medication counseling scenario. 

On pre-intervention surveys, 75% (18/24) of respondents reported having experience with medication 

counseling, however 63% (15/24) also reported a relative lack of confidence in their counseling 

ability. Overall, the workshops were well-received by the residents. On the post-workshop survey, 

94% (17/18) of respondents reported they learned something new, and 100% (18/18) reported 

they would implement changes to their clinical practice. 

Future aims include curricular development of other ICS topics, administration of annual ICS selfefficacy 

surveys, and implementation of bedside rounding. Regarding impact on patient outcomes, 

metrics including 1) rates of documentation of medication counseling, 2) utilization of the “Medsto-Beds” 

pharmacy program, and 3) Hospital Consumer Assessment of Healthcare Providers and 

Systems (HCAHPS) scores will be tracked. 


17

Marta Korytkowska, Ph.D., CCC-SLP 

Sacred Heart University 

Marta.Korytkowska@nuvancehealth.org 

Marta Korytkowska, Ph.D., CCC-SLP, is originally from Elk, Poland. 

She received her Bachelor’s and clinical Master’s degree from 

La Salle University in Philadelphia; following this, she went on 

to complete a theoretical Master’s and Ph.D. in neurolinguistics 

from the Speech Language Hearing Sciences Department at The 

Graduate Center, CUNY. Throughout her education career Marta 

has enjoyed being involved in all aspects of academic life. She served as a resident assistant as an 

undergraduate, a supplemental instructor as a graduate student, and on several committees in her 

Ph.D. program. Dr. Korytkowska considers herself a lifelong learner. 

Marta Korytkowska has been a practicing clinician for 9 years. She started as a clinical fellow at 

Nuvance’s Norwalk Hospital and has been a part of the Nuvance community since. Her clinical 

experience has spanned across various populations (e.g., acute care, acute rehabilitation, outpatient, 

and home care) and across several institutions. In addition to her clinical practice, Marta sits on 

the executive board of the Connecticut Speech Language and Hearing Association as the Continuing 

Education Administrator. 

Dr. Korytkowska is also a Clinical Assistant Professor at Sacred Heart University where she teaches 

both undergraduate and graduate students about swallowing and neurological disorders in adults. In 

her spare time, Dr. Korytkowska has launched Allied Foundations, a project to make interdisciplinary 

education more accessible to students, providers, and the general public. Her experience as a 

professor earned her the 2023 Martin Gitterman Excellence in Teaching Award. Outside of classroom 

teaching, Marta has given continuing education talks in the areas of Bilingualism and Aphasia, was 

featured on Health Talk to discuss PPA, and given many interviews to get the word out about SLP 

practice. 

As a researcher Dr. Korytkowska has published several book chapters and articles on language 

sampling, cognition, and dementia. She has presented at local and national conferences on the topics 

of neurolinguistics, aphasia, dysphagia, and dementia. In the last several years, Dr. Korytkowska has 

had an increased passion for interdisciplinary education. She is currently pursuing research that is 

focused on barriers to learning and understanding of colleagues in interprofessional roles other than 

one’s own. She continues to keep up her clinical research in cognition and aphasia. 

Marta lives in Norwalk. She is a daughter to the most amazing and supportive parents. She is an avid 

traveler. Having been born in Poland she returns to her roots yearly, but also manages to make a pit 

stop in another country and even on other continents. When she is not working you can find her at 

the gym boxing or practicing yoga in the morning and hosting a dinner party in the evening. 


Exploring Knowledge of Interdisciplinary 

Allied Health Education in the Undergraduate 

Medical Education Curriculum 

Marta Korytkowska, PhD, CCC-SLP 


Interdisciplinary care is essential in providing the best patient outcomes for diagnosis, management, 

and rehabilitation. Which and how allied health professionals need to be involved is setting dependent. 

Regardless of setting physicians are the gate-keepers for referrals which allow stakeholders to take 

advantage of the evidence-based rehabilitation services available to them. 

To explore the knowledge MDs have about allied health professionals informal interviews were 

conducted with undergraduate and graduate medical students. Four themes emerged: (1) no formal 

education about the role of allied health professions in undergraduate medical education, the mention 

of these professions occurs only within a list of “team members”, (2) all (8) individuals acknowledged 

they associate PT, OT, SLP with stroke patients, (3) education about this topic is informal and comes 

from experiential learning, (4) swallow difficulty is associated with stroke diagnosis, otherwise as part 

of a GI lecture with focus on esophageal conditions rather than the oro-pharynx. When asked about 

knowledge of the SLP specifically respondents said “nothing” or learning from a personal connection. 

For learning to be most efficient two assumptions must be met. First, constructivism, new knowledge 

must have a previous schema to attach to (Piaget, 1962). Second, rationale, a learner must engage 

with information and understand its importance for that information to be fully processed and encoded 

(Williams, Lombrozo & Rehder, 2010). Explanations allow for both of those assumptions to be met 

and provide the learner with foundational knowledge. 

Given anecdotal findings from the informal interviews, knowledge is passed on within the hierarchy, 

however, limited explanations of this knowledge result in incomplete schema formation. The purpose 

of this study is to explore knowledge across the continuum of education and implement an intervention 

to enhance this knowledge if needed. This will be achieved by conducting a formal survey with 

providers across the continuum. 


19



Susan.Le@nuvancehealth.org 

Susan Le was born and raised in Brooklyn, New York. She obtained 

her Bachelor’s of Science in Biology from Stony Brook University in 

2013. She worked in a variety of healthcare positions afterwards 

which inspired her to pursue a career in medicine. She obtained 

her Master’s of Science in Physician Assistant (PA) Studies from 

the Pace University – Lenox Hill Hospital PA Program in 2017. Her 

favorite and most memorable clinical rotation was Internal Medicine 

in Cape Town, South Africa which provided her one of the most 

unique and humbling experiences of her lifetime. Susan initially 

worked as a PA in Primary care, then transitioned to Cardiology. 

She eventually moved to the Hudson Valley to join the Hudson 

Valley Heart Center working as an inpatient Cardiology PA at Vassar 

Brothers Medical Center since 2019. In addition to helping people 

in a clinical setting, she also sees a need for high quality education 

in healthcare. She has a special interest in teaching, advising, 

mentoring, and curriculum development. She was fortunate to join 

Nuvance’s Patricia A. Tietjen Teaching Academy in the 2022-2023 

Cohort to further pursue her goals, and would like to focus those 

goals on Advanced Practice Practitioner education. 

She now lives in Poughkeepsie with her husband and is expecting 

a baby boy in May 2023. In her spare time she loves to go hiking 

in the beautiful Hudson Valley and beyond, travel, and just spend 

quality time with her family, friends, and cats. 


Strengthening Advanced Practice Practitioner 

Capacity Through Simulation 



Advanced Practice Practitioners (APPS) are integral parts of healthcare, and can work in many 

subspecialties. (Morrow et al., 2012) However, the nature of their initial training is limited, and 

opportunities to develop confidence in their fields are usually gained on-the-job, with skills acquired 

on a case-by-case basis as they arise during work hours. (Luckianow et al., 2015) Few programs 

offer regimented continuing education for their APPs. Lack of more consistent training can greatly 

determine patient wellbeing and thus suggests a need for more organized curriculums. (Good & 

Rabener, 2021) 

Simulation laboratories and other related technology can provide a more structured way of developing 

these skills. Benefits of simulation include hands-on training that would not necessarily compromise 

patient safety, an opportunity to become familiarized with complicated medical equipment and 

procedures, and integration of certain important topics into the providers’ training before they 

encounter those scenarios in an emergent situation involving actual patients. (Griswold-Theodorson 

et al., 2015) 

The objective of this project is to explore the potential benefits of simulation technology in 

continuing clinical education for APPs. The data will be collected in a mixed method manner by 

testing comprehension of simulated scenarios, gauging whether simulation improves the comfort 

level of the clinician to use specific medical devices/procedures, and assessing perception of impact 

on patient safety. 

One class was executed on temporary cardiac pacing which involved a formal lecture, followed by 

the use of equipment simulating external pacing from a defibrillator, and virtual use of a temporary 

venous pacemaker generator. Participants were asked to answer comprehension questions as well 

as survey questions regarding the objective topics stated above. A majority of answers suggested 

better comprehension, increased comfort levels, a great impact that simulation had on their learning 

experience, and simulation training having the potential to greatly improve patient safety. 

Future opportunities include obtaining more simulation equipment to host more classes to APPs in 

their specialty fields. These classes would be further supported by incentives for learners to continue 

their education in this manner, and incentives for teachers to share their expertise. We can also 

extend classes to beyond APPs, including nurses, physicians, and residents. We can also consider 

assessing the impact of simulation on nontechnical skills such as teamwork and communication. 

(Griswold-Theodorson et al., 2015) 


21



Stacie.Mclaughlin@nuvancehealth.org 

Stacie McLaughlin grew up in Danbury, CT, one of 6 children. She 

participated in a variety of activities including gymnastics, Junior 

Olympics as a sprinter, and received her black belt in Tae Kwon Do, prior 

to graduating from Danbury High School, where she was a member of the 

track and field hockey teams. Stacie competed as a member of the track 

and field, cross country, and swim and dive teams while at SCSU. She 

presently lives in Southbury with her son, two dogs and a cat. 

Stacie is a Physical Therapist and is currently a Physical Therapy Supervisor at Western Connecticut Home Care. 

She earned dual degrees with a BS in Physical Education with a minor concentration in Exercise Physiology, 

and a BS in Public and Community Health from Southern Connecticut State University. 

Stacie worked as a teacher, assistant field hockey coach at WCSU, a gymnastics coach and track coach prior 

to returning to school at University of Connecticut, where she graduated summa cum laude with a degree in 

Allied Health/Physical Therapy. She was the Recipient of UConn’s McMillan Award for Physical Therapy. 

Stacie was a certified wound care specialist and practiced as the wound care coordinator, at DATAHR, a neuro 

rehab facility now known as Ability Beyond. She was also a member of the International Wound Care Congress 

for 10 years. 

She has a strong orthopedic and sports medicine background with over 20 years in outpatient therapy, as 

therapist and manager. She specializes in foot and ankle biomechanics and gait dynamics. She has been a 

biomechanical foot orthotic tech rep for nearly 30 years. 

Stacie has presented at sports medicine seminars discussing biomechanical foot orthotics, ankle instability, 

rehabilitation for ankle and knee injuries, the effect of steroids on young adult athletes, the effect of eating 

disorders on young adults. 

Stacie is also a NASM certified Personal Trainer. She provides education to gymnasts and ninjas at a local 

gymnastics/ninja gym, to reduce young athletes’ potential for injuries. Stacie is a member of Southbury 

Justice group, the Nuvance LBGTQ+ ERG, and a trainer for state and local gymnastics meets. She is proudest 

of being a mom to her 20-year-old son, who competes and coaches in world ninja competitions. 

Stacie is active in her church, Bethel United Methodist Church, serving as a member of the Outreach and 

Nurture Committees, as an usher for the Healing services, as a sherpa in the Luke 5 Ministry. She is a member 

of the Bible study and Sisterhood groups as well. 

Stacie has always enjoyed teaching, including training students, volunteers, and new employees at each 

facility she has worked. When she came to Western Connecticut Home Care ten years ago, she took on the 

challenge of pioneering a home care orientation program for the therapy department that had not previously 

existed. She will continue to develop and evolve the program as she learns from the teaching academy. 

Stacie volunteers regularly in Nuvance Health Mission Day projects, which is where she first met Dr. Patricia 

Tietjen. She was fortunate to get to know her through the years and they often discussed their love for 

teaching and learning. Stacie is thrilled to be considered a scholar in the academy named after her beloved 

colleague, Dr Tietjen. 


Home Care Therapy Orientation Program 



This project looked to create a therapy orientation program including addressing competencies to 

be assessed annually. This is to improve clinical skills and the documentation requirements in the 

home care setting to improve the overall care provided to patients and the confidence of therapists. 

Home care provides a unique environment for clinicians as they are treating independently in the 

patient’s home but working as a member of a multi-disciplinary team with assistance and guidance 

from supervisors. Critical thinking skills are paramount in providing the best care to patients and 

educational guidance to caregivers, while the therapists address the myriad of illnesses and injuries 

the patient may be recovering from. 

An anonymous “Home Care Survey” was emailed to 30 current physical therapists to determine their 

confidence and experience in treatment strategies for different diagnosis. The results would help 

establish a foundation of skills that clinicians felt required more training and could then be addressed 

in meetings. The survey results regarding experience of specific skills were instrumental in creating 

a competency program. 

Results of therapist’s confidence regarding certain skills coincided with what some of the current 

clinicians had voiced regarding not feeling comfortable being a mentor when newer clinicians shadow. 

Mentor training is another skill that will be incorporated into the program to improve the community 

of practice and overall climate of the clinical group while allowing for the sharing of clinical skills and 

ideas. 

The expectation is that this orientation program will continue to transform as skill sets are gained 

with the community of practice and while open communication among therapists and supervisors 

develops. The goal is to provide this outline as a guide to be utilized for all therapy disciplines with 

subsets of their specific clinical competencies, and eventually be able to be incorporated into the 

outpatient facilities to improve the transition of care from home to outpatient facilities. 


23



Stephanie.Midgley@nuvancehealth.org 

Stephanie Midgley, MD, FPD-AEMUS, FACEP, is originally from 

Brooklyn, NY. She received her undergraduate degree at SUNY 

Binghamton with a B.S. in psychobiology, graduating summa cume 

laude. She then went on to medical school at SUNY Downstate 

Medical Center, graduating summa cume laude and receiving the 

distinction of Junior AOA. She did her residency in Emergency 

Medicine at Brown University at Rhode Island Hospital followed by an advanced clinical ultrasound 

fellowship at Brown University at Rhode Island Hospital. After completing her fellowship, Dr. Midgley 

moved to Poughkeepsie, NY and joined Vassar Brothers Medical Center in 2013 as an attending in 

the Emergency Department and Director of Emergency Ultrasound. In 2019 she joined the inaugural 

faculty for VBMC’s Emergency Medicine residency. Additionally, in 2019 she became an adjunct 

Clinical Instructor at Touro College of Osteopathic Medicine and in 2020 joined the Marist Physician 

Assistant Studies school as an adjunct Clinical Professor. In 2022 she was awarded best lecturer by 

the VBMC Emergency Medicine residency. 

Her initial focus was VBMC’s EM residency point of care ultrasound (POCUS) education. Under her 

guidance, the Division of Emergency Ultrasound has grown into a system wide division, now called 

the Division of Clinical Ultrasound and teaches POCUS education for Vassar’s Emergency Medicine, 

Internal Medicine, Family Medicine, Anesthesia, and Transitional Year residencies, Critical Care, Sports 

Medicine, and Ultrasound fellowships, as well as medical students, physician assistant students, 

nursing, and fellow attendings. In 2023 she founded the POCUS Training Academy, her Patrician 

Tietjen Teaching Academy academic project; a free POCUS education and training center for VBMC 

attendings. In addition to POCUS education at VBMC, she has lectured at the American Institute of 

Ultrasound in Medicine (AIUM) annual 2023 conference on How Many Diagnoses Can Ultrasound Make? 

and Threading the Needle: Ultrasound Guided Peripheral IVs. She has also presented her original 

research on simplifying the Venous Ultrasound Excess Score (VEXUS) at the Society of Academic 

Emergency Medicine (SAEM) annual conference in 2023 and NY ACEP in 2023. 

