Video-Based, Patient-Focused Opioid Education in the Perioperative Period Increases Self-Perceived Opioid-Related Knowledge: A Pilot Study.

OBJECTIVE: The aim of this study was to evaluate whether a video-based, patient-focused opioid education tool delivered in the perioperative period would decrease acute and chronic post-operative opioid prescription dispensations and increase self-rated knowledge about opioids. METHODS: We enrolled 110 patients with no reported opioid use in the previous 30 days, undergoing ambulatory surgery for breast, orthopedic, gynecologic, or other outpatient procedures for which opioids would be prescribed. Patients were randomized to receive either post-operative opioid education by the surgical team (control arm) or pre-operative education via a novel 5-minute video plus post-operative education by the surgical team (intervention arm). All patients received follow-up phone calls on post-operative day (POD) 7 to assess self-rated knowledge of opioids on a scale of 1 to 10, 10 being most informed, and self-reported opioid use (primary outcome). Arkansas Prescription Drug Monitoring Program (AR PDMP) data were obtained to assess opioid dispensations at POD 90-150 days. RESULTS: Seventy-seven percent of participants completed POD7 survey. Participants in the intervention arm rated their knowledge of opioids after surgery significantly higher than those in the control arm (p=0.013). Data from the AR PDMP reveal trends (non-significant) that show increased use of opioids in the control group when compared to the video intervention group at POD 30 (88.7% vs 76%) and POD 90-150 (22.6% vs 10%). CONCLUSION: Video-based, patient-focused opioid education can be effectively implemented in a large university hospital during the perioperative period and is effective for increasing a patient's perception of opioid-related knowledge. A fully powered, randomized control trial is needed to further explore observed trends and determine if this novel tool can decrease chronic post-operative opioid dispensations.

Community advisory boards: Experiences and common practices of clinical and translational science award programs.

Community advisory boards (CABs) are a valuable strategy for engaging and partnering with communities in research. Eighty-nine percent of Clinical and Translational Science Awardees (CTSA) responding to a 2011 survey reported having a CAB. CTSAs' experiences with CABs are valuable for informing future practice. This study was conducted to describe common CAB implementation practices among CTSAs; document perceived benefits, challenges, and contributions; and examine their progress toward desirable outcomes. A cross-CTSA collaborative team collected survey data from respondents representing academic and/or community members affiliated with CTSAs with CABs. Data representing 44 CTSAs with CABs were analyzed using descriptive statistics. A majority of respondents reported practices reflecting respect for CAB members' expertise and input such as compensation (75%), advisory purview beyond their CTSA's Community Engagement program (88%), and influence over CAB operations. Three-quarters provide members with orientation and training on roles and responsibilities and 89% reported evaluating their CAB. Almost all respondents indicated their CTSA incorporates the feedback of their CABs to some degree; over half do so a lot or completely. This study profiles practices that inform CTSAs implementing a CAB and provide an evaluative benchmark for those with existing CABs.

Developing and Launching a Research Participant Registry.

BACKGROUND: A major challenge in clinical research today is the difficulty that studies have in meeting recruitment goals. Up to 48% of studies do not meet accrual goals within the specified timeframe, significantly delaying the progress of projects and the dissemination of findings. This pervasive problem is a recruitment crisis. We developed a representative, ethnically and racially diverse research participant registry in a predominantly rural state with high levels of health care disparities and minority populations. We sought input at each step of development from members of community advisory boards (CABs) across Arkansas. We report how community involvement in the development of the registry was implemented. METHODS: Members of CABs were partners in developing all aspects of the registry website, including the name, content, appearance, educational messages, and testimonials used. Constructs from the Health Belief Model informed the educational messages and supported the intense multimedia campaign used to launch and promote ongoing registrations. Using CAB guidance, community events were held throughout the state of Arkansas at venues with diverse racial and ethnic attendance. RESULTS: From April 1, 2016 to September 1, 2017, 4,002 people registered statewide who match the demographic profile of Arkansas. CONCLUSION: CAB involvement in the registry, multiple cues to action, and face-to-face contact with diverse lay audiences throughout the state were key components of the successful registry launch.

