- Email: [email protected]
75. IN PURSUIT OF UNINTERRUPTED EDUCATION: TRANSITION FROM A NOON CONFERENCE TO AN ACADEMIC HALF DAY
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ACADEMIC PEDIATRICS metrics. Rigorous implementation of a CTA program should include a needs assessment and identification of key target areas of impact. Thoughtful design and expansion informed and supported by stakeholders is key to achieving acceptability, sustainability, and operational success.
our project established the usefulness of peer groups for the betterment of medical education programs.
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73. IMPLEMENTING A CARE TEAM ASSISTANT PROGRAM: LESSONS LEARNED Elizabeth Salazar, MD, Ryosuke Takei, MD, George Dalembert, MD, Jeanine Ronan, MD, MS, MSEd, Nicole Washington, MD, Stuti Tank, BA, Anna Sweeney, BS, Susan Kolb, MSN, CNP, Evan Fieldston, MD, MBA, MSHP, Children’s Hospital of Philadelphia, Philadelphia, PA INTRODUCTION: Excessive administrative tasks have been associated with adverse consequences for doctors and their patients. Furthermore, this burden of non-clinical tasks has been linked to depersonalization, a major component of physician burnout. The Care Team Assistant (CTA) program, established in Nov 2016, provides administrative support for the inpatient medical teams to help optimize patient care and promote wellness. OBJECTIVE: To share the acceptability, feasibility, sustainability, and effectiveness of implementing a CTA program. APPROACH: The program was established in a large, urban, academic, tertiary medical center. A needs assessment included time-motion studies, resident surveys, and drafting of a key driver diagram. Highest impact goals were identified by clinicians, nursing leadership, and administrative stakeholders. A physician lead and project manager were designated, and 5 CTAs were initially hired. Once didactic/clinical training was completed, the CTAs were incorporated into inpatient resident teams and assigned various non-clinical tasks. Program leaders met regularly to discuss the program’s development and to ensure quality assurance for the CTAs. OUTCOMES: Acceptability: Resident surveys showed CTAs completing a large percentage of daily administrative tasks with promotion of job satisfaction and time spent in direct clinical care. Feasibility: Initial challenges included a lack of benchmark and guidelines for CTA training. These were iteratively refined with input from CTAs and physician partners. Some CTAs were terminated given inability to meet established markers for competency. Another major challenge was the lack of familiarity with the role and sub-optimal utilization of the CTAs, requiring significant efforts to raise awareness. Effectiveness: The initiative has shown concrete positive impacts on various measures including PCP communication and family-centered rounds. CTAs have also helped address institutional needs relating to capacity management by facilitating earlier discharges. Sustainability: CTAs have become integral members of inpatient teams with involvement in multiple interdisciplinary initiatives. The program continues to grow with 12 current CTAs and expansion to the PICU. CONCLUSIONS: CTAs provide an effective means of reducing administrative burden and improving not only care delivery
74. LACK OF CORRELATION BETWEEN USMLE SCORES AND PERFORMANCE IN PEDIATRICS RESIDENCY TRAINING BASED ON ACGME MILESTONES RATINGS Ben Miller, MD, Stephanie B. Dewar, MD, Andrew Nowalk, MD, PhD, UPMC Medical Education, Pittsburgh, PA INTRODUCTION: The United States Medical Licensing Exam (USMLE) was designed to determine whether medical trainees are competent to become licensed physicians, not necessarily as a means of providing a comparative gradient on students’ knowledge. Despite this, many residency programs use USMLE scores in the residency selection process as indicators as to whether physicians will succeed in residency. Not only is this not the intended use of the USMLE, some previous studies have suggested that USMLE scores are not effective indicators of a physician’s success during residency. One method of assessing residents’ progress through residency training are the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the six clinical competency domains of Patient Care, Medical Knowledge, Systems Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal Communications Skills. Ratings along these milestones are completed by supervising physicians who observe and assess residents in the clinical setting. No previous literature has tried to link USMLE Step scores to resident performance using Milestone ratings. METHODS: USMLE Step 1 and 2 Scores and Milestones Ratings in twenty-one different competencies were collected over five years (2012 - 2017) from 187 residents enrolled in a single large pediatrics residency program. Correlations were examined using Pearson’s correlation coefficients. RESULTS: Among the residents studied, the mean score of Step 1 was 236, while the mean score of Step 2 was 250. While Step 1 and 2 had correlation (r2 = -0.628), no correlation was found between Step 1 and overall Milestones average (r2 = -0.130 and <0.001 for PGY1 and PGY3), or between Step 2 and overall Milestones average (r2 = -0.102 and 0.058 for PGY1 and PGY3). CONCLUSION: These results suggest that USMLE scores have no correlation to success in residency training as measured by progression along competency-based milestones. These confirm previous claims about the limited utility of USMLE scores in predicting success in residency training. 75. IN PURSUIT OF UNINTERRUPTED EDUCATION: TRANSITION FROM A NOON CONFERENCE TO AN ACADEMIC HALF DAY Morgan H. Khawaja, MD, Mason Walgrave, MD, Mark Siegel, MD, Medical University of South Carolina,
