Implementation and evaluation of IGNITE (Improving GME Nursing Interprofessional Team Experiences) to improve care in an academic health system.

Engaging residents with nurses in interprofessional performance improvement teams can improve learning and care. Residents at the University of Chicago Medicine were identified by nurses, and endorsed by program directors, to serve alongside nurses in Improving GME Nursing Interprofessional Team Experiences (IGNITE) teams. Teams met monthly with improvement coaches to implement institutionally aligned improvement plans. Institutional data was used to monitor progress. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) assessed interprofessional collaboration competency. Press Ganey Clinician Engagement (PGCE) data examined year over year differences in items related to teamwork comparing IGNITE units and non-IGNITE units. Length of stay (LOS) differences were also examined. From 2015 to 2019, IGNITE spread to 9 service lines engaging over 100 residents and nurses. Unit-based teams focused on adding nurses to attending rounds, implementing nurses-resident huddles, and improving multidisciplinary rounds. ICCAS scores significantly improved. PGCE data showed year over year improvements in composite teamwork and communication scores in IGNITE units. All adult inpatient IGNITE units saw a mean LOS reduction ranging from -0.15 days to -1.16 days, equating to an estimated cost savings of nearly 3 million dollars per quarter. Lessons learned include: 1) the importance of engaging hospital leadership; 2) the need to align collaborative practices with institutional goals; 3) the critical role of coaching; and 4) practices to ensure committed, consistent participants.

Reflect and Reset: Black Academic Voices Call the Graduate Medical Education Community to Action.

The COVID-19 pandemic highlighted the great achievements that the biomedical community can accomplish, but raised the question: Can the same medical community that developed a complex vaccine in less than a year during a pandemic help to defeat social injustice and ameliorate the epidemic of health inequity? In this article, the authors, a group of Black academics, call on the graduate medical education (GME) community to reset its trajectory toward solutions for achieving diversity, improving inclusion, and combating racism using education as the new vector. Sponsoring institutions, which include universities, academic medical centers, teaching hospitals, and teaching health centers, are the center of the creation and dissemination of scholarship. They are often the main sources of care for many historically marginalized communities. The GME learning environment must provide the next generation of medical professionals with an understanding of how racism continues to have a destructive influence on health care professionals and their patients. Residents have the practical experience of longitudinal patient care, and a significant portion of an individual's professional identity is formed during GME; therefore, this is a key time to address explicit stereotyping and to identify implicit bias at the individual level. The authors propose 3 main reset strategies for GME-incorporating inclusive pedagogy and structural competency into education, building a diverse and inclusive learning environment, and activating community engagement-as well as tactics that sponsoring institutions can adapt to address racism at the individual learner, medical education program, and institutional levels. Sustained, comprehensive, and systematic implementation of multiple tactics could make a significant impact. It is an academic and moral imperative for the medical community to contribute to the design and implementation of solutions that directly address racism, shifting how resident physicians are educated and modeling just and inclusive behaviors for the next generation of medical leaders.

Integrating Physicians Into Lean Quality Improvement Through a Structured Educational Program: The ECLIPSE Program.

In the increasingly complex health care system, physicians require skills and knowledge to participate with multidisciplinary team members in quality improvement (QI) that adds value to health care organizations. The Educational and Clinical Leaders Improving Performance with Structured E3L training (ECLIPSE) program was developed to address this challenge. Clinically relevant components of lean management were leveraged to create an online, flipped-classroom curriculum, and this was paired with Kaizen adapted specifically for physicians and multidisciplinary clinicians to promote experiential skills utilization. The focus of each adapted Kaizen was a topic of institutional QI priority, such as improving patient throughput or reducing readmission rates. Participants were awarded certification in the E3 Leadership management system-a patient-centered, equity-focused system based on lean principles. After 4 years, 50 E3 Leadership certificates were awarded to multidisciplinary clinicians, including 30 to physicians; participants scored an average 85% on module quizzes. The ECLIPSE program has improved physician participation in multidisciplinary QI projects with institutional alignment.

Utilizing Telesimulation for Advanced Skills Training in Consultation and Handoff Communication: A Post-COVID-19 GME Bootcamp Experience.