Developing and Piloting a Community Scientist Academy to Engage Communities and Patients in Research.

INTRODUCTION: Effective translational research requires engagement and collaboration between communities, researchers, and practitioners. We describe a community scientist academy (CSA) developed at the suggestion of our CTSA's community advisory board to engage and capacitate community members by 1) increasing community members' and patients' understanding about the research process and 2) increasing their access to opportunities to influence and participate in research. A joint CTSA/community planning committee developed this 8-hour workshop including sessions on: 1) research definitions and processes; 2) study design; 3) study implementation; and 4) ways to get involved in research. The workshop format includes interactive exercises, content slides and videos, and researcher and community presenters. METHODS: Community-based information sessions allowed assessment of community interest before piloting. Two pilots of the CSA were conducted with community members and patients. Participant data and a pre/post knowledge and feedback survey provides evaluation data. RESULTS: The pilot included 24 diverse participants, over half of whom had not previously participated in research. Evaluation data suggest knowledge gains. Post- CSA, one third have reviewed CTSA pilot grants and over 80% want to attend further training. CONCLUSIONS: The CSA can demystify the research process for those underrepresented in research and facilitate their engagement and influence within CTSAs.

An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy?

Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents' (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.

Evaluating Evidence-Based Practice Knowledge and Beliefs Through the e-Learning EBP Academy.

BACKGROUND: This research examined evidence-based practice (EBP) knowledge and beliefs before and after a 3-month e-learning program was implemented to build EBP capacity at a large children's hospital. METHOD: Ten clinicians completed the development, implementation, and evaluation of the e-learning education, comprising phase one. Revision and participation by 41 clinicians followed in phase two. Participants in both phases completed the EBP Beliefs and Implementation Scales preintervention, postintervention, and 6 months after postintervention. RESULTS: EBP beliefs and implementation increased immediately and 6 months after postintervention, with statistically significant increases in both phases. Participants in both phases applied knowledge by completing mentor-supported EBP projects. CONCLUSION: Although EBP beliefs and implementation scores increased and e-learning provided flexibility for clinician participation, challenges arose, resulting in lower-than-expected completion. Subsequent revisions resulted in hybrid education, integrating classroom and e-learning with project mentoring. This funded e-learning research contributes knowledge to the growing specialty of professional development. J Contin Educ Nurs. 2017;48(7):304-311.

Pediatric Residents' Perceptions of Potential Professionalism Violations on Social Media: A US National Survey.

BACKGROUND: The ubiquitous use of social media by physicians poses professionalism challenges. Regulatory bodies have disseminated guidelines related to physicians' use of social media. OBJECTIVE: This study had 2 objectives: (1) to understand what pediatric residents view as appropriate social media postings, and (2) to recognize the degree to which these residents are exposed to postings that violate social media professionalism guidelines. METHODS: We distributed an electronic survey to pediatric residents across the United States. The survey consisted of 5 postings from a hypothetical resident's personal Facebook page. The vignettes highlighted common scenarios that challenge published social media professionalism guidelines. We asked 2 questions for each vignette regarding (1) the resident's opinion of the posting's appropriateness, and (2) their frequency of viewing similar posts. We also elicited demographic data (age, sex, postgraduate year level), frequency of Facebook use, awareness of their institutional policies, and prior social media training. RESULTS: Of 1628 respondents, 1498 (92.01%) of the pediatric residents acknowledged having a Facebook account, of whom 888/1628 (54.55%) reported daily use and 346/1628 (21.25%) reported using Facebook a few times a week. Residents frequently viewed posts that violated professionalism standards, including use of derogatory remarks about patients (1756/3256, 53.93%) and, much less frequently, about attending physicians (114/1628, 7.00%). The majority of the residents properly identified these postings as inappropriate. Residents had frequently viewed a post similar to one showing physicians drinking alcoholic beverages while in professional attire or scrubs and were neutral on this post's appropriateness. Residents also reported a lack of knowledge about institutional policies on social media (651/1628, or 40.00%, were unaware of a policy; 204/1628, or 12.53%, said that no policy existed). A total of 372/1628 respondents (22.85%) stated that they had never received any structured training on social media professionalism. CONCLUSIONS: Today's residents, like others of their generation, use social media sites to converse with peers without considering the implications for the profession. The frequent use of social media by learners needs to change the emphasis educators and regulatory bodies place on social media guidelines and teaching professionalism in the digital age.

