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2017 Conference on Medical Student Education

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PR1 Scholarship Boot Camp: Creating, Completing, and Disseminating Research Related to Clinical Practice and Medical Education (PRE)

Peter Lewis, MD; Laurie Belknap, DO, MMEL; Juliann Binienda, PhD; Alexander Chessman, MD; John Delzell Jr, MD, MSPH; Joanna Drowos, DO, MPH, MBA; Joel J. Heidelbaugh, MD, FAAFP, FACG; Amanda Kost, MD; Desiree Lie, MD, MSED; Mary Lindholm, MD; Suzanne Minor, MD; Christopher Morley, PhD; Ryan Palmer, EdD; Julie P. Phillips, MD, MPH; Jacob Prunuske, MD, MSPH; Tomoko Sairenji, MD; Erika Schillinger, MD; Anne Walsh, PAC, MMSc

02/9/17 1:00 PM - 5:00 PM Grand A-B

Family physicians and other primary care health care professionals are critical to the success of academic medical centers and other practice and learning environments as leaders in the triple mission of clinical care excellence, teaching innovations, and research achievements. With health care delivery increasingly focused on patient-centered care delivered by primary care clinicians, the use of primary care data for innovations in quality and process improvements in clinical care delivery provides increasing opportunities for clinician educators to pursue scholarship. The Accreditation Council for Graduate Medical Education (ACGME) created requirements for resident and faculty participation in educational scholarship, yet few residents or faculty have formal training in research or methods of scholarship. Patient care and medical education have undergone revolutionary changes in both design and delivery methods. With the introduction of the electronic medical record (EMR) and the connection of society via technology, new methods of creating and disseminating scholarship have been developed. As consideration for the awarding of promotion (criteria for which will vary by institution), the creation of innovative teaching techniques and development of web-based or video teaching modules can be valuable contributions to scholarship that can be shared and disseminated in peer-reviewed publications and curriculum/presentation portals such as MedEdPortal and the STFM Resource Library. Family physicians often face barriers to scholarship including insufficient time and training as well as the lack of access to a mentor and/or individuals to collaborate with. This session will provide an interactive and engaging opportunity to explore innovative methods and technological advances to reduce barriers and promote participation in and the achievements of family medicine clinician educators in scholarship. Family physicians and other primary care health care professionals from both academic and community-based settings with a particular emphasis on junior faculty will be encouraged to attend so as to provide meaningful strategies, tools, and opportunities for collaboration and mentoring. Fellows, residents, and medical students will also be encouraged to attend as partnerships with these peer learners are integral to formulating, completing, and disseminating scholarship.

Upon completion of this session, participants should be able to:

  1. Identify and be prepared to utilize tools and resources in EHR(s) and disease registries to create, complete, and disseminate clinical scholarship such as quality improvement (QI) projects.
  2. Identify and be prepared to utilize tools and resources to create, complete, and disseminate educational scholarship such as the evaluation of educational methods and practices.
  3. Identify and be prepared to utilize resources for professional collaboration including mentorship that can lead to the creation, completion, and dissemination of clinical and educational scholarship.

PR2 From Preceptor Recruitment to Physician Burnout to Pay-for-Performance: Can Scribes Save Medicine? (PRE)

Wayne Altman, MD; David Collins MS IV; Kristen Hood Watson, MD; Bonnie T Jortberg, PhD, RD, CDE; Steven Lin, MD

02/9/17 1:00 PM - 5:00 PM Grand C-D

Over the past decade, physicians and other health care providers report significant burnout, which has been associated with lower patient satisfaction, reduced health outcomes, and it may increase health care costs. Medical educators across the US are continually challenged with recruiting and retaining clinical community preceptor sites where their medical students can experience outstanding patient-centered care. Barriers for precepting medical students include disruptions to clinic workflow and decrease in productivity. Many payers and health care systems are transitioning to pay-for-performance as a method for reimbursement, and many family medicine practices are unprepared to maximize this new payment plan. Can the inclusion of medical scribes help to solve these significant problems in health care, and what is the potential role for the medical student? A recent systematic review of the use of medical scribes in health care settings suggests medical scribes may improve clinician satisfaction, productivity, revenue, and patient-clinician interactions. This highly interactive preconference workshop will examine current models of implementation of medical scribes in family medicine practices; the role of medical students as scribes, and how they can effectively work with existing clinic scribes; and determine key research questions that need to be answered to determine the effectiveness of medical students as scribes. The goal of the workshop is to develop a specific action plan for medical student curricula, research questions, and engaging others in medical student education regarding the role of medical students as scribes.