COVID-19 forced the switch to virtual for many educational strategies, including simulation. Virtual formats have the potential to broaden access to simulation training, especially in resource-heavy "bootcamp"-type settings. We converted our in-person communication skills bootcamp to telesimulation and compared effectiveness and satisfaction between formats. During June 2020 orientation, 130 entering interns at one institution participated, using Zoom® to perform one mock consultation and three mock handoffs. Faculty rated performance with checklists and gave feedback. Post-bootcamp surveys assessed participant satisfaction and practice preparedness. Telesimulation performance was comparable to in-person for consultations and slightly inferior for handoffs. Survey response rate was 100%. Compared to in-person, there was higher satisfaction with telesimulation, and interns felt more prepared for practice (95% vs 78%, P < .01); 99% recommended the experience. Fifty percent fewer faculty were required for implementation. Telesimulation was well-received and comparable to in-person bootcamp, representing a feasible, scalable training strategy for communication skills essential in hospital medicine.

Implementation of an Ask Me 3 ® education video to improve outcomes in post-myocardial infarction patients.

OBJECTIVE: The Advanced Practice Providers (APPs) in an adult cardiology practice in a large metropolitan city, provide hospital follow-up care to post-myocardial infarction (MI) patients. The APPs identified a problem: patients retained very little of the information they receive during their hospitalization. The purpose of this pilot project was to evaluate the impact of an Ask Me 3 ® post-MI education video on patients' knowledge of self-care activities. The video was designed to promote secondary prevention of cardiovascular disease and support optimal cardiovascular health. METHODS: The project used a pre-test post-test quasi-experimental design to evaluate the feasibility and efficacy of a post-MI education video compared to the standard teaching methods. RESULTS: The sample consisted of 25 total participants, 12 in the control group and 13 in the intervention group. The increase in the intervention group's post- test scores was statistically significant (p value = 0.0056), showing a vast improvement in knowledge with the addition of an "Ask Me 3" education video. CONCLUSION: An "Ask Me 3" post-MI education video may effectively improve cardiovascular secondary prevention when incorporated with the standard teaching methods. Patients may view the video multiple times, enhancing their knowledge of lifestyle modifications following hospitalization and their overall cardiovascular health.

Resident Well-Being Before and During the COVID-19 Pandemic.

BACKGROUND: Preliminary studies reveal challenges posed by the COVID-19 pandemic to the well-being of health care workers. Little is known about the effects of the pandemic on the well-being of graduate medical education (GME) residents or about protective factors and post-traumatic growth. Through deeper examination of resident well-being during this unique crisis, we can identify trends and associated lessons to apply broadly to resident well-being. OBJECTIVE: To characterize resident burnout, resilience, and loneliness before and during the COVID-19 pandemic. METHODS: All residents in any specialty at a single institution were anonymously surveyed semiannually for 2 years (2019-2020), including the time period of the COVID-19 pandemic. Surveys included demographics, the 10-item Connor-Davidson Resilience Scale, the Maslach Burnout Inventory, and the UCLA Loneliness Scale. RESULTS: Overall response rates were 53% (508 of 964) in spring 2019, 55% (538 of 982) in fall 2019, 51% (498 of 984) in spring 2020, and 57% (563 of 985) in fall 2020. The overall rates of burnout were stable across all time periods and did not change during the COVID-19 pandemic. Among frontline residents, burnout rates were higher than other resident populations in both the pre- and post-COVID-19 pandemic time periods. Resilience and loneliness measures were similar for frontline and non-frontline residents and remained stable during the pandemic. CONCLUSIONS: Initial data from this single institution survey of all GME residents in the first 8 months of the COVID-19 pandemic demonstrated burnout and loneliness did not increase and resilience was preserved.

Keeping in Touch with Mental Health: The Orienting Reflex and Behavioral Outcomes from Calatonia.

Physical and psychological therapy based on touch has been gradually integrated into broader mental health settings in the past two decades, evolving from a variety of psychodynamic, neurobiological and trauma-based approaches, as well as Eastern and spiritual philosophies and other integrative and converging systems. Nevertheless, with the exception of a limited number of well-known massage therapy techniques, only a few structured protocols of touch therapy have been standardized and researched to date. This article describes a well-defined protocol of touch therapy in the context of psychotherapy-the Calatonia technique-which engages the orienting reflex. The orienting reflex hypothesis is explored here as one of the elements of this technique that helps to decrease states of hypervigilance and chronic startle reactivity (startle and defensive reflexes) and restore positive motivational and appetitive states.

myTIPreport and Training for Independent Practice: A Tool for Real-Time Workplace Feedback for Milestones and Procedural Skills.