Online Focus Groups with Parents And Adolescents with Heart Transplants: Challenges and Opportunities.

Pediatric heart transplant recipients are scarce and widely dispersed. Previous studies of adolescents in this population were limited to small homogenous samples. Although online focus groups are an emerging data collection method, its use in pediatric populations has not been fully realized. The purpose of this study was to explore the feasibility of using online focus groups with pediatric populations. Adolescents (aged 13 to 21 years) at least 6 months post-heart transplant and their parents were recruited from two children's hospitals. An online discussion forum (iTracks) was used to conduct asynchronous focus groups with separate parent and adolescent groups. Six parents and four adolescents participated in the discussions. iTracks provided a framework for conducting focus groups in dispersed populations. Access to the discussion transcripts enhanced data analysis and eliminated transcription costs. Overall, online discussion forums were a feasible and cost-effective option to conduct online focus groups in this pediatric population.

Medical student self-efficacy, knowledge and communication in adolescent medicine.

OBJECTIVE: To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities. METHODS: Data were collected during the 8-week pediatric rotation for third-year medical students at a local children's hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests. RESULTS: Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam. CONCLUSIONS: Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

Transition to self-management after pediatric heart transplant.

CONTEXT: Little is known about adolescent transition to self-management after heart transplant. This gap in knowledge is critically important because the consequences of poor self-management are costly and life-threatening, often resulting in nonadherence, rejection, repeated hospitalizations, and poor quality of life. OBJECTIVE: To explore how adolescents and parents perceive their roles in self-management, and how adolescents integrate self-management into their daily lives and navigate the transition from parent-dominated to self-management. DESIGN: Qualitative descriptive design, using online focus groups. SETTING: Online focus groups using itracks, an online qualitative software program. PARTICIPANTS: A purposive sample of 4 adolescents, 13 to 21 years old, who were at least 6 months posttransplant, and of 6 parents of adolescent heart transplant recipients. RESULTS: Several parallel themes emerged from the parent and adolescent online focus groups. Managing medications was the predominant theme for both parents and adolescents. For the remaining themes, parents and adolescents expressed similar ideas that were categorized into parallel themes, which included staying on top of things/becoming independent, letting them be normal/being normal, and worries and stressors. CONCLUSIONS: The transition to self-management after heart transplant was a clear goal for both parents and adolescents. The transition is a shared responsibility between parents and adolescents with a gradual shift from parent-directed to self-management. The process of transition was not linear or smooth, and in several instances, parents described efforts to transfer responsibility to the adolescent only to take it back when complications arose. Additional research with a larger sample is needed in order to fully understand adolescent heart transplant recipients' transition to self-management.

Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation.

PURPOSE: Pediatric residents often cite a lack of confidence with adolescents owing to minimal exposure during training. Self-efficacy has been evaluated in a general context but not in relation to perception of knowledge and communication skill. Study objectives were to evaluate resident self-efficacy during a month-long adolescent rotation and to assess knowledge and communication skills in their relationship to self-efficacy. METHODS: Data were collected as part of the adolescent medicine rotation for pediatric residents at a local children's hospital. Residents completed 2 standardized patient cases at the beginning of the rotation and a self-efficacy instrument before/after the cases and at the end of the rotation. The study assessed trends in self-efficacy using repeated-measures analysis of variance and χ tests to examine relationships between self-efficacy and knowledge as well as communication in preventative and sexually transmitted infection adolescent health. RESULTS: Resident (n = 44) self-efficacy levels significantly changed over all time points and were significantly related to knowledge and communication levels. Although self-efficacy levels decreased immediately after the standardized patient cases, all self-efficacy items were significantly higher at the end of the rotation. Residents confident or very confident in general health topics were deficient in asking basic history items and residents confident or very confident in high-risk topics often did not actually assess these areas with patients. CONCLUSIONS: Residents' personal assessments on paper may differ from actual clinical interactions. Standardized patient cases expose resident strengths and weaknesses with adolescents, and a month-long adolescent rotation allows for repetitive experiences with special adolescent health care topics with associated increase in self-efficacy, knowledge application, and communication skill.

