- Email: [email protected]
Sa1026 An Interprofessional Education Session Improved Medical Student Confidence in Providing Therapeutic Diet Advice
AGA Abstracts
Models were fitted to predict the likelihood of hospital charges beyond the 75th percentile of 30,405 dollars. Patient and hospital covariates included age, sex, race, comorbidities (Charlson Comorbidity Index, CCI), insurance status, socio-economic status, hospital location (rural vs. urban), region (Northeast, Midwest, West, or South), teaching status, and hospital bed size. Results: Overall, a weighted sample of 2,569,409 patient visits were identified, of which 1,304,199 (50.8%) were women. Of those admitted, 26.4% had biliary pancreatitis and 14.4% had alcoholic pancreatitis. The median hospital charges for acute pancreatitis were $15,646. The median hospital charges for biliary and alcoholic pancreatitis were statistically significantly different ($21,696 vs. $12,582, p-value <0.001). Of the patients with biliary pancreatitis, median costs differed according to whether or not a procedure was utilized including endoscopic retrograde cholangiopancreatography (ERCP) ($26,941 vs. $21,427, p<0.001) or cholecystectomy (CCY) ($27,115 vs. $15,075.59, p<0.001), and whether or not total parenteral nutrition (TPN) was used ($56,595 vs. $21,540, p<0.001). Multivariable analysis adjusting for patient and hospital variables revealed that patients with alcoholic pancreatitis were less likely to incur high hospital charges than those with biliary pancreatitis (OR=0.86 CI: 0.84 to 0.87, p<0.001). A high CCI score ‡3 (OR=3.59 CI: 3.56 to 3.63, p<0.001), older age (OR=1.01 CI: 1.01. to 1.01, p<0.001) and obesity (OR=1.22 CI: 1.19 to 1.25, p<0.001) were all independent predictors of significantly higher charges. Conclusions: Biliary pancreatitis incurs higher charges than alcoholic pancreatitis, likely because of the need for procedures. Even after adjusting for patient and hospital variables, biliary pancreatitis remained a predictor of higher hospital charges.
laparoscopic right hemicolectomy (LRH). A decision analytic model was constructed to analyze the outcome of the two strategies. The model included key determinants impacting strategy choice, including numbers of procedures, procedural/surgical complication rates, incomplete polyp removal rates, cancer mortality from prevalent neoplasia, and all associated medical costs. The primary endpoint for the analysis was mortality, and the secondary endpoint was cost. Values for the model parameters were derived from the published literature. Extensive sensitivity analyses were performed to assess the impact of parameter uncertainty on model results and the consequent robustness of the findings. RESULTS: The POLY strategy was superior when mortality was the primary endpoint for both NP lesions < 0.9 cm and 1.0 - 2.0 cm, by 1054 and 404 total deaths per 100,000 patients, respectively. For NP lesions > 2.0 cm, however, the LRH strategy was superior, resulting in 270 less total deaths per 100,000. The POLY strategy cost less than the LRH strategy for NP lesions < 0.9 cm and 1.0 - 2.0 cm by $4585.24 and $1632.42 per patient, respectively, but for lesions > 2.0 cm, the LRH strategy was less expensive by $2535.26. Sensitivity analysis found that model findings were sensitive to prevalent invasive cancer rates and LRH complication mortality rates; POLY would be the preferred strategy in NP lesions > 2.0 cm if cancer rates were below 44.3% (base case = 53.3%) or if LRH mortality rates were above 1.5% (base case = 1.1%). CONCLUSION: Based on our modeling analysis, endoscopic polypectomy is the preferred strategy for NP lesions in the right colon or cecum for polyps less than 2.0 cm, as it results in less overall mortality and is less expensive. However, for polyps 2.0 cm and greater, surgical management is preferred primarily because of the higher risk of prevalent invasive carcinoma and incomplete polypectomy rates.
