Enhancing point-of-care ultrasound (POCUS) utilization in primary care: A thyroid POCUS training course for internal medicine residents.

BACKGROUND: POCUS is valuable in primary care, yet outpatient-specific point-of-care ultrasound (POCUS) curriculum integration into internal medicine (IM) residency is limited. We addressed this gap by developing a thyroid POCUS workshop for IM residents. AIM: Develop and implement an educational curriculum to integrate thyroid POCUS into an IM residency program and evaluate the impact on resident knowledge, perceived skills, and attitudes. SETTING: The study was conducted in a resident primary care clinic at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Residency Program in Internal Medicine at North Shore University Hospital and Long Island Jewish Medical Center. PARTICIPANTS: All 108 IM residents (PGY1-3) in one program participated in the study during their ambulatory clinic block. PROGRAM DESCRIPTION: Residents participated in a 1-hour workshop involving a didactic session and two breakout groups: one for hands-on practice and another for case-based discussions with image review. PROGRAM EVALUATION: Residents completed pre- and post-session surveys assessing knowledge, perceived skills, and attitudes toward thyroid POCUS. These data showed statistically significant increases in all assessed areas. DISCUSSION: Integrating thyroid POCUS into an IM residency curriculum significantly improved resident knowledge, attitudes, and perceived skills related to these exams. Residents valued this learning experience and expressed intentions to incorporate it into their future practice.

Visual thinking strategies for interprofessional education and promoting collaborative competencies.

BACKGROUND: Interprofessional education (IPE) curricula require approaches that address the needs of learners from multiple professions and levels of clinical experience. Frameworks based in the arts and humanities, which can improve learners' skills in collaborative competencies such as communication and team building, remain limited in IPE. We describe the development, implementation and evaluation of a visual arts-based IPE session for over 400 interprofessional learners. APPROACH: During the 90-min session held in 2021, an art museum educator first guided learners through observations of art works using the Visual Thinking Strategies (VTS) approach. Subsequently, small groups of six to eight interprofessional learners and two trained facilitators explored how their observations were influenced by personal and professional identities and made connections to interprofessional collaborative practice. EVALUATION: Two hundred eleven of the 407 student attendees responded to the post-session survey (52%). Eighty percent of the respondents agreed or strongly agreed that 'the art of observation activity is an effective means of starting discussions with interprofessional teams.' On the Interprofessional Collaborative Competency Attainment Survey, a validated tool assessing changes in interprofessional collaboration-related competencies, there was a significant increase between pre- (M = 45.73, SD = 8.05, p < 0.001) and post-session scores (M = 51.46, SD = 7.97, p < 0.001), using a paired t-test analysis. Qualitative analysis of learners' takeaways identified themes of open-mindedness, hearing other opinions and perspectives, collaboration/teamwork, patient-centeredness and awareness of biases. IMPLICATIONS: Our curricular approach shows how integrating visual arts-based pedagogies into IPE activities with learners from diverse disciplines and clinical experiences is both feasible and helpful for developing collaborative competencies.

Career Plans of Internal Medicine Residents From 2019 to 2021.

This survey study examines career choices of internal medicine residents from 2019 to 2021 and compares them with findings from a decade earlier.

A Case for Case Reports: How to Write One and Promote Mentorship, Scholarship and Faculty Development.

Introduction Case reports form the base layer of the evidence pyramid, describing new or emerging diseases, side effects to treatments, common presentations of rare diseases, or rare presentations of common diseases. An important scholarly pursuit, writing case reports can be hindered by lack of time, training, and mentorship. Here, we describe a workshop incorporating case writing skills with mentorship opportunities to engage faculty and learners. Methods We designed and implemented a virtual, synchronous workshop addressing knowledge and attitudes on case reports for trainees and academic faculty at distributed sites. Participants discussed the contributions of case reports to the medical literature, key features of successful cases, approaches to writing learning objectives, and how to develop interesting cases into dynamic case reports. Case reports were discussed as a way to mentor learners to disseminate interesting cases as a source of clinical experience and academic productivity. A retrospective pre-post survey was collected two months after the workshop to evaluate its utility. Results Fifteen out of 42 participants responded to the survey. As a result of the workshop, respondents noted improvement in confidence in identifying and writing case reports and identifying and working with mentors or mentees, regardless of level of training or specialty. At the follow-up, seven (47%) respondents had identified a case and 10 (67%) had identified a mentor/mentee to write a case report with. Discussion This workshop, successfully delivered virtually, demonstrates the utility of a brief educational intervention in improving participant confidence in identifying and writing case reports with mentorship.