Upon completion of this session, participants should be able to:

  1. Describe best practices for incorporating medical students and scribes in a clinical education environment.
  2. Discuss the role of medical students as scribes as it relates to documentation rules, and describe advocacy for updating rules.
  3. Design a multiple intuition research project to determine the effectiveness of scribes and the impact of scribes on medical student education  and preceptor and physician satisfaction.

P1 Longitudinal Clinical Year Model to teach Empathy and Compassion (PRE)

Leonard Reeves, MD

02/9/17 6:00 PM - 7:00 PM Grand F

Many studies in the recent past have pointed out the drop in Empathy and Compassion by students in medical school. In developing the Northwest Clinical Campus of the Medical College of Georgia, the decision was made to implement a Longitudinal Integrated Clerkship model that aligns students with patients for their third-year of medical school. Students essentially study the core medical clerkships all year, following patients through the year in all areas including across medical specialties. We are beginning a 5-year study examining students Empathy through a measured scale and following them through medical school looking for differences in terms of campus location and rotational versus longitudinal models of instruction.

Upon completion of this session, participants should be able to:

  1. Describe the factors that attribute to the drop in empathy ratings among medical students during the course of their medical school training.
  2. Describe the differences between rotational medical school curriculum and longitudinal intergrated clerkship models of instruction.
  3. Upon completion of the session the learner should be able to discuss possible implications of longitudinal instruction may have for their institution.

P10 Using Interdisciplinary Teams to Promote Collaboration Between Medical Students and Physical Therapy Students

Alexa Smith, MEd; Sue Korek, MEd; Kimberly Stoner; Laurie Kontney; Kaitlin Pike, MS ; Jeff Wilkens

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: It is imperative that physicians and physical therapists continue to work together to promote better understanding and respect of each other’s roles in order to provide optimal patient care. Sharing knowledge and building professional relationships between medicine and physical therapy to promote an increased respect of each other’s role, responsibilities, and knowledge. Methods: An Interprofessional Educational (IPE) session consisted of bringing medical students and doctor of physical therapy (DPT) students together with the aim of fostering the development of collaborative skills, sharing expertise, and forming a respect for other’s professional roles, responsibilities, and knowledge. The Medical College of Wisconsin (MCW) and Marquette University Department of Physical Therapy developed and conducted an IPE session that brought 48 M2 medical students and 32 DPT-4 and DPT-5 students together for an interdisciplinary team session. Second-year medical students and DPT-4 and DPT-5 students with an interest in reviewing joint exams chose to participate in the session. Students listened to a lecture on athletic training and physical therapy. The lecture was delivered by multi-institutional faculty from Medical College of Wisconsin, Alverno College, and Marquette University. During a hands-on, small-group activity, the volunteer physical therapy students used their educational and technical skills to demonstrate how to evaluate joints (knee, shoulder, hip, and ankle), and the medical students were able to practice specific exam maneuvers. A joint debrief resulted in a rich, interdisciplinary discussion. Students completed written evaluations of the session to identify strengths of the session and provide constructive feedback to improve future sessions. Results: Medical and physical therapy faculty valued the learning experience and outcome for their respective learners. Feedback revealed that students valued collaborating with other disciplines and increasing their awareness of another disciplines’ roles, responsibilities, teamwork, and knowledge. Conclusions: Students were prepared to develop collaborative working relationships within interdisciplinary teams. Students expressed a desire to continue the MCW-MU IPE sessions at multiple student levels. Additional IPE events will be planned in the future.

P11 Evaluation of Motivational Strategies at a Student-Run Smoking Cessation Program (STU)

Amanda Wanous; Sarah Lund; Geoffrey Huntley

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: In 2012, only 52.4% of patients who tried to quit smoking were able to successfully achieve smoking cessation for at least 1 day (CDC, 2015). This study evaluates the efficacy of motivational strategies used for smoking cessation, with an emphasis on the newly implemented carbon monoxide (CO) monitoring. Methods: Mayo Clinic medical students staff a weekly Smoking Cessation Clinic. Patients completed an intake visit (n=18) and subsequent return visits (n=95); both included CO monitoring and a weekly survey as a part of this prospective cohort study. Average age of patients was 45 years old, with 56% males. Average number of cigarettes per day at the initial visit was 14 cigarettes. Motivational strategies evaluated include medical counseling, facts and information, CO monitoring, and free drug therapy (nicotine replacement therapy, Chantix or bupropion). Statistical analysis was used to identify whether change in cigarettes per day correlated to CO measurement. Student’s t test was used to compare utility of motivational strategies, impact of CO measurement on patient perceptions of the CO monitor and perceptions of the visit, and overall satisfaction with the visit. Results: Free drug therapy was reported as the most useful motivational strategy by patients; facts and information was least effective. CO measurement did not reliably correlate with self-reported change in cigarettes per day. Change in CO measurement had minimal impact on patient perceptions of CO monitor, perceptions of the visit, and overall visit satisfaction. The majority of patients, regardless of change in CO measurement week to week, responded positively to the use of CO monitoring. Conclusions: Free drug therapy was considered by patients the most effective strategy for smoking cessation, while CO monitoring had a positive effect on patient satisfaction. Our results demonstrate that medical students are able to successfully utilize a variety of motivational strategies to achieve patient satisfaction with weekly visits in a free smoking cessation clinic.