High-fidelity hybrid simulation of allergic emergencies demonstrates improved preparedness for office emergencies in pediatric allergy clinics.

BACKGROUND: Simulation models that used high-fidelity mannequins have shown promise in medical education, particularly for cases in which the event is uncommon. Allergy physicians encounter emergencies in their offices, and these can be the source of much trepidation. OBJECTIVE: To determine if case-based simulations with high-fidelity mannequins are effective in teaching and retention of emergency management team skills. METHODS: Allergy clinics were invited to Arkansas Children's Hospital Pediatric Understanding and Learning through Simulation Education center for a 1-day workshop to evaluate skills concerning the management of allergic emergencies. A Clinical Emergency Preparedness Team Performance Evaluation was developed to evaluate the competence of teams in several areas: leadership and/or role clarity, closed-loop communication, team support, situational awareness, and scenario-specific skills. Four cases, which focus on common allergic emergencies, were simulated by using high-fidelity mannequins and standardized patients. Teams were evaluated by multiple reviewers by using video recording and standardized scoring. Ten to 12 months after initial training, an unannounced in situ case was performed to determine retention of the skills training. RESULTS: Clinics showed significant improvements for role clarity, teamwork, situational awareness, and scenario-specific skills during the 1-day workshop (all P < .003). Follow-up in situ scenarios 10-12 months later demonstrated retention of skills training at both clinics (all P ≤ .004). CONCLUSION: Clinical Emergency Preparedness Team Performance Evaluation scores demonstrated improved team management skills with simulation training in office emergencies. Significant recall of team emergency management skills was demonstrated months after the initial training.

Improving resident self-efficacy in pediatric palliative care through clinical simulation.

CONTEXT: Pediatric residents have limited training and practice experience with palliative care. This study examined whether clinical simulation improved resident self-efficacy in pediatric palliative care. METHODS: Residents were surveyed on their self-efficacy and how they perceived the importance of pediatric palliative care; they were then randomized into either a control group or an intervention group. The intervention group participated in two simulated pediatric palliative care scenarios. The residents' responses before and after the intervention were analyzed to determine whether simulation training had influenced their responses. RESULTS: Although there were no differences in responses on the importance of pediatric palliative care, respondents were more comfortable with suggesting that conferences are needed with families of children who have life-limiting conditions in order to explain do-not-resuscitate orders. CONCLUSION: Simulation improved pediatric residents' self-efficacy with end-of-life discussions.

The use of a parent support group in the outpatient treatment of children and adolescents with eating disorders.

Our objective was to measure parents' level of satisfaction and perceived benefits gained from participating in a parent support group as part of an outpatient treatment program. We mailed surveys to 261 parent/guardian participants. Results reflected high satisfaction with the support group. Parents indicated that it assisted them in understanding eating disorders symptoms and treatment and supporting their child struggling with an eating disorder. Additionally, the group was a source of emotional support. Results suggest that inclusion of a parent support group in the outpatient treatment of children and adolescents with eating disorders has important implications for parents.

The development of a competency-based assessment rubric to measure resident milestones.

BACKGROUND: The outcomes-based assessment rubric is a novel systematic instrument for documenting improvement in clinical learning. APPROACH: This article describes the development of a rubric aimed at introducing specific performance indicators to measure the Accreditation Council for Graduate Medical Education competencies. RESULTS: The potential benefits and implications for medical education include specifying performance indicators and outcomes, ensuring that assessment is coherent and consistent for all residents, measuring resident outcomes based on real-life criteria, providing opportunities for residents to demonstrate proficiency in a specific competency and outcome level, and improving the quality of assessment.