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Purpose: Longitudinal patient-partnered experiences may promote medical student empathy, but evaluation of such programs is limited. The aim of this study was to compare areas of learning among first-year medical students randomized to a patient-centered track (PCT) or traditional track (TT) longitudinal clinical experience. Methods: PCT students (n = 24) were paired with 2 patients and a physician to participate in their patients’ care across multiple settings. TT students (n = 56) were paired with a physician preceptor and participated in caring for a variety of patients in a single setting. This qualitative study used a phenomenological approach to template analysis, examining and comparing student reflective essays for areas of learning. Results: Three domains of learning emerged: 1) Focus of learning (biomedical, patient-centered); 2) Roles and relationships (clinical skills, relationship-building, teaching from preceptor and patients); and 3) Context of care (health systems science, interprofessional care). PCT students described patient-centered learning, relationship-building, and patients’ role as teachers. In contrast, TT students emphasized biomedical learning, clinical skills development, and teaching from physician preceptors. Conclusions: Longitudinal patient-partnered clinical experiences provide rich opportunities for preclinical students to cultivate empathy and develop patient-centered values.

Introduction: Emergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE). Methods: We conducted a cross-sectional study between June–August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors during ED care. Survey questions addressed two major themes in quality of care: staff preparedness to provide trauma-response care; and available resources. Staff preparedness to provide trauma-informed care was assessed through observations of staff behaviors. We used Wilcoxon rank-sum and Kruskal-Wallis tests to analyze differences in responses according to geographic regions and SANE presence. Results: A total of 315 advocates from 99 crisis centers completed the survey. The survey had a participation rate of 88.7% and a completion rate of 87.9%. Advocates who indicated that a higher proportion of their cases were attended by SANEs were more likely to report higher rates of trauma-informed staff behaviors. For example, the recalled rate of staff asking patients for consent at every step of the exam was significantly associated with SANE presence (P < 0.001). With respect to access to resources, 66.7% of advocates reported that hospitals often or always have evidence collection kits available; 30.6% reported that resources such as transportation and housing are often or always available, and 55.3% reported that SANEs are often or always part of the care team. The SANEs were reported to be more frequently available in the Southwest than in other US regions (P < 0.001) and in urban as opposed to rural areas (P < 0.001). Conclusion: Our study indicates that support from sexual assault nurse examiners is highly associated with trauma-informed staff behaviors and comprehensive resources. Urban-rural and regional disparities exist regarding access to SANEs, suggesting that elevating nationwide quality and equity in care of survivors of sexual assault requires increased investments in SANE training and coverage.

Introduction Opioid overdose education and naloxone distribution (OEND) for use by laypersons are safe and effective at preventing deaths from opioid overdose, but emergency department (ED) implementation is challenging. Curricula addressing OEND could enable students to serve in value-added roles on the clinical team, overcome challenges of naloxone distribution, and improve patient care. Methods We created a 1-hour didactic session on opioid use disorder and OEND for first-year medical students in the emergency medicine elective. During two clinical shifts, students used this knowledge to perform screenings to identify patients at high risk of overdose. If a patient screened positive, students performed patient education and then notified the physician, who ordered a naloxone kit. Results Thirty students received the didactic and conducted screening shifts. Of 147 patients screened, 40% (n = 59) were positive for naloxone eligibility, 21% (n = 31) reported that someone close to them used opioids, 18% (n = 26) had witnessed an opioid overdose, 12% (n = 17) had previously overdosed themselves, and 12% (n = 18) previously knew what naloxone was. Fifty-nine naloxone kits were distributed over the 3-month pilot versus 13 naloxone prescriptions for patients discharged from the ED the prior year. Discussion Through didactic training and structured patient engagement, medical students gained knowledge of and hands-on experience with addiction medicine, discussed sensitive topics with patients, and identified a high volume of patients eligible to receive naloxone. Medical student screening for OEND in ED patients is feasible and adds significant value to the clinical team.