Sa1024 PEG Tube Replacements As a Health Cost Saving Measure of Providing Geriatric Gastroenterology Consultations in Long Term Care Facilities Mikram Jafri, Donald Kotler, Il Paik, Ali Afzal INTRODUCTION: Patients in long term care (LTC) have a 25% risk of hospitalization in any given 6 month period. Reducing hospital and office referrals from LTC settings is likely to improve health care costs. We established a Geriatric Gastroenterology(Geri-GI) service at a LTC facility with the aim of reducing hospitalizations and unnecessary admissions. MATERIAL AND METHODS: A Geri-GI consultation service was established in a 520 bed LTC facility and data was prospectively collected over a 2 year period. A retrospective chart review was performed on the effects of the Geri Consultation on PEG tube related hospitalizations, ED referals. Cost was calculated using ICD9 codes and Medicare fee schedules and CPT codes for consultations, transportation costs, ancillary services, and PEG tube replacements (See TABLE 1). Additionally we calculated annual savings for NY State based on current data on residents with PEG tubes. Subgroup analysis was conducted for cause replacement or routine replacement of PEG Tube in the Nursing home setting (TABLE 2). RESULTS: PEG tube evaluations accounted for one fourth (24%) of the gastroenterology consultations (61/259) . Fourty-one (65%) patients required PEG tube replacements while 21 (35%) consultations did not.Of the 41 PEG replacements;26 (42%) were replaced at bedside while Seven (11%) patients were refered for EGD prior to PEG placement. Another seven (11%) patients had PEG tube permenantly removed. The total cost of our consultation service and PEG tube replacements was $16,245 compared to an estimated cost of referal to the ED calculated as $162,870. Total cost saving was $146,625 or $ 2403 per patient. Calculated annual total savings of our model in all LTC in NYC state would be 21,152,459.Annual cost for routine replacements biannually was less than for cause replacements of PEG Tubes ($ 5978 vs 16,245) DISCUSSION: Geriatric Gastroenterology Service in a LTC facility for evaluation and replacement of PEG tube significantly reduces healthcare costs, ER referals and hospital admissions. This Geriatric GI care model is an easily implemented and economically viable leading to significant impact on health care delivery and costs. CPT CODES USED
Sa1026 An Interprofessional Education Session Improved Medical Student Confidence in Providing Therapeutic Diet Advice Sheryl Pfeil, Diane Habash, Marcia Nahikian-Nelms Background: Preclinical medical student education in nutrition has traditionally focused on nutrient biochemistry, absorption and utilization. There has been less information provided to students about eating behavior, social determinants of nutrition and therapeutic diets for medical conditions. A novel interprofessional session at the Ohio State University College of Medicine, involving Medical Dietetics faculty, post-baccalaureate medical dietetic interns and medical students was incorporated into the preclinical Gastroenterology block. A preand post-session survey was administered to the medical students. Aim: To assess whether an interprofessional medical dietetic session was perceived as a useful learning experience by preclinical medical students and to assess whether there was a change in their level of confidence in providing individualized dietary advice to patients and collaborating with dieticians. Methods: 1. Preclinical medical students (n=47) attended a two hour combined didactic and experiential session facilitated by medical dietetic faculty (n=2) and dietetic interns (n=20). The didactic lecture provided information about nutrition assessment and medical nutrition therapy (MNT) for specific diseases. During the experiential component, medical students worked with dietetic interns on a specific MNT diet and altering sample meals to meet MNT guidelines while incorporating patient challenges, barriers and motivations. 2. Medical students completed an 8 item pre- and post-session survey, rating their confidence in making correct diet suggestions, overcoming barriers to compliance with MNT, and collaborating with dieticians. They also rated the helpfulness of the session for learning about nutrition assessment, diet alterations, compliance issues, and the role of the dietician. 3. Results of pre- and post-session surveys were analyzed to determine the perceived usefulness of the session and the change in perceived confidence of the medical students in providing MNT advice. Results: Analysis of the survey results showed a significant increase in the students' confidence in making correct diet or food suggestions for MNT, providing suggestions to overcome barriers and working alongside the dietician. Conclusions: 1. A simulated diet counseling session facilitated by medical dietetic faculty and interns can be an effective application exercise for preclinical medical students and may improve their knowledge of medical, behavioral and social challenges that impact MNT, their confidence in altering meals in accordance with guidelines, and their confidence in working alongside dieticians. 2. We believe that IPE involving medical students and medical dietetic interns may have a favorable impact on future interprofessional collaboration and attitudes in clinical nutrition practice, a topic that deserves further study. Perceived Value of Interprofessional Nutrition Education Session