TAGEDENACADEMIC PEDIATRICS Charleston, SC, Jordan Newman, MD, Emory University/ Sibley Heart Center Cardiology, Atlanta, SC, Sarah Yale, MD, Not Affiliated with Program/Institution listed above, Milwaukee, WI INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to provide regularly scheduled didactic sessions. The ACGME does not, however, dictate the format of these didactic sessions, and traditionally programs have opted for a daily noon conference (NC). The daily NC format often leads to poor conference attendance for a variety of reasons including resident duty hour restrictions, clinical responsibilities, and increased off-campus rotations. Without clinical coverage, conference attendees are often interrupted to answer pages and phone calls, leading to poor participation in these learning sessions. In response to resident criticism of the NC structure, our institution transitioned to a pager-protected Academic Half Day (AHD) model in which didactic sessions are delivered in a single weekly afternoon learning session. METHODS: Second and third year residents (n=21) were surveyed at the start of the AHD transition and 5 months later using a five point Likert scale. Results were not statistically significant, likely due to lack of power with 21 participants. However, there was an overall trend of improvement between the two survey time intervals. Most notably, the areas showing the greatest improvement were: ability to arrive on time, frequency of interruptions, frequency of leaving early, perception of retention of medical knowledge, and overall satisfaction [Fig 1]. In addition, overall resident attendance increased from 50% with a NC model to approximately 80% with a AHD model. CONCLUSION: Transitioning from a NC to an AHD model improved overall resident satisfaction and provides a better learning environment with uninterrupted time for medical education. Follow-up data will assess the AHD impact on resident wellness and knowledge retention via analysis of in-training exam scores and ultimately Pediatric Board Exam scores.
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coordinators representing 177 programs (111 ACGME accredited residencies and fellowships, 66 non-ACGME accredited fellowships) found that although monthly meetings were provided by the Graduate Medical Education Office, gaps still existed in the knowledge and engagement of coordinators across-the-board. 86% of coordinators surveyed indicated that coordinator professional development is very important and needed. OBJECTIVE: To create and assess the impact and feasibility of a coordinator-led educational series for pediatric program coordinators. METHODS: The Department of Pediatrics at Stanford University School of Medicine instituted a monthly, coordinator-led educational series. Three coordinators organized the series, with a total of nine coordinators collaborating on presentation of topics. Over a period of 18 months, 20 distinct topics were delivered, with some topics being repeated (Figure 1). Participants were asked to rate the entire series as a whole at the end of the 18-month period. Descriptive statistics were used to analyze the results. RESULTS: Of 19 pediatric coordinators, 18 completed the final survey (95%). Coordinators reported they were satisfied with the series (94%), likely to recommend to new coordinators (100%), and likely to recommend to experienced coordinators (82%). CTAGME and opportunities for national participation were identified as topics that would be useful for future sessions. Comments underscored that rolling topics were necessary for new coordinators but would be repetitive for experienced coordinators. The time spent in organization and preparation of the series was estimated at eight hours a month. CONCLUSION: The implementation of a program coordinatorled educational series was found to be feasible and satisfactory, with coordinators likely to recommend the series to others. More work needs to be done to determine the best format, frequency, and topics for a coordinator-led series.
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TAGEDEN TAGEDEN 76. IMPLEMENTATION AND EVALUATION OF A COORDINATOR-LED, PEDIATRIC PROGRAM COORDINATOR MONTHLY EDUCATIONAL SERIES Megan K. Christofferson, BA, C-TAGME, Stanford University, Palo Alto, CA, Sara L. Salem, EdM, Charlene L. Rotandi, AB, C-TAGME, Stanford University, Stanford, CA BACKGROUND: With ever expanding requirements from the Accreditation Council of Graduate Medical Education (ACGME), the role of the program coordinator has grown, necessitating updated onboarding materials for new coordinators and continuing education for experienced coordinators. While the need for coordinator education and professional development is well-established, there remains the question of who should provide such education. A needs assessment at a single institution of
77. UTILIZATION OF HEAT-MAPPING SOFTWARE TO MATCH A RESIDENT STAFFING TEMPLATE TO ED ARRIVAL PATTERNS Abigail Schuh, MD, MMHPE, Mark Nimmer, Amy Drendel, DO, MS, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI BACKGROUND: Academic institutions rely on resident physicians to adequately staff emergency departments while residency programs need a steady flow of patients in order to provide trainees with a good clinical experience. Feedback from end-of-rotation evaluations suggest that residents feel competition for patients during some shifts and overworked during others. To investigate this, we utilized heat-mapping software to determine
ABSTRACTS
ACADEMIC PEDIATRICS metrics. Rigorous implementation of a CTA program should include a needs assessment and identification of key target areas of impact. Thoughtful design and expansion informed and supported by stakeholders is key to achieving acceptability, sustainability, and operational success.
our project established the usefulness of peer groups for the betterment of medical education programs.