P13 Obesity Bias: How to Deliver a Medical Student Education Workshop

Jessica Koran-Scholl, PhD; Birgit Khandalavala, MBBS

02/9/17 6:00 PM - 7:00 PM Grand F

Obesity bias has not been addressed in traditional medical education. We have developed a 4-hour workshop to introduce obesity bias via an Integrated Clinical Experience (ICE) for fourth-year medical students. This workshop has been offered for 3 consecutive years with positive feedback and strong participation from the student body. This workshop begins with a didactic lecture on obesity and the need for recognition of bias as a significant barrier to successful obesity management. Current teaching modalities include utilization of a simulation suit and interactive self-bias evaluation. We also use case discussion to promote recognition of obesity bias in the clinical setting. Concluding activities include formulation of a personalized plan by the students to reduce obesity bias in practice. This interactive and multidisciplinary approach to learning about obesity bias is at the forefront of medical education around this topic and encourages self reflection.

Upon completion of this session, participants should be able to:

  1. Learn how to define obesity bias and methodology.
  2. Identify and utilize tools and resources to incorporate learning about obesity bias in your teaching environment.
  3. Describe a format for teaching obesity bias in a medical student population.

P14 A Community-Based Intervention for Future Family Physicians: Implementation of a Harm Reduction Curriculum in Homeless Shelters in Rhode Island (STU)

David Corner; Paul Wallace; Jordan White, MD, MPH

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Opioid overdose is the most common cause of injury-related death in the United States and the most common cause of death overall among individuals experiencing homelessness. Our objective is to describe a medical student project providing overdose response training and naloxone distribution in homeless shelters, within the context of the Longitudinal Integrated Clerkship (LIC) at our medical school. Methods: As part of a Population Medicine course paired with the LIC, medical students partnered with community organizations to address local health needs. This project resulted from a collaboration between a medical student, a harm reduction group, and homeless shelters; it provided training sessions on opioid overdose response and naloxone administration for individuals experiencing homelessness. Following the training, participants received naloxone kits and answered an anonymous nine-item survey. The survey assessed personal history of and exposure to opioid overdose and naloxone, likelihood of calling 911 in response to overdose, and comfort level with opioid overdose response after completing the training. Results: Since December 2015, seven trainings have been held in homeless shelters, with 95 individuals trained and 83 naloxone kits distributed. Based on 31 completed surveys, participants had a median age of 45.5 years and were 81% male. Sixty-five percent had heard of naloxone prior to the training; 45% had witnessed an opioid overdose; 16% had personally experienced opioid overdose. Ninety-three percent of participants reported that they were somewhat or very likely to call 911 in response to an overdose, and 97% of participants reported that they were somewhat or very confident in responding to opioid overdose as a result of the training. Since this project began an additional 20 medical students have been trained to conduct regular naloxone distribution. Conclusions: This project demonstrates an effective curricular-inspired medical student intervention that connects homeless individuals at risk of experiencing and witnessing opioid overdose with important resources that may save lives. It also provides medical students the opportunity to learn about community-based health care while collaborating with local organizations outside of the clinical setting. Future directions to ensure the sustainability of this project include the creation of a harm reduction student interest group that provides regular naloxone distribution.

P15 A Student-Run Outreach and Vaccine Administration Clinic Provides Longitudinal Workplace-Based Learning and Improves Patient Care (STU)

Tenessa MacKenzie, MD; Alexander Haddad; Lillian Lai; Jason Parad, MPH, MBE; Lakshmi Subbaraj; Sarah Takimoto