Interprofessional Precepting: A Nursing-Medicine Partnership.

Interprofessional precepting can advance team-based collaboration. We evaluated the impact of nurse-led precepting of medical students on perceptions of nurse-physician relationships. Forty-six frontline nurses precepted 73 third year medical students in New York for a three-part clinical and classroom experience. Nurse preceptor and medical student attitudes toward healthcare teams and medical student attitudes toward nurse-physician collaboration improved after participation using validated scales. This pilot study suggests nurse-led interprofessional precepting can improve attitudes toward interprofessional collaboration.

Reversible dementia in the setting of multiple medical comorbidities due to B12 deficiency.

Vitamin B12 deficiency is a cause of reversible dementia that must be ruled out in the evaluation of neurocognitive decline. We present a case of neurocognitive decline secondary to B12 deficiency where the workup was obscured by multiple competing diagnoses and treatment with empiric B12 supplementation reversed symptoms. Although the pretest probability was low, the morbidity from undiagnosed B12 deficiency is high, warranting a trial of B12 supplementation that resolved the patient's symptoms.

Food waste (mis)takes: The role of (mis)perception and (mis)estimation.

Food waste (mis)takes are implicated as drivers of global issues including climate change, food security, environmental sustainability, and international trade. In this article, we review recent research in this area and generate a novel conceptual organization through which we can understand the theoretical underpinnings of food waste. Our framework identifies consumer (mis)perception of food safety and (mis)estimation of food for consumption as the dominant mechanisms underlying food waste and specifies a set of psychological antecedents that activate these two theoretical drivers. This dynamic conceptual lens offers a framework through which researchers might categorize extant work, frame subsequent research aimed at understanding the drivers of food waste, and design solutions aimed at curbing it.

Expanding Knowledge and Changing Attitudes About Poverty: An Interactive, Interprofessional Approach.

BACKGROUND: Poverty negatively affects the lives and health of the poor. However, health professionals often have limited personal experience and receive little formal education on surviving under conditions of poverty in the United States, which may contribute to suboptimal patient care and outcomes. PURPOSE: We conducted a 3-h, interactive, experiential poverty simulation workshop with an interprofessional group of pre-professional health students to increase their comprehension about the realities of poverty. METHOD: As part of the evaluation, participants completed a self-assessment of their attitudes and skills using a Likert scale and open-ended questions; a reflection prompt about how the workshop might affect their professional practice; and a pre- and post-assessment questionnaire. DISCUSSION: Participants' attitudes about low-income patients became more favorable; they gained awareness and expressed empathy through the role-play experience. Our analysis revealed increased understanding of social determinants of health, of life challenges that patients face outside of healthcare, and that solutions must be collaborative as the challenges facing poor patients are multifactorial. CONCLUSION: The workshop allowed interprofessional students to learn from and with each other about the experiences of poor patients. Future sessions should emphasize interprofessional skill-building and action, potentially in virtual formats.

The Financial Cost of Interprofessional Ambulatory Training: What's the Bottom Line?

BACKGROUND: Team-based care is recommended as a building block of high-performing primary care but has not been widely adapted in training sites. Cost may be one barrier to a team-based approach. OBJECTIVE: We quantified incremental annual faculty and staff costs as well as potential cost savings associated with an interprofessional (IP) ambulatory training program compared to a traditional residency clinic at the same site. METHODS: Cost calculations for the 2017-2018 academic year were made using US Department of Labor median salaries by profession and divided by the number of residents trained per year. Cost implications of lower no-show rates were calculated by multiplying the difference in no-show rate by the number of scheduled appointments, and then by the weighted average of the reimbursement rate. RESULTS: A total of 1572 arrived appointments were seen by the 10 residents in the IP program compared with 8689 arrived appointments seen by 57 residents in the traditional clinic. The no-show rate was 11.5% (265 of 2311) in the IP program and 19.2% (2532 of 13 154) in the traditional clinic (P < .001). Total cost to the health system through higher staffing needs was $113,897, or $11,390 per trained resident. CONCLUSIONS: Total costs of the IP model due to higher faculty and staff to resident ratios totaled $11,390 per resident per year. Understanding the faculty and staff costs and potential cost-saving opportunities associated with transformation to an IP model may assist in sustainability.

