A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities.

INTRODUCTION: Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS: An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS: Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION: This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.

Combating ageism in medical education with narrative medicine.

Ageism is common in medical trainees and difficult to overcome. The My Life, My Story program has been shown to be an effective tool for increasing empathy. We explored its use as an instrument for combating ageism by implementing it in a Geriatrics clerkship for fourth year medical students. During our evaluation, 151 students interviewed patients about their lives using a semi-structured question guide. Students completed the UCLA Geriatrics Attitudes Scale and the Expectations Regarding Aging Survey pre-and post-clerkship. We also facilitated 9 student debriefs and 5 faculty interviews. After completing My Life, My Story, students were more likely to disagree with "I would rather see younger patients than elderly ones" and "it's normal to be depressed when you are old". In qualitative analysis of the debriefs, we identified a key summative theme: "impact of the intervention on care teams". Within that, we describe three subthemes: an awareness of richness of the lives led by older people, their current value to society, and the social determinants of health they have faced. After participating in My Life, My Story, students' attitudes toward aging changed. A narrative medicine program using life stories can be a practical tool for addressing ageist stereotypes.

More specific feedback: why "confidence" in feedback is too ambiguous.

High quality feedback should be delivered in a timely manner, based on specific direct observation, and formulated to be actionable on the part of the trainee. Utilizing "confidence" as a point of feedback does not meet these criteria given the ambiguity and lack of actionable steps towards improvement. "Confidence"-based feedback makes a judgment about the trainee's internal state leading to potentially gender or culturally biased feedback. There is a risk of emotional harm for trainees when it is integrated into feedback and it is unclear if there is a role for the use of "confidence" in medical education. We are calling for a moratorium on the utilization of the word "confidence" in feedback in medical education until further studies are performed to assess its potential place. At this time, educators should refrain from "confidence"-based feedback and shift the focus towards more specific, actionable, behavioral-based feedback.

Evaluating a Video-Based Addiction Curriculum at a Safety Net Academic Medical Center.

BACKGROUND: Since 2019, the United States (US) has witnessed an unprecedented increase in drug overdose and alcohol-related deaths. Despite this rise in morbidity and mortality, treatment rates for substance use disorder remain inadequate. Insufficient training in addiction along with a dearth of addiction providers are key barriers to addressing the current addiction epidemic. Addiction-related clinical experiences can improve trainee knowledge, yet they remain dependent on practice sites and residency training environments. Asynchronous learning, in the form of video-based modules, may serve as a complement to formal, scheduled lectures and clinical experiences. OBJECTIVES: To evaluate the educational impact of a video-based addiction curriculum in 2 residency programs at a large safety net academic medical center with a high volume of patients with substance use disorders. METHODS: Family Medicine (FM) and Internal Medicine (IM) residency interns (PGY1s) (n = 60) had access to 28 minutes of video content related to opioid use disorder (OUD) and alcohol use disorder (AUD) during the first 2 months of their residency training. Interns were asked to complete voluntary and anonymized pre- and post-surveys in Qualtrics that included knowledge and confidence-based questions about the management of OUD and AUD, in addition to questions about prior exposure to and future interests in addiction training and practice. Data were analyzed with non-parametric sign tests. RESULTS: Twenty-eight interns completed both OUD pre- and post-surveys, and 24 interns completed all AUD survey questions. There was a statistically significant increase in the number of interns who reported increased knowledge of and confidence around diagnosis, management, and ability to provide evidence-based treatment recommendations for both OUD and AUD. CONCLUSIONS: Brief addiction focused video-modules can improve confidence and knowledge in managing OUD and AUD among medical trainees.

Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling.

Clinician bias negatively impacts the healthcare received by marginalized communities. In this study, we explored factors that influence clinician and trainee bias against individuals with intellectual disabilities and its impact on clinical judgment in prenatal genetic testing settings. Specifically, we examined bias toward a fetus with a higher chance of developing a disability. We compared genetics specialists with their non-expert counterparts. This web-based study included clinical vignettes, implicit association tests (IATs), and an educational module. 595 participants were recruited via their institution or professional society. We conducted statistical analyses, including regression models controlling for key demographic characteristics, to analyze recommendation patterns and degree of change after the module. Genetics expertise strongly correlated with appropriate testing recommendation when the patient would not consider pregnancy termination (r = 1.784 pre-module, r = 1.502 post-module, p < 0.01). Factors that influenced pre-module recommendation to test include increased age (r = -0.029, p < 0.05), high religiosity (r = 0.525, p < 0.05), and participant personal preference against testing (r = 1.112, p < 0.01). Responses among participants without genetics expertise improved after the educational module (Z = -4.435, p < 0.01). 42% of non-experts who answered inappropriately changed their answer to match guidelines after the module. Individual bias, along with structural and institutional bias, permeates family planning encounters and significantly decreases quality of care. We demonstrate here that anti-bias training is effective, particularly for non-expert providers, and it can improve the care provided to individuals with intellectual disability. Evidence-based training such as this one can help providers make appropriate genetic counseling recommendations.