Cost calculated as per National Average Medicare Physician payment rates DEFINATION
Sa1025 Surgical Versus Endoscopic Management of Flat and Depressed Polyps Found in the Right Colon: Results of a Decision Analysis Alvin Jeon, Jacob D. Nudel, Chin Hur BACKGROUND: There is an increasing acceptance of the significance of "flat and depressed" or non-polypoid (NP) lesions as aggressive precursors to invasive carcinoma in the colon. Endoscopic polypectomy during screening and surveillance colonoscopy deals with adenomatous precursors to prevent and curb the threat of carcinoma, but surgical management may be more favorable under certain conditions, particularly with laparoscopic right hemicolectomy. The size of the lesion strongly correlates with increased risk of malignancy, and surgery is necessary in the case of invasive cancer. AIM: To compare the outcomes of two treatment strategies for different sized NP lesions discovered in the right colon or cecum during colonoscopy. METHOD: Hypothetical average-risk patients who had undergone screening colonoscopy and were found to have an NP polyp in the right colon or cecum were modeled to either: (1) undergo endoscopic polypectomy (POLY), or (2) undergo
AGA Abstracts
X : 55624$1AGA 03-28-15 04:55:56 PDFd : 55624B : e
S-200
Page 200
Sa1028
Objectives: Despite the availability of multiple therapies for patients with Crohn disease (CD), gastroenterologists continue to underutilize immunomodulators and fail to prescribe biologic agents for appropriate patients, resulting in poor symptom control and a negative effect on quality of life. The objective of this study was to evaluate the effectiveness of online CME activities in improving physician practices related to treatment of CD and the subsequent effect on patient quality of life. Methods: This study comprised 2 components: a healthcare provider survey and a patient survey. Gastroenterologists who participated in either of 2 CME online activities (http://www.medscape.org/viewarticle/767665; http://www.medscape.org/ viewarticle/768905) were sent an invitation to complete a survey to ascertain their practice patterns, attitudes, and barriers regarding the use of early aggressive therapy in appropriate patients with CD. The control group for the study consisted of physicians who did not participate in the educational activities. Following the healthcare provider survey, both participant and nonparticipant physicians were asked to distribute invitations to their patients with CD to complete an online survey based on the short inflammatory bowel disease questionnaire (SIBDQ). Patients who completed the initial survey were contacted via email 4 to 6 weeks later and asked to complete a second survey; data from the 2 time points were analyzed to characterize therapy success and overall quality of life and function. Findings were found to be significant at P £ .05. Results: A total of 98 gastroenterologists and 134 patients participated in the study. Physicians who participated in the online CME activities (n=58) reported significantly fewer barriers to the early initiation of biologic therapy in appropriate patients with CD compared to nonparticipants (n=40), indicating the education was successful in increasing physician confidence in overcoming barriers to care, such as concern for the risk of patients developing hepatosplenic T-cell lymphoma or antibodies or uncertainty as to how to taper steroid therapy to avoid steroid dependence ( P<.05). Additionally, participants were significantly less likely to consider biologics as a last-line option ( P= .05). Physician participation in online education also had measurable effects on the health of their patients with CD. Patients of physician participants in online CME activities showed a significantly improved SIBDQ score from baseline to follow-up ( P=.02) compared with no change seen in the scores of the control group ( P=.16). Conclusions: The study demonstrated that online CME activities, designed using adult learning principles, can not only effectively improve physician confidence related to the treatment of CD and promote performance change but can also improve patients' quality of life.
Number of survey participants = 47 Pre- and Post- Session Medical Student Confidence in Diet Counseling and Interprofessional Collaboration
*Number of respondents = 47
Sa1027 The Flipped Classroom in Medical Student Gastroenterology Teaching: Inferior Rating of Independent E-Learning Modules Sheryl Pfeil, Alice Hinton Background: Teaching gastroenterology (GI) in the preclinical curriculum is evolving from a traditional didactic, lecture type approach to one that is learner-centered, utilizing selfdirected learning to deliver didactic content and combining that with in-person active learning experiences as part of a "flipped classroom". In 2014/2015 (the second year of the new GI curriculum at the Ohio State University College of Medicine) approximately half of the GI topics have been converted to e-learning modules, and the remainder are delivered as traditional "sage on the stage" lectures. Students may attend lectures in person, livestream or podcast them. There are also in-class activities (dissection labs, Team Based Learning exercises, case-based discussions). A subset of students evaluates all Teaching Learning Methods (TLMs) at the conclusion of each block. Aim: To evaluate the student rating of module quality of e-learning (guided learning and pre-recorded) modules compared to the rating of traditional lecture modules. Methods: 1. The GI e-learning (guided learning) methods include interactive modules (Articulate software) as well as pre-recorded talks, selfstudy cases and questions. The lectures are live talks that students may view in-person, or remotely by live-stream or podcast. 