Stephanie is a mother to two girls ages eight and ten. She encourages her girls to be hardworking, 

fierce, and strong. You can find Stephanie in the local CrossFit gym, Warlock Athletics, when she is 

not at work or teaching. Her dedication to physical fitness and training led her to rank in the top 10% 

of her age group for the last 3 years in the worldwide CrossFit Open competition and one of the top 

athletes in her gym. She also enjoys snowboarding, SCUBA diving, Obstacle Course Racing, hiking, 

and relaxing poolside. 


Point of Care Ultrasound Training Academy 



Point of Care Ultrasound (POCUS) is an ultrasound performed by the clinician at the bedside in 

conjunction with history, physical exam, imaging, and laboratory tests. POCUS increases diagnostic 

accuracy, improves patient safety and satisfaction, decreases cost of care, and shortens length of 

stay. However, despite POCUS’s benefits, it can lead to patient harm when used by those untrained 

or undertrained. Outside emergency medicine, there is no formal POCUS training or pathway for 

hospital privileges. Additional barriers to the implementation of POCUS include lack of access to 

machines, oversight, and time for performing exams. Our objective is to provide POCUS education 

through a the creation of the POCUS Training Academy to improve patient care while eliminating the 

barriers to integrating POCUS outside the Emergency Department. 

We surveyed EM/IM/ICU physicians at Vassar Hospital about their perceived barriers to implementation 

and desired POCUS applications. We determined barriers included: 

1. Access to machines 

2. Access to education/, lack of knowledge regarding US acquisition and exam interpretation 

3. Supervision for image acquisition 

4. Confirmation of image interpretation 

5. Time to perform pocus exam 

6. Requested applications to be taught include : Echocardiography, Thoracic, Inferior Vena 

Cava (IVC)/Volume Assessment, Focused Assessment using Sonography in Trauma (FAST), 

Renal, Deep Vein Thrombosis (DVT), and Soft Tissue. 

The POCUS Training Aacademy begins with an 8 hour hands on workshop, followed by monthly 

lectures reviewing the indications, how to acquire, image interpretation, and pathology review for 

each of the requested topics, followed by , scanning sessions, image review, and development of an 

image portfolio. Upon completion, providers may apply for hospital POCUS privileges. 

Using observational data, we seek to answer the following questions: 1. Can the implementation of 

a hospital-wide POCUS Training Academy increase POCUS usage? 2. Will there be sustained POCUS 

usage after completion of training? 3. Cost of implementation of a POCUS training program (i.e. 

machines, image storage, educational software). 4. Revenue generated from billed POCUS exams. 

Using survey data, we will assess the impact of POCUS training on providers’ perceived confidence in 

clinical assessment, treatment plans, job satisfaction, patient satisfaction when POCUS was utilized, 

and comfort with POCUS. 


25


Hudson Valley Radiologists, PC 

Anthony.Mohabir@nuvanceHealth.org 

Dr. Anthony Dennis Mohabir, MD is an accomplished Diagnostic 

and Interventional Radiologist who specializes in diagnosing and 

treating medical conditions using advanced medical imaging 

technology. He studied Medicine at The Albert Einstein College of 

Medicine and Biology with a focus on Computational Biology at 

Cornell University. 

Presently, Dr. Mohabir is a partner at Hudson Valley Radiologists, PC. He has gained valuable 

experience through his fellowship in Interventional Radiology at Long Island Jewish Medical Center 

and his residency in Diagnostic Radiology at North Shore University Hospital and Long Island Jewish 

Medical Center. Dr. Mohabir is currently the Section Chief of Interventional Radiology at Nuvance 

Health West. 

Dr. Mohabir is passionate about education and derives fulfillment from the process of teaching. He 

holds a firm belief in the profound significance of education and its capacity to shape the trajectory 

of healthcare in the future. With a profound commitment to imparting knowledge, he has assumed 

the role of a lecturer and mentor, dedicating himself to equipping aspiring medical professionals 

with critical thinking abilities and adept problem-solving skills. Dr. Mohabir’s passion for education 

extends well beyond conventional classroom settings, as he actively participates in conferences, 

workshops, and scholarly exchanges with fellow experts to continually broaden his own learning and 

pedagogical impact. He perceives teaching as a medium to ignite inspiration and enable others, driven 

by the ultimate objective of nurturing a new cohort of empathetic and highly proficient healthcare 

practitioners. 

Outside of work, Dr. Mohabir lives with his family in Lagrange. He enjoys activities like fishing, 

cooking, biking, swimming, and real estate investing. 


Evaluating the Effectiveness of Blended Online and 

In-Person Radiology Lectures 



Radiographic image interpretation is a vital skill for medical professionals across various disciplines. 

However, the variability in proficiency levels and the increasing accessibility of radiologic studies 

necessitate the establishment of a strong foundation in radiology education. This study aims to 

evaluate the effectiveness of a blended learning approach, combining online lectures with in-person 

sessions, in enhancing basic radiology skills among hospital residents. 

Participants from multiple disciplines will engage in online lectures covering key radiology topics, 

while in-person sessions will facilitate supplementary activities, including case-based discussions. 

Pre-test and post-test questionnaires will be administered to assess knowledge before and after the 

lecture units. Data analysis, utilizing a paired t-test, will determine the significance of the findings. 

The study seeks to not only provide valuable radiology education but also gauge the effectiveness of 

multimodality learning. By evaluating participants’ interpretation skills and clinical decision-making 

abilities, this research aims to contribute to the optimization of radiology education programs. The 

findings will also shed light on the feasibility and acceptability of blended online and in-person 

learning methods, providing insights for future enhancements in radiology education within hospital 

residency programs. 


27

Danielle Paravati, BSN, RN, CEN, TCRN 


Danielle.Paravati@nuvancehealth.org 

Danielle Paravati BSN, RN, CEN, TCRN is originally from Carteret, 

New Jersey. She attended Monmouth University in West Long 

Branch, New Jersey earning a Bachelor’s degree in Anthropology 

with a Forensics minor. She later completed an accelerated 

Bachelor’s of Science in Nursing degree from the University of Saint 

Joseph in West Hartford, Connecticut. She is currently enrolled in 

and anticipated to complete a Master of Nursing Education degree 

program with a Forensics concentration from Duquesne University in July 2023. Danielle is also a 

member of Epsilon Phi Chapter of Sigma Theta Tau International Nursing Honor Society at Duquesne 

University. Previously, Danielle interned with the New Jersey State Police Forensic Anthropology Lab 

while completing her initial undergraduate degree, assisting in the identification of human skeletal 

remains in the lab setting and in crime scene investigation. 

Danielle has been a practicing nurse since 2015, having experience in float and emergency nursing. 

Danielle began her career at Danbury Hospital in the float pool as a graduate nurse, eventually 

transitioning to the emergency department full time in 2019. She has specialty training as a 

Connecticut Sexual Assault Forensic Examiner (SAFE), advocating for victims of crime and abuse, 

assisting in educating staff how to care for these vulnerable populations. Danielle is dual board 

certified as a Certified Emergency Nurse (CEN) and a Trauma Certified Registered Nurse (TCRN). She 

is Training Center Faculty for the American Heart Association in the BLS, ACLS, and PALS distinctions, 

continuing to act as an instructor in these courses. Danielle’s current role is as the Medical-Surgical 

Nurse Educator, Nursing Professional Development Specialist for Danbury and New Milford Hospitals. 

Her responsibilities include Medical, Stroke, and Float Pool Units, assisting with educational content 

development, orientation, and ongoing educational initiatives. She is an active member of multiple 

professional organizations including the Emergency Nurses Association, International Association of 

Forensic Nurses, Academy of Medical Surgical Nursing, and the Association of Nursing Professional 

Development to help promote continuous evidence-based practice and learning. 

Danielle is also the mother of three young girls and enjoys spending time with them and her husband 

in her free time. She currently lives in New Milford, Connecticut. 


Closing the Gap: Use of Human Trafficking and Intimate 

Partner Violence Screening Tools 

Danielle Paravati, BSN, RN, CEN, TCRN 


The purpose of this project is to examine the educational gap in Emergency Department (ED) nurses 

for their comfort in screening for victims of Intimate Partner Violence (IPV) and Human Trafficking 

(HT). The study uses the available screening tool in the EMR. The study aims to acknowledge and 

decrease this gap, increase use of the obtained information, and to better identify victims in these 

vulnerable patient populations. Some of the causes of inappropriate use of the screening tool 

include that the ED nurses are hesitant to ask the questions, as they do not want to be responsible 

for the information in which they obtain. This project will focus on the educational points of what to 

do with the information acquired from the screening tool, increasing the nurse’s knowledge on HT 

and IPV, and increasing the appropriate use of the screening tool. 

The design of the study is a 30-minute educational intervention on IPV and HT screening tool use 

and legal requirements presented in an online, recorded format. It will be provided to ED nurses at 

Danbury and New Milford Hospitals on a voluntary basis, with an estimated sample size of 30-40 

nurses. The study will include a pre- and post- intervention anonymous mixed methods researcher 

designed survey on the use of the current EHR screening tool, comfort with screening for victims of 

IPV and HT, knowledge with the use of the data obtained from the screening tools, with comparison 

for pre- and post- intervention answers. There will also be questions in the pre-interventional 

survey relating to previous IPV and HT education, and post-intervention with overall comfort for 

caring for victims of IPV and HT. 

Next steps will include the beginning of the IRB process, approval of the educational intervention, 

and the ability to begin the educational intervention through December 2023. Analysis of survey 

data would begin in January 2024 with completion through April 2024. Future education would also 

entail inclusion of HT and IPV screening information in the Annual Education content for nursing 

staff in the Danbury and New Milford Hospital Emergency Departments for the 2023/24 calendar 

years. Over the next 2-3 years expansion of the educational intervention to include APP would be 

planned. 


29


Sharon Hospital 

Mary.Pearson@nuvancehealth.org 

Mary Pearson, MS, CTRS, CDP is from Staatsburg, NY. She holds 

a bachelor’s degree in Psychology from the State University of 

New York, College at Oneonta and a master’s degree in Recreation 

Therapy from State University of New York, College at Cortland. 

She is currently enrolled at Cornell University and is anticipated to 

earn a master’s degree in Healthcare Administration in December 

of 2023. 

Mary joined Nuvance Health in 2017, as a recreation therapist on 

the geriatric behavioral health unit where she utilized recreationand 

leisure-based interventions to promote the well-being of her 

patients. She also kindled a love of teaching in this role when she 

began leading the “Dementia Capable Care” course. 

Ms. Pearson has recently transitioned roles, and now serves as an 

assistant practice manager with gastroenterology. 

Mary has been a Certified Dementia Practitioner since 2019. She 

sits on the board for the New York State Therapeutic Recreation 

Association and is a frequent lecturer on topics including mental 

health, caregiver burnout, and the social determinants of health. 

Mary enjoys spending time outdoors with her family, gardening, 

and drinking a great cup of coffee. Mary is grateful to have 

been part of the second class of Patricia A Tietjen, MD Teaching 

Academy scholars and to have been encouraged by this cohort to 

be a better educator. 


Patients with Dementia: 

A System-Wide Training Program to Improve 

Professional Knowledge 



Patients with dementia, a disease that impacts memory, sensory perception, and problem-solving, 

require increased and specialized care. As these patients are increasingly challenged with the 

mounting inability to navigate their surroundings, they will need care services from multiple providers, 

in multiple settings. It has been estimated that 10% of the US population over the age of 65 is 

living with dementia and that another 22% has a mild cognitive impairment. As the baby boomer 

generation ages, this number is expected to climb1. How are we training healthcare staff to support 

these patients? While there has been a nationally sponsored effort to address Alzheimer’s disease 

and other dementias through the US Department of Health and Human Services, training efforts 

are far less centralized2. At Nuvance Health, there is currently no system-wide training to provide 

staff with resources or tools for working with people with dementia. The purpose of this program is 

to prepare all patient-facing Nuvance employees to thoughtfully and skillfully care for patients with 

dementia through a comprehensive, uniform training initiative. Using the Consolidated Framework 

for Implementation Research, the program will consider several important programmatic domains, 

including the setting, the culture of our organization and specific teams, as well as the individual 

learning needs of staff3. As such, the training will be conducted in-person and will be structured with 

flexibility in mind to adapt to the needs of multiple healthcare teams. Topics covered in the training 

will be focused on a healthcare audience and attention will be paid to ensuring accessibility and 

belonging. Evaluation before, during, and after the training will guide ongoing program development. 

Investigation of core concepts will continue after initial training through in-services, unit champions, 

and coaching. Program formation is in the beginning stages. Continued development steps include 

formation of a pre- and post- assessment, pilot testing, and network adoption. 


31



Michael.Pote@nuvancehealth.org 

Michael Pote MSN, RN CWCN is a nurse at Norwalk Hospital. Michael 

is a wound care specialist, CWCN and is the clinical manager of 

the Wound Care and Hyperbaric Medicine department at Norwalk 

Hospital. 

With his bachelor’s degree in Psychology, Michael began his 

career at Norwalk Hospital in 2001, where he worked nights as a 

psych-tech and pursued his nursing degree during the day. After 

becoming a registered nurse, he eventually moved away from 

Psychiatry to Medicine where he gained a variety of experiences 

over the subsequent years. Michael soon found and specialized in 

wound care. He then worked as the inpatient wound care nurse at 

Norwalk Hospital for several years. He returned to school, earned 

his Master’s degree, and after graduation started working in the 

Outpatient Wound Care and Hyperbaric department where he has 

started a deep dive into Hyperbaric medicine. 

When Michael’s not busy with wounds or the world of hyperbaric 

medicine, he’s an avid volunteer in the community with his wife 

and two children, Emily and Gabe. 


Hyperbaric Oxygen Therapy (HBOT): A Successful Adjunct 

Treatment for Avascular Necrosis (AVN) 



Since the first rudimentary use of a pressurized chamber used to treat patients in 1662, the benefits 

of HBOT have been explored, documented, and in some cases heavily scrutinized. Though as more 

quality research is explored, the benefits of HBOT have become clear and well established for now 

fourteen approved indications according to the Undersea Hyperbaric Medicine Society (UHMS). 

Whereas the Center for Medicare & Medicaid Services (CMS) are still only endorsing thirteen 

indications. The indication in question is my focus of research, will HBOT significantly help in the 

treatment of AVN. 

It has been said, that HBOT is a treatment in search of a disease. Thus far the research is showing 

that the science of HBOT is sound, and can help statistically in more than a few cases. While a solid 

case now has been made for treating AVN with HBOT, I intend on gathering further evidence and 

with a proposed study treating AVN with HBOT. Once complete, the information would be tabulated 

in the form of scholarly research paper in hopes of making clear the benefit, or non-benefit, of HBOT 

on AVN. 

To come to this conclusion I will need to create an IRB proposal for a likely single arm study, or double 

arm study comparing HBOT outcomes with conventional conservative therapy. Once completing this 

hurdle, then next one hurdle would be applying for a grant. If these two hurdles are accomplished, 

I would then approach our Nuvance Orthopedic partners to garner interest in the study. Finally, 

interpret the study information in a scholarly article. 


33



Lisa.Ricker@nuvancehealth.org 

A born and raised New Yorker, Lisa completed her Bachelor of 

Science in Nursing in 1993 at Mount Saint Mary’s College. After 

graduation, Lisa worked at NYU Tish Medical Center as a staff 

nurse. Seeking to grow further as a nurse, she enrolled in the NYU 

Nurse Practitioner Program in 1995. Lisa was awarded the NYU 

Nursing Excellence in 1996. 