Inequities in the care of older adults: Identifying education gaps in geriatric medicine fellowship.

The past year amplified inequities in the care of older adults. Milestones focused on social determinants of health (SDOH) are lacking within Geriatric fellowship training. A virtual learning collaborative GERIAtrics Fellows Learning Online And Together (GERI-A-FLOAT) was developed to connect trainees nationwide. To address gaps in education around SDOH, a needs assessment was conducted to inform a curricular thread. A voluntary, anonymous survey was distributed to fellows through a broad network. We sought to understand prior curricula trainees had that were specifically focused on SDOH and older adults. Respondents prioritized topic areas for the curriculum. Seventy-five respondents completed the survey. More than 50% of participants indicated no training on homelessness, immigration, racism, or LGBTQ+ health at any level of medical training, with more than 70% having no training in sexism or care of formerly incarcerated older adults. The most commonly taught concepts were ableism, ageism, and poverty. Respondents prioritized the topic of racism, ageism, and ableism. There is a lack of consistent SDOH curricula pertaining to older adults across all levels of training. This needs assessment is guiding a curricular thread for GERI-A-FLOAT and ideally larger milestones for fellowships. The time is now to prepare future geriatricians to serve as change agents.

Safety and Tolerability of 23.4% Hypertonic Saline Administered Over 2 to 5 Minutes for the Treatment of Cerebral Herniation and Intracranial Pressure Elevation.

BACKGROUND: Hyperosmolar therapy is the cornerstone of medical management of sustained elevated intracranial pressure from cerebral edema. Acute intracranial hypertension and herniation is a medical emergency that requires rapid treatment and stabilization to prevent secondary brain injury or death. Intravenous hypertonic sodium chloride (NaCl) 23.4% is an effective treatment modality commonly used in this setting. Because of its high osmolarity, use has historically been limited primarily to central venous line administration as an intermittent infusion due to concerns about thrombophlebitis, injection site pain, and tissue necrosis or injury with extravasation. The objective of this analysis was to prospectively evaluate the safety of administration of 23.4% NaCl as a rapid intravenous push over 2-5 min. METHODS: A prospective analysis of patients admitted between April 2021 and December 2021 who received 23.4% NaCl intravenous push over 2-5 min in a central or peripheral line was performed. Safety end points included incidence of new onset hypotension [defined as systolic blood pressure (SBP) < 90 mm Hg or SBP decrease of at least 20 mm Hg], bradycardia (defined as heart rate < 50 beats per minute), and infusion site reactions documented within 1 h of administration. For secondary safety outcomes, highest and lowest SBP and lowest heart rates documented within 1 h before 23.4% NaCl administration were compared with values collected within 1 h post administration and evaluated by mixed-design analysis of variance test with adjustment for peripheral versus central line administration. RESULTS: We identified 32 patients who received 79 administrations of 23.4% NaCl through a central line or peripheral line during the study period. An SBP decrease of at least 20 mm Hg was observed in 13% of patients, an SBP < 90 mm Hg occurred in 16% of patients, and bradycardia occurred in 3% of patients who received 23.4% NaCl. Injection site pain was reported by one patient without documented thrombophlebitis, cellulitis, or tissue damage. Pain was not reported during two subsequent administrations in the same patient. There was no documented occurrence of soft tissue injury or necrosis in any patient. Compared with baseline vital signs before 23.4% NaCl administration, no difference in vital signs post administration was observed. CONCLUSIONS: Central and peripheral administration of 23.4% NaCl over 2-5 min was well tolerated, and incidence of hypotension, bradycardia, or infusion site-related adverse events was rare.

An Opportunity for Improvement: Evaluation of Diabetes Technology Education Among Adult Endocrinology Training Programs.