2. Both traditional lectures and guided learning modules have accompanying power point slide sets. Students may view the slides and watch the guided learning modules and the lectures (via podcast) as many times as they wish. The elearning module authors and the lecturers are equally accessible to the students. 3. A subset of students evaluates each Gastroenterology TLM ["Rate the overall quality of these teaching/ learning experiences"] using a 4-point scale of 1 (poor) to 4 (excellent). 4. Ratings of quality of e-learning (guided learning) modules were compared to those of the lectures. The comparison was performed at year 2 of the new curriculum in order to avoid potential negative bias related to technical implementation of e-learning modules. Results: The average rating for the e-learning modules was 3.12, compared to an average rating of 3.32 for the lecture modules. The average rating for lectures was significantly higher than that of the elearning modules, p=0.0014 two-sample t-test. Conclusions: 1. In the new pedagogical model of the flipped classroom, we need to carefully assess the quality of new types of content delivery. 2. Because traditional lectures may be viewed remotely (asynchronous learning), the higher rating of lectures suggests that there are human factors involving content delivery that influence the perceived quality of GI learning modules. 3. Identification of best-practice methods, dissemination of exemplar modules and faculty support/development may be needed to help GI educators optimize teaching quality using independent learning methods. Comparison of e-Learning Modules and Lectures
Sa1029 Retrospective Safety Analysis of Trainee-Performed Liver Biopsies at the National Institutes of Health Clinical Center - A 35-Year Experience Varun Takyar, Yaron Rotman, Xiongce Zhao, Marc G. Ghany, Theo Heller, Edward Doo, Jake Liang, Jay Hoofnagle, Christopher Koh Introduction: Liver biopsy (LB) plays an important role in the diagnosis and management of patients with liver disease. However, the procedure is not without risk, and operators should be trained to recognize and treat complications. Current guidelines and advanced training requirements recommend 40 supervised LBs for proficiency; however this is based on empirical evidence and the number of LBs required for adequate training is unknown. Aims: To assess the adequacy of current training requirements in LB utilizing >35 years of experience from a training fellowship program in gastroenterology/hepatology at the National Institutes of Health Clinical Center. Methods: Consecutive LB data performed from July 1978 to November 2014 by trainees with attending supervision were collected. Complications evaluated included: moderate-through-severe pain, bleeding (±intervention), injury to other viscera, hypotension (±intervention), pulmonary (atelectasis) and neurologic. Serious complications included: death, severe pain, bleeding or hypotension requiring intervention, other organ injury and TIA. For patients with serious complications, peri-biopsy clinical, lab and radiologic data were evaluated. Results: 3664 percutaneous LBs were performed by 75 trainees (mean per operator=49±39). Most (99%) utilized a 16 gauge Klatskin needle. Transthoracic techniques included percussion (1978-1985) and ultrasound-guided (19862014) approaches. The total complication rate was 4.2% (154), and 1.7% (62) were serious. Serious bleeding occurred in 21 patients (0.6%) with 7 requiring surgical/radiological intervention and 3 (0.08%) procedure-related deaths. Other organs injured included gallbladder (n=10, 0.3%), kidney (n=2, 0.05%), and lung (n=1, 0.03%). Of 75 trainees, 33 (44%) performed a LB resulting in a serious complication. Trainees with complications performed significantly more procedures, (68 vs 24, p=<0.0001). On Kaplan-Meier analysis, the median time to any complication was 22 biopsies and to a serious complication 49 biopsies. By regression analyses of time to multiple events using the Andersen-Gill model, an earlier firsttime serious complication by a physician was associated with more overall such complications encountered, p=0.0239 with unit hazard ratio of 0.978. A similar result was found with analysis of all complications, p<0.0001 with unit hazard ratio of 0.971. Conclusion: Complications of LB are rare in training programs but are experienced by a large proportion of operators. Further exploration should be performed to confirm whether physicians who encounter serious complications early in their training are more likely to have complications in the future. Training programs and trainees should be aware that for the majority of trainees, the first serious complication tends to occur outside of the currently recommended supervised training window.