In 2000, as an Adult Nurse Practitioner, Lisa embraced a position 

to establish a Hospitalist Nurse Practitioner program at Vassar 

Brothers Medical Center (VBMC). At that time, this program would 

be the only one of its kind in all of Hudson Valley. Lisa was the first 

clinician hired and eventually became the Lead Hospitalist Nurse 

Practitioner. 

In2006, Lisa launched the Rapid Response Team (RRT) at VBMC. 

She developed educational playbooks and classes to facilitate the 

new venture. Under her direction, the VBMC RRT succeeded in 

reducing annual Code Blue rates by 50 percent within 2 months. 

In 2021, Lisa joined the VBMC Critical Care department to develop 

and manage the new Medical Step-Down Unit. She is tasked 

with optimizing clinical outcomes and promoting a collaborative 

environment between nursing and physicians. Lisa was awarded 

the VBMC Medical Staff Honoree of the Month in December 2022. 

In 2022, Lisa joined the Patricia A. Tietjen Teaching Academy 

as a scholar. She is developing a “POP UP” education classes for 

residents and nursing. These classes will be structure education 

with the ability to POP UP when the time is available. Her first class 

is ACLS review, with plans to expand to other topics in the future. 

Lisa has many accomplishments as a Nurse Practitioner but her 

greatest accomplished is being a wife, daughter, and aunt. She 

lives in Port Ewen, NY with her husband and 2 cats. She will 

always be a New Yorker (still has her Queens accent!) but spends 

weekends in Vermont in her cabin. She and her husband enjoy the 

woods and watch the bears from their deck. 


Development of “POP UP” Education Program in a Medical 

Step-Down Unit 



Medical Step-Down Unit (MSDU) provides an intermediate level of care between the Intensive care 

unit (ICU) and the medical floors. The patients may not require full ICU but are not stable enough for 

transfer to the general floor. MSDU can provide closely monitored clinical care on the floor with better 

patient outcomes and safety goals. Vassar Brother Medical Center (VBMC) recognized the need and 

implemented this new unit. 

To implement the MSDU, existing internal medicine residents and med/surg nurses need education 

specific to their new roles. The major barrier to this required education is finding time for teaching 

and learning during patient care shifts. The MSDU Education Program therefore was designed with a 

POP-UP format, utilizing 30-60 min classes to educate nurses and residents about medical conditions 

and procedures specific to MSDU patients, with a focus on patient safety and best outcomes. 

POP-UP classes are an innovative approach to teaching classes with clear objectives and the flexibility 

to launch when time is available. The classes will meet the needs of the learner to accommodate 

different learning styles. The goal is to have multiple classes available to POP-UP at the appropriate 

time with learning objectives, equipment, reading material and evaluation tool. The first class is an 

acute cardiopulmonary (ACL) class with stimulation model, code cart, case scenarios and written 

material. 

These classes are based on Blooms Taxonomy of Learning through engagement (why we are learning), 

representation (what we are learning) and action (how we are learning). POP UP classes can engage 

the residents and nurses to work as team. These classes can be repeated to the learner over time to 

activate the retrieval practice of learning. 

The impact of these classes will be tracked by patient outcomes within MSDU, pre/post testing of 

the learner using the Objective Structured Clinical Examination Tool to assess knowledge and Self – 

Efficacy Scale to assess confidence. The classes will be adjusted based on these assessments 


35


Danbury, New Milford and Norwalk Hospitals 

Ramanathan.Seshadri@nuvancehealth.org 

Ram Seshadri, MD is a hepatobiliary and pancreas surgeon in the 

Division of Surgical Oncology at Nuvance Health (East). He also 

serves as the program director of the General Surgery Residency 

at Danbury Hospital / CT branch campus of the Larner College of 

Medicine at University of Vermont. 

Dr. Seshadri completed a clinical fellowship in hepatobiliary 

surgery at Atrium Health in Charlotte, NC, and a clinical fellowship 

in abdominal transplant surgery at Northwestern University 

Feinberg School of Medicine in Chicago, IL. He completed residency 

trainings at Baystate Medical Center in Springfield, MA and Lahey 

Clinic Medical Center in Burlington, MA, both teaching affiliates of 

Tufts University School of Medicine. Born and raised in southern 

India, he earned his medical and undergraduate degrees from Sri 

Ramachandra Medical College and Research Institute in Madras, 

India. 

Before joining Nuvance Health, Dr. Seshadri was a hepatobiliary 

and pancreas surgeon at Novant Health Forsyth Medical Center 

in Winston-Salem, NC. He was the surgeon champion for the 

institution and was instrumental in earning several accolades from 

the National Surgical Quality Improvement Program (ACS-NSQIP) 

for best clinical outcomes in a tertiary care referral center. 

Dr. Seshadri currently serves as a committee member in several 

surgical societies including the American College of Surgeons, the 

Americas Hepatopancreatobiliary Association and the International 

Hepato-Pancreato biliary Association. 

Dr. Seshadri is passionate about surgical education and teaching. 

He is the first physician from Nuvance Health to be inducted 

into the Teaching Academy at University of Vermont School of 

Medicine. His research interests include outcome based research 

and surgical simulation. 

When he is not seeing patients, Dr. Seshadri enjoys playing tennis, 

hiking trails and national parks, exploring the world culinary 

cuisine and spending time with his wife — an endocrinologist — 

and their two young children. 


Learning styles and its impact on feedback in a surgical 

residency training program – A “VARK” theory based study 



Feedback is critical to the success of any surgical resident and is generally given in a uniform and 

standardized manner. However, surgical residents all have different ways of learning. When the 

learning style of the resident is not in line with the way that feedback is given, then the lesson fails 

to leave an impact. The purpose of our project is to better identify the way that residents learn, 

so that feedback can be tailored to the individual. We seek to use learning style tests to better 

understand how a resident comprehends and retains information; from there, we want to apply this 

understanding in a way that allows us to give feedback more effectively. 

The methodology by which we will accomplish the objectives of the project is both qualitative and 

quantitative in nature. To begin, we will first administer a VARK questionnaire to each resident. The 

results will be shared with each resident, and to each of the participating faculty. These will thereby 

form a VARK “profile” for each resident. The results of the profile will be used to create a learning 

plan for teaching the steps of a standard general surgery procedure- a laparoscopic cholecystectomy; 

and provide feedback in real-time in a similar fashion. Residents will be matched with one faculty 

member for the task. Based on their identified VARK profile, they will be taught a laparoscopic 

cholecystectomy using a pre-prepared lesson plan. There will be 4 lesson plans that faculty members 

can employ: one made for each of the VARK modalities. For residents identified as “multimodality”, a 

combination of the lesson plans can be employed. Importantly, lesson plans will seek to convey the 

same information, but differ as to exactly how the information is conveyed. Following the procedure, 

the resident will complete a questionnaire. They will be asked to address how they felt about the 

lesson plan (did they feel like the information was conveyed to them in an appropriate manner? 

Would they like more or less information? Could the information have been conveyed in different 

way that would better help them learn?), and how they felt about the procedure (did you feel more 

comfortable doing the procedure than in the past?). Finally, they will be asked whether they preferred 

the individualized, VARK-based lesson plan compared to the informal information/feedback that was 

given to them in the past. 

The next steps would be to pilot the test of a new and formalized method of teaching and giving feedback 

amongst surgical residents and medical students. Our goal to use the VARK profiles to match 

mentors with mentees. By pairing a “visual” surgeon with a “visual” resident, for example, we may 

help foster a closer and more beneficial mentor-mentee relationship. By providing a standardized 

lesson plan that differs only by the way that the information is conveyed, we hope to provide an 

example for future formalized lesson plans. 


37



Barbara.Spielman@nuvancehealth.org 

Barbara Spielman, BSN, RN is currently the Patient Care Manager 

of the Post Anesthesia Care Unit, Ambulatory Surgery and Pre- 

Admission Testing at Norwalk Hospital, a community hospital 

part of the Nuvance Health Network, in Fairfield County, CT. 

Most recently, she served as the Surgical Quality Coordinator at 

the same facility. Having worked in the Emergency Department, 

Special Needs pediatrics, School Nursing, Homecare, Hospice, 

Case Management, and Surgical Quality she has a diverse nursing 

experience. 

Her education includes a Bachelor of Science in Marketing from 

the University of Maryland School of Business. Feeling unfulfilled in 

business and following in her father’s footsteps, pursued a career 

in nursing through Johns Hopkins University, earning a Bachelor of 

Science in Nursing. Barbara was awarded the Sinai Nurses Alumna 

Association Award for creative patient care and earned a grant 

for “In War and Peace: Sustainable Development, Refugees, and 

Human Rights in Guatemala”. 

Barbara is a Patricia A. Tietjen, MD Teaching Academy Scholar, 

board certified in case management and participated in the ACS 

CT Collaborative. Barbara’s work, “Practicing in Someone Else’s 

Playground” was published in School Nurse News, highlighting the 

adaptability of nurses to provide excellent patient centered care, 

no matter the physical setting. She and her husband have three 

terrific adult children and two rescue dogs. The best days are spent 

hiking, on the lake kayaking or canoeing, or sharing great books 

with friends. Barbara has also taken on golf and pickle ball, and no, 

she is not good at either. 


Utilizing the Morbidity and Mortality Conference 

for Education and Quality 



The traditional Morbidity and Mortality (M&M) Conference is a stronghold of medical education. 

Objectives of today’s Case Review Conference are educating Physicans Assistant (PA) Residents in 

surgical occurrences, quality, case and literature reviews, best practices and professionalism. The 

quality prospectus of The Norwalk Hospital/Yale Surgical PA Residency program, one of the oldest in 

the country, aims to offer intensive didactic curriculum, engage an interdisciplinary group in teaching 

and learning to improve patient safety and quality of care. 

Through system process and literature reviews, attendee polls, and American College of Surgeons 

(ACS) National Surgical Quality Improvement Program (NSQIP) data reviews, a Case Review 

Conference was developed at Norwalk Hospital, a Nuvance Health community hospital in Fairfield 

County, CT. Following the Accreditation Council for Graduate Medical Education (ACGME) core 

competencies, the department adopted best practices while ingraining the culture of education 

and safety. NSQIP’s performance assessment identifies areas of opportunity which are matched 

to PA Residents by participation or specialty interest. PA Residents review cases, consult with 

surgeons, and prepare a 10-minute presentation. Skills in case presentation, chart and literature 

review, root cause analysis, and surgical quality are taught. PA Residents present targeted cases 

and attendees spark instuctional conversation and reccomendations for improved patient care. The 

recommendations from these interactive sessions are discussed in the Surgical Quality Committee 

for possible performance improvement projects (PIPs). Tracking NSQIP data reflects effectiveness 

of corrective action plans. 

The Standardized Case Review Conference meets educational core competencies, promotes surgical 

education, and quality clinical improvements. Better patient outcomes were achieved with focused 

case review conference than with traditional quality projects. NSQIP smoothed rate (SR) report is 

used for data tracking and reporting. This risk adjusted SR of specific occurrences compares to the 

population rate (PR) in terms of a fixed standard from July 1, 2018, to June 30, 2022. The PIPs born 

out of this process have reduced readmission (2018 SR 5.53 PR 4.69 to 2022 SR 5.07 4.69 PR), 

return to operating room (ROR) (2018 SR 2.99 PR 2.53 to 2022 SR 2.61 PR 2.53), sepsis (2018 

SR 2.18 PR 0.88 to 2022 SR 1.06 PR 0.88), and venous thromboembolisms (VTE)s(2018 SR 0.98 

PR 0.79 to 2022 SR 0.76 PR0.79). Subjective feedback from participants in the 2018 deep dives 

reported unfavorably on the quality project. Classes in case review conference quality education 

reported favorably on the effort required and skills learned. Meeting attendance has increased 66%. 

A participant poll of 36% surgeons, 27% residents, and 32% clinical staff reflects a culture of 

transparency, participant safety, education, and patient safety with effective PIPs. 

Focused case review conferences educate residents on professionalism, teamwork, clinical knowledge, 

and quality patient care. Adoption of case review conferences focused on patient outcomes benefit 

community hospitals by combining goals of a single meeting to address resident education, continuous 

staff education, and quality PIPs for improved patient care. 


39



Robert.Storck@nuvancehealth.org 

Robert Storck MPA, EMS-I, NRP has been involved in medicine and 

EMS since 2008 when took a year off between high school and 

college to do search and rescue in the White Mountains of New 

Hampshire. Dabbling in medicine while doing search and rescue 

was enough to keep him coming back for more. Following his year 

off Robert attended Washington College in Chestertown, Maryland 

where he graduated with degrees in Molecular Biology and Behavioral 

Neuroscience. During his time at Washington College Robert worked 

as an EMT where he served on the dive rescue team and as an 

athletic trainer. 

While EMS was always a passion of his, Robert had circuitous path 

to make medicine and education his career. Following graduation, 

Robert was recruited into finance where he became a commodities 

trader. During his time in finance Robert continued to pursue his 

passion, working as an EMT as night. Upon leaving that profession 

Robert worked as rowing coach and home flipper before ending up 

at Norwalk Hospital in 2014. While working at Norwalk Hospital 

Robert transitioned from a per diem EMT to full time paramedic after 

attending Capital Community College for his paramedic degree. 

During his time at Norwalk Robert found a passion for teaching and 

lecturing taking a promotion to become a Field Training Officer (FTO) 

and becoming a state licensed Emergency Medical Service Instructor 

(EMS-I). 

Robert regularly provides lectures on prehospital emergency care 

and continuing medical education to the paramedics and EMTs at 

Norwalk Hospital as well as at the surrounding fire departments and 

volunteer EMS organizations. His favorite topics to lecture on are 

botany, toxicology, and implicit bias. Robert has lectured nationally 

on toxicology at such conferences as the Emergency Nursing 

Association Conference. 

Robert went on to obtain his master’s in public administration 

from Sacred Heart University with a concentration in emergency 

management. Looking forward Robert hopes to obtain his doctorate 

of health sciences in education. 

Robert lives in Easton with his wife, son, two dogs, cat, chickens, and 

bees. When not at work Robert enjoys cycling, making pizza, and 

renovating houses from the 1700s. 


Community Paramedicine Interventions for 

Reducing CHF Readmissions 



In 2016 congestive heart failure (CHF) was the leading cause of hospitalizations in people over 

the age of 65. Of these patients that were hospitalized, one in four returned to the hospital with 

complications stemming from their CHF diagnosis. As the baby-boomer generation continues to 

age, hospitalizations will continue to increase leading to increased financial burdens on both patients 

and health care institutions. One group of providers that can aid in keeping these patients at home 

are Community Paramedics (CP). Community paramedics respond to patient’s healthcare needs in 

their homes and aid in managing certain conditions as part of a multi-disciplinary healthcare team 

including visiting nurses, social workers, and primary care providers. Community paramedics can 

assist in managing chronic conditions at home in an on-call nature, they are uniquely positioned 

to slow the influx of patients admitted to hospitals. This will lead to better quality of life for 

patients, increased satisfaction scores, and patient and institutional cost savings. Studies evaluating 

community paramedicine effects on CHF management typically are quasi-experimental design, often 

comparing outcomes between a community paramedicine intervention group and control group 

receiving usual care. Several studies demonstrate a reduction in emergency room visits for CHF 

patients when paired with a community paramedic; however, the largest and most robust studies 

are still ongoing. 


41


Northern Dutchess Hospital 

Ellen.Tangney@nuvancehealth.org 

Ellen Tangney DNS, M.S. Ed., RN is a doctorally prepared nurse 

educator, professor in the State University of New York System 

(SUNY) nursing program, and an employee at Nuvance Health, 

Northern Dutchess Hospital. 