BACKGROUND: Despite increases in continuous glucose monitor (CGM) and insulin pump use in adults with diabetes, there is room for expansion. Technology adoption may be influenced by the training environment and fellowship education. However, little is known about adult endocrinology trainee comfort with, understanding of, or methods by which trainees receive education about diabetes technology. METHODS: Mixed methods, sequential explanatory evaluation using survey and semi-structured interviews of endocrinology trainees and fellowship leadership in Accreditation Council for Graduate Medical Education (ACGME)-accredited adult endocrinology fellowship programs to assess trainee and leadership comfort with, perceived knowledge of, and current methods for diabetes technology education. RESULTS: Seventy-seven respondents completed the survey. The majority of training programs have curricula for training on insulin pumps (74%) and CGM (75.3%); 52% of fellows felt curricula are adequate. First- and second-year fellows were more comfortable with CGM than insulin pump use. Only half of third-year fellows felt comfortable with starting insulin pump therapy or recommending insulin dose adjustments based on CGM rate of change arrows. Qualitative interviews identified the importance of both direct instruction and experiential learning in diabetes technology education. CONCLUSIONS: Almost half of trainees feel that curricula for learning to use and manage insulin pumps and CGM are inadequate and feel uncomfortable with critical aspects of technology use, demonstrating the need for increased attention to trainee education in the use of diabetes technology. Based on a better understanding of current and preferred methods for instruction, this study provides direction for future development of initiatives to improve fellow education in this field.

An innovative clinic model for student learning.

BACKGROUND: Ambulatory rotations are a key part of medical student education, but there are few educational initiatives aimed to improve student experience. APPROACH: This initiative implemented a new model for an urgent care clinic, based on Erickson's framework for learning, designed to provide students with more autonomy, and more time for teaching, discussion, feedback and patient encounters. Participants were fourth year medical students in their ambulatory rotation who were randomly assigned to participate in the urgent care clinic. Students were asked to respond to a survey at the end of the rotation. EVALUATION: A total of 59 fourth-year medical students participated in the ambulatory care rotation, of which 40 students responded to the survey. Students who participated in the urgent care clinic reported more autonomy, feedback, learning and time to see patients. They were happier overall with their experience and felt more prepared for their intern year of residency. IMPLICATIONS: Our intervention was able to achieve our goals of improving student satisfaction in their ambulatory experience at our institution. This model could be used to design a more effective teaching experience for medical students in other rotations at our institution, as well as at other institutions.

Gender and Sexual Diverse Health Education: A Needs Assessment Among Internal Medicine Residents.

Purpose: The purpose of this study was to assess perception of competency and comfort level of internal medicine (IM) residents in caring for gender and sexual diverse (GSD) patients, and to identify residents' preferred educational modalities and perceived facilitators and barriers to GSD curriculum implementation. Methods: A survey was distributed among IM residents during a mandatory didactic session between November 9 and December 18, 2020. Categorical variables were analyzed using Fisher's exact test. Open-ended questions were analyzed using content and theme analysis. Results: Of 138 residents, 89 (64%) completed the survey. Residents had varying levels of comfort and perceived competence. Small group (n = 61, 69%) and case-based learning (n = 58, 66%) formats were preferred. Content and theme analysis resulted in four major themes on facilitators and three major themes on barriers to GSD curricular implementation. Conclusion: This study provides unique insight to facilitate implementation of a learner-centered and developmentally appropriate curricular approach to GSD health education.

An Interactive Workshop on Managing Dysphagia in Older Adults With Dementia.

Introduction: Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles. Methods: We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids. Results: The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia. Discussion: Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.

"Getting Started": A Pilot Introductory Narrative Writing Session for Interprofessional Faculty in Academic Health Sciences.

Purpose: We designed and implemented a pilot introductory narrative writing session with the two-fold goal of fostering the dissemination of faculty writing for submission to peer-reviewed journals and other publication venues while simultaneously creating a framework for establishing collaborative and empathic interprofessional teams by enhancing narrative-related competencies. Methods: The session was open to interprofessional faculty at our academic health sciences center. Participants were accepted via a competitive application process, with group size limited to 18 individuals due to the workshop-style format. Learners were reflective of our diverse campus regarding sex, race/ethnicity, department, rank, and professional role. The session began with an experiential seminar providing instruction on writing theory and practice, discussion questions, and reflective writing prompts. The seminar was followed by a writing workshop. We conducted a mixed-methods evaluation to gauge participant satisfaction and educational efficacy. Results: The mixed-methods evaluation revealed that faculty reported high satisfaction with the session as a designated space to contemplate, discuss, practice, share, and critique narrative writing. All learners (18, 100%) rated it "very good" or "excellent" in overall quality and value as well as in relevance to personal growth. Participants reported growth in communication (13, 72%), self-reflection (12, 67%), active listening (12, 67%), writing confidence (11, 61%), perspective-taking (11, 61%), writing skills (10, 56%), and empathy (8, 44%). Discussion: Faculty valued the session as a venue for improving their writing skills and sharing with a diverse group of colleagues about the significance of narrative in relation to their professional lives. Conclusion: Seminar outcomes suggest that narrative-based education for interprofessional health sciences faculty can be effective in achieving the two-fold goal of enhancing writing competencies while simultaneously fostering essential skills for building collaborative and empathic teams to promote high-quality education, research, and whole person clinical care.

