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David W Musick,1 R Brock Mutcheson,2 David B Trinkle2 1Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; 2Department of Health System and Implementation Sciences, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: David W Musick, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, USA, Tel +1 540 526-2566, Fax +1 540 581-0741, Email dwmusick@vt.eduBackground and Purpose: Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students’ HSS knowledge and attitudes concerning health system citizenship.Methods: This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey.Results: Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher).Discussion: There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely

Background and Purpose: Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students’ HSS knowledge and attitudes concerning health system citizenship. Methods: This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey. Results: Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher). Discussion: There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.

Background: COVID-19 increased moral distress (MD) and moral injury (MI) among healthcare professionals (HCPs). MD and MI were studied among inpatient and outpatient HCPs during March 2022. Objectives: We sought to examine (1) the relationship between MD and MI; (2) the relationship between MD/MI and pandemic-related burnout and resilience; and (3) the degree to which HCPs experienced pandemic-related MD and MI based on their background. Methods: A survey was conducted to measure MD, MI, burnout, resilience, and intent to leave healthcare at 2 academic medical centers during a 4-week period. A convenience sample of 184 participants (physicians, nurses, residents, respiratory therapists, advanced practice providers) completed the survey. In this mixed-methods approach, researchers analyzed both quantitative and qualitative survey data and triangulated the findings. Results: There was a moderate association between MD and MI (r = .47, P < .001). Regression results indicated that burnout was significantly associated with both MD and MI (P = .02 and P < .001, respectively), while intent to leave was associated only with MD (P < .001). Qualitative results yielded 8 sources of MD and MI: workload, distrust, lack of teamwork/collaboration, loss of connection, lack of leadership, futile care, outside stressors, and vulnerability. Conclusions: While interrelated conceptually, MD and MI should be viewed as distinct constructs. HCPs were significantly impacted by the COVID-19 pandemic, with MD and MI being experienced by all HCP categories. Understanding the sources of MD and MI among HCPs could help to improve well-being and work satisfaction.

Background: Finding the ideal candidate for a residency/fellowship program has always been difficult. Finding the "perfect" match has always been the ultimate goal. However, many factors affect obtaining that "perfect" match. In the past, we would have each attending physician review around 20 to 50 Electronic Residency Application Service (ERAS) applications and rank them into three categories: high, middle, or low. Depending on their ranking, the applicant would be invited for an interview. After the interview, the applicants' files (ERAS and interview) would he reviewed and ranked by the faculty as a group. This was time-consuming and fraught with too much subjectivity and minimal objectivity. We, therefore, sought to find a way to assess and rank applicants in a more objective and less time-consuming manner. By creating a customizable scoring tool, we were able to screen applicants to our pulmonary/critical care fellowship program in an efficient and a more objective manner. Objectives: A customizable scoring tool was developed weighting components in the ERAS and interview process, allowing residency/fellowship programs to create a final rank list consistent with the programs' desired applicants. Methods: Two hundred and sixty pulmonary/critical care fellowship applications were reviewed from 2013 to 2018. In 2018, we used our new scoring rubric to create a rank list and rescore previous applicants. The traditional and new lists were compared to the final rank list submitted to the National Residency Matching Program (NRMP) for 2018. We wanted to ascertain which scoring method correlated best with the final rank list submitted to the NRMP. We obtained feedback from eight faculty members who had reviewed applicants with both scoring tools. Results: The novel customizable scoring tool positively correlated with the final rank list submitted to the NRMP (r = 0.86). The novel tool showed a better correlation to the final rank list than the traditional method. Facul

Background and Purpose: There is limited training for healthcare students in the performance of telephone consultations. To facilitate communication between healthcare professionals when face-to-face interactions are not possible, a telephone consultation simulation was developed. The simulation involved students in a doctor of physical therapy program and senior medical students. This study aimed to explore the development and suitability of a simulated case with a focus on interprofessional telephone consultation. Methods: A convenience sample of 28 physical therapy students and 38 medical students from two institutions in southwest Virginia participated in the simulation experience. To assess the outcomes of the simulation on interprofessional communication, the IPASS verbal handoff assessment was performed by the participants and focus group interviews occurred immediately following the experience. In addition, an assessment of key information pro-vided during the conversation was performed for each of the seven interprofessional groups. Results: Students demonstrated near perfect agreement on the IPASS assessment. Five of the seven interprofessional groups perceived that they were able to communicate key information and collectively agree upon a recommendation for the continuation of the patient assessment. The two groups that demonstrated more difficulty with communication appeared to struggle with communicating the patient’s past medical history relevant to the current situation, despite the majority of students feeling confident in their communications. In addition, two themes were presented during the interprofessional focus group interviews: 1) clear communication to maintain patient safety and 2) efficiently conveying the patient’s background. Discussion: The health professions students participating in the scenario were able to consistently note the communication skills observed and reflect upon the need for clear communication between providers during a