There is a significant difference in the average of the recorded/guided learning and the lectures, p=0.0014 two sample t-test
Sa1030 The Role of Whole Body Video Monitoring and Feedback in a Laparoscopic Simulation Laboratory Deepa Shah, Daniel J. Torrent, L. W. Nifong, Carl Haisch Purpose: Awareness of posture and ergonomics is lacking in many surgeons, especially in laparoscopy. Technique and positioning is imperative in order to become proficient with laparoscopic instruments and needs to be stressed early in training during residency. There
S-201
AGA Abstracts
AGA Abstracts
The Effect of Physician Education on Improving Quality of Life in Patients With Crohn Disease Jelena Spyropoulos, Jovana Lubarda
Models were fitted to predict the likelihood of hospital charges beyond the 75th percentile of 30,405 dollars. Patient and hospital covariates included age, sex, race, comorbidities (Charlson Comorbidity Index, CCI), insurance status, socio-economic status, hospital location (rural vs. urban), region (Northeast, Midwest, West, or South), teaching status, and hospital bed size. Results: Overall, a weighted sample of 2,569,409 patient visits were identified, of which 1,304,199 (50.8%) were women. Of those admitted, 26.4% had biliary pancreatitis and 14.4% had alcoholic pancreatitis. The median hospital charges for acute pancreatitis were $15,646. The median hospital charges for biliary and alcoholic pancreatitis were statistically significantly different ($21,696 vs. $12,582, p-value <0.001). Of the patients with biliary pancreatitis, median costs differed according to whether or not a procedure was utilized including endoscopic retrograde cholangiopancreatography (ERCP) ($26,941 vs. $21,427, p<0.001) or cholecystectomy (CCY) ($27,115 vs. $15,075.59, p<0.001), and whether or not total parenteral nutrition (TPN) was used ($56,595 vs. $21,540, p<0.001). Multivariable analysis adjusting for patient and hospital variables revealed that patients with alcoholic pancreatitis were less likely to incur high hospital charges than those with biliary pancreatitis (OR=0.86 CI: 0.84 to 0.87, p<0.001). A high CCI score ‡3 (OR=3.59 CI: 3.56 to 3.63, p<0.001), older age (OR=1.01 CI: 1.01. to 1.01, p<0.001) and obesity (OR=1.22 CI: 1.19 to 1.25, p<0.001) were all independent predictors of significantly higher charges. Conclusions: Biliary pancreatitis incurs higher charges than alcoholic pancreatitis, likely because of the need for procedures. Even after adjusting for patient and hospital variables, biliary pancreatitis remained a predictor of higher hospital charges.
laparoscopic right hemicolectomy (LRH). A decision analytic model was constructed to analyze the outcome of the two strategies. The model included key determinants impacting strategy choice, including numbers of procedures, procedural/surgical complication rates, incomplete polyp removal rates, cancer mortality from prevalent neoplasia, and all associated medical costs. The primary endpoint for the analysis was mortality, and the secondary endpoint was cost. Values for the model parameters were derived from the published literature. Extensive sensitivity analyses were performed to assess the impact of parameter uncertainty on model results and the consequent robustness of the findings. RESULTS: The POLY strategy was superior when mortality was the primary endpoint for both NP lesions < 0.9 cm and 1.0 - 2.0 cm, by 1054 and 404 total deaths per 100,000 patients, respectively. For NP lesions > 2.0 cm, however, the LRH strategy was superior, resulting in 270 less total deaths per 100,000. The POLY strategy cost less than the LRH strategy for NP lesions < 0.9 cm and 1.0 - 2.0 cm by $4585.24 and $1632.42 per patient, respectively, but for lesions > 2.0 cm, the LRH strategy was less expensive by $2535.26. Sensitivity analysis found that model findings were sensitive to prevalent invasive cancer rates and LRH complication mortality rates; POLY would be the preferred strategy in NP lesions > 2.0 cm if cancer rates were below 44.3% (base case = 53.3%) or if LRH mortality rates were above 1.5% (base case = 1.1%). CONCLUSION: Based on our modeling analysis, endoscopic polypectomy is the preferred strategy for NP lesions in the right colon or cecum for polyps less than 2.0 cm, as it results in less overall mortality and is less expensive. However, for polyps 2.0 cm and greater, surgical management is preferred primarily because of the higher risk of prevalent invasive carcinoma and incomplete polypectomy rates.