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: A key element of UCSF’s new educational curriculum is the clinical microsystem clerkship (CMC) in which students learn quality improvement and clinical skills through workplace-based longitudinal learning. A student-run outreach and vaccine administration clinic provides experiential learning while also increasing immunization rates and access to care at our family medicine clinic in an academic health system. Methods: Six medical students will be spending a weekly half-day at our primary care clinic during their first year where they will be learning and participating in collaborative continuous quality and systems improvement work. A student-run vaccine clinic provides opportunities for students to engage in immunization education and shared decision-making, as well as learn clinical skills in vaccine administration. We plan to outreach to our pediatric patients who are overdue for routine childhood immunizations and administer injections during a student-run vaccine clinic. Concurrently, we will run an influenza immunization clinic for all patients at our clinic on a walk-in basis. Students will be certified in administering vaccines through an internal certification process that will include learning modules and practical training in vaccine administration. We plan to regularly run reports on our lists of under-vaccinated children to monitor for improvement in pediatric immunization rates and monitor influenza vaccination rate data for the current year compared to previous years without a student-run vaccine clinic. Results: By the time of the STFM Conference on Medical Student Education in February 2017, we will have developed scripts for outreaching to parents of children who are overdue for vaccinations and will have started administering immunizations in the student-run clinic based at our primary care clinic. We hope to find increases in vaccination rates as well as improved patient satisfaction. We believe that medical students will find satisfaction in their systems improvement work and will be able to articulate how improving immunization rates fits into high-quality health care. Conclusions: Our student-run outreach and vaccine administration clinic empowers students to make meaningful contributions to high-quality health care while learning quality improvement and clinical skills. Starting from the first year of medical school, students will be committed partners adding value to systems efforts that improve health care outcomes.

P16 Examining the Impact of a fmCASES Mid-Clerkship Examination

Matthew Holley, PhD; Scott Renshaw, MD; Jennifer Burba, MSEd; Shannon Cooper, MSEd

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: The purpose of this presentation to examine the relationship between the development of a fmCASES mid-clerkship examination and performance on the final fmCASES exam. More specifically, the mid-clerkship examination has been developed using a progress testing framework to serve as formative assessment to help guide learner preparation for the final exam and to identify students at-risk of failing the Family Medicine Clerkship. Evaluation Methods: Throughout the 2014-2015 academic year, data was collected on all third-year medical students completing the Family Medicine Clerkship. More specifically, information was collected that included whether or not the student completed the fmCASES mid-clerkship examination, the student’s score on the mid-clerkship exam, the student’s score on the final examination, and the percentage change between the mid-clerkship and final exam score. As such, the primary data sources were the mid-clerkship and final exam scores. Other data included gender and timing of rotation. Results were analyzed using SPSS. Results: Initial results completed at the end of the 2014-2015 academic year found the following results: • 90.2% of all students completed the mid-clerkship exam (284 completed, 31 did not complete). • The average gain for all students between the mid-clerkship and final exam was +10.06 percentage points. The average gain for students failing the practice exam (n=93) was +20.78 percentage points. • Of the 284 students who took the mid-clerkship and final exam, 223 had positive gains, 52 had negative gains, and five students had no change. The average positive gain was +13.77% while the average negative gain was -6.17%. • The difference between the practice and final exam scores (gain) is highly significant, P<.0001. Conclusions: For those using fmCASES and the fmCASES exam in their clerkship, the findings from this study may help to develop similar curricular interventions or help develop a common mid-clerkship exam for those institutions already implement a mid-clerkship exam. Given clerkships vary in content (family medicine specific versus ambulatory) and length, the development of a mid-clerkship examination using a progress testing framework can help build knowledge acquisition.

P17 The Basic Life Support in Obstetrics Course: Priming Preclinical Medical Students for Action

Karyn Kolman, MD; Colleen Cagno, MD; Jessie Pettit, MD; Autumn Stevenson

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: The Basic Life Support in Obstetrics (BLSO) course should provide medical students with an opportunity to gain early, practical, clinical experience. Completion of the BLSO course should improve medical students’ knowledge and self-assessment of managing normal deliveries and obstetrical emergencies. Methods: 30 students were enrolled in the BLSO course. Prior to receiving any BLSO course materials, participants’ baseline knowledge was assessed using the 37-question BLSO multiple choice pre-course examination in a closed-book format. The same examination was given in open-book format after the students received the BLSO written course materials, with students using these materials as a reference. Student’s practical skills were assessed using direct observation and skills checklists. Instructors observed participants individually as they performed a simulated normal vaginal delivery. At the end of the course, participants were observed in groups as they managed scenarios including: normal labor and delivery, shoulder dystocia, eclampsia, preterm labor, and neonatal resuscitation. Participants were given a self-assessment questionnaire prior to beginning the course and after course completion. They were asked to rate their competence/experience level in the management of eight complications frequently encountered when caring for pregnant women and newborns. A post-course evaluation was distributed that included a question on how this BLSO course would change future practice. Results: All participants successfully demonstrated skills needed to manage a normal vaginal delivery. After reviewing BLSO written course materials, participants’ exam scores increased by 35%. Prior to the course 95% of participants stated they had no experience in managing common complications of maternity and newborn care. After completion of the course, 96% of participants rated themselves as at least beginners when managing these complications. On the post-course evaluation, multiple students commented that they were more confident going into their family medicine and obstetrics clerkships. Additionally, many noted an increased interest in pursuing a career in family medicine. Conclusions: Participants demonstrated an increase in knowledge of the management of frequent complications encountered during maternity care and care of the newborn. Routine incorporation of BLSO taught by family physicians may increase the number of students choosing family medicine as a career.