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73. IMPLEMENTING A CARE TEAM ASSISTANT PROGRAM: LESSONS LEARNED Elizabeth Salazar, MD, Ryosuke Takei, MD, George Dalembert, MD, Jeanine Ronan, MD, MS, MSEd, Nicole Washington, MD, Stuti Tank, BA, Anna Sweeney, BS, Susan Kolb, MSN, CNP, Evan Fieldston, MD, MBA, MSHP, Children’s Hospital of Philadelphia, Philadelphia, PA INTRODUCTION: Excessive administrative tasks have been associated with adverse consequences for doctors and their patients. Furthermore, this burden of non-clinical tasks has been linked to depersonalization, a major component of physician burnout. The Care Team Assistant (CTA) program, established in Nov 2016, provides administrative support for the inpatient medical teams to help optimize patient care and promote wellness. OBJECTIVE: To share the acceptability, feasibility, sustainability, and effectiveness of implementing a CTA program. APPROACH: The program was established in a large, urban, academic, tertiary medical center. A needs assessment included time-motion studies, resident surveys, and drafting of a key driver diagram. Highest impact goals were identified by clinicians, nursing leadership, and administrative stakeholders. A physician lead and project manager were designated, and 5 CTAs were initially hired. Once didactic/clinical training was completed, the CTAs were incorporated into inpatient resident teams and assigned various non-clinical tasks. Program leaders met regularly to discuss the program’s development and to ensure quality assurance for the CTAs. OUTCOMES: Acceptability: Resident surveys showed CTAs completing a large percentage of daily administrative tasks with promotion of job satisfaction and time spent in direct clinical care. Feasibility: Initial challenges included a lack of benchmark and guidelines for CTA training. These were iteratively refined with input from CTAs and physician partners. Some CTAs were terminated given inability to meet established markers for competency. Another major challenge was the lack of familiarity with the role and sub-optimal utilization of the CTAs, requiring significant efforts to raise awareness. Effectiveness: The initiative has shown concrete positive impacts on various measures including PCP communication and family-centered rounds. CTAs have also helped address institutional needs relating to capacity management by facilitating earlier discharges. Sustainability: CTAs have become integral members of inpatient teams with involvement in multiple interdisciplinary initiatives. The program continues to grow with 12 current CTAs and expansion to the PICU. CONCLUSIONS: CTAs provide an effective means of reducing administrative burden and improving not only care delivery
74. LACK OF CORRELATION BETWEEN USMLE SCORES AND PERFORMANCE IN PEDIATRICS RESIDENCY TRAINING BASED ON ACGME MILESTONES RATINGS Ben Miller, MD, Stephanie B. Dewar, MD, Andrew Nowalk, MD, PhD, UPMC Medical Education, Pittsburgh, PA INTRODUCTION: The United States Medical Licensing Exam (USMLE) was designed to determine whether medical trainees are competent to become licensed physicians, not necessarily as a means of providing a comparative gradient on students’ knowledge. Despite this, many residency programs use USMLE scores in the residency selection process as indicators as to whether physicians will succeed in residency. Not only is this not the intended use of the USMLE, some previous studies have suggested that USMLE scores are not effective indicators of a physician’s success during residency. One method of assessing residents’ progress through residency training are the Accreditation Council for Graduate Medical Education (ACGME) Milestones in the six clinical competency domains of Patient Care, Medical Knowledge, Systems Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal Communications Skills. Ratings along these milestones are completed by supervising physicians who observe and assess residents in the clinical setting. No previous literature has tried to link USMLE Step scores to resident performance using Milestone ratings. METHODS: USMLE Step 1 and 2 Scores and Milestones Ratings in twenty-one different competencies were collected over five years (2012 - 2017) from 187 residents enrolled in a single large pediatrics residency program. Correlations were examined using Pearson’s correlation coefficients. RESULTS: Among the residents studied, the mean score of Step 1 was 236, while the mean score of Step 2 was 250. While Step 1 and 2 had correlation (r2 = -0.628), no correlation was found between Step 1 and overall Milestones average (r2 = -0.130 and <0.001 for PGY1 and PGY3), or between Step 2 and overall Milestones average (r2 = -0.102 and 0.058 for PGY1 and PGY3). CONCLUSION: These results suggest that USMLE scores have no correlation to success in residency training as measured by progression along competency-based milestones. These confirm previous claims about the limited utility of USMLE scores in predicting success in residency training. 75. IN PURSUIT OF UNINTERRUPTED EDUCATION: TRANSITION FROM A NOON CONFERENCE TO AN ACADEMIC HALF DAY Morgan H. Khawaja, MD, Mason Walgrave, MD, Mark Siegel, MD, Medical University of South Carolina,
