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Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration. Students attend 14 sessions at one of 18 different clinical sites. They work directly with different health professionals from among 17 possible professions, including nurses, pharmacists, social workers, and respiratory, occupational, and physical therapists. Between 2015 and 2016, 167 students completed the course, and 81 completed the end-of-course evaluation. Students agreed or strongly agreed that ICE meaningfully contributed to their understanding of healthcare teams and different professional roles (86%), improved their understanding of healthcare systems (84%), improved their ability to communicate with healthcare professionals (61%), and improved their ability to work on interprofessional teams (65%). Select themes from narrative comments suggest that clinical immersion improves understanding of professional roles, helps students understand their own future roles in healthcare teams, and increases awareness of and respect for other professionals, with the potential to change future practice. ICE may be a template for other schools wishing to expand their current educational offerings, by engaging learners in more authentic, longitudinal clinical experiences with practicing healthcare professionals.

Background The lumbar puncture (LP) is a procedural competency deemed necessary by the Accreditation Council for Graduate Medical Education and the Emergency Medicine and Pediatric Residency Review Committees. The emergency department (ED) is a primary site for residents to be evaluated performing neonatal LPs. Current evaluation methods lack validity evidence as assessment tools. Objectives This was a pilot study to develop an objective structured assessment of technical skills for neonatal LP (OSATS-LP) and to document validity evidence for the instrument in regard to five sources of test validity: content, response process, relation to other variables, inter-rater reliability, and consequences of testing. Methods Pediatric residents were videotaped in the fall of 2011 for comparison of faculty evaluation of resident performance during a neonatal LP using a video-delayed format. Residents completed a demographic experience survey evaluating relations to other variables. Content and response process validity was obtained through expert panel meetings and resulted in the following seven domains of performance for the OSATS-LP: preparation, positioning, analgesia, needle insertion, cerebrospinal fluid (CSF) collection, management of laboratory studies, and sterility. t-tests assessed significance between level of training, previous intensive care unit experience, and residents' self-assessed confidence in comparison with their total performance score. The inter-rater agreement of the OSATS-LP was obtained using the Fleiss' kappa for each domain. Results Sixteen pediatric residents completed the simulation with six raters evaluating each resident (96 ratings). The domains of sterility and CSF collection had moderate statistical reliability (κ = 0.41 and 0.51, respectively). The domains of preparation, analgesia, and management of laboratories had substantial reliability (κ = 0.60, 0.62, and 0.62, respectively). The domains of positioning and needle insertion were less reliable (κ = 0.16 and 0.16, respectively). Individuals who had completed one or more rotations in the neonatal intensive care unit (NICU) had a higher total score (12.5 vs. 16.9; p

Background The eosinophilic response to clozapine is well described in the literature, causing a variety of responses, from serositis to colitis. However, there are not case reports describing a clozapine-induced marked eosinophilia resulting in multiorgan dysfunction. Case presentation In this case report, we describe a 24 year old Caucasian male who presented with severe systemic eosinophilia resulting in eosinophilic GI tract infiltration, myocarditis, pericardial and pleural effusions with dramatic improvement following drug withdrawal. Conclusions Clozapine associated eosinophilia should be suspected in the setting of eosinophilic infiltration of multiple organs.

Introduction This resource is a part of a six-module curriculum that uses TBL approaches to teach medical students clinical applications of general pediatric topics. This case is one of six used for third-year medical students during their pediatric clerkship at the University of Michigan during a weekly 2-hour time slot. The six pediatric modules cover topics of asthma, nutrition, fever, abdominal pain, anemia, and pneumonia. Methods This module is on pediatric asthma. Included are questions, answer keys, citations for reference articles, and descriptions of how to facilitate and evaluate a TBL exercise. A prior version of this module was previously published in MedEdPORTAL in 2010, but it has been revised in 2015 to reflect updated readings as well as to address student concerns that there were too many readiness questions and too few application questions. Results After implementation of TBL in our clerkship, National Board of Medical Examiners Pediatric Shelf examination scores improved by 3.04 points (from 79.46 to 82.50; p