Ellen started her career as a volunteer at a local hospital when she 

was thirteen years of age. She pursued entry into nursing practice 

via the City University System (CUNY) as an Associate Degree 

Nurse in 1987. As a lifelong learner, she continued her education, 

culminating in a Doctoral degree from Sage University, Troy NY in 

2016. The dissertation titled: Emergency Nurses’ Knowledge of 

and Attitude Toward Older Adults was a mixed methods research 

design aimed at exploring the relationship of age, education, years 

of experience, general knowledge of aging as well as the culture 

of the emergency department on the attitude of nurses working 

in the emergency department toward the older adult. Ellen was 

in continuous employment as a nurse throughout her educational 

journey and honed her craft of nursing through working in the 

Operating room, Post Anesthesia Care Unit, Intensive Care Unit, 

Interventional Radiology and the Emergency Department. To honor 

the path of her own education, she accepted a position as an educator 

in the SUNY Ulster nursing program to assist in the education of 

future associate degree nurses. Her pursuit of applicable knowledge 

and thirty-seven years of professional roles, positions her to provide 

excellent educational experiences for her learners and the clients of 

Nuvance Health. 

Ellen has received numerous awards, grants, and scholarships as she 

progressed in her academic studies. Most recently, she has been 

recognized with the Excellence in Nursing Education Award from the 

Professional Nurse Association (PNA) of Dutchess County, NY and 

the Leadership and Education Award from the Council of Community 

Colleges, SUNY system. 

When Ellen is not working as a professional nurse in the hospital 

setting or teaching in the clinical setting or college, you can find her 

either in her garden or glass workshop. 


Why Won’t you Stay. An exploratory study of the affective 

domain of newly quantified nurses and nurses’ intention to 

stay in their first position 



The literature is replete with opinion commentaries, articles, peer reviewed papers, and studies about 

why nurses leave the organization they work for. A study done by Yarbrough., 2017, found Generational 

Boomers were more satisfied with their nursing job as the profession provided identify and relationship 

with patients. Gen X and Millennials were less satisfied with the job of the professional nurse and the 

authors suggested increasing job satisfaction which is strongly corelated with job retention. Koehler 

& Olds, 2022 illuminated the differences in generational intention to leave their job and concluded all 

generations (Boomers, Gen X, GenY and Millennials) require a reasonable workload and manageable 

staffing. Nurses, age 53 and older indicate they want to spend more time with patients, work shorter 

or fewer hours and work at a pace that meets their physical needs. Those under 40 years have family 

work balance where family obligations were the second most common reason Millennials and Gen X 

leave their positions. Whereas, Generation Z report the pursuit of a different specialty or developmental 

opportunities (Koehler & Olds, 2022). The literature has identified the current workforce job satisfaction 

needs yet, still document a retention issue for newly qualified nurses. 

There is a paucity in literature concerning newly qualified and soon to be graduates of their basic nursing 

program intention to stay at the current organization. Newly qualified nurses who participate in a nurse 

residency program that met the Commission of Collegiate Nursing Education (CCNE) standards have 

shown “promise” yet, a limited number of institutions follow the recommended length and recommended 

standards (Erickson, 2018). A review by Brook, et al, 2019 report nurse residency programs have shown 

a reduction in turnover rate in the first year yet, Church et al, 2018 found these nurses were not retained 

in the second year. To understand this phenomena, an investigation of the affective domain is imperative 

to understand the needs of the newly qualified registered nurse. 

Utilizing Cowden and Cummings (2011) nursing theoretical model of clinical nurse intention to stay, one 

can investigate and describe the affective domain of the young nurses’ intention to stay in their current 

clinical area of work. This descriptive study will attempt to examine for the significance and influence of 

the affective constructs on the intention to stay in their current job or organization for the newly qualified 

nurses and those positioned for licensure. 

Age 

Boomers 1946-1964 

Gen X 1965-1979 

Millennials 1980-1994 

Gen Z 1995-2021 

Gen Alpha 2013-2025 

Increased understanding may 

result in higher retention rates 

of newly qualified nurses. 


43

44 PATMDTA 2023 

ACADEMIC POSTERS


45

Implementing a Population Panel Management 

Curriculum for Internal Medicine Residents 

Cynthia R. Feher MD, FACP, Norwalk Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRODUCTION 

METHODOLOGY 

NEXT STEPS 

It is estimated that only 55% of adults receive recommended 

preventative services. The traditional medical practice focused 

on an individual, visit-based approach. 

Population panel management allows primary care physicians 

to direct proactive care for their patients, using staff support 

and IT tools to conduct outreach to patients. Practices that 

implement a population-based approach are more likely to 

adhere to evidence-based guidelines. Implementation of panel 

management curricula has been shown to increase panel 

management skills and confidence in panel management. 

Panel management has been a part of the Norwalk Hospital 

Quality Improvement curriculum since 2017 when panel 

information was made available to Norwalk Hospital 

Residents. A new electronic medical record (EMR) was 

implemented in May 2022, and panel data is becoming 

increasingly available. 

We plan to implement a population panel management 

curriculum for Norwalk Hospital Internal Medicine residents. 

OBJECTIVES 

• Residents will learn the importance of population panel management 

• Residents will understand quality measures regarding patient panels 

• Residents will participate in panel management as a part of a team. 

• Survey residents on their 

current attitude and comfort 

level with panel management 

(pretest) 

• Distribute a user guide on 

panel management for the 

medical resident 

• Identify resident physician 

champions to lead specific 

projects 

• Residents and supervising ambulatory faculty will be trained 

in panel management. They will receive both individual and 

group instruction. Group instruction will take place at 

beginning of ambulatory rotation update sessions and as a 

noon conference. 

• Residents will be instructed in the importance of panel 

management, key term, how to access panel data, 

strategies and workflows around panel management, and a 

team-based approach. 

• Individual instruction and support will take place as part of 

scheduled quality improvement sessions and during 

administrative time. 

• Initial areas of focus will include chronic disease 

management (Diabetes and Hypertension) and preventative 

care (colorectal cancer screening) and special populations 

(patients with diagnosis of Hepatitis C) 

Monitor if population health curriculum results in: 

• Increase in resident engagement and experience ie 

comfort in panel management 

• Increase in resident publications of quality 

improvement projects 

• Change in Norwalk Community Health Center patient 

outcomes 

REFERENCES 

Fellner AN, Pettit RC, Sorscher J, Stephens L, Drake B, Welling RE. Chronic 

disease management: a residency-led intervention to improve outcomes in 

diabetic patients. Ochsner J. 2012 Winter;12(4):323-30. PMID: 23267258; 

PMCID: PMC3527859. 

Kaminetzky CP, Beste LA, Poppe AP, Doan DB, Mun HK, Woods NF, Wipf JE. 

Implementation of a novel population panel management curriculum among 

interprofessional health care trainees. BMC Med Educ. 2017 Dec 22;17(1):264. 

doi: 10.1186/s12909-017-1093-y. PMID: 29273028; PMCID: PMC5741920. 

Kimura J, DaSilva K, Marshall R. Population management, systemsbased practice, 

and planned chronic illness care: Integrating disease management competencies 

into primary care to improve composite diabetes quality measures. Dis Manag. 

2008;11:13–22. 

Loo TS, Davis RB, Lipsitz LA, Irish J, Bates CK, Agarwal K, et al. Electronic 

medical record reminders and panel management to improve primary care of 

elderly patients. Arch Intern Med. 2011;171(17):1552–8 

ACKNOWLEDGEMENTS 

Thank you to my team at the Norwalk Community Health 

Center and to our community of practice at the Patricia A. 

Tietjen Teaching Academy! 

Team Care 


"Talk the Talk and Walk the Walk": A Resident 

Communications Curriculum Revamp 

Vasiliki Harisis, MD, FACP, Norwalk Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRODUCTION 

• Effective communication is essential to high value healthcare. 

• Interpersonal and Communication Skills (ICS) is an 

Accreditation Council of Graduate Medical Education (ACGME) 

core competency and its integration into program curriculum is 

an ACGME Common Program Requirement. 

• Yet educational initiatives remain the responsibility of local 

institutions without a standardized implementation model. 3 

• Full integration with assessment, experiential learning, and 

multiple communication domains have been cited as markers 

of a fully mature communications curriculum, yet examples are 

rare. 7 

Residents engaged in small-group role play during the Direct 

Oral Anticoagulant (DOAC) counseling workshop 

OBJECTIVES 

• Our goal is to create a comprehensive, longitudinal, structured 

ICS curriculum using multimodal pedagogical techniques. 

• We hypothesize that a spaced learning approach with 

reinforcement from a bedside rounding initiative will improve 

residents’ self-efficacy and performance in ICS, with resultant 

positive impact on patient experience and outcomes. 

• Medication counseling was chosen as the first component of 

ICS curricular development. 

METHODS 

• An interprofessional working group including pharmacy and residency program 

leadership developed the workshop content, guided by an informal program needs 

assessment. 

• Three 1-hour workshops on high-risk medications were held from February to May 

2023. Each was comprised of a didactic component, video review, and small-group 

role play. 

• Pre-workshop surveys were conducted, assessing residents' self-confidence in 

medication counseling. In June 2023, Objective Structured Clinical Examinations 

(OSCEs) were held and a post-intervention survey reassessing self-confidence was 

administered. 

• Pre- and post-intervention HCAHPS data and discharge summary documentation 

will be tracked to assess impact on patient experience and residents’ practice, 

respectively. 

How confident are you in your ability to counsel patients on new 

insulin and changes in insulin? 

50% 

13% 

4% 

33% 

n=24 

Extremely confident 

Very confident 

Somewhat confident 

Not so confident 

Not at all confident 

Ilearned something new in this session on insulin counseling. 

Yes 

No 

0.00% 

94.44% 

RESULTS 

• On pre-intervention surveys, 75% (18/24) of respondents reported having 

experience with medication counseling, however 63% (15/24) also reported a 

relative lack of confidence in their counseling ability. 

• Discharge summary review from February 2023 reveals that only 9% (7/78) of 

patients discharged home on a high-risk medication had documented counseling 

by a resident. 

• On post-workshop evaluations, 94% (17/18) of respondents reported they learned 

something new, and 100% (18/18) reported they would implement changes to 

their clinical practice. 

Pre-intervention survey: Residents’ self-confidence and attitudes 

Who do you think should be primarily responsible for counseling 

patients on new medications prior to discharge? 

Residents’ Evaluation of Workshop on Insulin Therapy 

Iwould benefit from more direct observation and feedback... 

Yes 

No 

4% 

5.56% 

29% 

13% 

54% 

n=24 

the medical resident and intern 

the medical students 

the pharmacy team 

the attending hospitalist 

the consultant who makes the 

medication recommendation 

the nursing staff 

88.89% 

NEXT STEPS 

• Other curricular topics will be developed and delivered in a 

similar format. The foundational principles of ICS will be 

reviewed in each module, as supported by spaced learning 

theory. 

• A bedside rounding initiative will be implemented. Through the 

creation of an “on the fly” digital mini-clinical evaluation form, 

the author hopes to promote real-time, specific and behaviorbased 

feedback during rounds. 

• Interprofessional 

collaboration with the Quality 

Department and Patient 

Experience Team will be key in 

identifying metrics that may signal 

an impact of this initiative 

on patient outcomes. 

REFERENCES 

1. Allenbaugh, J., Corbelli, J., Rack, L., Rubio, D., & Spagnoletti, C. (2019). A brief communication curriculum 

improves resident and nurse communication skills and patient satisfaction. Journal of General Internal 

Medicine, 34(7), 1167–1173. https://doi.org/10.1007/s11606-019-04951-6 

2. Becker, C., Zumbrunn, S., Beck, K., Vincent, A., Loretz, N., Müller, J., Amacher, S. A., Schaefert, R., & 

Hunziker, S. (2021). Interventions to improve communication at hospital discharge and rates of 

Readmission. JAMA Network Open, 4(8). https://doi.org/10.1001/jamanetworkopen.2021.19346 

3. Burke, G., Melvin, L., & Ginsburg, S. (2023). “Patients are the people who teach me the most”: Exploring 

the development of communication skills during Internal Medicine Residency. Journal of Graduate Medical 

Education, 15(1), 59–66. https://doi.org/10.4300/jgme-d-22-00433.1 

4. Hipp, D. M., Rialon, K. L., Nevel, K., Kothari, A. N., & Jardine, L. C. D. R. D. (2017). “Back to bedside”: 

Residents' and fellows' perspectives on finding meaning in work. Journal of Graduate Medical Education, 

9(2), 269–273. https://doi.org/10.4300/jgme-d-17-00136.1 

5. Kripalani, S., Osborn, C. Y., Vaccarino, V., & Jacobson, T. A. (2011). Development and evaluation of a 

medication counseling workshop for physicians: Can we improve on ‘take two pills and call me in the 

morning’? Medical Education Online, 16(1), 7133. https://doi.org/10.3402/meo.v16i0.7133 

6. M. S. S. G. E. M. C. L. A. M. (2015). Developing a communication curriculum and workshop for an Internal 

Medicine Residency Program. Southern Medical Journal. Retrieved April 25, 2023, from 

https://pubmed.ncbi.nlm.nih.gov/26079455/ 

7. Ratanawongsa, N., Federowicz, M. A., Christmas, C., Hanyok, L. A., Record, J. D., Hellmann, D. B., 

Ziegelstein, R. C., & Rand, C. S. (2011). Effects of a focused patient-centered care curriculum on the 

experiences of internal medicine residents and their patients. Journal of General Internal Medicine, 27(4), 

473–477. https://doi.org/10.1007/s11606-011-1881-8 

8. Wild, D., Nawaz, H., Ullah, S., Via, C., Vance, W., & Petraro, P. (2018). Teaching residents to put patients 

first: Creation and evaluation of a comprehensive curriculum in patient-centered communication. BMC 

Medical Education, 18(1). https://doi.org/10.1186/s12909-018-1371-3 


Amina Ramic, Pharm.D, and the Pharmacy Residency Program for 

their collaboration on this project. 

Beth West, Dr. Robyn Scatena and the Patricia A. Tietjen, MD 

Teaching Academy for their guidance and expertise. 

I am not sure 

5.56% 

0% 20% 40% 60% 80% 100% 

unsure 

5.56% 

0% 20% 40% 60% 80% 100% 

Dr. Jason Orlinick, Dr. Mark Kulaga and Dr. Raman Gill-Meyer for 

this opportunity and continued support of this work. 


47

Exploring Knowledge of Interdisciplinary Allied Health Across 

the Medical Education Curriculum 

Marta Korytkowska Ph.D., CCC-SLP 

INTRO 

Interdisciplinary care is essential in providing the best 

patient outcomes for diagnosis, management, and 

rehabilitation 1, 2. . 

The extent to which professionals need to be involved 

and how they need to be involved changes by setting. 

Regardless of setting physicians are often the gate 

keepers for referrals and orders to allied health 

professionals. 

Appropriate referrals allow for stakeholders to take 

advantage of the evidence-based rehabilitation 

services available to them at each step of their care, 

and after hospital discharge. 

Pre-Study: Interview 

An informal interview was conducted with 3 rd and 4 th 

year medical students, PGY-1s, PGY-2s, and PGY-3s. 