Physician trainees' compassion satisfaction, burnout, and self-efficacy when caring for people who inject drugs.

Background: Front-line providers working with people who inject drugs (PWID) are at increased risk of experiencing burnout. Few studies have examined protective factors against burnout incurred in the care of PWID, including harm reduction counseling skills. We measured self-efficacy in harm reduction counseling, burnout, and compassion satisfaction among Internal Medicine (IM) trainees caring for PWID. Methods: In this cross-sectional study, we surveyed IM interns and residents. Self-efficacy was assessed by asking trainees about attitudes, comfort, and knowledge in harm reduction counseling on a five-point Likert scale. Burnout and compassion satisfaction were assessed via an adapted 20-question Professional Quality of Life Scale. We compared self-efficacy in harm reduction counseling, compassion satisfaction, and burnout between interns and residents using ANOVA and Mann-Whitney U tests. We used Spearman's rho correlational analysis to examine the relationship between these three variables. Results: Seventy-nine IM trainees (36 interns, 43 residents) completed the survey for a 52% response rate. Residents reported higher self-efficacy in harm reduction counseling, similar levels of burnout, and higher compassion satisfaction compared to interns. Across training levels, we found a negative correlation between burnout and compassion satisfaction (r = -0.55, p < 0.01) and a positive correlation between compassion satisfaction and comfort counseling PWID on harm reduction (r = 0.30, p < 0.01). Conclusions: Among IM trainees at an urban institution serving a large population of PWID, self-efficacy in harm reduction counseling and compassion satisfaction increase with time in training while burnout remains similar. Strengthening trainees' capacity to counsel PWID on harm reduction may improve their compassion satisfaction in caring for this population, potentially leading to improved care. This relationship should be explored longitudinally in larger cohorts and through evaluations of harm reduction-focused medical education.

Network Inference of Transcriptional Regulation in Germinating Low Phytic Acid Soybean Seeds.

The low phytic acid (lpa) trait in soybeans can be conferred by loss-of-function mutations in genes encoding myo-inositol phosphate synthase and two epistatically interacting genes encoding multidrug-resistance protein ATP-binding cassette (ABC) transporters. However, perturbations in phytic acid biosynthesis are associated with poor seed vigor. Since the benefits of the lpa trait, in terms of end-use quality and sustainability, far outweigh the negatives associated with poor seed performance, a fuller understanding of the molecular basis behind the negatives will assist crop breeders and engineers in producing variates with lpa and better germination rate. The gene regulatory network (GRN) for developing low and normal phytic acid soybean seeds was previously constructed, with genes modulating a variety of processes pertinent to phytic acid metabolism and seed viability being identified. In this study, a comparative time series analysis of low and normal phytic acid soybeans was carried out to investigate the transcriptional regulatory elements governing the transitional dynamics from dry seed to germinated seed. GRNs were reverse engineered from time series transcriptomic data of three distinct genotypic subsets composed of lpa soybean lines and their normal phytic acid sibling lines. Using a robust unsupervised network inference scheme, putative regulatory interactions were inferred for each subset of genotypes. These interactions were further validated by published regulatory interactions found in Arabidopsis thaliana and motif sequence analysis. Results indicate that lpa seeds have increased sensitivity to stress, which could be due to changes in phytic acid levels, disrupted inositol phosphate signaling, disrupted phosphate ion (Pi) homeostasis, and altered myo-inositol metabolism. Putative regulatory interactions were identified for the latter two processes. Changes in abscisic acid (ABA) signaling candidate transcription factors (TFs) putatively regulating genes in this process were identified as well. Analysis of the GRNs reveal altered regulation in processes that may be affecting the germination of lpa soybean seeds. Therefore, this work contributes to the ongoing effort to elucidate molecular mechanisms underlying altered seed viability, germination and field emergence of lpa crops, understanding of which is necessary in order to mitigate these problems.

Project Inclusive Genetics: Exploring the impact of patient-centered counseling training on physical disability bias in the prenatal setting.