Sa1024 PEG Tube Replacements As a Health Cost Saving Measure of Providing Geriatric Gastroenterology Consultations in Long Term Care Facilities Mikram Jafri, Donald Kotler, Il Paik, Ali Afzal INTRODUCTION: Patients in long term care (LTC) have a 25% risk of hospitalization in any given 6 month period. Reducing hospital and office referrals from LTC settings is likely to improve health care costs. We established a Geriatric Gastroenterology(Geri-GI) service at a LTC facility with the aim of reducing hospitalizations and unnecessary admissions. MATERIAL AND METHODS: A Geri-GI consultation service was established in a 520 bed LTC facility and data was prospectively collected over a 2 year period. A retrospective chart review was performed on the effects of the Geri Consultation on PEG tube related hospitalizations, ED referals. Cost was calculated using ICD9 codes and Medicare fee schedules and CPT codes for consultations, transportation costs, ancillary services, and PEG tube replacements (See TABLE 1). Additionally we calculated annual savings for NY State based on current data on residents with PEG tubes. Subgroup analysis was conducted for cause replacement or routine replacement of PEG Tube in the Nursing home setting (TABLE 2). RESULTS: PEG tube evaluations accounted for one fourth (24%) of the gastroenterology consultations (61/259) . Fourty-one (65%) patients required PEG tube replacements while 21 (35%) consultations did not.Of the 41 PEG replacements;26 (42%) were replaced at bedside while Seven (11%) patients were refered for EGD prior to PEG placement. Another seven (11%) patients had PEG tube permenantly removed. The total cost of our consultation service and PEG tube replacements was $16,245 compared to an estimated cost of referal to the ED calculated as $162,870. Total cost saving was $146,625 or $ 2403 per patient. Calculated annual total savings of our model in all LTC in NYC state would be 21,152,459.Annual cost for routine replacements biannually was less than for cause replacements of PEG Tubes ($ 5978 vs 16,245) DISCUSSION: Geriatric Gastroenterology Service in a LTC facility for evaluation and replacement of PEG tube significantly reduces healthcare costs, ER referals and hospital admissions. This Geriatric GI care model is an easily implemented and economically viable leading to significant impact on health care delivery and costs. CPT CODES USED
Sa1026 An Interprofessional Education Session Improved Medical Student Confidence in Providing Therapeutic Diet Advice Sheryl Pfeil, Diane Habash, Marcia Nahikian-Nelms Background: Preclinical medical student education in nutrition has traditionally focused on nutrient biochemistry, absorption and utilization. There has been less information provided to students about eating behavior, social determinants of nutrition and therapeutic diets for medical conditions. A novel interprofessional session at the Ohio State University College of Medicine, involving Medical Dietetics faculty, post-baccalaureate medical dietetic interns and medical students was incorporated into the preclinical Gastroenterology block. A preand post-session survey was administered to the medical students. Aim: To assess whether an interprofessional medical dietetic session was perceived as a useful learning experience by preclinical medical students and to assess whether there was a change in their level of confidence in providing individualized dietary advice to patients and collaborating with dieticians. Methods: 1. Preclinical medical students (n=47) attended a two hour combined didactic and experiential session facilitated by medical dietetic faculty (n=2) and dietetic interns (n=20). The didactic lecture provided information about nutrition assessment and medical nutrition therapy (MNT) for specific diseases. During the experiential component, medical students worked with dietetic interns on a specific MNT diet and altering sample meals to meet MNT guidelines while incorporating patient challenges, barriers and motivations. 2. Medical students completed an 8 item pre- and post-session survey, rating their confidence in making correct diet suggestions, overcoming barriers to compliance with MNT, and collaborating with dieticians. They also rated the helpfulness of the session for learning about nutrition assessment, diet alterations, compliance issues, and the role of the dietician. 3. Results of pre- and post-session surveys were analyzed to determine the perceived usefulness of the session and the change in perceived confidence of the medical students in providing MNT advice. Results: Analysis of the survey results showed a significant increase in the students' confidence in making correct diet or food suggestions for MNT, providing suggestions to overcome barriers and working alongside the dietician. Conclusions: 1. A simulated diet counseling session facilitated by medical dietetic faculty and interns can be an effective application exercise for preclinical medical students and may improve their knowledge of medical, behavioral and social challenges that impact MNT, their confidence in altering meals in accordance with guidelines, and their confidence in working alongside dieticians. 2. We believe that IPE involving medical students and medical dietetic interns may have a favorable impact on future interprofessional collaboration and attitudes in clinical nutrition practice, a topic that deserves further study. Perceived Value of Interprofessional Nutrition Education Session
Cost calculated as per National Average Medicare Physician payment rates DEFINATION
