Erratum: Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

[This corrects the article DOI: 10.1055/s-0043-1771355.].

Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.

Assessment of Internal Medicine Resident Preparedness to Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Patients.

BACKGROUND: Recognizing the unique health needs of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer/questioning individuals) is critical to providing competent and comprehensive healthcare. OBJECTIVE: To assess resident knowledge of healthcare issues uniquely affecting sexual and gender minorities as well as the role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients. DESIGN: A multicenter online education intervention from December 2016 to April 2018. PARTICIPANTS: The study population consisted of 833 PGY1-3 residents at 120 internal medicine residency programs in the USA who completed 1018 tests. INTERVENTIONS: A 1-h online module addressing sexual and gender minority (SGM) health. The test evaluated each resident in four categories: (1) terminology relevant to SGM patients; (2) health disparities and preventive care issues affecting SGM patients; (3) substance use and mental health issues unique to SGM patients; and (4) common sexually transmitted illnesses affecting SGM populations. MAIN MEASURES: Participants completed a pre-test assessing SGM health knowledge. A didactic module reviewing diagnosis and management of these diseases was then completed, followed by a post-test. KEY RESULTS: Among 1018 resident respondents, there was no difference between post-graduate year pre-test performance (PGY-1 52%, PGY-2 50%, PGY-3 51%; p = 0.532) or post-test performance (PGY-1 80%, PGY-2 82%, PGY-3 82%; p = 0.285). Pre-test and post-test performance of an online didactic module was the same across test categories and patient populations for PGY-1 vs. PGY-2 vs. PGY-3. Residents demonstrated an improvement between pre- and post-test knowledge. CONCLUSIONS: Baseline knowledge of health issues of sexual and gender minorities, as assessed by pre-test performance, did not change during residency training. An online didactic module introduced trainees to critical issues regarding the care of these vulnerable populations until such curricula are required in training. Health disparities in LGBTQ communities may improve with improved physician training on clinical care of LGBTQ patients and families.

Provider Perceptions of the Organization's Cultural Competence Climate and Their Skills and Behaviors Targeting Patient-Centered Care for Socially At-Risk Populations.

As part of a cultural competence needs assessment study at a large academic health care system, we conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients. Less than half of providers reported engaging in behaviors to address cultural and social barriers more than 75% of the time. In multivariable logistic regression models, providers who reported moderate or major structural problems were more likely to report low skillfulness in identifying patient mistrust (aOR: 2.01; 95% CI: 1.23-3.28, p<0.01), how well patients read and write English (aOR: 1.63; 95% CI: 1.03-2.57, p=0.03), and socioeconomic barriers (aOR: 2.14; 95% CI: 1.14-4.01, p=0.01), than providers who reported only small or no structural problems. Improved structural support for socially and culturally complex medical encounters is needed to enhance care for socially at-risk patients.

Residents' Attitude, Knowledge, and Perceived Preparedness Toward Caring for Patients from Diverse Sociocultural Backgrounds.

Purpose: Training residents to deliver care to increasingly diverse patients in the United States is an important strategy to help alleviate racial and ethnic disparities in health outcomes. Cross-cultural care training of residents continues to present challenges. This study sought to explore the associations among residents' cross-cultural attitudes, preparedness, and knowledge about disparities to better elucidate possible training needs. Methods: This cross-sectional study used web-based questionnaires from 2013 to 2014. Eighty-four internal medicine residency programs with 954 residents across the United States participated. The main outcome was perceived preparedness to care for sociocultural diverse patients. Key Results: Regression analysis showed attitude toward cross-cultural care (beta coefficient [ß]=0.57, 95% confidence interval [CI]: 0.49-0.64, p<0.001) and report of serving a large number of racial/ethnic minorities (ß=0.90, 95% CI: 0.56-1.24, p<0.001), and low-socioeconomic status patients (ß=0.74, 95% CI: 0.37-1.10, p<0.001) were positively associated with preparedness. Knowledge of disparities was poor and did not differ significantly across postgraduate year (PGY)-1, PGY-2, and PGY-3 residents (mean scores: 56%, 58%, and 55%, respectively; p=0.08). Conclusion: Residents' knowledge of health and healthcare disparities is poor and does not improve during training. Residents' preparedness to provide cross-cultural care is directly associated with their attitude toward cross-cultural care and their level of exposure to patients from diverse sociocultural backgrounds. Future studies should examine the role of residents' cross-cultural care-related attitudes on their ability to care for diverse patients.

Predictors of resident satisfaction in caring for limited English proficient families: a multisite study.

OBJECTIVE: To assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes. METHODS: A multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care. RESULTS: A total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.6), increasing year in training (OR 3.2, 95% CI 1.01-10.2), frequent non-English language use (OR 3.1, 95% CI 1.1-8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02-3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18-0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration. CONCLUSIONS: A majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction.

Development of a research ethics knowledge and analytical skills assessment tool.

INTRODUCTION: The goal of this project was to develop and validate a new tool to evaluate learners' knowledge and skills related to research ethics. METHODS: A core set of 50 questions from existing computer-based online teaching modules were identified, refined and supplemented to create a set of 74 multiple-choice, true/false and short answer questions. The questions were pilot-tested and item discrimination was calculated for each question. Poorly performing items were eliminated or refined. Two comparable assessment tools were created. These assessment tools were administered as a pre-test and post-test to a cohort of 58 Indian junior health research investigators before and after exposure to a new course on research ethics. Half of the investigators were exposed to the course online, the other half in person. Item discrimination was calculated for each question and Cronbach's α for each assessment tool. A final version of the assessment tool that incorporated the best questions from the pre-/post-test phase was used to assess retention of research ethics knowledge and skills 3 months after course delivery. RESULTS: The final version of the REKASA includes 41 items and had a Cronbach's α of 0.837. CONCLUSION: The results illustrate, in one sample of learners, the successful, systematic development and use of a knowledge and skills assessment tool in research ethics capable of not only measuring basic knowledge in research ethics and oversight but also assessing learners' ability to apply ethics knowledge to the analytical task of reasoning through research ethics cases, without reliance on essay or discussion-based examination. These promising preliminary findings should be confirmed with additional groups of learners.