Four themes emerged: 

There is no formal 

education about the role 

of allied health 

professions in 

undergraduate medical 

education, the mention of 

these professions occurs 

only within a list of 

“members who are 

on the team 

All (8) individuals 

acknowledged they 

associate PT, OT, SLP with 

stroke patients, 

THEORETICAL BACKGROUND 

For learning to be most efficient two assumptions 

must be met: 

1 st Constructivism: new knowledge must have a 

previous schema to attach to (Piaget, 1962). 

2 nd Rationale: a learner must engage with 

information for that information to be processed and 

encoded (Williams, Lombrozo & Rehder, 2010). 

Explanations of content allow for both of those 

assumptions to be met and provide the learner with 

foundational knowledge. 

Bottom line: 

RESPONDENT PERCEPTIONS 

Construct a 

survey 

IRB 

Approval 

Disseminate 

Survey 

OBJECTIVES 

1. Describe the knowledge medical providers have 

regarding role of allied health professionals at each 

level of medical education. 

2. Analyze how foundational knowledge relates to 

clinical decision making for referrals. 

3. Classify gaps in knowledge to select the 

appropriate intervention. 

NEXT STEPS 

Current 

background 

knowledge 

Quantitative 

and Qualitative 

Data Collection 

Medical 

students and 

Residents 

REFERENCES 

Clinical 

Implications 

Online 

administration 

Attendings: 

Teaching and 

Non Teaching 

1. Aries, A., & Hunter, S. M. (2014). Optimising rehabilitation potential after stroke: a 24- 

hour interdisciplinary approach. British Journal of Neuroscience Nursing, 10(6), 268- 

273. 

2. Ranford, J., Asiello, J., Cloutier, A., Cortina, K., Thorne, H., Erler, K. S., ... & Lin, D. J. 

(2019). Interdisciplinary stroke recovery research: the perspective of occupational 

therapists in acute care. Frontiers in Neurology, 10, 1327. 

Swallow difficulty is 

associated with 

individuals who had 

strokes, otherwise as part 

of a GI lecture with little 

to no focus on the oropharynx. 

Education about this topic 

is informal and comes 

from being told to order a 

particular discipline, 

without the knowledge of 

why 

Anecdotal findings passed on from informal interviews 

suggest that information about allied health 

professions is passed on through the training hierarchy 

and experiential learning. While there are pros to this 

approach, without a foundational schema to attach to 

this information cannot be fully developed, applied, 

and accessed with confidence. 


1. Norwalk Hospital’s medical students, residents, and fellows for 

their input and candid conversations. 

2. Colleagues of the Academy for their support and feedback. 

3. Directors of PATMD Teaching Academy for their unwavering 

encouragement. 


Strengthening Advanced Practice Practitioner 

Capacity Through Simulation 

Susan Le, PA-C, Hudson Valley Heart Center, Vassar Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

Advanced Practice Practitioners (APPs), such as Physician 

Assistants (PAs) and Nurse Practitioners (NPs), play crucial roles 

in critical care and specialty care, leading to improved patient 

outcomes by reducing hospital stays and complications. However, 

their initial training is often limited, with few specialized 

education programs available. APPs acquire skills on the job, 

resulting in variability in competence. Recent studies highlight 

the need for a structured curriculum to ensure consistent 

exposure to relevant topics. Simulation laboratories offer a 

formalized approach for APPs to develop skills, providing handson 

training, improved engagement, and familiarity with medical 

equipment. Simulation-based education has demonstrated 

positive impacts on patient care processes and outcomes. 

OBJECTIVES 

To explore the benefits of simulation technology in the 

augmentation of APP continuing education in regards to: 

• Improving comfort level with the use of medical devices 

and procedures 

• Improving retention of medical information and its 

applications to clinical practice 

• Improving patient safety measures 

METHODS 

A mixed-method approach was employed to examine the impact 

of simulation technology on APP education. APPs participated in a 

class on Temporary Cardiac Pacing, which included a formal 

lecture, hands-on practice, and computer simulation. Pre- and 

post-test surveys assessed knowledge, comfort with equipment, 

and the perceived benefits of simulation. The study involved 17 

participants and measured material comprehension, comfort 

level, and the perceived impact on patient safety. 

Quiz responses involving comprehension questions 

on the delivered content showed more correct 

answers post-class. 

RESULTS 

Figure 2 Figure 3 

Figure 4 

Perceived comfort level with troubleshooting 

transvenous pacemakers overall increased. 

Figure 5 Figure 6 

Perceived comfort level to use a Zoll defibrillator for 

external temporary pacing in an emergent situation 

overall increased. 

Analysis of this data suggests that 

simulation has a positive impact on 

continuing clinical education in regard 

to familiarity and comfort level of 

operating certain medical devices, and 

perceived improvement of patient 

safety. 

NEXT STEPS 

• Quantifying the proposed end-points, rather than 

perceived comfort level and perceived impact on patient 

safety. 

• Incentive to further education APPs to partake in 

regimented classes, such as lunches, continuing medical 

education (CME) credits, stipends, time allotted from 

their typically bust workdays. 

• Same incentives for the those involved in teaching said 

classes and managing simulation equipment. 

• Obtaining simulation equipment that is relevant to the 

practice of APPs, which could be assisted by 

organizational pursual of grants. 

• Specific project ideas for Cardiology APPs include mock 

codes/ACLS classes, echocardiogram simulation, cardiac 

catheterization simulation. 

• The creation of the actual simulation equipment is 

needed for the ever-changing field of medicine. 

• Assess the impact of simulation for healthcare workers 

other than APPs. 

• It would be interesting to further evaluate the impact of 

simulation on nontechnical skills like teamwork. 

(Griswold-Theodorson et al., 2015) 

REFERENCES 

1. Good, J., & Rabener, M. J. (2021). ACLS interventional skills: Are we as good as we 

should be? JAAPA, 34(4), 40–45. 

https://doi.org/10.1097/01.jaa.0000735764.43931.0c 

2. Griswold-Theodorson, S., Ponnuru, S., Dong, C., Szyld, D., Reed, T., & McGaghie, 

W. C. (2015). Beyond the Simulation Laboratory. Academic Medicine, 90(11), 

1553–1560. https://doi.org/10.1097/acm.0000000000000938 

3. Luckianow, G., Piper, G. L., & Kaplan, L. J. (2015). Bridging the gap between 

training and advanced practice provider critical care competency. JAAPA. 

https://doi.org/10.1097/01.jaa.0000464711.42477.79 

4. Morrow, D. A., Fang, J. C., Fintel, D. J., Granger, C. B., Katz, J. N., Kushner, F. G., 

Kuvin, J. T., Lopez-Sendon, J., McAreavey, D., Nallamothu, B. K., Page, R. E., 

Parrillo, J. E., Peterson, P. N., & Winkelman, C. (2012). Evolution of Critical Care 

Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the 

Emerging Need for New Medical Staffing and Training Models. Circulation, 126(11), 

1408–1428. https://doi.org/10.1161/cir.0b013e31826890b0 

5. Multak, N., Smith, J. S., & Coerver, D. M. (2015). Simulation PA faculty 

development. JAAPA. https://doi.org/10.1097/01.jaa.0000471547.65543.04 


Figure 1. 

Zoll defibrillator, and computer simulation of transvenous cardiac pacing 

The majority of people stated that having hands-on experience with cardiac equipment 

extremely augmented their learning experience, and that it will have a great impact on improving 

patient safety. (Figures 5,6) 

Anne Lucas 

David Steckman 

Beth West 

Robyn Scatena 

Lisa Ricker 

John Leopold 

Hudson Valley Heart Center APPs 


49

Home Care Therapy 

Orientation Program 

Stacie McLaughlin, Physical Therapist, PT Supervisor Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRODUCTION 

This project aims to create a therapy orientation program for training 

therapists in providing home care. Initially focused on meeting regulations 

and documentation expectations, the program has evolved into a dynamic 

approach for all therapists and supervisors. It emphasizes compliance, 

mutual respect, and leveraging individual strengths. Training in mentoring is 

needed, as some clinicians feel unprepared to provide feedback. Introducing 

guidance can improve their comfort level. A survey was conducted to assess 

therapists' confidence in various skills and treatment. Survey results identify 

training gaps and guide competency development. Combining data with 

APTA guidelines enables growth within the therapy department. 

Figure 1. Manual techniques 

enhance the treatment 

provided to patients. 

OBJECTIVES 

1. Determine the essential skills clinicians need for effective assessment and 

treatment in home care settings. 

2. Develop a competency program with hands-on skills training, covering 

areas such as vitals, ROM, balance and strength testing, wound care, 

manual techniques, and basic vestibular skills. 

3. Create a virtual toolbox to provide ongoing guidance, adapting to 

evolving skills, changing home care regulations, and departmental 

growth. 

4. Establish a mentorship program within home care to foster a community 

of practice, enhancing critical thinking, assessment and treatment skills, 

and documentation while promoting teaching and assistance in the 

nuances of home care. 

METHODOLOGY 

• The study was a mixed method of qualitative results with direct and 

indirect observation and quantitative results with use of the Home Care 

Survey data collection. 

• A 4-question survey was designed using Microsoft forms and email 

distributed to all current home care physical therapists and physical 

therapist assistant staff. Survey questions asked the recipients to rate 

their confidence, skill set, and experience in a variety of treatments and 

diagnosis. 

• Survey results from 28/30 recipients led to the creation of learning module 

opportunities and an opportunity for therapists to act as mentors to other 

clinicians with different skill sets. 

• Based off evaluation and visit note reviews, it had been anticipated that 

most current clinicians preferred and were most confident in treating ortho 

cases. It was also expected that Vestibular cases and 

Amputation/prosthetic cases would be considered the least confident and 

comfortable treating. 

RESULTS 

The first two questions, demonstrate that the therapists would prefer to treat the 

type of cases with which they are comfortable. The results show that it would be 

beneficial to create in-services and educational opportunities for all the clinicians to 

enable them to become more confident in treating all types of cases. 

The results from question 3, demonstrates the need for hands on training to enable 

the clinicians to become more skilled with manual treatment. DME requirements 

ranked higher than expected based on the feedback many clinicians express with 

regard ordering equipment for patients and with the follow through required to 

access it. Although most therapists in home care were comfortable with general 

ortho cases and advising on what DME is required, detailed instructions regarding 

where and how to access the needed equipment may benefit this situation and can 

be accomplished easily. 

Along with dressing changes, performing soft tissue mobilization/joint mobilization 

is one of the important skills sets needed to successfully treat ortho/post op cases 

but survey results reveal the lack of experience (question 4). 

1 = Very Experienced (orange bar), 2 = Moderate Experience (Grey bar), 3 = No Experience except School (Blue bar) 

CONCLUSIONS and RECOMMENDATIONS 

Conclusions: 

• Clinicians would benefit from further training in vestibular, manual skills, wound 

care, and working with amputations/prosthetics to improve patient care and 

value-based performance. 

• Addressing these training gaps will enhance clinicians' comfort and confidence in 

performing these skills during home treatment sessions, improving continuity of 

care. 

Recommendations: 

• Implement a simulation lab to assess skills upon hiring and practice annually for 

competency assurance. 

• Provide specialized in-services in smaller group settings to allow for practice and 

skill carryover. 

• Develop a virtual toolbox with documentation guidance and resources for 

clinicians treating independently in the field. 

• Establish programs for advancing specific educational opportunities, such as 

vestibular and prosthetics. 

• Create a mentorship program to facilitate skill sharing and ensure continuity of 

care for patients. 

NEXT STEPS 

• Confidence and competence are often correlated. A comprehensive virtual 

guide with step-by-step instructions tailored to home care assessments will 

enhance confidence and competence. 

• Hands-on labs are needed to practice manual techniques, suture and staple 

removal, and improve proficiency in ordering specialized medical equipment. 

• Content-specific videos on Bag Technique and COVID PPE are necessary based 

on observation findings. 

• Functional skills practice and annual competency testing will strengthen all 

disciplines and better prepare clinicians for diverse diagnoses. 

• Expanding similar orientation and competency programs to other disciplines 

like Occupational Therapy and Speech Therapy will ensure high-quality patient 

care standards in the home care team. 

REFERENCES 

1. Alexander,Kathleen M.,Olsen,Janette, Seiger,Cindy, Peterson,Teri S. Student physical therapists’ competence and self-confidence in basic clinical 

assessment and musculoskeletal differential diagnosis. Journal of Allied Health, summer 2016; 45(2): 95-100 

2. Atun-Einy, Osnat, Kafri, Michele. Implementation of motor learning principles in physical therapy practice: Survey of physical therapists’ perception and 

reported implementation. Physiotherapy Theory and Practice: Taylor & Francis LTD (Philadelphia, PA July 2019: V.35 n.7,633-644. 

3. Ellingham, C., Fleischaker, K. (1982)Competencies in physical therapy: An analysis of practice (ed 3) American Physical Therapy Association. 

Washington, DC, Volume 62, N6, 

4. Martin, S.; Kessler, M. (2016)Neurologic Interventions. (ed3) Elsevier Saunders.. St Louis, MO. The roles of the physical therapist and physical therapist 

assistant in neurologic rehabilitation, p1-9 


Thank you to Alyson Blanck, Brian O’Loughlin, Kelsey Brewer, and Gil Guilas for allowing me the time to devote to the 

teaching academy. Thank you to the WCHC therapists for assisting me by completing the survey and for giving me ongoing 

feedback on what they feel they need regarding training and mentoring in home care. Immense gratitude to Beth West and 

Robyn Scatena MD, for providing an incredible platform for multi-disciplinary learning and the guidance along the way. Most 

importantly, thank you to Pat Tietjen MD, who often said, “All you need is a plan”. Thank you for the foresight to ‘plan’ for 

this. 


POCUS TRAINING ACADEMY 

Stephanie Midgley, MD, FPD-AEMUS, FACEP 


INTRO 

OBJECTIVES 

NEXT STEPS 

Point of Care Ultrasound (POCUS) is an ultrasound performed by 

the clinician at the bedside in conjunction with history, physical 

exam, imaging, and laboratory tests. POCUS can increase 

diagnostic accuracy, improve patient safety and satisfaction, 

decrease cost of care, and shorten length of stay, ultimately 

helping to improve clinical care. 

Source: Koratala, A. NephroPOCUS.com 

Almost no Vassar Brothers Medical Center attendings integrate 

POCUS into their clinical care. The Division of Clinical Ultrasound 

teaches a POCUS course for Emergency Medicine, Internal 

Medicine, and Family Medicine residents, but there is little 

additional POCUS use or education beyond this elective. The lack 

of hospital wide POCUS usage limits our patients from receiving 

the best care and maximizing our residents’ medical education 

and understanding of POCUS. 

Szabó GV, Szigetváry C, Szabó L, Dembrovszky F, Rottler M, Ocskay K, Madzsar S, Hegyi P, Molnár Z. Point-of-care ultrasound 

improves clinical outcomes in patients with acute onset dyspnea: a systematic review and meta-analysis. Intern Emerg Med. 

2023 Mar;18(2):639-653. doi: 10.1007/s11739-022-03126-2. Epub 2022 Oct 31. PMID: 36310302; PMCID: PMC10017566. 

Importantly, despite POCUS's benefits, it can lead to patient harm 

when used by those untrained or undertrained. Outside of 

emergency medicine residency training, POCUS education is not 

standardized. Additionally, at Vassar Brothers Medical Center there 

is no accepted pathway for credentialing or applying for hospital 

privileges, except for those trained in Emergency Medicine. 

Identify barriers to POCUS usage, optimize educational content, 

develop and implement a structured POCUS educational program 

and image Quality Assurance for medical providers to increase 

POCUS usage by faculty and enhance resident POCUS education 

through the POCUS Training Academy (PTA). We aim to improve 

patient care, POCUS resident education, and overall POCUS 

utilization. 