Sa1025 Surgical Versus Endoscopic Management of Flat and Depressed Polyps Found in the Right Colon: Results of a Decision Analysis Alvin Jeon, Jacob D. Nudel, Chin Hur BACKGROUND: There is an increasing acceptance of the significance of "flat and depressed" or non-polypoid (NP) lesions as aggressive precursors to invasive carcinoma in the colon. Endoscopic polypectomy during screening and surveillance colonoscopy deals with adenomatous precursors to prevent and curb the threat of carcinoma, but surgical management may be more favorable under certain conditions, particularly with laparoscopic right hemicolectomy. The size of the lesion strongly correlates with increased risk of malignancy, and surgery is necessary in the case of invasive cancer. AIM: To compare the outcomes of two treatment strategies for different sized NP lesions discovered in the right colon or cecum during colonoscopy. METHOD: Hypothetical average-risk patients who had undergone screening colonoscopy and were found to have an NP polyp in the right colon or cecum were modeled to either: (1) undergo endoscopic polypectomy (POLY), or (2) undergo
AGA Abstracts
X : 55624$1AGA 03-28-15 04:55:56 PDFd : 55624B : e
S-200
Page 200
Sa1028
Objectives: Despite the availability of multiple therapies for patients with Crohn disease (CD), gastroenterologists continue to underutilize immunomodulators and fail to prescribe biologic agents for appropriate patients, resulting in poor symptom control and a negative effect on quality of life. The objective of this study was to evaluate the effectiveness of online CME activities in improving physician practices related to treatment of CD and the subsequent effect on patient quality of life. Methods: This study comprised 2 components: a healthcare provider survey and a patient survey. Gastroenterologists who participated in either of 2 CME online activities (http://www.medscape.org/viewarticle/767665; http://www.medscape.org/ viewarticle/768905) were sent an invitation to complete a survey to ascertain their practice patterns, attitudes, and barriers regarding the use of early aggressive therapy in appropriate patients with CD. The control group for the study consisted of physicians who did not participate in the educational activities. Following the healthcare provider survey, both participant and nonparticipant physicians were asked to distribute invitations to their patients with CD to complete an online survey based on the short inflammatory bowel disease questionnaire (SIBDQ). Patients who completed the initial survey were contacted via email 4 to 6 weeks later and asked to complete a second survey; data from the 2 time points were analyzed to characterize therapy success and overall quality of life and function. Findings were found to be significant at P £ .05. Results: A total of 98 gastroenterologists and 134 patients participated in the study. Physicians who participated in the online CME activities (n=58) reported significantly fewer barriers to the early initiation of biologic therapy in appropriate patients with CD compared to nonparticipants (n=40), indicating the education was successful in increasing physician confidence in overcoming barriers to care, such as concern for the risk of patients developing hepatosplenic T-cell lymphoma or antibodies or uncertainty as to how to taper steroid therapy to avoid steroid dependence ( P<.05). Additionally, participants were significantly less likely to consider biologics as a last-line option ( P= .05). Physician participation in online education also had measurable effects on the health of their patients with CD. Patients of physician participants in online CME activities showed a significantly improved SIBDQ score from baseline to follow-up ( P=.02) compared with no change seen in the scores of the control group ( P=.16). Conclusions: The study demonstrated that online CME activities, designed using adult learning principles, can not only effectively improve physician confidence related to the treatment of CD and promote performance change but can also improve patients' quality of life.
Number of survey participants = 47 Pre- and Post- Session Medical Student Confidence in Diet Counseling and Interprofessional Collaboration
*Number of respondents = 47
Sa1027 The Flipped Classroom in Medical Student Gastroenterology Teaching: Inferior Rating of Independent E-Learning Modules Sheryl Pfeil, Alice Hinton Background: Teaching gastroenterology (GI) in the preclinical curriculum is evolving from a traditional didactic, lecture type approach to one that is learner-centered, utilizing selfdirected learning to deliver didactic content and combining that with in-person active learning experiences as part of a "flipped classroom". In 2014/2015 (the second year of the new GI curriculum at the Ohio State University College of Medicine) approximately half of the GI topics have been converted to e-learning modules, and the remainder are delivered as traditional "sage on the stage" lectures. Students may attend lectures in person, livestream or podcast them. There are also in-class activities (dissection labs, Team Based Learning exercises, case-based discussions). A subset of students evaluates all Teaching Learning Methods (TLMs) at the conclusion of each block. Aim: To evaluate the student rating of module quality of e-learning (guided learning and pre-recorded) modules compared to the rating of traditional lecture modules. Methods: 1. The GI e-learning (guided learning) methods include interactive modules (Articulate software) as well as pre-recorded talks, selfstudy cases and questions. The lectures are live talks that students may view in-person, or remotely by live-stream or podcast. 