Introduction: An important area of communication in healthcare is the consultation. Existing literature suggests that formal training in consultation communication is lacking. We aimed to conduct a targeted needs assessment of third-year students on their experience calling consultations, and based on these results, develop, pilot, and evaluate the effectiveness of a consultation curriculum for different learner levels that can be implemented as a longitudinal curriculum. Methods: Baseline needs assessment data were gathered using a survey completed by third-year students at the conclusion of the clinical clerkships. The survey assessed students’ knowledge of the standardized consultation, experience and comfort calling consultations, and previous instruction received on consultation communication. Implementation of the consultation curriculum began the following academic year. Second-year students were introduced to Kessler’s 5 Cs consultation model through a didactic session consisting of a lecture, viewing of “trigger” videos illustrating standardized and informal consults, followed by reflection and discussion. Curriculum effectiveness was assessed through pre- and post- curriculum surveys that assessed knowledge of and comfort with the consultation process. Fourth-year students participated in a consultation curriculum that provided instruction on the 5 Cs model and allowed for continued practice of consultation skills through simulation during the Emergency Medicine clerkship. Proficiency in consult communication in this cohort was assessed using two assessment tools, the Global Rating Scale and the 5 Cs Checklist. Results: The targeted needs assessment of third-year students indicated that 93% of students have called a consultation during their clerkships, but only 24% received feedback. Post-curriculum, second-year students identified more components of the 5 Cs model (4.04 vs. 4.81, p

Abstract Introduction Trainees from the millennial generation are adopting technology at a faster rate than their senior counterparts. Technology adoption in health care is also being fueled by national policies such as the sharp rise in electronic medical record (EMR) use after President Obama's 2009 health care stimulus package. Nonetheless, there is very little curricular focus addressing patient-centered use of technology. Abraham Verghese has drawn attention to the unfortunate practice of focusing on the “iPatient,” who exists only on the computer screen as a set of data points, while ignoring the real patient. Methods Our resource provides a framework for educators to teach learners of various levels (students, residents, fellows, and attendings) how technology use (e.g., EMRs and tablet computers) can affect patient-doctor communication in both the inpatient and outpatient settings. The resource includes a PowerPoint lecture on patient-centered EMR use and best practices; two teaching videos of a less-than-ideal and a more-ideal patient-provider interaction, along with an accompanying worksheet; pocket cards to summarize best practices for patient-centered technology use in both outpatient and inpatient settings; resource files for implementing the patient-centered EMR-use objective structured clinical exam (OSCE), including iPaCT Curriculum; overview and description, standardized patient (SP) guide, and door chart for active experimentation; and an e-CEX evaluation tool for use during the OSCE as well as for direct observation. The lecture, OSCE, and feedback take about 90 minutes. Results We implemented this patient-centered EMR-use curriculum with second-year students at the University of Chicago Pritzker School of Medicine. To date, we have results only for our second-year students, with our third-years (who did not receive the lecture but did participate in the same OSCE and evaluation) as a comparison controls. For these two groups, we demonstrated statistically significant improvement in SP evaluation OSCE performance scores of second-years who received this curriculum as compared to third-years who did not. We also demonstrated statistically significant improvement on second-year scores on a post-OSCE survey assessing self-perceived knowledge, attitude, and skills. Discussion We first started our curriculum in 2013 with second-year students, but we have since expanded it to internal medicine residents and will be also including faculty (of various disciplines). The curriculum can help train learners of all levels to promote and maintain patient-centered care in the context of EMR use. Furthermore, the e-CEX evaluation tool can help programs monitor the quality of patient-centered technology use and identify areas for improvement.