METHODOLOGY 

We surveyed EM/IM/ICU physicians at Vassar Hospital about their 

current POCUS usage, desired applications, and perceived barriers 

to implementation. From the survey responses, we determined: 

1. Little to no POCUS is being performed by attendings. 

2. Barriers included: 

a. access to machines 

b. access to education 

c. lack of knowing how to interpret exams 

d. supervision for learning image acquisition 

e. time to perform pocus exam 

3. Requested applications to be taught included: Echo, Lung, 

IVC/Volume Assessment, FAST, Renal, DVT, and Soft Tissue 

Using two of the six pillars of educational scholarship, curriculum 

development and teaching, we have designed an immersive six 

month long POCUS training program named the POCUS Training 

Academy (PTA). The PTA focuses its educational curriculum on 

emphasizing POCUS indications, image acquisition, interpretation, 

and integration into medical decision making and clinical care. The 

training academy includes an 8 hour workshop, monthly lectures, 

hands-on scanning sessions, image review, and development of 

an image portfolio. Upon completion, providers may apply for 

hospital POCUS privileges. 

Using observational data, we plan to answer the following 

questions: 

1. Can the implementation of a hospital wide POCUS Training 

Academy increase POCUS usage? 

2. Will there be sustained POCUS usage after completion of 

training? 

3. Cost of implementation of POCUS Training Program (i.e. 

machines, image storage, educational software). 

4. Revenue generated from billed POCUS exams. 

5. Length of stay of POCUS trained vs non-POCUS trained 

physicians for patients with a discharge diagnosis of Acute 

Decompensated Heart Failure. 

6. Number of POCUS providers who enroll in the PTA and 

number who obtain hospital privileges. 

Using survey data every 3 months for 1 year period, we will 

assess the impact of POCUS training on: 

1. Providers' perceived confidence in their clinical assessment 

and treatment. 

2. Job satisfaction. 

3. Provider’s patient satisfaction. 

4. Provider’s comfort with POCUS. 

REFERENCES 

1.Anstey J, Jensen T, Lalani F, Conner SM. Teaching the Teachers: 

A Flexible, Cognitive-Focused Curriculum in Point-of-Care 

Ultrasound Education for Hospital Medicine Faculty. J Ultrasound 

Med. 2022 Dec;41(12):3103-3111 

2.Gaudreau-Simard, M., Kilabuk, E., Halman, S. et al. Start 

spreading the news: a deliberate approach to POCUS program 

development and implementation. Ultrasound J 15, 13 (2023) 

3.Olgers, T.J., ter Maaten, J.C. Point-of-care ultrasound curriculum 

for internal medicine residents: what do you desire? A national 

survey. BMC Med Educ 20, 30 (2020). 

4.Saati A et al (2020) Creating an efficient point-of-care 

ultrasound workflow. POCUS J 5(2):2 

5.Wong J et al (2020) Barriers to learning and using point-of-care 

ultrasound: a survey of practicing internists in six North 

American institutions. Ultrasound J 12(1):19 

Beth West 

Robyn Scatena, MD 

Dereck DeLeon, MD 


Melissa Hazlitt, MD 

Joseph Felice, MD 


51

Evaluating the Effectiveness of Blended Online 

and In-Person Radiology Lectures 

Anthony Dennis Mohabir, MD, DABR, Vassar Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

METHODOLOGY 

NEXT STEPS 

Interpretation of radiographic images is critical for medical 

students, residents, and medical professionals of all 

categories. Medical imaging guides medical decision making. 

However, the fundamental interpretation skills vary and may 

be suboptimal. 

In the modern era with advancing availability to order, 

perform, and view radiologic studies, it is imperative to foster 

a medical society that is familiar with essential aspects of 

Radiology. 

There is a clear need to have basic radiology education. A 

series of lectures can be targeted to hospital residents of all 

stages to guide them on the basics. 

Combining online and in-person teaching methods, maximal 

learning may be achieved. 

. 

Participants will include hospital 

residents of multiple disciplines. 

Online lectures will cover key 

radiology topics and concepts. 

• Develop succinct lecture series 

• IRB Approval 

• Develop questionnaire 

• Reach out to Program Directors 

to schedule lectures 

• Implement study 

• Acquire Feedback 

OBJECTIVES 

The goal of this project is to create a short lecture series to 

teach basic radiology skills to hospital residents. These 

lectures will encompass common indications, appropriateness 

of imaging studies, basic radiation safety, and image 

interpretation. 

The study will assess effectiveness of an online lecture series, 

combined with an in person didactic lecture. The goal is to not 

only teach the participants but to gauge the effectiveness of 

multimodality learning. 

. 

In-person sessions will cover 

supplementary activities, such as 

case-based discussions. 

Pre-test and post-test 

questionnaires will be 

administered before and after the 

lecture units. 

REFERENCES 

1.Franken Jr, E. A., et al. "The visiting lectureship in radiology: 

an evaluation." American Journal of Roentgenology 140.4 

(1983): 803-805. 

2.Salajegheh, A., Jahangiri, A., Dolan-Evans, E. et al. A 

combination of traditional learning and e-learning can be 

more effective on radiological interpretation skills in medical 

students: a pre- and post-intervention study. BMC Med 

Educ 16, 46 (2016). 

3.Swensson, Jordan, et al. "Curricula for teaching MRI safety, 

and MRI and CT contrast safety to residents: how effective 

are live lectures and online modules?." Journal of the 

American College of Radiology 12.10 (2015): 1093-1096. 

Data analysis by means of a 

paired t-test will be used to 

assess for significance of the 

findings. 


Beth A West 

Robyn N Scatena, MD 

The entire Tietjen Academy 


Closing the Gap: Education for Emergency Department Nurses 

in the Use of Human Trafficking and Intimate Partner Violence Screening Tools 

Danielle Paravati BSN,RN,CEN,TCRN, Medical-Surgical Nurse Educator, Danbury and New Milford Hospitals 


INTRO 

Objective: This study aims to address the knowledge gap among Emergency Department (ED) nurses 

regarding the use of screening tools for Intimate Partner Violence (IPV) and Human Trafficking (HT). The 

goal is to increase their comfort and competence in screening for IPV and HT, utilizing available tools in 

the EMR system, and effectively utilizing the obtained information to identify victims in these vulnerable 

patient populations. 

Relevant Findings: 

• Wolf, Perhats, & Delao (2022) found that only 17.6% of ED nurses reported self-competence in caring 

for victims of interpersonal violence and 7.4% for human trafficking. 

Murphy (2022) implemented an educational intervention for ED nurses, • resulting in improved levels of 

self-reported self-efficacy in identifying HT victims. 

Hulick et al. (2022) highlighted that 80% of trafficking • victims may seek medical care during their 

victimization, emphasizing the need for awareness and training in screening tools among ED nurses. 

Ambikile, Leshabari, & Ohnishi (2021) identified curricular limitations in healthcare provider education 

• 

for appropriate IPV care, recommending further training and improvement of educational 

infrastructure. 

Ahmad et al. (2017) revealed discrepancies in screening practices and identified healthcare provider 

• 

factors such as knowledge, attitude, and awareness affecting screening and IPV identification rates. 

Application of Knowles Adult Learning Theory: 

• Applying Knowles' theory of adult learning, ED nurses' limited knowledge of caring for victims of 

IPV and HT motivates them to seek more education in these areas. 

• By understanding the relevance of the 

presented information and how it relates to 

their role in caring for victims, nurses can 

enhance their ability to provide appropriate 

care. 

Addressing the knowledge gap through 

• 

education will empower nurses to 

effectively utilize screening tools and 

improve care for victims of IPV and HT. 

METHODOLOGY 

The goal of the study is to increase the Emergency Department nurses ability to identify and screen appropriately for victims of Intimate 

Partner Violence and Human Trafficking, decreasing the identified knowledge gap, promoting a trauma-informed care approach to help this 

vulnerable patient population. 

Study Design: 

• The study will involve a 30-minute recorded, online educational intervention on Intimate Partner 

Violence (IPV) and Human Trafficking (HT), focusing on screening tool use and legal requirements. 

• The intervention will be presented in a PowerPoint format with voiceover and will be voluntary for 

Emergency Department nurses at Danbury and New Milford Hospitals. 

• Nurses working in the emergency department will be eligible to participate. 

https://humantraffickinghotline.org/en/statistics/Connecticut 

Educational Intervention Content: 

• The intervention aims to increase knowledge on the appropriate use of screening tool information 

within the Electronic Health Record (EHR). 

• Information on local resources, legal requirements, and mandated reporter obligations will be 

provided. 

• Content will cover the signs, symptoms, and red flags of IPV and HT for improved nurse 

assessment. 

• Explanation of the screening tool questions, suggested scripting options, and education on traumainformed 

care will be included. 

• Emphasis will be placed on observing patient body language and interaction with the immediate 

environment. 

There will be a pre- and post-interventional anonymous mixed-methods survey on use of the current 

EHR screening tool, comfort with screening for victims of Intimate Partner Violence and Human 

Trafficking, knowledge with the use of the data obtained from the screening tools, with comparison for 

pre- and post- intervention answers. There will also be questions in the pre-interventional survey 

relating to previous Intimate Partner Violence and Human Trafficking education, and post-intervention 

with overall comfort for caring for victims of Intimate Partner Violence and Human Trafficking after 

intervention. 

NEXT STEPS 

This figure is adapted from: Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and Guidance for a trauma-informed approach. HHS publication no. (SMA) 14-4884. Rockville, MD: 

Substance Abuse and Mental Health Services Administration 

OBJECTIVES 

An identified knowledge gap exists for Emergency Department nurses in the use of Intimate Partner 

Violence and Human Trafficking screening tools already in use within the Cerner EHR. This identified gap 

within the Danbury and New Milford Hospital Emergency Departments causes an inappropriate use of 

the screening tool, as well as uncertainty of what to do with the obtained knowledge when using the tool 

by the ED nurses, putting these vulnerable patient populations at risk. This project focuses on closing 

the identified educational gap for the nurses by providing information on how to identify victims of IPV 

and HT by focusing on the following educational points. 

1. What to do with the information obtained from the screening tool in use. 

2. Increase the nurse's knowledge on HT and IPV. 

3. Increase the appropriate use of the screening tool. 

By educating staff on these important topics, it will increase the possible identification of victims, and 

referrals to the appropriate organizations due to more appropriate screening, providing better patient 

outcomes. 

REFERENCES 

Ahmad, I., Ali, P. A., Rehman, S., Talpur, A., & Dhingra, K. (2017). Intimate partner violence screening in emergency department: A rapid review of the literature. Journal of Clinical Nursing, 26(21-22), 3271–3285. 

https://doi.org/10.1111/jocn.13706 

Ambikile, J. S., Leshabari, S., & Ohnishi, M. (2021). Curricular limitations and recommendations for training health care providers to respond to intimate partner violence: An integrative literature review. Trauma, Violence, & 

Abuse, 23(4), 1262–1269. https://doi.org/10.1177/1524838021995951 

Hulick, J., Jensen, L.., Mihaiuc, A., Shin, Ruth H., Pope, S., Gimbel, S. Current practices and nurse readiness to implement standardized screening for commercially and sexually exploited Individuals in emergency 

departments in western Washington hospitals. Advanced Emergency Nursing Journal, 44(4):p 322-332, October/December 2022. | DOI: 10.1097/TME.0000000000000427 

Murphy M. C. (2022). Supporting emergency department Nurse's self-Efficacy in victim identification through human trafficking education: A quality improvement project. International Emergency Nursing, 65, 101228. 

https://doi.org/10.1016/j.ienj.2022.101228 

Wolf, L. A., Perhats, C., & Delao, A. (2022). Educational needs of U.S. emergency nurses related to forensic nursing processes. Journal of Trauma Nursing, 29(1), 12–20. https://doiorg.authenticate.library.duq.edu/10.1097/jtn.0000000000000627 


Thank you to my fellow Danbury Nursing Professional Development educators for your support, as well as my original support team the Danbury Hospital Emergency Department Team. 

Without your support and belief in me I would not be the educator I am today. And thank you to the fellow educators of the Patricia A. Tietjen, MD Teaching Academy, for sharing your 

knowledge and Community of Practice. 



53

Patients with Dementia: A System-Wide Training Program to 

Improve Professional Knowledge 

Mary Pearson, MS, CTRS, CDP, Nuvance Health Medical Practices, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

METHODOLOGY 

NEXT STEPS 

Patients with dementia, a disease that impacts memory, sensory 

perception, and problem-solving, require increased and 

specialized care. As these patients are challenged with the 

mounting inability to navigate their surroundings, they will need 

care services from multiple providers, in multiple settings. It has 

been estimated that 10% of the US population over the age of 65 

is living with dementia and that another 22% has a mild cognitive 

impairment. As the baby boomer generation ages, this number is 

expected to climb (Manly et al., 2022). 

How are we training healthcare staff to support these patients? 

While there has been a nationally sponsored effort to address 

Alzheimer's disease and other dementias through the US 

Department of Health and Human Services, training efforts are far 

less centralized (ASPE, 2022). At Nuvance Health, there is 

currently no system-wide training to provide staff with resources 

or tools for working with people with dementia. 

The training will be built using the Consolidated Framework for 

Implementation Research (CFIR). This approach was constructed 

through meta-analysis and synthesis of techniques used to 

transform research into clinical practice. The CFIR specifically 

looks at what works and why within the implementation process 

(Damschroder et al., 2009). The methodology includes five major 

domains to frame project development, which will serve as the 

scaffolding for the dementia training program. 

. 

1 

2 

3 

4 

Build & launch knowledge and willingness to 

learn survey, with IRB approval 

Using CFIR framework, best practices, and 

survey data, build training program 

Work with one in-patient unit and one 

ambulatory office to pilot program 

Adapt program and launch across network 

REFERENCES 

OBJECTIVES 

Create a training program for healthcare staff working with people 

with dementia that: 

• Addresses the whole patient, including their physical, cognitive, 

social, emotional needs 

• Includes tools for working with caregivers 

• Is appropriate for system-wide use 

• Creates measurably impactful change 

Intervention Characteristics 

The training program will be conducted in-person and will be structured 

with flexibility in mind to adapt to the needs of multiple healthcare 

settings. Topics covered in the training will be focused on a healthcare 

audience and attention will be paid to ensuring accessibility and 

belonging. 

Outer Setting 

National and state guidelines will be examined for compliance. An 

investigation of local community barriers and resources will be 

conducted. Community voices, including those of people with dementia 

will be incorporated. 

Inner Setting 

Nuvance core values will be highlighted. Use of existing structures will 

be prioritized. The program will be interdisciplinary, including all 

members of the treatment team. 

Characteristics of Individuals 

A survey of baseline knowledge and willingness to learn will be 

deployed within all patient-facing departments. 

Process 

Assessment before, during, and after the training will guide ongoing 

program development. Investigation of core concepts will continue 

after initial training through in-services, unit champions, and 

coaching. 

Alzheimer’s Association. (2023). 2023 Alzheimer’s disease facts and figures . Alz- 

Journals. https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13016 

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & 

Lowery, J. C. (2009, August 7). Fostering implementation of health services 

research findings into practice: A Consolidated Framework for advancing 

implementation science - implementation science. BioMed Central. 

https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908- 

4-50 

Hung, L., Phinney, A., Chaudhury, H., Rodney, P., Tabamo, J., & Bohl, D. (2017). 