Background: Finding the ideal candidate for a residency/fellowship program has always been difficult. Finding the "perfect" match has always been the ultimate goal. However, many factors affect obtaining that "perfect" match. In the past, we would have each attending physician review around 20 to 50 Electronic Residency Application Service (ERAS) applications and rank them into three categories: high, middle, or low. Depending on their ranking, the applicant would be invited for an interview. After the interview, the applicants' files (ERAS and interview) would he reviewed and ranked by the faculty as a group. This was time-consuming and fraught with too much subjectivity and minimal objectivity. We, therefore, sought to find a way to assess and rank applicants in a more objective and less time-consuming manner. By creating a customizable scoring tool, we were able to screen applicants to our pulmonary/critical care fellowship program in an efficient and a more objective manner. Objectives: A customizable scoring tool was developed weighting components in the ERAS and interview process, allowing residency/fellowship programs to create a final rank list consistent with the programs' desired applicants. Methods: Two hundred and sixty pulmonary/critical care fellowship applications were reviewed from 2013 to 2018. In 2018, we used our new scoring rubric to create a rank list and rescore previous applicants. The traditional and new lists were compared to the final rank list submitted to the National Residency Matching Program (NRMP) for 2018. We wanted to ascertain which scoring method correlated best with the final rank list submitted to the NRMP. We obtained feedback from eight faculty members who had reviewed applicants with both scoring tools. Results: The novel customizable scoring tool positively correlated with the final rank list submitted to the NRMP (r = 0.86). The novel tool showed a better correlation to the final rank list than the traditional method. Facul

Shala Cunningham,1 David W Musick,2 David B Trinkle3 1Doctor of Physical Therapy Program, Radford University Carilion, Roanoke, VA, USA; 2Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; 3Department of Interprofessionalism, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: David W Musickc/o Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, USATel +1 540 562-2566Email dwmusick@vt.eduBackground and Purpose: There is limited training for healthcare students in the performance of telephone consultations. To facilitate communication between healthcare professionals when face-to-face interactions are not possible, a telephone consultation simulation was developed. The simulation involved students in a doctor of physical therapy program and senior medical students. This study aimed to explore the development and suitability of a simulated case with a focus on interprofessional telephone consultation.Methods: A convenience sample of 28 physical therapy students and 38 medical students from two institutions in southwest Virginia participated in the simulation experience. To assess the outcomes of the simulation on interprofessional communication, the IPASS verbal handoff assessment was performed by the participants and focus group interviews occurred immediately following the experience. In addition, an assessment of key information provided during the conversation was performed for each of the seven interprofessional groups.Results: Students demonstrated near perfect agreement on the IPASS assessment. Five of the seven interprofessional groups perceived that they were able to communicate key information and collectively agree upon a recommendation for the continuation of the patient assessment. The two groups that demonstrated more difficulty with communication appeared to struggle with communicating the patient’s past medical history relevant to the current situ

Background and Objectives: Excessive packed red blood cell (pRBC) transfusions are associated with worse clinical outcomes and unnecessary costs. While multi-faceted continuing medical education (CME) approaches have been shown to be effective methods for changing physician practice, few studies have evaluated this approach as a method for changing blood transfusion practices. Methods: In this prospective cohort study sought to use a multi-faceted CME platform to modify physician transfusion practices. In this prospective cohort study, the authors implemented a multi-faceted CME intervention including didactic presentations, distribution of educational materials, educational posters, and electronic medical record clinical decision support. Primary outcomes were number of pRBC transfusions prior to and after intervention and associated costs. Secondary outcomes included knowledge acquisition, satisfaction, self-reported improvement in knowledge, and intent to change behavior. The intervention targeted physicians from four departments: Surgery, Internal Medicine, Obstetrics and Gynecology, and Emergency Medicine. Results: Fifty-eight physicians participated in the experimental group and seventy-three physicians in the control group. There was a 26% decrease (P<.0001) in pRBC transfusions monthly when comparing the year prior to intervention to post-intervention year. Clinicians reported improved knowledge acquisition regarding transfusion risks and indications (P<.001). Adjusted transfusion practices saved the primary teaching hospital $722,950 following the intervention. Conclusion: This study supports the use of a multi-faceted CME intervention to align clinical practice with evidencebased transfusion guidelines. Future studies should investigate the effectiveness of individual components of multi-faceted CME interventions regarding improved physician knowledge and clinical practice, patient outcomes, and cost-benefit.