2. Both traditional lectures and guided learning modules have accompanying power point slide sets. Students may view the slides and watch the guided learning modules and the lectures (via podcast) as many times as they wish. The elearning module authors and the lecturers are equally accessible to the students. 3. A subset of students evaluates each Gastroenterology TLM ["Rate the overall quality of these teaching/ learning experiences"] using a 4-point scale of 1 (poor) to 4 (excellent). 4. Ratings of quality of e-learning (guided learning) modules were compared to those of the lectures. The comparison was performed at year 2 of the new curriculum in order to avoid potential negative bias related to technical implementation of e-learning modules. Results: The average rating for the e-learning modules was 3.12, compared to an average rating of 3.32 for the lecture modules. The average rating for lectures was significantly higher than that of the elearning modules, p=0.0014 two-sample t-test. Conclusions: 1. In the new pedagogical model of the flipped classroom, we need to carefully assess the quality of new types of content delivery. 2. Because traditional lectures may be viewed remotely (asynchronous learning), the higher rating of lectures suggests that there are human factors involving content delivery that influence the perceived quality of GI learning modules. 3. Identification of best-practice methods, dissemination of exemplar modules and faculty support/development may be needed to help GI educators optimize teaching quality using independent learning methods. Comparison of e-Learning Modules and Lectures
Sa1029 Retrospective Safety Analysis of Trainee-Performed Liver Biopsies at the National Institutes of Health Clinical Center - A 35-Year Experience Varun Takyar, Yaron Rotman, Xiongce Zhao, Marc G. Ghany, Theo Heller, Edward Doo, Jake Liang, Jay Hoofnagle, Christopher Koh Introduction: Liver biopsy (LB) plays an important role in the diagnosis and management of patients with liver disease. However, the procedure is not without risk, and operators should be trained to recognize and treat complications. Current guidelines and advanced training requirements recommend 40 supervised LBs for proficiency; however this is based on empirical evidence and the number of LBs required for adequate training is unknown. Aims: To assess the adequacy of current training requirements in LB utilizing >35 years of experience from a training fellowship program in gastroenterology/hepatology at the National Institutes of Health Clinical Center. Methods: Consecutive LB data performed from July 1978 to November 2014 by trainees with attending supervision were collected. Complications evaluated included: moderate-through-severe pain, bleeding (±intervention), injury to other viscera, hypotension (±intervention), pulmonary (atelectasis) and neurologic. Serious complications included: death, severe pain, bleeding or hypotension requiring intervention, other organ injury and TIA. For patients with serious complications, peri-biopsy clinical, lab and radiologic data were evaluated. Results: 3664 percutaneous LBs were performed by 75 trainees (mean per operator=49±39). Most (99%) utilized a 16 gauge Klatskin needle. Transthoracic techniques included percussion (1978-1985) and ultrasound-guided (19862014) approaches. The total complication rate was 4.2% (154), and 1.7% (62) were serious. Serious bleeding occurred in 21 patients (0.6%) with 7 requiring surgical/radiological intervention and 3 (0.08%) procedure-related deaths. Other organs injured included gallbladder (n=10, 0.3%), kidney (n=2, 0.05%), and lung (n=1, 0.03%). Of 75 trainees, 33 (44%) performed a LB resulting in a serious complication. Trainees with complications performed significantly more procedures, (68 vs 24, p=<0.0001). On Kaplan-Meier analysis, the median time to any complication was 22 biopsies and to a serious complication 49 biopsies. By regression analyses of time to multiple events using the Andersen-Gill model, an earlier firsttime serious complication by a physician was associated with more overall such complications encountered, p=0.0239 with unit hazard ratio of 0.978. A similar result was found with analysis of all complications, p<0.0001 with unit hazard ratio of 0.971. Conclusion: Complications of LB are rare in training programs but are experienced by a large proportion of operators. Further exploration should be performed to confirm whether physicians who encounter serious complications early in their training are more likely to have complications in the future. Training programs and trainees should be aware that for the majority of trainees, the first serious complication tends to occur outside of the currently recommended supervised training window.
There is a significant difference in the average of the recorded/guided learning and the lectures, p=0.0014 two sample t-test
Sa1030 The Role of Whole Body Video Monitoring and Feedback in a Laparoscopic Simulation Laboratory Deepa Shah, Daniel J. Torrent, L. W. Nifong, Carl Haisch Purpose: Awareness of posture and ergonomics is lacking in many surgeons, especially in laparoscopy. Technique and positioning is imperative in order to become proficient with laparoscopic instruments and needs to be stressed early in training during residency. There
S-201
AGA Abstracts
AGA Abstracts
The Effect of Physician Education on Improving Quality of Life in Patients With Crohn Disease Jelena Spyropoulos, Jovana Lubarda