“Little things matter!” exploring the ... - wiley online library. Wiley Online 

Library. https://onlinelibrary.wiley.com/doi/10.1111/opn.12153 

Manly, J. J., Jones, R. N., & Langa, K. M. (2022). Estimating the prevalence of 

dementia and mild cognitive impairment in the US. Jama Neurology. 

https://jamanetwork.com/journals/jamaneurology/article-abstract/2797274 

Office of the Assistant Secretary for Planning and Evaluation. (2022). National plan 

to address alzheimer’s disease: 2022 update. ASPE. 

https://aspe.hhs.gov/reports/national-plan-2022-update#strat-2d 

Surr, C. A., & Gates, C. (2017, October). What works in delivering dementia 

education or training to hospital staff? A critical synthesis of the evidence. 

International Journal of Nursing Studies. 

https://www.sciencedirect.com/science/article/pii/S0020748917301748 


Thank you to the team on Senior Behavioral Health for 

encouraging my learning journey as well as to everyone in the 

Digestive Health Institute who supported me this year. Beth and 

Robyn, thank you for your guidance. 


Hyperbaric Oxygen Therapy (HBOT) 

The Ultimate Adjunct Treatment in Your Toolbox for AVN 

Michael Pote, MSN, RN, CWCN, Norwalk Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

Since the first rudimentary use of a pressurized chamber used to 

treat patients in 1662, the benefits of HBOT have been explored, 

documented, and heavily scrutinized. Though as more quality 

research is explored, the benefits of HBOT have become clear and 

well established for now fourteen approved indications. 

In recent years much exciting and promising research has been 

done on the effects of HBOT for neurological conditions such 

as Alzheimer's, TBI’s, concussion, and muscular skeletal 

conditions. In particular, Avascular Necrosis (AVN) of the femoral 

head in particular has shown much benefit from HBOT. 

OBJECTIVES 

Listed below are the five major pathways and mechanisms of 

action of HBOT: angiogenesis, stem cell stimulation, inflammation 

reduction, and antioxidant defense enhancement. 

1. Hyperbaric Treatment of Air or Gas 8. Delayed Radiation Injuries (Soft Tissue 

Embolism: Current Recommendations and Bony Necrosis) and Potential for 

2. Arterial Insufficiencies 

Future Research 

A. Central Retinal Artery Occlusion 9. Sudden Sensorineural Hearing Loss 

B. Hyperbaric Oxygen Therapy for Selected 10. Intracranial Abscess 

Problem Wounds 

11. Necrotizing Soft Tissue Infections 

3. Carbon Monoxide Poisoning 

12. Refractory Osteomyelitis 

4. Clostridial Myonecrosis (Gas Gangrene) 13. Severe Anemia 

5. The Effect of Hyperbaric Oxygen on 14. Adjunctive Hyperbaric Oxygen Therapy 

Compromised Grafts and Flaps 

in the Treatment of Thermal Burns 

6. The Role of Hyperbaric Oxygen for 

Acute Traumatic Ischemias 

7. Decompression Sickness 

METHODOLOGY 

A systematic review of 

multiple studies through 

a literature search from 

various electronic 

databases of peer 

reviewed journals 

resulted in mounting 

evidence of the efficacy 

of HBOT for AVN of the 

femoral head. Prevalence 

is currently estimated at 

6% resulting in about 

10,000 to 20,000 cases a 

year. 

• Create IRB proposal. 

• Apply for grant. 

NEXT STEPS 

• Propose double blind, randomized control trial to 

our Nuvance Orthopedic partners. 

• Report findings to further define the benefits of HBOT. 

REFERENCES 

HBOT for AVN of the femoral head has been evaluated and reevaluated 

through the years, and as of late the evidence is 

mounting. Approved by UHMS in 2022, but not yet by CMS given 

the lack of quality studies. 

The following list is the most current approved indications for 

treatment. The Undersea and UHMS is considered the primary 

source of scientific information for diving and hyperbaric medicine. 

1. Fu, Q., Duan, R., Sun, Y., & Li, Q. (2022). Hyperbaric oxygen therapy for healthy aging: From mechanisms to 

therapeutics. Redox Biology, 53, 102352. doi:10.1016/j.redox.2022.102352 

2. Jones MW, Brett K, Han N, et al. Hyperbaric Physics. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure 

Island (FL): StatPearls Publishing; 2023 Jan-. Available from: 

https://www.ncbi.nlm.nih.gov/books/NBK448104/ 

3. Moghamis I, Alhammoud AA, Kokash O, Alhaneedi GA. (2021) The outcome of hyperbaric oxygen therapy 

versus core decompression in the non-traumatic avascular necrosis of the femoral head: Retrospective 

Cohort Study. 30;62:450-454. doi: 10.1016/j.amsu.2021.01.084. PMID: 33643644; PMCID: PMC7889431. 

4. Sai Krishna MLV, Kar S, Kumar R, Singh H, Mittal R, Digge VK. (2023) The Role of Conservative Management in 

the Avascular Necrosis of the Femoral Head: A Review of Systematic Reviews. Indian J Ortho. Feb 3;57(3):410- 

420. doi: 10.1007/s43465-023-00818-5. PMID: 36777071; PMCID: PMC9897604. 

5. Smolle C, Lindenmann J, Kamolz L, Smolle-Juettner FM. (2021) The History and Development of Hyperbaric 

Oxygenation (HBO) in Thermal Burn Injury. Medicina (Kaunas). Jan 8;57(1):49. doi: 

10.3390/medicina57010049. PMID: 33430046; PMCID: PMC7827759. 

6. Shah J. Hyperbaric oxygen therapy. J Am Col Certif Wound Spec. (2010) Apr 24;2(1):9-13. doi: 

10.1016/j.jcws.2010.04.001. PMID: 24527137; PMCID: PMC3601859. 


Thank you to our Patricia A. Tietjen, MD Teaching Academy 

Community of Practice for the support and platform to exercise 

research in each of our fields of interest. 


55

Development of “ POP UP” Education Program 

in a Medical S tep- Down Unit 

Lisa R icker ANP- C, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

Medical Step- Down Unit (MSDU) provides an intermediate level of care 

between the ICU and the medical floors. The patients may not require full ICU 

care but are not stable enough for transfer to the general floor. MSDU can 

provide closely monitored critical care on the floor with better patient outcomes 

and safety goals. 

METHODOLOGY 

The impact of these classes will be tracked by patient outcomes within MSDU 

and pre/post testing to assess knowledge and confidence level for the 

learners. The learners will be the resident and nursing staff in MS DU. 

Patient outcomes Learner Knowledge Learner Confidence 

NEXT STEPS 

First of the POP- UP class: Advance Cardiovascular Life Support (ACLS) 

Review 

Description: This class will review the ACLS with leaners working as team 

during a stimulation cardiac arrest cases. 

Vassar Brother Medical Center (VBMC) recognized the need for a MSDU unit. 

To implement the MSDU, existing internal medicine residents and med/surg 

nurses need education specific to their new roles. The major barrier to this 

required education is finding time for teaching and learning during patient care 

shifts. 

Research has shown that stimulation training builds not only clinical skills but 

builds teamwork and interprofessional collaboration with learners. S timulation 

training provides deliberate practice with models rather than on real patients. 

This allows the learner to practice and learn, develop confidence and the 

clinical skills to perform in a real patient setting such as the MS DU. 

1. Track patient outcome and safety goals within MS DU: 

• Number of Rapid Response and Code Blue Activations 

• I ntubation rates 

• Transfer to ICU or return to MSDU 

• Procedure outcomes 

2. Pre/Post testing with the learner after each session using the Objective 

Structured Clinical Assessment tool. The teacher/expert will evaluate 

technical skills of the learner on performance. There will be a working list of 

competencies that are each rate on a 4- point Likert scale 

ADVANCED 

CARDI OVASCULAR 

LI FE SUPPORT 

POP UP 

CLASS 

Learning Objectives: 

1. R eview of the Code Cart including medication 

2. R eview Zoll machine and capabilities 

3. Recognition and management of cardiac 

arrest ( shockable/non- shockable rhythm) 

4. I ntroduction to Airway Management with 

intubation box and RS I box 

5. Work a team in a simulation cardiac arrest 

cases 

Classroom • Code cart 

Setup • Zoll machine 

Equipm ent • I ntubation box 

List • CPR mannequin with Airway Management 

• ACLS Binder with all learning sheets 

The MSDU Education Program therefore was designed with a POP- UP format, 

utilizing 30- 60 min classes to educate nurses and residents about medical 

conditions and procedures specific to MS DU patients, with a focus on patient 

safety and best outcomes. 

3. Pre/ Post self- assessment evaluation by leaner using the Nursing Self – 

Efficacy S cale to assess confidence level using the Likert 5- point scale 

based on behavioral descriptors. 

OBJECTIVES 

NEXT STEPS 

REFERENCES 

POP UP classes are innovation approach to have learning goals but the 

flexibility to have a class when time is available. The goal is to have multiple 

classes available to POP- UP at the appropriate time using stimulation training 

with learning objectives, equipment, reading material and evaluation tool. 

The classes will meet the needs the different type of learning styles and can 

adapt to the needs of the learner. I t is important to repeat the same class for 

the learner to retrieval the information. Retrieval practice is key to strengthen 

memory for long term application of this knowledge. These classes will be led 

by various experts within the field. 

The building blocks for the POP- UP classes w ill 

have 

• Learning objectives 

• S timulation training 

• Lecture 

• Reflection 

• Evaluation for knowledge and confidence levels 

These classes based on Blooms Taxonomy of 

Learning: 

• Engagement (why we are learning) 

• Representation (what we are learning) 

• Action (how we are learning) 

The MSDU education series has 2 classes in production, but the goal is to 

expand the series to other classes. 

MS DU Education S eries topics with S timulation Training: 

1. Advanced Cardiovascular Life Support (in production) 

2. R apid Response case scenarios (in production) 

3. Modes of oxygenation ( future) 

4. Pulmonary toileting and indication for your patient ( future) 

5. Thoracentesis Procedure (future) 

6. Chest Tube Placement Procedure (future) 

7. Central Line Placement (future) 

The growth of this education series requires simulation training equipment 

and other supplies to reach our goal. There will be ongoing reevaluation of the 

classes with feedback from the participants. Based on this feedback, 

adjustments will be made to the classes. MSDU is growing to meet the needs 

of the patients; likewise, our education classes will grow and change to meet 

the needs of our patients. 

T he goal is to build a foundation of knowledge and skills that 

can last for years for the learner with these POP- UP classes and 

excellent patient outcomes. 

Brown, Peter et al. Make I t S tick- The Science of Successful Learning. The Belknap Press of 

Harvard University Press, 2014. 

Caruso R, Pittella F, Zaghini F, Fida R , S ili A. Development and validation of the Nursing 

Profession S elf- Efficacy Scale. Int Nursing Rev. 2016 Sep; 63(3): 455- 64. doi: 

10.1111/inr.12291. Epub 2016 Jun 12. PMID: 27291103. 

Selina F, Hasan MF, Talha KA, Al- Muhaimin M, Momo FR, Debnath J, Begum S, Ahmad J. 

Assessing the Effectiveness of Clinical S kills Laboratory and Traditional Lecture in Teaching 

Basic Life S upport and Performance Evaluation According to Different Domains of Revised 

Bloom's Taxonomy. Mymensingh Med J. 2023 Jan; 32(1): 207- 212. PMID: 36594322. 

Shabatura, J. (2022, July 26th). Using Bloom’s Taxonomy to Write Effective Learning 

Outcomes. University of Arkansas Tips. https:/ / tips.uark.edu/ using- blooms- taxonomy 

Thomas, Patricia MD et al. Curriculum Development for Medical Education. # 3rd ED., John 

Hopkins University Press, 2016. 

Zayyan M. Objective structured clinical examination: the assessment of choice. Oman Med J. 

2011 Jul; 26(4): 219- 22. doi: 10.5001/omj.2011.55. PMID: 22043423; PMCID: PMC3191703 


Marty R icker and my parents who always support me in my career. 

Dr. Tim Collins who gave me the opportunity work in MS DU. 

Beth W est and R obyn Scatena who started the Learning Academy. 

Dr. Steven R itter who is working with me on the ACLS class. 


Impact of learning styles on providing feedback 

in a Surgical Residency 

Ramanathan M. Seshadri MD FACS, Danbury Hospital, Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

Feedback is critical to the success of any surgical resident. The 

methodology of providing feedback has always been challenging. 

Although feedback is generally given in a uniform and 

standardized manner, surgical residents all have different ways of 

learning. 

When the learning style of the resident is not in line with the way 

that feedback is given, then the lesson fails to leave an impact. 

The purpose of our project is to 

better identify the way that 

residents learn, so that feedback 

can be tailored to the individual. 

We seek to use learning style tests 

to better understand how a 

resident comprehends and retains 

information; from there, we want 

to apply this understanding in a 

way that allows us to give 

feedback more effectively. 

OBJECTIVES 

The project objectives are 3 fold: 

• To identify the VARK modality that each resident fits into. 

• To use the identified VARK modality to provide tailed feedback 

to an individual resident for a particular task. 

• To see if residents prefer feedback to be given in a VARK-styled 

manner. 

METHODOLOGY 

The methodology by which we will accomplish the objectives of 

the project is both qualitative and quantitative in nature. 

To begin, we will first administer a VARK questionnaire to each 

resident. The results will be shared with each resident, and to 

each of the participating faculty. These will thereby form a VARK 

“profile” for each resident. The results of the profile will be used to 

create a learning plan for teaching the steps of a standard general 

surgery procedure- a laparoscopic cholecystectomy; and provide 

feedback in real-time in a similar fashion. 

Residents will be matched with one faculty member for the task. 

Based on their identified VARK profile, they will be taught a 

laparoscopic cholecystectomy using a pre-prepared lesson plan. 

There will be 4 lesson plans that faculty members can employ: 

one made for each of the VARK modalities. For residents identified 

as “multimodality”, a combination of the lesson plans can be 

employed. Importantly, lesson plans will seek to convey the same 

information, but differ as to exactly how the information is 

conveyed. 

Following the procedure, the resident will complete a 

questionnaire. They will be asked to address how they felt about 

the lesson plan (ie did they feel like the information was conveyed 

to them in an appropriate manner? Would they like more or less 

information? Could the information have been conveyed in 

different way that would better help them learn?), and how they 

felt about the procedure (ie did you feel more comfortable doing 

the procedure than in the past?). 

Finally, they will be asked whether they preferred the 

individualized, VARK-based lesson plan compared to the informal 

information/feedback that was given to them in the past. 

NEXT STEPS 

• To pilot the test of a new and formalized method of teaching 

and giving feedback amongst surgical residents and medical 

students. 

• Use the VARK profiles to match mentors with mentees. By 

pairing a “visual” surgeon with a “visual” resident, for example, 

we may help to foster a closer and more beneficial mentormentee 

relationship. 

• By providing a standardized lesson plan that differs only by the 

way that the information is conveyed, we hope to provide an 

example for future formalized lesson plans. 

REFERENCES 

1. “Teacher feedback and student learning- The Student’s 

perspective”, Leung et al, 2022 

2.“Understanding your student: using the VARK model” by 

Prithishkumar and Michael, 2014 

3.“The relationship between the VARK learning styles and 

academic achievement in dental students”. Mozaffari et al, 

2022. 


