A Path to Wisdom: Examining the Multi-Faceted Mentoring Journey.

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Employing Natural History Collections in the Aid of Conservation: Streamlining an Approach to Model Species Distributions En Masse for the Preservation of Biodiversity

Using species distribution models (SDMs) in Natural History Collections (NHCs) can influence how humans implement conservation changes in flora and fauna communities and ecosystems. Through the use of legacy data (old NHCs and their associated locality/collection information), data correction (background data or pseudo absences added to presence-only data), and the SDM software, Maxent (and its associated geographic information systems or GIS projected models), it has been shown that it is feasible to create a low budget protocol/setup to project the past, present and future of species population changes. This has been done in the past few decades as more collections and their locality data have become digitized, potentially allowing more natural history collecting institutions and scientists to participate in more conservation projects. We can learn from how past and present population ranges have changed due to climate change, urbanization, and deforestation (among other changes) to be able to project where species ranges could exist in the future. The ultimate goal of this project is to provide both a streamlined protocol to input NHC data into Maxent in order to share the results of the Maxent models and associated statistics of NHC data, even if not publication worthy, to larger stakeholders, environmental policy makers and non-profits. Additionally, this project can allow scientists to follow up on the methods and results of the models to see if there really are possible conservation concerns. Interns, citizen sciences, collections workers (non-PhD scientists) can do this in smaller NHCs, and report their findings from their collections. This project has the potential to have a broader impact on rare species housed in smaller collections. Further, it has the capacity to be able allow for specific species and biota to be conserved with the help of precise small grants for specified flora and fauna to be modeled. While this type of project is not the end all be all cure for the biodiversity crisis, it can be a way to use available resources and technology for the advancement of our planet and its inhabitants

Medical students as EMTs: skill building, confidence and professional formation

Objective: The first course of the medical curriculum at the Hofstra North Shore-LIJ School of Medicine, From the Person to the Professional: Challenges, Privileges and Responsibilities, provides an innovative early clinical immersion. The course content specific to the Emergency Medical Technician (EMT) curriculum was developed using the New York State Emergency Medical Technician curriculum. Students gain early legitimate clinical experience and practice clinical skills as team members in the pre-hospital environment. We hypothesized this novel curriculum would increase students’ confidence in their ability to perform patient care skills and enhance students’ comfort with team-building skills early in their training. Methods: Quantitative and qualitative data were collected from first-year medical students (n=97) through a survey developed to assess students’ confidence in patient care and team-building skills. The survey was completed prior to medical school, during the final week of the course, and at the end of their first year. A paired-samples t-test was conducted to compare self-ratings on 12 patient care and 12 team-building skills before and after the course, and a theme analysis was conducted to examine open-ended responses. Results: Following the course, student confidence in patient care skills showed a significant increase from baseline (p<0.05) for all identified skills. Student confidence in team-building skills showed a significant increase (p<0.05) in 4 of the 12 identified skills. By the end of the first year, 84% of the first-year students reported the EMT curriculum had ‘some impact’ to ‘great impact’ on their patient care skills, while 72% reported the EMT curriculum had ‘some impact’ to ‘great impact’ on their team-building skills. Conclusions: The incorporation of EMT training early in a medical school curriculum provides students with meaningful clinical experiences that increase their self-reported level of confidence in the performance of patient care skills early in their medical education

Promoting Faculty Scholarship – An evaluation of a program for busy clinician-educators

Background Clinician educators face barriers to scholarship including lack of time, insufficient skills, and access to mentoring. An urban department of family medicine implemented a federally funded Scholars Program to increase the participants’ perceived confidence, knowledge and skills to conduct educational research. Method A part-time faculty development model provided modest protected time for one year to busy clinician educators. Scholars focused on designing, implementing, and writing about a scholarly project. Scholars participated in skill seminars, cohort and individual meetings, an educational poster fair and an annual writing retreat with consultation from a visiting professor. We assessed the increases in the quantity and quality of peer reviewed education scholarship. Data included pre- and post-program self-assessed research skills and confidence and semi-structured interviews. Further, data were collected longitudinally through a survey conducted three years after program participation to assess continued involvement in educational scholarship, academic presentations and publications. Results Ten scholars completed the program. Scholars reported that protected time, coaching by a coordinator, peer mentoring, engagement of project leaders, and involvement of a visiting professor increased confidence and ability to apply research skills. Participation resulted in academic presentations and publications and new educational leadership positions for several of the participants. Conclusions A faculty scholars program emphasizing multi-level mentoring and focused protected time can result in increased confidence, skills and scholarly outcomes at modest cost