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers.

OBJECTIVE: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers. DESIGN: Mixed-methods study with survey collection and semistructured interviews. SETTING: Multiple academic hospitals in New York. PARTICIPANTS: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. INTERVENTIONS: Introduction of IStop. MAIN OUTCOME MEASURE(S): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and comanagement) as reported by primary care providers for patients with chronic pain. RESULTS: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management comanagement with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and comanagement (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management. CONCLUSIONS: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

The serving temperature effect: Food temperature, expected satiety, and complementary food purchases.

We show that the temperature at which foods and beverages are served impacts consumers' complementary purchases, defined as additional foods and beverages purchased for a consumption episode. Across a series of studies, including field studies and controlled laboratory experiments, we show that consumers choose more complementary food items when they consume or intend to consume a food or beverage served cold rather than hot. This occurs because cold consumables are expected to be less satiating compared to hot consumables. Serving temperatures that increase complementary purchasing may enhance the firm's bottom line, but could add unnecessary calories to the meal, and thus is of interest to both consumers and managers.

Implementation of an Interprofessional Nutrition Workshop to Integrate Nutrition Education into a Preclinical Medical School Curriculum.

Objective: The patient-physician encounter provides an ideal opportunity to assess a patient's dietary history and its impact on total health. However, nutrition assessments and counseling in physician-patient encounters is often lacking. Insufficient nutrition education during medical school may lead to insecurity in assessing and counseling patients.Methods: Physicians and registered dietitians (RD) co-developed and co-facilitated a nutrition workshop for first-year medical students. Goals included increasing recognition of nutrition's impact on health and promoting student confidence and skills when attaining a nutrition history, assessing risk factors, and advising.Results: Seventy percent of students attested to having "sufficient" knowledge to counsel a patient on nutrition after the session compared to 38% before (Z= -4.46, p < 0.001). Sixty eight percent felt comfortable completing a nutritional assessment after the session compared to 35% before (Z= -4.30, p < 0.001). Sixty-three percent felt confident in advising patients about nutrition after the session compared to 32% before (Z= -4.20, p < 0.001). Students also significantly outperformed a control cohort on a nutrition-related component of an Objective Standardized Clinical Examination.Conclusions: Clinical nutrition education can be successfully integrated into the medical school curriculum as early as the first year. Interprofessional collaboration with RDs provided evidence-based content and authentic clinical experience in both the development of the workshop and in facilitating student discussion.

A novel longitudinal interprofessional ambulatory training practice: the improving patient access care and cost through training (IMPACcT) clinic.

Few graduating health professionals choose primary care. Trainees satisfied with continuity ambulatory experiences are more likely to pursue primary care. The authors developed a longitudinal interprofessional ambulatory training program to improve team-based care and encourage primary care careers. The Improving Patient Access Care and cost through Training (IMPACcT) clinic, launched in 2016, includes physician, physician assistant, pharmacy, and psychology trainees. Residents, faculty, and interprofessional trainees complete "on-service" weeks together. Co-located administrative team members coordinate care and lead team "huddles." Interprofessional signout facilitates patient follow-up. The initial evaluation included process and quality indicators compared to the traditional resident practice. Learners reported increased perceived competence in interprofessional communication and teamwork after completing their training. Clinical quality outcomes suggested improved provider continuity and arrival rate compared to traditional resident practice (56.5% vs. 32.9%; 66.3% vs. 62.2%, p < .01). Patient satisfaction was higher in the IMPACcT clinic in the areas of coordinated care and team functioning. Ten of eighteen physician graduates in the program chose further training in primary care compared to 20 of 150 graduates not in the program (55.6% vs. 13.3%, p < .01). Implementing a longitudinal team-based ambulatory interprofessional training practice was associated with improved continuity of care and improved patient satisfaction indicators.

Access and Continuity: A Multidisciplinary Education Workshop to Teach Patient-Centered Medical Home (PCMH) Principles.