P18 Medical Student End-of-Life Counseling for Underserved Geriatric Patients (STU)

Ruth Goodson; Matthew Mulroy

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Although advance care planning empowers patients to choose treatments that align with their values, less than 30% of Americans have advance directives, including those with chronic disease. Advance care planning has been identified as an important part of medical education. This study aims to determine the role of medical students as facilitators of end-of-life (EOL) discussions with underserved geriatric patients. Methods: Four pairs of medical students received training on the use of advance directive forms and techniques in leading discussions about EOL issues. Each medical student pair held private sessions with patients and accompanying family members after their scheduled geriatric clinic appointments. During a session, the following items are completed: (1) a pre-session survey to assess patient demographics, medical status, and current attitudes and knowledge about EOL care, (2) the Five Wishes advance directive document, and (3) a post-session survey to assess satisfaction with the counseling experience as well as any changes in attitudes and knowledge about EOL care. All parties received a copy of Five Wishes, and the medical students transcribed the patients’ expressed wishes for EOL care. Results: Medical student teams discussed EOL topics with 41 patients. Only 15% had previously discussed an advance directive, and no participant had previously completed one, but 88% completed an advance directive during the session. Only 39% were aware they could choose to accept or reject treatment at the EOL, but 83% felt it was important to learn about these options. After the session, 90% felt comfortable discussing EOL goals with other people compared to 65% pre-session. 98% reported feeling very comfortable completing advance directives with medical students. Conclusions: Medical students may be trained to lead EOL discussions and improve advance care planning participation in underserved communities. Involving medical students in advance care planning may help prepare future doctors to lead difficult conversations they will inevitably face in their careers.

P19 Medical Scribing in Family Medicine: An Online Curriculum for Pre-Medical Students, Medical Assistants, and Physician Extenders

Catherine Carragee; Alexis Kofoed, MPH, PA-S; Steven Lin, MD

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Academic health systems across the country are beginning to integrate medical scribes into the primary care setting. One of the greatest, and often expensive, hurdles in building a scribe program is training new scribes. The ideal training program is one that can be rapidly delivered while being sufficiently robust in producing qualified medical scribes in the busy clinical environment. The Stanford Clinical Observation and Medical Transcription (COMET) Fellowship is a first of its kind scribe program designed for post-baccalaureate students who are interested in pursuing a career in the health professions. Students in the COMET program have created an online training curriculum that can be disseminated and implemented at other academic health systems to train medical scribes. Methods: The online curriculum consists of six lectures describing the following essential topics: core elements of a medical note, fundamental medical terminology, electronic medical records, billing and coding, and common conditions seen in a family medicine clinic. The curriculum is PowerPoint based with integrated flashcards and quizzes, as well as links to external reference materials. The curriculum takes approximately 10 hours to complete. Students in the COMET program tested the curriculum and compared it to a lengthier 40-60 hour curriculum designed by an established commercial scribe vendor. Results: The COMET curriculum can be used as an effective way to train medical scribes in family medicine. It can be rapidly delivered and implemented in the busy clinical environment for pre-medical students, medical assistants, and physician extenders. The curriculum can also be easily repurposed to train pre-clerkship medical students on the basics of clinical documentation. We will have an interactive display of this curriculum using an iPad interface for attendees. We aim to publish the curriculum on MedEdPORTAL. Conclusions: Designed by scribes for scribes, our online training curriculum was created based on student experience in the Stanford COMET Fellowship with the goal of helping other family medicine clinics develop their own scribe programs. Finding the right balance between designing the shortest, most high-yield curriculum and one that is sufficiently robust in producing qualified scribes remains a major challenge. More research is needed to evaluate the effectiveness and impact of scribe training curricula as medical scribes become increasingly prevalent.