PURPOSE: There is robust research examining the negative impact of racial and socioeconomic implicit bias on healthcare provider clinical decision-making. However, other under-studied important biases are likely to impact clinical care as well. The goal of this study was to explore the presence of bias against people with physical disability among a heterogeneous group of healthcare workers and trainees and to evaluate the effect of implicit association testing and an educational module on this bias. METHOD: The study was composed of a one-hour web-based survey and educational module. The survey included an explicit disability bias assessment, disability Implicit Association Tests (IATs), demographic collection, and pre- and post- module clinical vignettes of prenatal patient scenarios. In addition to providing counseling to hypothetical patients, participants also indicated their personal preferences on genetic testing and termination. The educational module focused on the principles of patient-centered counseling. RESULTS: The collected data reflects responses from 335 participants. Within this sample, there were both explicit and implicit biases towards individuals with physical disabilities. Prior to the IAT and educational module, when respondents were tasked with providing genetic testing recommendations, implicit biases and personal preferences for genetic testing and termination influenced respondents' clinical recommendations. Importantly, having previous professional experience with individuals with disabilities diminished biased clinical recommendations prior to the intervention. In response to the IAT and educational intervention, the effect of implicit bias and personal preferences on clinical recommendations decreased. CONCLUSIONS: This study demonstrates how bias against a marginalized group exists within the medical community and that personal opinions can impact clinical counseling. Importantly, our findings suggest that there are strategies that can be easily implemented into curricula to address disability bias, including formal educational interventions and the addition of professional experiences into healthcare professional training programs.

A call for training graduate medical students on harm reduction for people who inject drugs.

There is a lack of standardized education on topic of harm reduction for graduate medical students. In order to fill this curricular gap, we delivered a two-hour pilot training introducing local community harm reduction organizations and harm reduction ideology and strategies for people who inject drugs to graduate medical students at Boston University. We used pre-post survey design to evaluate attendee demographic characteristics and training efficacy. We matched 29 attendees responses, 69% were first and second year medical students, and found that our training positively reinforced comfort and knowledge surrounding harm reduction ideology, safer injection techniques, and naloxone administration. Delivering trainings covering harm reduction early in graduate medical schools may be beneficial in giving students initial exposure to practical risk mitigation tools they can utilize later in their clinical careers.

Infectious Complications in Injection Drug Use.

Introduction: The prevalence of opioid use disorder has increased steadily over the last decade (from 2.2 million in 2010 to 10.2 million in 2018) and with it, a surge in infectious complications associated with injection drug use (IDU). Trainees in internal medicine routinely diagnose, manage, and treat patients experiencing these infections in the hospital setting as well as screen for and immunize against other comorbid infections in the ambulatory setting. Methods: This 90-minute, case-based, interactive workshop was led by two facilitators, an infectious diseases specialist and a senior internal medicine resident. To evaluate its effectiveness, we used a pre- and postsession survey administered at the beginning and end of the workshop. Learners were asked to rate comfort level in recognizing, managing, and counseling about various IDU-related infections, as well as to answer specific, content-level questions. Result: Thirty of 42 participants who attended the workshop completed the evaluation. There was a statistically significant change in participants' comfort level with diagnosing and managing IDU-associated infections as well as ambulatory standards of care for people who inject drugs (PWID) from pre- to postworkshop. Discussion: Our workshop focused on the management and prevention of infections among PWID in both the inpatient and ambulatory settings. Learners demonstrated increased comfort in managing these conditions.

Standardizing Endoscopy Training: A Workshop for Endoscopy Educators.

Introduction: Endoscopy education in the US traditionally follows the apprenticeship model, in which educators often have little formal training in education, and the acquisition of procedural skills by trainees relies heavily on procedure volume and learning by doing. A growing appreciation of the need to formally educate endoscopy trainers has led to the development of mandatory training curricula in other countries, but the implementation of such courses in the US has been limited. This 1-hour workshop aimed to provide educators the rationale and skills to offer a more standardized approach to procedural training. Methods: We implemented a 1-hour interactive workshop designed for both gastroenterology faculty and trainees. The four sections of the workshop focused on: (1) rationale for standardized approach, (2) verbal and physical preparation for training, (3) training using standardized language and avoidance of cognitive overload, and (4) providing feedback. Four interactive video cases followed by large-group discussion were included. Results: A total of 13 gastroenterology faculty and trainees attended the workshop. Eight additional members of the gastroenterology faculty watched an online video of the workshop. Survey data revealed that the workshop was effective in helping faculty set goals with trainees (Mpre = 2.4, Mpost = 3.6), identify standardized language to use during endoscopy (Mpre = 3.1, Mpost = 3.8), and give feedback after sessions (Mpre = 3.4, Mpost = 4.1). Discussion: A 1-hour lecture-based interactive workshop with video cases was an engaging and effective introduction to formal endoscopy education techniques. The format was easy to incorporate into faculty conferences and can help bridge the current gap in formal endoscopy faculty training.