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Immunology Fellowship Programs: Assessment Methods for Determining Competency of Fellows in-Training
Abstracts AB93
303
Quality of Facebook Pages on Food Allergy: Many Food Ingredient Alerts and Event Announcements but Little Research News and Patient Education
Mosaab Mohameden, Ves Dimov, MD, Frank J. Eidelman, MD, FAAAAI; Cleveland Clinic Florida, Weston, FL. RATIONALE: Facebook is the most popular and frequently used social media website in US. One third of American adults reported using social network sites, such as Facebook or Twitter as a source of health information. Our study aimed to determine the quality of health information on Facebook pages dedicated to food allergy. METHODS: Facebook main page was searched for ‘‘food allergy’’ to retrieve top ten pages dedicated to the topic. A 0-9 score for quality content was developed based on the guidelines by National Library of Medicine, focusing on 9 domains: author/organization, reviewer, contact info, authenticity, language used (simple vs scientific), evidence-based vs. opinion, references vs. testimonials, current information, sponsorship, commercial interest. The score was used to analyze the last 10 posts of each Facebook page. Posts were categorized into 5 groups: food ingredient alerts, patient education, research news, event announcements, legislation updates. RESULTS: 37% of posts were announcements/advertisements, 29% were related to patient education, 9% legislation updates, only 5% were research news. Quality score was relatively high with an average of 7.1 (0-9). Most pages were by patient advocate organizations. Only one was by a physician specialty organization, and one by an allergy practice. CONCLUSIONS: In spite of the wide popularity of Facebook, only a minority of the pages on food allergy contained patient education information. A paucity of research news was likely related to low engagement by allergists/immunologists. Professional use of Facebook by allergists/immunologists for patient education and sharing research news should be encouraged and its implications explored.
304
Level of Knowledge, Concerns and Healthcare Practices Among Physicians Regarding E-Cigarettes
Venkatkiran Kanchustambham, MD1, Jonathan Rodrigues, Fellow-inTraining2, Abhishek Krishna, Fellow in training3, Sadashiv Santosh, Assistant professor3; 1Saint Louis University School of Medicine, St. Louis, MO, 2Saint Louis University School of Medicine, Saint Louis, MO, 3Saint Louis University, Saint Louis, MO. RATIONALE: Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver aerosolized nicotine. With easy access and over the counter availability, many patients consider using e-cigarettes for smoking cessation. Few studies have looked at long-term safety and efficacy of e-cigarettes. Physicians have insufficient guidelines for advising their patients. METHODS: An anonymous online questionnaire was sent to all residents, fellows and faculty in the departments of internal medicine and surgery at Saint Louis University. RESULTS: We received 114 responses (51%). 57 % of respondents knew what ‘‘vaping’’ meant. 9% reported being ‘‘very familiar’’ with e-cigarettes, while 26 % reported no familiarity. 15% of physicians would advise e-cigarettes as nicotine replacement therapy, if asked by patients. 91% were aware of the nicotine content of e-cigarettes, but seem to be unaware of the presence of carcinogens (19%) and polyethylene glycol (38%). Lack of evidence regarding long-term safety (76%), e-cigarettes as starter products for nonsmokers (50%), absence of FDA regulations (51%) and marketing to youth (42%) were major concerns. Stricter regulations (54%), warning labels similar to tobacco products (53%), restricting advertising (36%), banning sales to minors (34%) and banning use in public spaces (25%) were favored as regulatory measures. 50% of physicians see a role for e-cigarettes as part of ‘‘harm reduction strategy’’. Training and familiarity showed no significant correlation. CONCLUSIONS: Further research is needed to assess whether ecigarettes could be an effective smoking cessation tool. There is an apparent knowledge gap among physicians and an urgent need for evidence based guidelines to aid with advising smokers enquiring about e-cigarettes.
305
Educational Needs Assessment of US Allergy/ Immunology Fellowship Programs: Assessment Methods for Determining Competency of Fellows in-Training
Lily C. Pien, MD, MHPE, FAAAAI, Erica J. Glancy, MD, Katrina Zell, Colleen Y. Colbert, PhD; Cleveland Clinic, Cleveland, OH. RATIONALE: ACGME introduced a milestone framework to assist in competency development in GME trainees. Little is known about current use of assessment methods in U.S. Allergy/Immunology (A/I) Fellowship programs. A recommendation by the A/I Milestone Working Group was that programs ‘‘should make use of all available data’’ from a wide variety of assessment sources. METHODS: IRB approval was obtained for a prospective survey study designed as a needs assessment. A link to a REDcap questionnaire, previously piloted, was e-mailed to 74 U.S. Program Directors (PDs) to identify currently used assessment methods. We were also interested in the provision of feedback to trainees. Program characteristics were examined for continuous and categorical variables. RESULTS: Twenty-one of 74 PDs (28%) responded, with 19 completing questions regarding assessment methods. Thirteen PDs completed all questionnaire items. The most commonly used assessment methods were the ITE (100%), direct observation of trainees (95%), faculty assessments (89%), and 360-degree assessments (89%). Commonly used methods (>50% of programs) included self-assessments, portfolios, and patient surveys. More information about multiple choice examinations (23%), teamwork assessments (15%), chart-stimulated recall (15%), and OSCEs (15%) was wanted. Feedback, verbal and written, was typically provided to trainees every six months and classified as both formative and summative in nature. CONCLUSIONS: Our results indicate consistency in the type of assessment methods used in respondents’ training programs. Peer assessments and OSCEs, while recommended, were less commonly used in this sample. Faculty development regarding recommended methods may increase their use and provide additional valuable feedback to trainees.