Introduction: As more practices move to patient-centered medical home (PCMH) models, future health care professionals must train to work in collaborative settings. We implemented a 3-hour workshop for multidisciplinary trainees on the PCMH principles of access and continuity based on the EFECT framework (eliciting a patient-centered narrative, facilitating an interprofessional team discussion, evaluating the clinical evidence, creating a shared care plan, and tracking outcomes). Methods: Participants included internal medicine residents and medical, physician assistant (PA), and clinical psychology students. The workshop incorporated reflective activities identifying patient and provider health care delivery priorities, plus a PCMH presentation and group activities focusing on access and continuity. Evaluations were analyzed qualitatively and quantitatively. Results: The workshop had 39 participants (seven physicians, one PA, one educator, one psychologist, three staff, nine residents, one PA student, one psychology extern, and 15 medical students). On a 0-10 Likert scale (0 = don't agree at all, 10 = completely agree), learners reported higher knowledge of PCMH principles (M = 8.8), feeling better prepared for PCMH work (M = 8.6), and having obtained real-world skills (M = 8.3). Open-ended responses describing the workshop's take-home message included the role of patient-centeredness in clinical redesign, the value of the multidisciplinary team in optimizing access and continuity, and how to use a quality improvement approach for access and continuity. Discussion: This workshop increased PCMH-related knowledge and encouraged discussion of professional roles within the team. Learners recognized the benefits of team-based rather than provider-centric approaches to access and continuity.

Contract Negotiation Skills: A Workshop for Women in Medicine.

Introduction: Contract negotiation is a high-stakes interaction, yet most physicians are never taught negotiation skills. Studies suggest that women, as compared with men, display a lower propensity to initiate negotiations and negotiate less competitively, highlighting a need for training to help level the playing field for female physicians. Methods: We devised a learner-centered workshop for female physicians that included a mini-didactic on negotiation principles, a question-and-answer time with a lawyer, an interactive role-play on contract negotiation style, and guided reflection. The workshop was intended for women in medicine from the level of medical student to full professor. The workshop was evaluated by pre- and postworkshop surveys with quantitative questions assessing perceived comfort with and knowledge of negotiation skills and strategies, as well as qualitative questions assessing lessons learned and areas for improvement. Results: After the workshop, participants (n = 34) reported significantly improved comfort with contract negotiation (p < .01) and with negotiation skills and strategies (p < .01). Through qualitative evaluation, we discovered that participants gained an appreciation for the self-advocacy in negotiation, as well as a better understanding of negotiation logistics. We also received positive feedback from participant comments, with most learners reporting that the topic was useful and worthwhile. Discussion: We believe that this workshop fills a gap in the literature regarding contract negotiation training for physicians while also helping to level the playing field with regard to female physicians and the gender pay gap.

An interprofessional experience in diabetes management for pharmacy and medical students.

BACKGROUND AND PURPOSE: The 2016 Standards of the Accreditation Council for Pharmacy Education state that curricula must include opportunities for interprofessional education (IPE). This report describes a collaborative effort between a pharmacy program and a school of medicine to develop, implement, and evaluate an interprofessional workshop focused on collaborative disease management. EDUCATIONAL ACTIVITY AND SETTING: A medical school course in diabetes management was identified as optimal for an IPE approach. One class session was designed to highlight the advantages of team-based care in diabetes management and describe the roles of members of an interprofessional healthcare team. Students were divided into groups to discuss cases and demonstrate diabetic device counseling. Students were surveyed before and after the IPE experience to examine their attitudes towards interprofessional learning. FINDINGS: We obtained matched pre and post-evaluations from 168 participants (138 medical students and 30 pharmacy students). Learner attitudes were positive overall, and improved from pre-test (M = 80.28, SD = 10.29) to post-test (M = 82.83, SD = 9.40, F = 14.92, df = 1, p < .001), suggesting more favorable attitudes to interprofessional learning after completing the class. Multivariate analysis indicated a significant main effect for learner profession, suggesting pharmacy students had more positive attitudes to interprofessinal learning both before and after the workshop. SUMMARY: Adding an IPE dimension to an existing medical school course had a positive impact on student perceptions of interprofessional practice, particularly for the pharmacy students who could demonstrate the value of their role on a team for patient care.

Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic.

BACKGROUND: Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. OBJECTIVE: We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. METHODS: This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. RESULTS: During the study period, mean resident continuity was 23% (range 13%-37%) in the comparison clinic (57 residents) and 54% (range 38%-66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P < .001 for all comparisons). CONCLUSIONS: Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.