Creation of an asynchronous faculty development curriculum on well-written narrative assessments that avoid bias.

BACKGROUND: The COVID-19 pandemic in parallel with concerns about bias in grading resulted in many medical schools adopting pass/fail clinical grading and relying solely on narrative assessments. However, narratives often contain bias and lack specificity. The purpose of this project was to develop asynchronous faculty development to rapidly educate/re-educate > 2000 clinical faculty spread across geographic sites and clinical disciplines on components of a well-written narrative and methods to minimize bias in the assessment of students. METHODS: We describe creation, implementation, and pilot data outcomes for an asynchronous faculty development curriculum created by a committee of volunteer learners and faculty. After reviewing the literature on the presence and impact of bias in clinical rotations and ways to mitigate bias in written narrative assessments, the committee developed a web-based curriculum using multimedia learning theory and principles of adult learning. Just-in-time supplemental materials accompanied the curriculum. The Dean added completion of the module by 90% of clinical faculty to the department chairperson's annual education metric. Module completion was tracked in a learning management system, including time spent in the module and the answer to a single text entry question about intended changes in behavior. Thematic analysis of the text entry question with grounded theory and inductive processing was used to define themes of how faculty anticipate future teaching and assessment as a result of this curricula. OUTCOMES: Between January 1, 2021, and December 1, 2021, 2166 individuals completed the online module; 1820 spent between 5 and 90 min on the module, with a median time of 17 min and an average time of 20.2 min. 15/16 clinical departments achieved completion by 90% or more faculty. Major themes included: changing the wording of future narratives, changing content in future narratives, and focusing on efforts to change how faculty teach and lead teams, including efforts to minimize bias. CONCLUSIONS: We developed a faculty development curriculum on mitigating bias in written narratives with high rates of faculty participation. Inclusion of this module as part of the chair's education performance metric likely impacted participation. Nevertheless, time spent in the module suggests that faculty engaged with the material. Other institutions could easily adapt this curriculum with provided materials.

PA job availability in primary care during 2014 and 2016.

OBJECTIVES: The objective of this project was to evaluate demand for PAs by examination of job postings. We compared proportions of PAs in primary care with proportions of job postings in primary care in 2014 and 2016 and described job postings for PAs by specialty in 2014 and 2016. METHODS: Internet job postings for PAs supplied by Burning Glass Technologies were evaluated for practice specialty. Job postings were compared with existing filled positions by specialty as reported by the National Commission for the Certification of Physician Assistants. RESULTS: In both years, more than 25% of PAs in practice were in primary care and fewer than 20% of job openings were in primary care. More than half of postings were in medical and surgical subspecialties. CONCLUSIONS: Our findings provide insights into which specialties have emerging high demand for PAs. The demand for PAs appears to remain much stronger for specialty jobs than for primary care jobs.

Course on care of patients with chronic illness: patient-centered medical home model.

BACKGROUND: In the United States, the Patient-centered Medical Home (PCMH) is an emerging concept in primary care that is guiding clinical reorganization to meet the needs of patients with chronic illness. We developed a one-semester curriculum to teach the principles and practice of PCMH to medical and physician assistant students during their clinical clerkship year. METHODS: The mini-course on PCMH consists of three 3-h weekend sessions over 16 weeks and a student project to develop constructive planning ideas for an assigned clinical site. In the first two sessions, students receive didactics and engage in project development discussions. Subsequently, participants work with a faculty advisor and clinic site administrative staff to identify and analyze an area of interest for the student and clinic site. In the last session, students present their projects to the larger group. During the first year of implementation, student evaluations were collected after the first and last sessions. RESULTS: At the end of the course, students reported confidence in their understanding of PCMH concepts and practical implementations of it. Completing a student project at their clinical sites posed challenges that were logistical, rather than conceptual, and was difficult to integrate with classroom learning. DISCUSSION: We present an interprofessional PCMH curriculum for medical and physician assistant students during their clinical year. This course provides students a familiarity with principles of the medical home model and practical experience with practice redesign issues in the context of PCMH transformation.

Population health initiatives for primary care at Duke University School of Medicine.

To help shape the future of health care in North Carolina, Duke University School of Medicine has implemented several new initiatives aimed at providing primary care providers with the knowledge, skills, and attitudes required to improve population health and health care.

Design and Evaluation of an Interprofessional Preceptor Development Mini-Fellowship Program.