Abstract Introduction When patient care is handed off to covering residents who may not have prior knowledge of patients, it is critical to ensure a properly created and well-maintained written signout document. The UPDATED resource was created to evaluate the quality of written signouts used by residents to augment patient handoffs in accordance with internal medicine milestones put forth by the ACGME. The UPDATED audit tool can be used to evaluate milestone-specific performance in a manner that can provide timely summative and formative feedback as well as promote resident reflection on performance and facilitate transfer of knowledge into clinical practice. The intended examinee audience for the audit tool is PGY-1 resident trainees who are rotating on inpatient ward rotations in internal medicine. This population was selected because PGY1 residents are the most common senders and receivers of patient handoffs, and they are typically responsible for completing the signout documents that accompany those handoffs. Methods The UPDATED tool assesses skills inherent the in the internal medicine EPA #8 (i.e., manage transitions of care). Several ACGME internal medicine milestones are addressed within this EPA, including ensuring appropriate and accurate documentation, appropriate synthesis and definition of clinical problems, and effective communication during transitions of care. The tool incorporates a points system to create an overall signout score, which is used to reflect overall achievement of competence. This resource includes a slide set to educate residents on the UPDATED criteria as well as a facilitator guide for instructors using the slide set. This resource also includes the paper-based UPDATED tool, and an auditor training guide. Results From April through July 2011, workshops to introduce the tool were held at three Chicago area teaching hospitals for a total of 130 participants (62% senior medical students, 38% internal medicine and family medicine residents). Participants felt more confident in creating a written signout (95%), and reported that auditing a written signout was helpful (93%). Many also thought the UPDATED framework was helpful (85%). After the workshop, almost all learners reported a commitment to change their practice. Learners described the workshop as “very practical” and felt “able to implement skills learned without much difficulty.” At one institution (The University of Chicago), the UPDATED audit tool was successfully piloted in academic year 2012-2013 as a formal assessment of signouts done by all 45 internal medicine interns on noncritical care internal medicine ward rotations. The workshop was associated with a significant improvement in actual signout quality in that only 13% of signouts audited received “good” scores prior to implementation compared to 73% receiving “good” scores following implementation (p < 0.001). Discussion Our experience during the pilot period of 2012-2013 demonstrated that the UPDATED tool is a feasible and effective way for residency programs to address resident achievement of competency in ACGME milestones related to handoffs. The tool was easy to use and required minimal training for auditors unfamiliar with it. This tool is easily adaptable to outside institutions seeking milestones-based tools for assessing signout communication skills.

Frailty is a predictor of poor outcomes following many types of operations. We measured thoracic surgeons' accuracy in assessing patient frailty using videos of standardized patients demonstrating signs of physical frailty. We compared their performance to that of geriatrics specialists.We developed an anchored scale for rating degree of frailty. Reference categories were assigned to 31 videos of standardized patients trained to exhibit five levels of activity ranging from "vigorous" to "frail." Following an explanation of frailty, thoracic surgeons and geriatrics specialists rated the videos. We evaluated inter-rater agreement and tested differences between ratings and reference categories. The influences of clinical specialty, clinical experience, and self-rated expertise were examined.Inter-rater rank correlation among all participants was high (Kendall's W 0.85) whereas exact agreement (Fleiss' kappa) was only moderate (0.47). Better inter-rater agreement was demonstrated for videos exhibiting extremes of behavior. Exact agreement was better for thoracic surgeons (n = 32) than geriatrics specialists (n = 9; p = 0.045), whereas rank correlation was similar for both groups. More clinical years of experience and self-reported expertise were not associated with better inter-rater agreement.Videos of standardized patients exhibiting varying degrees of frailty are rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.

Abstract   Background: Mutations in the tumor suppressor gene p53 are associated with neoplasia in ulcerative colitis, but little is understood of their significance in Crohn’s disease (CD). Purpose: To explore p53 expression as a marker of neoplasia in CD patients. Methods: This is a retrospective review of CD patients who underwent p53 IHC staining in our center between 1995 and 2003. The p53 status was correlated to the presence and grade of neoplasia at the time of staining and in subsequent follow-up. Results: Fourteen CD patients had p53 assessment: eight were p53 positive and six were p53 negative. Seven of eight p53 had dysplasia (six LGD, one HGD); one of six p53−had dysplasia (LGD) (P = 0.03). Four p53 patients with follow-up had persistent dysplasia and two had progression to a higher grade. Three p53− patients with follow-up remained free of dysplasia. Conclusions: This limited study shows that p53 over expression in CD patients is associated with dysplasia that may progress to a higher grade of neoplasia over time. [ABSTRACT FROM AUTHOR]