An Innovative Program Using Magic to Provide Early Clinical Experiences for Preclinical Medical Students: Goals, Experiences, and Results of the MagicAid Program.

Objective: Effectively training medical students in compassion, communication, and empathy is essential in fostering a holistic approach to patient care. We sought to address this by implementing an early clinical experience service learning program for medical students in the initial years of their medical education. Methods: Medical students at Stony Brook University initiated, designed, and facilitated the volunteer program, which provides students a framework to learn magic therapy and engage with pediatric patients. The program includes an introductory presentation, training course, and organized bedside sessions with patients. To evaluate the program, a sample of participants partook in a focus group, written questionnaire, and/or online survey. Results: From 2015 to 2020, 130 students participated in magic therapy rounds, engaging 1391 patients. Nine themes of student benefit emerged from qualitative analysis, including acquisition of familiarity with the hospital and healthcare team, cultivation of communication skills, contribution to improvement of patient affect, development of empathic qualities and techniques, and improvement in psychological health. Students were very satisfied with their experiences and viewed the activity as helpful for patients, parents, staff, and themselves. Conclusions: The program engaged students in compassionate patient care within a holistic approach to patient care early in training. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-021-01456-y.

Essential yet Ill-defined: leadership roles to support fourth-year medical students in pediatrics.

BACKGROUND: Few studies have been published about specialty-specific fourth-year medical student leadership in any discipline. This paper provides insight from pediatric educators about the current status and recommendations for pediatric-specific fourth-year leaders. OBJECTIVE: To identify the prevalence of pediatric fourth-year medical student directors across the US and Canada and to compare current and ideal responsibilities for this role. METHODS: Five multi-part questions were written and submitted for the 2019 Council on Medical Student Education in Pediatrics (COMSEP) Annual Survey and subsequently disseminated to all COMSEP member physicians. Anonymous responses were collected and results analyzed. The study was IRB exempt. RESULTS: The program-level survey response rate was 79%. Of 115 respondent medical schools, 37% reported having a pediatric fourth-year director separate from the clerkship director, with an average of 9.8% full-time equivalent (FTE) protected time for the role. In contrast, individuals indicated 20% FTE would be ideal for fourth-year director responsibilities. The most common role identified for pediatric fourth-year directors was directing sub-internships. Respondents indicated it would be ideal for pediatric fourth-year directors to have an increased level of involvement in all areas queried in the survey, especially directing a pediatric residency preparatory course/boot camp, faculty development for educators of fourth-year students, and remediating fourth-year students. CONCLUSIONS: As specialty-specific experiences have grown in the fourth year of medical school, there is an increasing demand for faculty leadership separate from direction of the pediatric clerkship. In this national survey, pediatric educators expressed a need for additional protected time to lead fourth-year specific activities. Similar findings in other disciplines would support advocating for more protected time and expanded roles for specialty-specific fourth-year directors nationally.

Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center.

BACKGROUND: Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented. METHODS: To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014-2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula. RESULTS: These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients' cultural needs, identify 'at-risk' patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort. CONCLUSIONS: Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.

Integrating iPads into Team-Based Learning in the Pediatrics Clerkship: Do They Provide Any Value?

BACKGROUND: Team-Based Learning (TBL) is an instructional strategy that embraces the concept of a flipped classroom. At our institution, the Clerkship in Pediatrics utilizes TBL sessions to deliver curricular content rather than lecture format. In 2016, matriculating medical students were given iPads for the purpose of transitioning to electronic delivery of curricular materials in the pre-clinical phase of their study. In 2017, the Clerkship in Pediatrics was tasked with investigating methods to integrate iPad use into clinical education. ACTIVITY: We employed the web-based platform Examplify to deliver test questions for TBL sessions over the span of 1 academic year (2018-2019). Curricular content was converted to Examplify for half of the TBL sessions and team performance for the sessions was compared to those administered traditionally. Students participating in the course were surveyed regarding their satisfaction with the 2 formats using a 15-item survey with a 4-point rating scale and open-ended questions. RESULTS AND DISCUSSION: Integration of technology into TBL sessions was met with mixed results. Performance on the eTBL sessions was significantly higher for 2 of the 6 sessions: the Abdominal Pain (90.2% vs 84.1%, P = .04) and the Toxicology (85.6% vs 79.4%, P = .03) sessions. A majority of students felt that the eTBL sessions facilitated multiple learning styles, promoted discussions, and nurtured different learning styles. However, students also felt that the electronic sessions were more cumbersome and difficult to navigate. Future research comparing the 2 modalities using a more comprehensive integration of media content, such as video and audio files, will further inform the success of this endeavor.