306
Immunotherapy Guide Increases Dosing Accuracy
Jared I. Darveaux, MD1, Sameer K. Mathur, MD, PhD, FAAAAI2, Sujani Kakumanu, MD2, Diane Dierdorff, CPhT3; 1Gundersen Health System, Onalaska, WI, 2University of Wisconsin School of Medicine and Public Health, Madison, WI, 3University of Wisconsin Hospitals and Clinics. RATIONALE: Immunotherapy (IT) is an effective therapeutic tool used to treat allergic disease. Proper dosing of IT is important for optimizing patient results and minimizing the risk of shot reactions/anaphylaxis. In 2011, practice parameters (PP) were published with dosing recommendations for standardized and non-standardized antigens. We launched a quality improvement initiative to study current prescribing practices and develop a decision support tool (DST) to improve dosing accuracy. METHODS: Developed a DST to provide a dosing guide based on PP guidelines. Education was provided in the form of 1:1 coaching, didactic training sessions and real time guidance. Prior to implementing the DST, 50 most recent new IT prescriptions were reviewed (excluding venom) and were categorized as either accurate (in accordance with PP guidelines), high, very high, low, or very low. The DST was then placed in clinics for optional use by providers. After 4 months, the 49 most recent prescriptions were reviewed and compared to pre-implementation values using chi-square analysis. RESULTS: Prior to DST use, 28% of prescriptions were accurately dosed. The majority of prescriptions (38%) were dosed very low (less than ½ lowest recommended dose). After DST implementation accurate dosing improved by 143% (p 5 < 0.0001). There were also significant reductions in very high (60%, p 5 <0.0001) and very low (79%, p 5 <0.0001) doses. CONCLUSIONS: Implementation a DST dramatically improves the accuracy of IT dosing. A bundled approach of education, coaching and decision support linked to the ordering process leads to better adherence to guideline recommendations.
SATURDAY
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
303
Quality of Facebook Pages on Food Allergy: Many Food Ingredient Alerts and Event Announcements but Little Research News and Patient Education
Mosaab Mohameden, Ves Dimov, MD, Frank J. Eidelman, MD, FAAAAI; Cleveland Clinic Florida, Weston, FL. RATIONALE: Facebook is the most popular and frequently used social media website in US. One third of American adults reported using social network sites, such as Facebook or Twitter as a source of health information. Our study aimed to determine the quality of health information on Facebook pages dedicated to food allergy. METHODS: Facebook main page was searched for ‘‘food allergy’’ to retrieve top ten pages dedicated to the topic. A 0-9 score for quality content was developed based on the guidelines by National Library of Medicine, focusing on 9 domains: author/organization, reviewer, contact info, authenticity, language used (simple vs scientific), evidence-based vs. opinion, references vs. testimonials, current information, sponsorship, commercial interest. The score was used to analyze the last 10 posts of each Facebook page. Posts were categorized into 5 groups: food ingredient alerts, patient education, research news, event announcements, legislation updates. RESULTS: 37% of posts were announcements/advertisements, 29% were related to patient education, 9% legislation updates, only 5% were research news. Quality score was relatively high with an average of 7.1 (0-9). Most pages were by patient advocate organizations. Only one was by a physician specialty organization, and one by an allergy practice. CONCLUSIONS: In spite of the wide popularity of Facebook, only a minority of the pages on food allergy contained patient education information. A paucity of research news was likely related to low engagement by allergists/immunologists. Professional use of Facebook by allergists/immunologists for patient education and sharing research news should be encouraged and its implications explored.