Krist Aploks PGY3 Surgical Resident, Danbury Hospital 


57

PATMDTA 2022 

Utilizing the Morbidity and Mortality 

Conference for Education and Quality 

Barbara Spielman, BSN Norwalk Hospital 

INTRODUCTION 

OUTCOMES 

REFERENCES 

Norwalk Hospital/Yale Physician Assistant (PA) Surgical Residency 

Program 

What if. . . 

The traditional M&M Conference could be transformed to 

an educational platform for a multidisciplinary team to 

improve patient outcomes 

Meet educational core competencies 

Quality Prospectus: 

OBJECTIVES 

Offer PA Residents intensive didactic and clinical curriculum 

Engage an interdisciplinary group in teaching and learning 

Maintain high quality patient care 

NSQIP Smoothed Rate Reports 

Used for data tracking and reporting. This is a risk adjusted construct model of specific 

occurrences over a designated amount of time compared to population rates. 

References available upon request 


Special thanks to 

Dr. Kathleen LaVorgna 

Department of Surgery Chair 

Dr. Alan Meinke 

Department of Surgery Vice Chair 

ACS Surgeon Champion 

Richard Cassa 

PA Residency Program Director 

Promote surgical education 

Recommend quality clinical improvements 

Establish a strong culture of transparency, participant safety and education 

Develop effective performance improvement plans (PIPs) 

Beth West 

Director, Tietjen Teaching Academy 

Dr. Robyn Scatena 

Associate Director CC-Med 

METHODS 

Case Review Conference Development 

Through a system process review, attendee polls, literature review, American 

College of Surgeons (ACS) and National Surgical Quality Improvement 

Program (NSQIP) data review, a process was developed for standardized 

quality education 

1) ACS NSQIP performance assessment identifies areas of opportunity and 

case selection 

2) PA Residents review cases, consult with surgeons, review literature, 

perform root cause analysis, and prepare presentations 

3) Monthly informal PA Resident conferences provide peer and instructional 

feedback 

4) Monthly Case Review Conferences attended by Surgeons, PAs, PA 

Residents and medical students 

5) Attendees spark instructional conversation and recommendations for 

improved patient care 

6) Recommendations from these interactive sessions are discussed for PIPs 

RESULTS AND LIMITATIONS 

Adoption of case review conferences, focused on patient outcomes, benefit community hospitals 

by combining goals to address resident education, continuous staff education, and quality PIPs for 

improved patient care 

Focused case review conferences offer residents expanded clinical knowledge, professional 

awareness, enhanced collaboration, and a focus on quality patient care 

Surgeons use this meeting as an opportunity to teach and learn 

Better outcomes than the traditional deep dive review of 2018 

Focused case selection identified from NSQIP data likely creates a Hawthorn effect and may be 

responsible for improved data scores 

Subjective feedback from 

those involved in 2018 

occurrence deep dives 

reported unfavorably on the 

quality project. Participating 

classes in case review 

conference quality education, 

reported favorably on the 

effort required and skills 

learned 

Joyce Bretherton 

Communications Manager 

Mark Cohen 

Statistical Manager, ACS 

Christie Good 

Manager of Surgical Registries and 

Quality Improvement Specialist 


Community Paramedicine Interventions for 

Reducing CHF Readmissions 

Robert Storck MPA, NRP, EMS-I, Norwalk Hospital Patricia A. Tietjen, MD Teaching Academy, Nuvance Health 

INTRO 

An estimated 6.2 million adults in the United States have been 

diagnosed with congestive heart failure (CHF) (CDC). Of those 6.2 

million patients who are seen in the hospital for symptoms of CHF 

nearly a quarter will be readmitted to the hospital within 30 days of 

discharge due to complications from their disease. When CHF patients 

are enrolled in mobile integrated health (MIH) or community 

paramedicine (CP) programs saw a reduction in the number of 

emergency room visits and subsequent readmissions (Lurie et. al 

2023). Norwalk Hospital Emergency Medical Services (NHEMS) is 

uniquely positioned to provide community paramedic programs as 

NHEMS paramedics are already hospital employees who are involved in 

community care and clinical coordination on a day-to-day basis. 

METHODOLOGY 

Studies evaluating community 

paramedicine in CHF management 

typically are quasi-experimental design, 

often comparing outcomes between a 

community paramedicine intervention 

group and control group receiving usual 

care. The community paramedicine 

intervention typically involves a 

combination of patient education, 

medication management, home visits, 

and remote monitoring, depending of the 

specific needs of the patient. 

Patient outcomes that are commonly measured in these studies include 

hospital readmissions, emergency department visits, medication 

adherence, quality of life, and mortality. Data is collected through 

chart reviews, patient surveys, electronic health records. Statistical 

analyses, such as t-tests and regression models, are used to compare 

outcomes between the intervention and control groups. 

It’s important to note that there is some variability in the methodology 

used in the studies of community paramedicine in CHF management, 

as different interventions may be tailored to specific patient 

populations or settings. However, the overall goal of these studies is to 

evaluate the effectiveness of community paramedicine in improving 

outcomes for CHF patients. 

NEXT STEPS 

• Ascertain current patient census that could benefit from Community 

Paramedics. 

• Get buy in for senior leadership and visiting nurse group. 

• Obtain foundation funding for a community paramedicine vehicle, 

LifePak 15, iPad, and community paramedics salaries for the pilot 

program duration. 

• Teach a community paramedic program at Norwalk Hospital to 

Norwalk Hospital paramedics using the AAOS Community Health 

Paramedicine Curricula. 

• Assist those paramedics who took the course in passing their ISBC 

(International Board of Specialty Certifications) Community 

Paramedicine (CP-C) Exam. 

• Clinical rotations with physicians and nurses on the inpatient units to 

gain a deeper understanding of the CHF disease process. 

• Have CP-C credentialed paramedics sit in on frequent visitor health 

care meetings to identify patients that would benefit from increased 

medical assistance. 

• Work with Nuvance visiting nurses and the Norwalk Hospital 

inpatients team to develop a set of guidelines for visits. This should 

include but not be limited to patient education, medication 

compliance, and general wellness check. 

OBJECTIVES 

Community paramedicine aims to help reduce healthcare cost for 

patients by avoiding unnecessary trips the emergency room through 

access to on demand healthcare. In addition to the obvious cost 

savings to patient’s healthcare institutions such as Norwalk Hospital 

can save on fines due to patient readmissions. 

Specifically, healthcare costs can be decreased by focusing on patient 

education. Community paramedics can do this by identifying high EMS 

and Emergency Department (ED) utilizers and aiding them in 

medication adherence and requisition. These patients can also benefit 

from steering patient’s to more appropriate treatment facilities such 

as urgent cares, and connecting patients with other healthcare 

providers such as physical therapists. 

Through continued medical education community paramedics can 

reduce unnecessary 911 requests and emergency room visits. This in 

turn can improve health outcomes for patients. Doing so will also 

increase patient satisfaction scores through a more personalized 

healthcare approach. 

REFERENCES 

1. Centers for Disease Control and Prevention. (2023, January 5). Heart failure. 

Centers for Disease Control and Prevention. Retrieved May 1, 2023, from 

https://www.cdc.gov/heartdisease/heart_failure.htm 

2. Lurie, T., Adibhatla, S., Betz, G., Palmer, J., Raffman, A., Andhavarapu, S., 

Harris, A., Tran, Q. K., & Gingold, D. B. (2023). Mobile Integrated Health- 

Community paramedicine programs' effect on emergency department visits: An 

exploratory meta-analysis. The American Journal of Emergency Medicine, 66, 1– 

10. https://doi.org/10.1016/j.ajem.2022.12.041 


Thank you to Aaron Katz, my director, whose enthusiasm for the 

advancement of the field of paramedicine and dedication to the many 

“firsts” of Norwalk Hospital Paramedics allowed for me to participate in 

this program. 

Thank you to my wife April, a fellow clinical educator, who spent many 

hours proofreading and listening to my late night ramblings. Her 

dedication has without a doubt bettered the collaboration between the 

emergency room and EMS 


59

Intent to stay 

Figure 1 Theoretical model of clinical nurses’ intent to stay. 

Why Won’t You Stay? 

Ellen Margaret Tangney, DNS, MS, MS.Ed., RN 


INTRO 

METHODOLOGY 

NEXT STEPS 

The literature is replete with opinion commentaries, articles, peer 

reviewed papers, and studies about why nurses leave the organization 

they work for. However, there is a paucity in literature concerning 

newly qualified and soon to be graduates of their basic nursing 

program intention to stay at organization. Utilizing Cowden and 

Cummings (2012) nursing theoretical model of clinical nurse intention 

to stay, one can investigate and describe the affective domains of the 

young nurses’ intention to stay in their current clinical area of work. 

This descriptive study will attempt to examine for the significance and 

influence of the affective constructs on the intention to stay in their 

current job or organization for the newly qualified nurses and those 

positioned for licensure. 

Increased understanding may result in higher retention rates of newly 

qualified nurses. 

Figure 1. 

https://www.google.com/imgres?imgurl=https%3A%2F%2Fwww.healt 

hleadersmedia.com 

OBJECTIVES 

More than seventeen percent of first-year nurses leave their job within 

the first year and up to 56% leave within two years. The average time 

to recruit an experienced nurse ranges from 66 to126 days according 

to 2021 NSI National Health Care Retention and RN staffing report. 

The result of employee turnover equates to a significant loss in 

resources via orientation, development as well as overtime and job 

satisfaction for those nurses who remain. The 2018 Press Ganey 

Nursing Special Report Optimizing the Nursing Workforce: Key Drivers 

of Intent to Stay for Newly licensed and experienced nurse estimate 

and average of 45,ooo dollars is the individual cost of one nurse 

leaving the institution . Additionally, The online Journal of Nursing 

article report hospitals with low turnover rates, ranging between 4% 

and 12%, had lower risk-adjusted mortality and lower patient lengths 

of stay than organizations with moderate (12% to 22%) or high (22% 

to 44%) turnover rates. 

Therefore, meeting the professional needs of newly qualified and 

young professional nurses will stabilize the workforce of the hospital 

and increase quality of care for the patients served. 

Manager characteristics: 

Leadership 

Praise & recognition 

Shared decision- making 

Supervisor support 

Organization characteristics: 

Career development 

Staffing 

Time to Nurse 

Work characteristics: 

Abuse 

Autonomy 

Work group cohesion 

Nurse characteristics: 

Age 

Education level 

Position preference 

Tenure 

Work status 

Cognitive response to work: 

Empowerment 

Organizational commitment 

Quality of care 

Opportunity elsewhere 

Affective response to work: 

Desire to stay 

Job satisfaction 

Joy at work 

Moral distress 

Theoretical Framework 

Cowden & Cummings (2011) 

Theoretical model of an nurses’ intent to 

stay in current position will be utilized as 

the foundation to explore and organize 

the data and themes of this study. This 

model expands on previous models which 

focused on the cognitive(knowing) 

determinants to include the affective 

(feeling) determinants by responses of 

participants in both domains. A greater 

understanding of the affective 

determinants of nurses’ intent to stay in a 

job would assist mangers, administrators 

and organizations to retain qualified 

nurses in positions within the institution 

and develop new retention strategies. 

Affective or emotional domain is reflective 

in the concepts of degree of personal 

empowerment, quality of patient care 

provided, work group cohesion, 

experience of joy at work, praise and 

recognition received, overall job 

satisfaction, organizational commitment, 

perception of immediate supervisor, moral 

distress and abuse at the workplace, 

attainment of position preference, age, 

and opportunities elsewhere. 

The initial investigation will be conducted as an exploratory descriptive 

qualitative study. 

Plan to request access employee name and institutional email data for 

nurses hired within two years of initiation of study. This investigator 

will then construct a short email to potential participants identified with 

a demographic data sheet requesting participation in the study. Those 

who meet participant requirements and agree to interview will be 

contacted for a meeting via an internet platform of their choice. 

A complementary second section of the study will include nursing 

students. A short email with the identical demographic sheet will be 

sent to students in their senior year of nursing programs requesting 

participation in the study. Participants will be screened for qualification 

and then sent an invitation for an internet interview. 

Interviews will be transferred to a transcript format and themes will 

be elicited. Themes will then be corelated with the attributes of the 

affective domain of Cowden & Cummings (2011) theoretical model . 

1.Complete Chapter One and organize articles in Chapter Two. 

2.Construct the demographic form and List of interview questions 

for IRB approval. 

3.Do it! 

RESEARCH 

• Bell., M, & Sheridan, A. (2020). How organizational commitment 

influence nurses’ intention to stay in nursing throughout their 

career. Int. J. Nurs. DOI: 10.1016/j.ijnsa.2020.100007. 

• Cowden., R & Cummings, G. (2012). Nursing Theory and concept 

development: A theoretical model of clinical nurses’ intetnions to 

stay in heir current positions. Journal of Advanced Nursing. 68(7). 

• Gensimore,M., Maduro, R., Morgan,M., McGee,G., Zimbro,K. (2020). 

The effect of Nurse practice environment on retention and quality of 

care via bunout, work characteristics, and resilience: A moderated 

mediation model. JONA. 50(10). 

• Yahyaei,A.A, Hewison,A., Efstathiou, N., Carrick-Sen, D. (2022). 

Nurses’ intention to stay in the work environment in acute 

healthcare: A systematic review. Journal of Research in Nursing. 

27(4) p. 374-397. DOI: 10.1171/1744 9871221080731. 

• Koehler, T., & Olds, D. (2022). Generational differences to nurses’ 

intention to leave. Western Journal of Nursing Research. 44(5). 

DOI: 10.1177/0193945921999608. 

• Owens, R., Burwell, P., Petros, T. (2022). Nurses’ and nursing 

students’ intent to stay. Nursing Management. DOI: 

10.1097/01.NUMA.0000853236.32160. 


Thank you for the opportunity to reinvigorate my love of research and 

scholarship 

Thank you to my husband for tolerating me. 


We are honored to carry out Dr. Tietjen’s vision of creating an interprofessional community of educators at Nuvance 

Health, and know she would be proud of the incredible scholars in this cohort. If you would like to get involved in 

future Teaching Academy activities, please reach out to us at teachingacademy@nuvancehealth.org and be sure 

to visit our intranet page on the Hub and our website at www.nuvancehealth.org/patmdta for upcoming events, 

resources, and to connect with other clinical educators at Nuvance Health. 

With your support, we are building an interprofessional community of educators at Nuvance Health. 

Robyn Scatena, MD 

Executive Director, 

Patricia A. Tietjen, MD Teaching Academy 

Beth West 

Director, 

Patricia A. Tietjen, MD Teaching Academy 


61

Support the Teaching Academy 

The Patricia A. Tietjen, MD Teaching Academy is named in honor of 

the late Dr. Tietjen, Nuvance Health’s former Chief Medical Officer 

and a beloved member of the community. A passionate advocate for 

interprofessional education, Dr. Tietjen dreamed of launching a Teaching 

Academy for clinical educators at Nuvance Health. It continues to be a 

privilege to bring Dr. Tietjen’s vision of the Teaching Academy to life - we 

hope she would be proud of what has been accomplished so far these 

first few years and there is still so much more to come. All Teaching 

Academy activities and programming are funded through philanthropy. 

If you would like to show your support for the Teaching Academy, 

please visit the link below. 

If you are an employee and would like to 

make a gift through payroll deduction 

please contact the Foundation at 203.739.7227 

or foundation@nuvancehealth.org 

We thank you for your generosity and supporting future cohorts 

of the Patricia A. Tietjen, MD Teaching Academy! 

https://www.nuvancehealth.org/giving/teaching-academy-support

Patricia Tietjen Teaching Academy Academic Symposium 2023

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