The IUSM Scholarly Concentrations Program: Strategic Collaborative Education Across Schools and Departments

Presented as a poster at 2020 IUSM Education Day.A changing healthcare landscape calls for innovation and expansion of expertise in medical education. How does a medical school better prepare medical students to thrive in a changing profession? Through its Scholarly Concentrations Program, Indiana University School of Medicine is collaborating with non-physician experts from schools with expertise in topics that are medically relevant and of interest to medical students. Scholarly Concentrations are longitudinal experiences that enhance the medical education program through coursework and scholarly work. In addition to enhancing students’ education, it offers the opportunity to enhance campus reputation and develop research focus for students and faculty. Partnerships were created in both directions. IU School of Medicine sought out schools and departments with unique expertise on different medical campuses. Schools and departments also approached IU School of Medicine about its Scholarly Concentrations program as momentum built. These partnerships are creating mutual benefits for IUSM, partners, faculty and students. Benefits for partner organizations include mentoring opportunities, reputational enhancement, having an impact on healthcare system, and pathways to certificates and advanced degrees. For IUSM and its students, the partnerships enhance professional development through Scholarly Concentrations in areas of clinical, teaching, research, advocacy and administration

Educational Programs and Adaptability: A Systems Approach to Creating Adaptable Educational Programs

The IUSM Scholarly Concentrations Program is an optional four-year longitudinal program that allows students to explore interests outside the core medical curriculum. In two years, 17 concentrations were developed statewide and more than 220 students enrolled. As a part of developing a sustainable educational program, a Plan-Do-Check-Act improvement cycle is being used. This workshop will feature examples of the use of the Plan-Do-Check-Act improvement cycle during the launch and pilot a large, novel educational program that is “good enough” and builds toward sustainability and excellence while responding to large-scale systematic changes. Participants in the workshop will apply these principles to their own educational programs

Scholarly Concentrations: A Novel Platform for Delivery of Health Systems Science Exposure and Highlight Unique Learning Environments Across the Nine Campuses of Indiana University School of Medicine

Presented as a Poster at 2020 IUSM Education Day.Rapidly evolving challenges in health care mandate changes in the way health care professionals are educated. How do we integrate the need for new and different content into the medical school curriculum? One area of particular focus is called Health Systems Science. Health Systems Science is being called the 3rd leg of modern medical education to complement the foundational and clinical sciences curricula. IU School of Medicine is integrating Health Systems Science content into Scholarly Concentrations. Scholarly Concentrations is a program offering students longitudinal educational enhancement through coursework and scholarly work

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Clinical Ultrasound Is Safe and Highly Specific for Acute Appendicitis in Moderate to High Pre-test Probability Patients

Introduction: Clinical ultrasound (CUS) is highly specific for the diagnosis of acute appendicitis but is operator-dependent. The goal of this study was to determine if a heterogeneous group of emergency physicians (EP) could diagnose acute appendicitis on CUS in patients with a moderate to high pre-test probability. Methods: This was a prospective, observational study of a convenience sample of adult and pediatric patients with suspected appendicitis. Sonographers received a structured, 20-minute CUS training on appendicitis prior to patient enrollment. The presence of a dilated (>6 mm diameter), non-compressible, blind-ending tubular structure was considered a positive study. Non-visualization or indeterminate studies were considered negative. We collected pre-test probability of acute appendicitis based on a 10-point visual analog scale (moderate to high was defined as >3), and confidence in CUS interpretation. The primary objective was measured by comparing CUS findings to surgical pathology and one week follow-up. Results: We enrolled 105 patients; 76 had moderate to high pre-test probability. Of these, 24 were children. The rate of appendicitis was 36.8% in those with moderate to high pre-test probability. CUS were recorded by 33 different EPs. The sensitivity, specificity, and positive and negative likelihood ratios of EP-performed CUS in patients with moderate to high pre-test probability were 42.8% (95% confidence interval [CI] [25–62.5%]), 97.9% (95% CI [87.5–99.8%]), 20.7 (95% CI [2.8–149.9]) and 0.58 (95% CI [0.42–0.8]), respectively. The 16 false negative scans were all interpreted as indeterminate. There was one false positive CUS diagnosis; however, the sonographer reported low confidence of 2/10. Conclusion: A heterogeneous group of EP sonographers can safely identify acute appendicitis with high specificity in patients with moderate to high pre-test probability. This data adds support for surgical consultation without further imaging beyond CUS in the appropriate clinical setting

Experience introducing physician assistant students into a medical student emergency medicine clerkship

Background Physician assistants continue to play an increasingly important role in our healthcare system, including a growing role in the emergency department. Introducing physician assistant students into an existing emergency department learning environment makes efficient use of resources and provides an opportunity for interprofessional education, but the success of such a strategy and the resultant impact on medical student education have not been previously described. The goals of our study were to determine the impact of the introduction of physician assistant students into a learning environment that already serves medical students and residents, and to assess the readiness of physician assistant students to participate in an established medical student emergency medicine clerkship. Methods A survey was completed by emergency medicine faculty and residents shortly after the introduction of physician assistant students into an emergency department learning environment. The survey contained 18 questions in two sections: 11 questions asking about the effect of physician assistant students on the emergency department learning environment and 7 questions comparing the skills of physician assistant students with medical students. Data from medical student evaluations of the clerkship were also collected. Results and Discussion: Forty-six physician preceptors (43%) responded to the survey. The majority of preceptors felt that the presence of physician assistant students offered valuable interprofessional education and overall was a positive experience, though some expressed concerns about the effect on the education of other learners. Most preceptors felt that physician assistant students had comparable skills with medical students, though some concerns were expressed regarding knowledge base and variability of skill level. Medical student evaluations of the clerkship were similar before and after the introduction of physician assistant students. These results, however, must be viewed with caution as we were able replace a medical student with a physician assistant student, keeping the total number of students at the study sites constant, which some institutions may not be able to do. Conclusions The impact of introducing physician assistant students to a medical student emergency medicine clerkship is viewed as being positive overall, though more research is needed to understand and optimize the learning involvement for all learners