TAGEDENACADEMIC PEDIATRICS Charleston, SC, Jordan Newman, MD, Emory University/ Sibley Heart Center Cardiology, Atlanta, SC, Sarah Yale, MD, Not Affiliated with Program/Institution listed above, Milwaukee, WI INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to provide regularly scheduled didactic sessions. The ACGME does not, however, dictate the format of these didactic sessions, and traditionally programs have opted for a daily noon conference (NC). The daily NC format often leads to poor conference attendance for a variety of reasons including resident duty hour restrictions, clinical responsibilities, and increased off-campus rotations. Without clinical coverage, conference attendees are often interrupted to answer pages and phone calls, leading to poor participation in these learning sessions. In response to resident criticism of the NC structure, our institution transitioned to a pager-protected Academic Half Day (AHD) model in which didactic sessions are delivered in a single weekly afternoon learning session. METHODS: Second and third year residents (n=21) were surveyed at the start of the AHD transition and 5 months later using a five point Likert scale. Results were not statistically significant, likely due to lack of power with 21 participants. However, there was an overall trend of improvement between the two survey time intervals. Most notably, the areas showing the greatest improvement were: ability to arrive on time, frequency of interruptions, frequency of leaving early, perception of retention of medical knowledge, and overall satisfaction [Fig 1]. In addition, overall resident attendance increased from 50% with a NC model to approximately 80% with a AHD model. CONCLUSION: Transitioning from a NC to an AHD model improved overall resident satisfaction and provides a better learning environment with uninterrupted time for medical education. Follow-up data will assess the AHD impact on resident wellness and knowledge retention via analysis of in-training exam scores and ultimately Pediatric Board Exam scores.
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coordinators representing 177 programs (111 ACGME accredited residencies and fellowships, 66 non-ACGME accredited fellowships) found that although monthly meetings were provided by the Graduate Medical Education Office, gaps still existed in the knowledge and engagement of coordinators across-the-board. 86% of coordinators surveyed indicated that coordinator professional development is very important and needed. OBJECTIVE: To create and assess the impact and feasibility of a coordinator-led educational series for pediatric program coordinators. METHODS: The Department of Pediatrics at Stanford University School of Medicine instituted a monthly, coordinator-led educational series. Three coordinators organized the series, with a total of nine coordinators collaborating on presentation of topics. Over a period of 18 months, 20 distinct topics were delivered, with some topics being repeated (Figure 1). Participants were asked to rate the entire series as a whole at the end of the 18-month period. Descriptive statistics were used to analyze the results. RESULTS: Of 19 pediatric coordinators, 18 completed the final survey (95%). Coordinators reported they were satisfied with the series (94%), likely to recommend to new coordinators (100%), and likely to recommend to experienced coordinators (82%). CTAGME and opportunities for national participation were identified as topics that would be useful for future sessions. Comments underscored that rolling topics were necessary for new coordinators but would be repetitive for experienced coordinators. The time spent in organization and preparation of the series was estimated at eight hours a month. CONCLUSION: The implementation of a program coordinatorled educational series was found to be feasible and satisfactory, with coordinators likely to recommend the series to others. More work needs to be done to determine the best format, frequency, and topics for a coordinator-led series.
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TAGEDEN TAGEDEN 76. IMPLEMENTATION AND EVALUATION OF A COORDINATOR-LED, PEDIATRIC PROGRAM COORDINATOR MONTHLY EDUCATIONAL SERIES Megan K. Christofferson, BA, C-TAGME, Stanford University, Palo Alto, CA, Sara L. Salem, EdM, Charlene L. Rotandi, AB, C-TAGME, Stanford University, Stanford, CA BACKGROUND: With ever expanding requirements from the Accreditation Council of Graduate Medical Education (ACGME), the role of the program coordinator has grown, necessitating updated onboarding materials for new coordinators and continuing education for experienced coordinators. While the need for coordinator education and professional development is well-established, there remains the question of who should provide such education. A needs assessment at a single institution of
77. UTILIZATION OF HEAT-MAPPING SOFTWARE TO MATCH A RESIDENT STAFFING TEMPLATE TO ED ARRIVAL PATTERNS Abigail Schuh, MD, MMHPE, Mark Nimmer, Amy Drendel, DO, MS, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI BACKGROUND: Academic institutions rely on resident physicians to adequately staff emergency departments while residency programs need a steady flow of patients in order to provide trainees with a good clinical experience. Feedback from end-of-rotation evaluations suggest that residents feel competition for patients during some shifts and overworked during others. To investigate this, we utilized heat-mapping software to determine