P2 Spanish for Medical Professionals: Creating a Case-Based Curriculum (STU)

Arhanti Sadanand; Mark Ryan

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: The population of Latinos in the US is projected to double by 2060, creating a growing necessity for Spanish-speaking medical providers for patients with limited English proficiency (LEP). We offered a medical Spanish elective with emphasis on comprehension and fluency in realistic health care scenarios with the goal of improving Spanish knowledge, fluency, and confidence. Methods: Participants attended one of two interactive medical Spanish courses during the spring of 2016. Standardized pre- and post-intervention questionnaires were used to compare improvement and confidence in Spanish ability. Additionally, students were objectively assessed using a standardized rubric during a mock medical encounter with a Spanish-speaking standardized patient (SP) at the end of the course. Results: Pre-elective and post-elective questionnaire data (n=17) showed that students rated themselves as having improved in all assessed domains, including introductions, evaluating chief complaints such as hypertension and joint pain, instructing patients through the physical exam, and discussing the plan. The average difference between pre- and post-elective scores was 1.78 on a self-rating scale of 1-5, with a mean score across all pre-elective abilities of 1.60 and a mean score across all post-elective abilities of 3.38. After the elective, students reported higher confidence levels at tasks including introducing themselves, performing a history of present illness (HPI) and physical exam, providing medication instructions, providing discharge information, and addressing patient concerns in Spanish. The average difference between pre- and post-elective scores of confidence was 1.39 on a self-rating scale of 1-5; the mean score across all pre-elective confidence levels was 1.92 and the mean score across all post-elective confidence levels was 3.31. Conclusions: Results reaffirmed the efficacy of an interactive medical Spanish course and provided data to the VCU School of Medicine curriculum council in support of the official addition of this course to the fourth-year electives catalog. This will assist future doctors in communicating with Spanish-speaking patients in their practice and will hopefully translate into improved health outcomes of Spanish-speaking LEP populations.

P20 Surprise! Family Medicine Is Amazing: Reflections From a Target School (STU)

Tracy Rydel, MD; Art Johnson, MA

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: For several years, the Clerkship in Family and Community Medicine has recorded student reflections on the following two questions: "Were you surprised by any aspect of the Family and Community Medicine Clerkship? If so, what?" and "Did you expand or gain a new point of view?" In this project in process, we seek to analyze common themes in response to this question, reporting reflections in the context of students experiencing Family and Community Medicine at a Target School. Methods: Qualitative analysis of narrative comments, using phenomenological study techniques to thematically analyze the responses of all students on the required (100% response rate) rotation in Family and Community Medicine. Participants are in both their first and second clinical years (MS3 and MS4+). Results: In process. Conclusions: This is a project in progress. We anticipate several themes emperically based on our observations including exposure to integrative medicine, exposure to musculoskeletal medicine, and exam techniques, nuances of patient-physician interaction, and a focus on the patient perspective of illness.

P21 Patient Perspectives on Weight Counseling in a Primary Care Setting (STU)

Pamela Ayala; Michelle Klawans, MPH; Thomas Northrup, PhD; Angela Stotts, PhD; Deepa Iyengar MD; Amber Zulfiqar, MD; Bal Reddy, MD

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Primary care physicians (PCPs) should talk to patients about their weight because two-thirds of adults in the US are overweight or obese. The aim of this study was to survey patients’ perceived weight category and their perceptions on receiving weight counseling from their PCP. Methods: Six hundred adults seeking care at an urban, academic-based family medicine clinic completed an anonymous 19-question survey, reporting on their demographic information, height, weight, perceived weight category (underweight, normal, overweight, obese, morbidly obese), preferences regarding weight management strategies, and level of comfort with physician-directed weight management. Chi-squared and t tests were run in order to examine associations between BMI and patient perceptions. Results: Only 24% (n=48) of obese and morbidly obese patients, as determined by their body mass index (BMI), identified themselves as obese. Half of patients (49%, n=260) selected doctors or other health care providers as the best source for providing information on weight management. Most patients (81%, n=448), are comfortable receiving information about weight management from their doctors. Nearly all patients (90%, n=518) denied feeling too embarrassed to talk to doctors about their weight, with 61% (n=31) of the patients who felt too embarrassed classified as obese. The results showed that patients perceived the most helpful weight management plan to be: written materials such as pamphlets (29%, n=130), referrals to weight loss specialists and programs (31%, n=140), and in-office counseling with follow-up by calls, text messages, or in-office appointments (40%, n=180). Nearly half (43%, n=68) of obese patients preferred to be referred. Patients’ mean score was 6.7 on their ability to get to a healthier weight, with 0 representing no confidence and eight representing complete confidence. Similarly, patients’ mean score was 6.4 on how confident they perceived their PCP was in their ability to get to a healthier weight. Conclusion: Three-quarters of obese and morbidly obese patients incorrectly perceived themselves as overweight or at a normal weight, which suggests low self-awareness among the obese. Patients perceived doctors as a reliable source for weight management, and most were comfortable discussing weight issues. Our study revealed that patients are open to discussing their weight, so concern about patient resistance should not deter PCPs from discussing patients’ weight issues.