INTRODUCTION: Health professions preceptors require skills and knowledge to effectively meet the educational needs of interprofessional students in clinical environments. We implemented a mini-fellowship program to enhance the knowledge, skills, and self-efficacy of preceptors teaching students and applying quality improvement (QI) methods across disciplines and patient care settings. METHOD: The design, implementation, and evaluation of the program were informed by the faculty development literature, principles of adult learning, and preceptor needs. The 3-day program included workshops on curriculum design, clinical teaching methods, QI, social determinants of health, cultural humility, and interprofessional teamwork. Quantitative and qualitative evaluation methods were used including preprogram and postprogram knowledge and self-efficacy surveys, along with end-of-session and program evaluations. RESULTS: Five annual cohorts involving 41 preceptors with varied demographics, professions, and clinical practices completed the mini-fellowship program. Participants' percentage of items answered correctly on a QI knowledge test increased from 79.2% (pretest) to 85.5% (post-test), a gain of 6.3% (90% CI: 2.9-9.7%; P < .003). The average QI self-efficacy scores improved from 2.64 to 3.82, a gain of 1.18 points on a five-point scale (P < .001). The average education/teaching self-efficacy increased from 2.79 to 3.80 on a five-point scale (P < .001). Ultimately, 94% would recommend the program to other preceptors. DISCUSSION: An interprofessional preceptor development program designed to train clinicians to effectively teach in the clinical setting and to conduct QI projects with students was achievable and effective. This program can serve as a model for academic centers charged with training future health care workers and supporting their community-based preceptors' training needs.

Physician Assistant Program Policies to Assess and Address Student Reports of Mistreatment During Clinical Training.

INTRODUCTION: Many physician assistant (PA) students experience mistreatment in clinical learning environments, and accredited PA programs are required to define, publish, and make readily available policies and procedures for student reports of mistreatment. The purpose of this study is to describe the prevalence, content, and dissemination of program policies to address students' reports of mistreatment involving preceptors during supervised clinical experiences. METHODS: To conduct a national policy analysis, the investigators included 10 new survey items in the 2019 Physician Assistant Education Association annual program survey. Deidentified data were analyzed by using descriptive statistics. RESULTS: The program response rate to the survey items was 99% (232). Approximately 76% of PA programs reported having a learner mistreatment policy. Policy content across programs varied widely, and several student reporting mechanisms were available. Program directors, clinical faculty, and institutional leadership were most likely to be involved in the management of reports. A majority programs actively assessed for mistreatment and most did so through clinical course evaluations and at the end of each clinical phase course. Most programs disseminated information about policy to faculty, students, and preceptors at least once a year. DISCUSSION: The descriptions of policy content, procedures, and dissemination increase educators' understanding of current policies across PA programs in the context of renewed efforts to write or revise policy that is specific to mistreatment. The authors discuss key policy priorities to define mistreatment, offer a range of confidential reporting mechanisms, review the management of reports, and consider how to optimize dissemination strategies.

Addressing the Opioid Crisis: A Dynamic Case-Based Module Set for Interprofessional Educators, Learners, and Clinicians.

Introduction: In 2017, the opioid crisis was declared a public health emergency in the United States. The CDC has called for a multifaceted, collaborative approach to address the opioid epidemic. Though many resources have been made available for provider education, much of what has been published to date has focused narrowly on specific contexts and/or has become outdated. Methods: To address the need for more up-to-date and broad-based training, we designed a dynamic, module-based curriculum aligned with the 2016 CDC Opioid Prescribing Guideline. The three-part module set addresses safe opioid prescribing, recognizing and treating opioid use disorders, and opioids and pain management. Each module contains interactive content and assessments and culminates in case-based applications. The modules provide an anchor point for supplemental activities that can be utilized in various contexts. Results: As of May 2021, we recorded 3,529 module completions (≥80% performance on module assessments). A 6-month follow-up survey revealed that the majority of respondents had used the strategies they had learned to improve their prescribing practice and believed they had improved outcomes for patients. Discussion: The modules and supplementary resources can be used by clinicians and educators to combat the opioid epidemic with best practices in patient care and by meeting many state licensure requirements. Included supplemental resources are ideal for learners, providing a comprehensive understanding of the opioid crisis as well as tools for medication-assisted treatment that create capacity to immediately address these issues once learners become fully licensed.

COVID Collaborations: A Physician Assistant Program and Health Department Partnership.

ABSTRACT: The onset of the COVID-19 pandemic resulted in the displacement of clinical-phase medical learners across the country. Physician assistant (PA) and other health professions programs were challenged to innovate and offer alternate learning experiences that would meet students' needs as future health care professionals. At the same time, local and state health departments were faced with quickly increasing their capacity for contact tracing and case investigation in response to the growing number of COVID-19 infections. Through a collaborative partnership based on the needs of the local health department and clinical-phase PA students, the Duke PA program developed an elective in which students served as contact tracers and case investigators. PA students provided over 1500 hours of contact tracing and case investigation support to the local health department. Qualitative review showed students gained a greater appreciation of the impact of social determinants of health, saw first-hand how the pandemic disproportionately affected communities of color, and increased their knowledge about the role of public health. The partnership between the PA program and the health department was mutually beneficial and established a foundation for future collaborative experiences that support both the community and the needs of health professions' learners.

A novel curriculum to train physician assistant students how to write effective discharge summaries.

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving inter-provider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.