304
Level of Knowledge, Concerns and Healthcare Practices Among Physicians Regarding E-Cigarettes
Venkatkiran Kanchustambham, MD1, Jonathan Rodrigues, Fellow-inTraining2, Abhishek Krishna, Fellow in training3, Sadashiv Santosh, Assistant professor3; 1Saint Louis University School of Medicine, St. Louis, MO, 2Saint Louis University School of Medicine, Saint Louis, MO, 3Saint Louis University, Saint Louis, MO. RATIONALE: Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver aerosolized nicotine. With easy access and over the counter availability, many patients consider using e-cigarettes for smoking cessation. Few studies have looked at long-term safety and efficacy of e-cigarettes. Physicians have insufficient guidelines for advising their patients. METHODS: An anonymous online questionnaire was sent to all residents, fellows and faculty in the departments of internal medicine and surgery at Saint Louis University. RESULTS: We received 114 responses (51%). 57 % of respondents knew what ‘‘vaping’’ meant. 9% reported being ‘‘very familiar’’ with e-cigarettes, while 26 % reported no familiarity. 15% of physicians would advise e-cigarettes as nicotine replacement therapy, if asked by patients. 91% were aware of the nicotine content of e-cigarettes, but seem to be unaware of the presence of carcinogens (19%) and polyethylene glycol (38%). Lack of evidence regarding long-term safety (76%), e-cigarettes as starter products for nonsmokers (50%), absence of FDA regulations (51%) and marketing to youth (42%) were major concerns. Stricter regulations (54%), warning labels similar to tobacco products (53%), restricting advertising (36%), banning sales to minors (34%) and banning use in public spaces (25%) were favored as regulatory measures. 50% of physicians see a role for e-cigarettes as part of ‘‘harm reduction strategy’’. Training and familiarity showed no significant correlation. CONCLUSIONS: Further research is needed to assess whether ecigarettes could be an effective smoking cessation tool. There is an apparent knowledge gap among physicians and an urgent need for evidence based guidelines to aid with advising smokers enquiring about e-cigarettes.
305
Educational Needs Assessment of US Allergy/ Immunology Fellowship Programs: Assessment Methods for Determining Competency of Fellows in-Training
Lily C. Pien, MD, MHPE, FAAAAI, Erica J. Glancy, MD, Katrina Zell, Colleen Y. Colbert, PhD; Cleveland Clinic, Cleveland, OH. RATIONALE: ACGME introduced a milestone framework to assist in competency development in GME trainees. Little is known about current use of assessment methods in U.S. Allergy/Immunology (A/I) Fellowship programs. A recommendation by the A/I Milestone Working Group was that programs ‘‘should make use of all available data’’ from a wide variety of assessment sources. METHODS: IRB approval was obtained for a prospective survey study designed as a needs assessment. A link to a REDcap questionnaire, previously piloted, was e-mailed to 74 U.S. Program Directors (PDs) to identify currently used assessment methods. We were also interested in the provision of feedback to trainees. Program characteristics were examined for continuous and categorical variables. RESULTS: Twenty-one of 74 PDs (28%) responded, with 19 completing questions regarding assessment methods. Thirteen PDs completed all questionnaire items. The most commonly used assessment methods were the ITE (100%), direct observation of trainees (95%), faculty assessments (89%), and 360-degree assessments (89%). Commonly used methods (>50% of programs) included self-assessments, portfolios, and patient surveys. More information about multiple choice examinations (23%), teamwork assessments (15%), chart-stimulated recall (15%), and OSCEs (15%) was wanted. Feedback, verbal and written, was typically provided to trainees every six months and classified as both formative and summative in nature. CONCLUSIONS: Our results indicate consistency in the type of assessment methods used in respondents’ training programs. Peer assessments and OSCEs, while recommended, were less commonly used in this sample. Faculty development regarding recommended methods may increase their use and provide additional valuable feedback to trainees.
306
Immunotherapy Guide Increases Dosing Accuracy
Jared I. Darveaux, MD1, Sameer K. Mathur, MD, PhD, FAAAAI2, Sujani Kakumanu, MD2, Diane Dierdorff, CPhT3; 1Gundersen Health System, Onalaska, WI, 2University of Wisconsin School of Medicine and Public Health, Madison, WI, 3University of Wisconsin Hospitals and Clinics. RATIONALE: Immunotherapy (IT) is an effective therapeutic tool used to treat allergic disease. Proper dosing of IT is important for optimizing patient results and minimizing the risk of shot reactions/anaphylaxis. In 2011, practice parameters (PP) were published with dosing recommendations for standardized and non-standardized antigens. We launched a quality improvement initiative to study current prescribing practices and develop a decision support tool (DST) to improve dosing accuracy. METHODS: Developed a DST to provide a dosing guide based on PP guidelines. Education was provided in the form of 1:1 coaching, didactic training sessions and real time guidance. Prior to implementing the DST, 50 most recent new IT prescriptions were reviewed (excluding venom) and were categorized as either accurate (in accordance with PP guidelines), high, very high, low, or very low. The DST was then placed in clinics for optional use by providers. After 4 months, the 49 most recent prescriptions were reviewed and compared to pre-implementation values using chi-square analysis. RESULTS: Prior to DST use, 28% of prescriptions were accurately dosed. The majority of prescriptions (38%) were dosed very low (less than ½ lowest recommended dose). After DST implementation accurate dosing improved by 143% (p 5 < 0.0001). There were also significant reductions in very high (60%, p 5 <0.0001) and very low (79%, p 5 <0.0001) doses. CONCLUSIONS: Implementation a DST dramatically improves the accuracy of IT dosing. A bundled approach of education, coaching and decision support linked to the ordering process leads to better adherence to guideline recommendations.
SATURDAY
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2