P23 Online Family Medicine Clerkship Newsletters: Building Community and Providing Faculty Development (MSEDI) (PRE)

Sarah Stumbar, MD, MPH; Suzanne Minor, MD; Irmanie Eliacin, MD; Marquita Samuels, BA

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Family medicine clerkships rely heavily on community—and often, voluntary—preceptors to provide the majority of their clinical teaching. This presents the unique challenge of finding new and innovative ways in which to engage these educators in faculty development activities. With both this and the goal of creating a sense of community among our preceptors in mind, Herbert Wertheim College of Medicine/Florida International University started a quarterly online Family Medicine Clerkship Newsletter in the fall of 2015. Methods: The Family Medicine Clerkship Newsletter is published quarterly and distributed through email to both our full-time and voluntary faculty. The newsletter covers several regular topics, including clerkship and medical school updates, faculty development topics, opportunities for free CME within the university community, quotes from students highlighting positive experiences with community preceptors, and a narrative medicine essay written by a student as an assignment during his/her family medicine rotation. The newsletter-generating software that we use allows us to track the number of times that the newsletter is opened, as well as the number of times that each specific article or link is clicked and downloaded. This enables us to track the level of interactive engagement with our final product and also allows us to determine the most frequently viewed sections of the newsletter. Results: To date, an average of 56.9% of our community preceptors and 60% of our fulltime faculty have opened the Family Medicine Clerkship Newsletter. Ten percent of those receiving the newsletter have also downloaded the essay highlighted in the “Narrative Medicine Corner." Only one person, or approximately 2% of faculty, has downloaded any of the articles discussing a faculty development topic. Conclusions: The number of times that our Family Medicine Clerkship Newsletter has been opened suggests that the majority of faculty is engaging, at least to some extent, with the provided information and articles, many of which do not require additional clicking or downloading in order to view them. It also suggests that preceptors may be most interested in topics directly related to the student experience, such as the student narrative medicine essays. However, it remains to be seen whether this online forum presents a true opportunity for providing voluntary preceptors with informal—but meaningful—faculty development.

P26 Increasing Matriculation Into Family Medicine Residency: Analysis of Two Family Medicine-Sponsored Student Groups (STU) (MSEDI)

Kristen Hood Watson, MD

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: It is imperative to the health of our nation to reduce the deficit in primary care providers. At Medical University of South Carolina we typically have family medicine match rates at or above national average but aim to become a leader in students matching into family medicine. Our institution has an active Family Medicine Interest Group (FMIG) as well as a program called FamTrack, a group where students are selected by application to participate in lectures and clinical experiences during their preclinical years. This project aims to evaluate the effectiveness of our current programming by looking at the association between participation and choice of a family medicine residency. Methods: This will be a retrospective analysis of participation in FamTrack and/or FMIG for students who have matched into family medicine over the past 2 years. Two years was chosen as there have been two classes who have graduated since the implementation of FamTrack. The log of FMIG meetings will be reviewed to discover if there is a statistically significant correlation between FMIG involvement, including degree of participation noted by the number of meetings attended, as well as FamTrack involvement and entrance into a family medicine residency. Results: Pending completion of analysis. Conclusions: The results are pending. However, the results will be utilized to determine how to best recruit medical students and ultimately foster matriculation into a family medicine residency. Next Steps: If FamTrack proves to have a significant correlation with the choice of a family medicine residency, the number of students who are accepted will be re-evaluated and possibly increased. In addition, if FMIG is a major driver we will continue our frequent programming. Another possibility is that there are a significant number of students who chose family medicine but were not involved in either group. In that case, a future step will be to survey students to determine what led them to choose family medicine.

P29 BLSO® (Basic Life Support in Obstetrics): Assessing Student, Faculty, and Staff's Perception of the Impact of an Obstetrics Patient Safety Course in a Transition Course Curriculum