BACKGROUND: Few tools currently exist for effective, accessible delivery of real-time, workplace feedback in the clinical setting. OBJECTIVE: We developed and implemented a real-time, web-based tool for performance-based feedback in the clinical environment. METHODS: The tool (myTIPreport) was designed for performance-based feedback to learners on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and procedural skills. "TIP" stands for "Training for Independent Practice." We implemented myTIPreport in obstetrics and gynecology (Ob-Gyn) and female pelvic medicine and reconstructive surgery (FPMRS) programs between November 2014 and May 2015. Residents, fellows, teachers, and program directors completed preimplementation and postimplementation surveys on their perceptions of feedback. RESULTS: Preimplementation surveys were completed by 656 participants of a total of 980 learners and teachers in 19 programs (12 Ob-Gyn and 7 FPMRS). This represented 72% (273 of 378) of learners and 64% (383 of 602) of teachers. Seventy percent of participants (381 of 546) reported having their own individual processes for real-time feedback; the majority (79%, 340 of 430) described these processes as informal discussions. Over 6 months, one-third of teachers and two-thirds of learners used the myTIPreport tool a total of 4311 times. Milestone feedback was recorded 944 times, and procedural feedback was recorded 3367 times. Feedback addressed all ACGME Milestones and procedures programmed into myTIPreport. Most program directors reported that tool implementation was successful. CONCLUSIONS: The majority of learners successfully received workplace feedback using myTIPreport. This web-based tool, incorporating procedures and ACGME Milestones, may be an important transition from other feedback formats.

Surgical Skills Feedback and myTIPreport: Is There Construct Validity?

OBJECTIVE: To initiate construct validity testing of myTIPreport for procedural skill assessment in a prospective multicenter evaluation study. METHODS: Teachers and learners from a convenience-based site selection of obstetrics and gynecology (OBGYN) and female pelvic medicine and reconstructive surgery (FPMRS) training programs performed procedural assessments in myTIPreport. The specifically defined 5-point Dreyfus rating scale describing ability levels from novice to expert was used. Defined as the degree to which a test or measure assesses what it was designed to measure, construct validity of myTIPreport was tested by comparing the medians of procedure-specific overall assessments, by both teachers and learners themselves, of senior learners with junior learners. To minimize type I error, comparisons were performed only when a threshold of 10 or greater feedback encounters per learner group was met. Correlation of teacher assessments and learner self-assessments was examined for myTIPreport. RESULTS: From November 2014 to May 2016, 12 OBGYN and 7 FPMRS training programs participated. There were 440 learners and 443 teachers. Feedback was recorded on 5,093 surgical procedures; 4,567 for OBGYN residents and 526 for FPMRS fellows. Each OBGYN procedure had two categories of teacher and learner assessments comparing postgraduate year (PGY)-4 with PGY-1 learner performance. This yielded 48 possible assessment comparisons for the included 24 OBGYN procedures. In all, 28 of these 48 (58%) met the threshold number of observations per learner group. In 28 of these 28 (100%) comparison categories, PGY-4s rated significantly higher than PGY-1s. Similarly, in 16 of 18 (89%) comparison categories meeting inclusion criteria, FPMRS PGY-7s rated significantly higher than FPMRS PGY-5s. Strong correlation was noted of teacher assessments and learner self-assessments in myTIPreport with a Spearman correlation coefficient of 0.89 (P<.001). CONCLUSION: As noted for the majority of compared teacher assessments and learner self-assessments, myTIPreport appeared to detect differences between senior and junior learners. These data support the emerging construct validity of myTIPreport for procedural skills assessment.

Preventive Care in Women's Health.

Specialists in general obstetrics and gynecology are key providers of primary care in women. They diagnose and provide the initial management of many medical conditions unrelated to reproductive health. Most importantly they can impact the overall health of patients through incorporating preventive approaches in the annual well-woman visit. This article defines preventive care and identifies leading causes of mortality in women. A framework for identifying key elements of the well-woman examination is summarized. Examples of prevention are provided, which focus on major health care issues that affect adult women.