This resource is a part of a six-module curriculum that uses TBL approaches to teach medical students clinical applications of general pediatric topics. This case is one of six used for third-year medical students during their pediatric clerkship at the University of Michigan during a weekly 2-hour time slot. The six pediatric modules cover topics of asthma, nutrition, fever, abdominal pain, anemia, and pneumonia. This module is on pediatric fever. Included are questions, answer keys, citations for reference articles, and descriptions of how to facilitate and evaluate the TBL exercise. A prior version of this module was previously published in MedEdPORTAL in 2010, but it has been revised in 2015 to reflect updated readings as well as to address student concerns that there were too many readiness questions and too few application questions. After implementation of TBL in our clerkship, National Board of Medical Examiners Pediatric Shelf examination scores improved as did students' scores on an emergency medicine rotation exam question on pediatric fever taken the subsequent academic year.

Background Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports. The rubric used the acronym SAFEST as a reminder to include 6 key elements:1. Staff involved in the incident.2. Actual event description.3. Follow-up initiated.4. Effect on patient.5. Standard of care described.6. To-do/suggestions for improvement. Objectives This study was designed to determine if the addition of this educational rubric into a standard quality improvement curriculum improves the consistency of information documented in patient safety reports as a subset of a larger quality improvement project aimed at improving safety reporting. Methods A team of faculty members analyzed individual resident error reports for adherence to the 6 tenets of the SAFEST mnemonic. Results From April to October of 2014, 2015, and 2016, a convenience sample of 131, 110, and 132 reports, respectively, were extracted and analyzed. For the rates of reporting "staff involved" and "standard of care," the differences over time were significant, both with P values < 0.001. After training, residents were 2.2 times more likely to report on the "staff involved" in the error and 1.8 times more likely to report the "standard of care." Discussion These results describe successful education on a rubric designed to improve the content of patient safety reports.

Introduction Being procedurally competent to perform a lumbar puncture (LP) is an ACGME requirement for both emergency medicine and pediatric residents. There are few assessment tools with validity evidence for lumbar puncture. An objective structured assessment of technical skills for neonatal lumbar puncture (OSATS-LP) was developed and validity evidence was obtained in four of five areas of validity: content, response process, relation to other variables, and interrater reliability. Methods The development of this tool was part of a prospective study comparing pediatric resident performance of neonatal lumbar puncture with direct observation by faculty. T tests assessed significance between level of training, and previous ICU experience in comparison to their total performance score. The interrater agreement of the OSATS-LP was obtained using the Fleiss' Kappa for each domain. Results Sixteen pediatric residents completed the simulation with six raters evaluating each resident (96 ratings). The domains of sterility and cerebral spinal fluid collection had moderate statistical reliability (k = 0.41 and 0.51, respectively). The domains of preparation, analgesia, and management of labs had substantial reliability (k = 0.60, 0.62, and 0.62, respectively). The domains of positioning and needle insertion were less reliable (k = 0.16 and 0.16, respectively). Residents who had performed more LPs correlated with higher total score (Pearson's Correlation coefficient = 0.5, p < .05). Individuals who had completed one or more rotations in the neonatal intensive care unit had a higher total score (12.5 vs. 16.9; p < .01). The OSATS-LP has reasonable evidence in four of the five sources for test validity. Discussion This study serves as a launching point for using this tool in clinical environments such as the emergency department, and therefore, has the potential to provide real time formative and summative feedback to improve resident skills and ultimately lead to improvements in patient care. There are limited number of assessment tools for LP with validity evidence. This tool has demonstrated validity evidence in content, response process, and interrater reliability. This tool was successfully piloted in fifteen pediatric residents and showed increased competence in five of the seven domains with increasing PGY level.