Laura Shaw, MD; Bridgett Giordmaina

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: Health professionals such as medical students may encounter obstetrical emergencies. The purpose of the initial project was to incorporate the BLSO® course into the medical school curriculum at the University of Nevada School of Medicine to improve patient safety, inter-professional communication and collaboration, and confidence levels of health providers. The purpose of this follow-up project is to assess faculty, nursing staff, and student perception of the impact of this course in a transitional course curriculum both at the time of the course and later after students had completed their obstetrics clerkship. Methods: In July 2016, UNSOM will conduct the BLSO® course to medical students prior to the third-year rotations during a transition course. Prior to the course, students take a survey that assesses confidence handling obstetric emergencies covered in BLSO®. After the course, a second survey assesses confidence levels and if and when BLSO® should be mandatory within the medical curriculum. A final survey will be collected after the obstetrics clerkship to reassess confidence and the impact of BLSO® on the clerkship experience. Results: The initial pilot course was positively received by the medical students. The course was then planned for the July 2016 transition course. Surveys will be collected at the transition course in July as well as after each obstetrics clerkship rotation. The data will be analyzed and presented in the final results and conclusion sections. Conclusions: Post-course surveys of the initial pilot showed increased levels of self-confidence, knowledge of protocols, team communication, and overall handling of emergency situations after the course. Other medical schools have successfully piloted BLSO®, but these course participants already had an interest in obstetrics. BLSO® has never been part of a transition course for all students. The July 2016 course, which will have a sample size of 73, will include all third-year students regardless of their interests and intended field. It is hoped that the BLSO® course will show the benefit of a structured patient safety course prior to clinical clerkships in contrast to the traditional point-of-care teaching during obstetrics clerkships. This course may also complement the clerkship experience by allowing accelerated teaching during the clerkship and may increase student interest in the field of family medicine and obstetrics.

P3 ECG Use in a Student-Run Free Clinic (STU)

Jessica Churchill; Evan Dombrosky; John Raduka; Anastasia Samaras

02/9/17 6:00 PM - 7:00 PM Grand F

This study explores the use and success of ECG testing in the student-run free clinic setting to decrease emergency room admissions while educating medical students. Methods: This retrospective chart review assessed all EVMS HOPES Clinic patient charts between April 1, 2015 and July 31, 2015. A total count for ECG tests run during the study period was tabulated. Those patients who had ECG testing performed as part of their clinic visit were further evaluated. Charts of patients who received ECG testing were assessed for presenting symptoms, ECG test interpretations and appointment outcomes. Results: Seven ECG tests were run by students during the study period at the EVMS HOPES Student-Run Free Clinic. Six ECG tests were included in this assessment; one was excluded due to incomplete data documentation. Of the six ECG tests run during the study period, 50% (three tests) were run based on claims of chest pain. 33% (two tests) were run based on complaints of palpitations. 17% (one test) was run for complaints of syncopal episodes. Overall, six ECG tests performed during this study period were analyzed for outcomes, and of the tests, 50% (three tests) resulted in a recommendation to seek emergent treatment based on ECG findings. Discussion: Of the six tests we examined, only three resulted in a recommendation of emergent treatment. This suggests that the use of ECG in the HOPES Clinic allowed physicians and clinicians to make treatment recommendations, giving medical students valuable experience in ECG testing and critical health decision making while reducing avoidable Emergency Room visits for patients.

P30 Preclerkship Medical Students Use an Educational Model to Improve the Treatment of Hypertension (STU)

Andrew Paisley, MEd; Jasen Tjahjadi; Christine Matson, MD

02/9/17 6:00 PM - 7:00 PM Grand F

Purpose: To engage the preclerkship medical student in a specific role within the health care team using an educational model for improving the treatment of hypertension (HTN). Hypothesis: Medical students can effectively contribute to a health care team and hypertension treatment through the delivery of an educational curriculum. Methods: A team of medical students designed a series of educational modules to train hypertension health coaches in various family medicine settings. The project is a partnership with the Virginia Department of Health and the National Million Hearts Campaign. The modules focused on the topics of hypertension basics, motivational interviewing, medications, lifestyle modifications, and addressing barriers to care. The medical students piloted the modules for input from representative nurses and then presented the modules to groups of medical assistants and licensed practical nurses from regional FM residency and safety net practices. The nurses’ learning was assessed with a pretest and posttest quiz to evaluate the effectiveness of the curriculum. A survey was also administered to assess the nurses’ perceptions about the roles and functions of HTN coaching, motivational interviewing, and lifestyle modification. Results: This project is in progress. Data to be tracked include blood pressure results at each visit, percentage of hypertension control in patients of a practice, emergency department visits for hypertension, medication adherence, wellness plan adherence and number of referrals. Conclusions: Medical students can successfully identify problems and contribute to solutions in the health care setting to achieve durable systems change. This project demonstrates a role for preclerkship medical students in improving patient outcomes by training hypertension health coaches with an educational curriculum. This project supports the concept of engaging learners as integral partners on inter-professional teams early in their medical education.1,2 1. Matson CC, Stephens MB, Davis AK, et al. Engaging learners to achieve escape velocity in transformational education and practice. Ann Fam Med 2016;14:184-5. doi: 10.1370/afm.1920. 2. Lin SY, Schillinger E, Irby DM. Value-added medical education: engaging future doctors to transform health care delivery today. J Gen Intern Med 2014;30(2):150-1.


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