A Magic Therapy Program to Alleviate Anxiety in Pediatric Inpatients.

OBJECTIVES: Hospitalization generates increased psychological discomfort for children and their caregivers. This anxiety can affect the patient-caretaker response to the health care team and the course of treatment. We aim to evaluate the impacts of a magic therapy program, organized and facilitated by medical students, on alleviating pediatric inpatient and caregiver anxiety. METHODS: Patients aged 5 to 16 years admitted to an inpatient pediatric unit and their caregivers were eligible for inclusion. Patient-caregiver pairs were randomly assigned to a magic therapy intervention group or a control group. Anxiety was measured before and after the intervention by using validated self-report tools. The Facial Image Scale and Venham Picture Test were used to measure anxiety for young patients, the short State-Trait Anxiety Inventory and Facial Image Scale were used for older patients, and the short State-Trait Inventory was used for caregivers. A subset of the intervention group was reevaluated at 1 hour posttherapy. Health professionals were also surveyed regarding their opinions of the program. RESULTS: One hundred patients and 90 caregivers were enrolled. The patient magic group's standardized anxiety was reduced by 25% (n = 47; P < .001) posttherapy. The caregiver magic group's anxiety was reduced by 24% (n = 34; P < .001). Data suggest that anxiety reductions lasted through at least 1 hour posttherapy. Physicians (n = 9), nurses (n = 8), and pediatric residents (n = 20) supported program continuance, reported favorable impressions, and suggested patient, caregiver, and staff benefits. CONCLUSIONS: Integration of a magic therapy program into pediatric inpatient care was feasible and successful in decreasing patient and caretaker anxiety. Health care professionals support the program's continuance.

Can Individualized Learning Plans in an advanced clinical experience course for fourth year medical students foster Self-Directed Learning?

BACKGROUND: Residency programs have utilized Individualized Learning Plans (ILPs) to customize resident education while undergraduate medical education has not done so in a meaningful way. We discuss the use of ILPs within a fourth year medical school course to facilitate self-directed learning (SDL). METHODS: At Stony Brook University School of Medicine, an ILP component was added to the Advanced Clinical Experience (ACE) course for fourth year students. Each completed an ILP outlining personal learning goals and strategies to achieve them. An adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ) (Duncan T and McKeachie W, Educ Psych 40(2):117-128, 2005 and Cook DA et al., Med Ed 45:1230-1240, 2011) was used to measure success of ILPs in improving SDL. Qualitative data analysis was conducted on the ILPs and self-reflections. RESULTS: Forty-eight students participated. Two of the four SDL sub-domains identified on the MSLQ showed improvement; self-efficacy (p = .001) and self-regulation (p = .002). 'Medical Knowledge' was the competency most frequently identified as an area of concentration (90 %) and professionalism was selected least frequently (4 %). A higher percentage (83 %) of students who reported complete achievement of their ILP goals also reported feeling better prepared for entering residency. CONCLUSIONS: ILPs improve SDL strategies among medical students and may serve as useful tools to help shape future learning goals as they transition to residency training.

Partnering with residents for evidence-based practice.

Medical residents are a distinct group of health sciences library users that need detailed instruction in literature searching. Core residency competencies from the Accreditation Council for Graduate Medical Education require that all residents be competent in finding, critically appraising, and incorporating the latest clinical evidence into their daily practice with patients. With the collaboration of the library and a clinical department of pediatrics, a program was developed that teaches residents the basic elements of EBM searching and then reinforces this learning over the course of three years.

Pediatric observation units.

Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.