The Virginia Tech Carilion School of Medicine (VTCSOM) is a 4-year allopathic medical school in Roanoke, VA. The curriculum is organized into four learning domains: basic science, clinical science, research, and interprofessionalism (IPE). A recent curriculum renewal effort allowed the school to embark upon a redesign of the IPE learning domain to incorporate new core content from health systems science (HSS).We describe how our unique approach to IPE is being preserved as we innovate to produce graduates who are future thought leaders and “systems citizens,” prepared to deliver patient care with an expanded knowledge of the health systems in which they will eventually practice.

Background and Objectives: Excessive packed red blood cell (pRBC) transfusions are associated with worse clinical outcomes and unnecessary costs. While multi-faceted continuing medical education (CME) approaches have been shown to be effective methods for changing physician practice, few studies have evaluated this approach as a method for changing blood transfusion practices. Methods: In this prospective cohort study sought to use a multi-faceted CME platform to modify physician transfusion practices. In this prospective cohort study, the authors implemented a multi-faceted CME intervention including didactic presentations, distribution of educational materials, educational posters, and electronic medical record clinical decision support. Primary outcomes were number of pRBC transfusions prior to and after intervention and associated costs. Secondary outcomes included knowledge acquisition, satisfaction, self-reported improvement in knowledge, and intent to change behavior. The intervention targeted physicians from four departments: Surgery, Internal Medicine, Obstetrics and Gynecology, and Emergency Medicine. Results: Fifty-eight physicians participated in the experimental group and seventy-three physicians in the control group. There was a 26% decrease (P<.0001) in pRBC transfusions monthly when comparing the year prior to intervention to post-intervention year. Clinicians reported improved knowledge acquisition regarding transfusion risks and indications (P<.001). Adjusted transfusion practices saved the primary teaching hospital $722,950 following the intervention. Conclusion: This study supports the use of a multi-faceted CME intervention to align clinical practice with evidencebased transfusion guidelines. Future studies should investigate the effectiveness of individual components of multi-faceted CME interventions regarding improved physician knowledge and clinical practice, patient outcomes, and cost-benefit.

As health professions education increasingly focuses on community engagement, population health and prevention of health disparities, there has been a corresponding expansion of teaching on culinary medicine. Clinical nutrition is critically important in addressing many of the most vexing clinical problems in medicine and population health. Culinary medicine also offers a new method to enhance interprofessional education (IPE) by providing students with additional opportunities to learn with, about and from each other (as recommended by the World Health Organization). We revised our existing IPE curriculum to deliver new content on culinary medicine as part of an existing twelve-month IPE course. Students from three different health professions education programs (medicine, nursing, physician assistant) completed two curricular tracks: a traditional roles and scopes of practice track and a new culinary medicine track. The new culinary medicine track involved students working in interdisciplinary teams with professional chefs from a local culinary arts school to cook and serve a meal to designated patient populations. Students were assessed in a variety of ways including attendance and participation, a twenty-item quiz (roles and scopes track), required reflective essays and completion of all assignments. The curriculum was evaluated based on student and faculty feedback. The implementation of the new culinary medicine program in an interprofessional format was well-received by students. Implications for future efforts along these lines are as follows: 1) similar programs may be scalable and easily accomplished; and 2) imbedding culinary medicine experiences within an existing IPE curricular framework may provide an opportunity to reinforce competencies related to teamwork and leadership while simultaneously increasing students’ knowledge of clinical nutrition.

The initial round of the Small Arms Seminar Series was convened at the United States Military Academy at West Point from September 11-13, 2012. The first gathering drew together a combination of technological consultants, subject matter experts, US Army officers, historians, and other interested parties to set the boundaries that would be in play in the future explorations in the long term development of small arms. The heart of the discussion was the examination of historical processes which had resulted in large-scale changes to the military art, discussions of the history of science, and several case studies of recent issues involving doctrine and development that might offer clues to the central tensions of the seminar. Specifically the seminar was seeking to define three areas of understanding: what is a revolution in small arms as opposed to an evolution?; what systemic factors must be considered in the pursuit of a revolution?; and finally, given such a definition and variables, is it feasible to pursue such a revolution? This report answers these questions and summarizes the results of the seminar.