Promoting Faculty Scholarship – An evaluation of a program for busy clinician-educators

Background: Clinician educators face barriers to scholarship including lack of time, insufficient skills, and access to mentoring. An urban department of family medicine implemented a federally funded Scholars Program to increase the participants’ perceived confidence, knowledge and skills to conduct educational research.Method: A part-time faculty development model provided modest protected time for one year to busy clinician educators. Scholars focused on designing, implementing, and writing about a scholarly project. Scholars participated in skill seminars, cohort and individual meetings, an educational poster fair and an annual writing retreat with consultation from a visiting professor. We assessed the increases in the quantity and quality of peer reviewed education scholarship. Data included pre- and post-program self-assessed research skills and confidence and semi-structured interviews. Further, data were collected longitudinally through a survey conducted three years after program participation to assess continued involvement in educational scholarship, academic presentations and publications.Results: Ten scholars completed the program. Scholars reported that protected time, coaching by a coordinator, peer mentoring, engagement of project leaders, and involvement of a visiting professor increased confidence and ability to apply research skills. Participation resulted in academic presentations and publications and new educational leadership positions for several of the participants.Conclusions: A faculty scholars program emphasizing multi-level mentoring and focused protected time can result in increased confidence, skills and scholarly outcomes at modest cost

Implementing inter-professional patient-family centered plan of care meetings on an inpatient hospital unit

Inpatient plan of care meetings support efforts to encourage collaborative practice and patient-family centered care and result in an effective strategy to enhance communication and patient satisfaction. Clinical team members participated in patient/family centered plan of care meetings at a community hospital in a selected inpatient unit with full time hospitalist physicians. Quantitative data were gathered pre/post implementation from the external Hospital Consumer Assessment of Health Care Providers (HCAHPS) survey. HCAHPS data were collected independently, specifically for questions related to communication between patients, family members/guardians and the medical team and also the effects of care transition. There was a slow but steady upward trend in selected domains that reflected the standpoint of patients/families specific to patient communication and patient experience in care transition(s) during hospitalization. A greater upward trend was noted in the domain of communication with doctors. Qualitative data analysis revealed positive attitudes towards the plan of care meetings, and team members expressed concern regarding redundancy of information. Sharing amongst providers throughout the day identified a need for clearer criteria in patient selection for these meetings to maximize efforts and resources. A major concern was lack of direct feedback from the patient and family, the end users of the meetings. From this study, inter-professional collaboration in patient family centered care can be viewed as a positive aspect of efficient and innovative care delivery. More evidence-based research is needed to guide how inpatient hospital clinical care planning can be standardized to optimize the way in which patient family centered care can be supported by a collaborative coordinated effort among clinical team members. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Factors Influencing Primary Care Residency Selection among Students at an Urban Private Medical School

This study investigated factors influencing primary care–focused students’ selection of a family medicine residency at a private urban medical school. Reasons for why or why not students chose family medicine as opposed to other primary care–focused residencies is discussed. A questionnaire was sent to all fourth-year students (N=157) selected for residency with a primary care focus (medicine and pediatrics (medicine/pediatrics), emergency medicine (EM), obstetrics/gynecology (OB/GYN), internal medicine, pediatrics, and family medicine) from 2006 to 2008. Sixty-three surveys were completed. Respondents reported the most influential factor in primary care selection was patient-care model, followed by patient population and mentor/role model. The factor reported as having the strongest positive and negative influence on residency choice was clerkship experience. Half of respondents (53%) reported being told or directly overhearing negative comments about their career interest in primary care frequently (5+ times) during clinical clerkships. The most frequently cited reasons for not pursuing family medicine as a residency choice were broad focus, lack of prestige, and stereotype of family medicine as a nonacademic field. The Department of Family Medicine is focusing on strategies to combat these perceptions and expose students to positive primary care experiences early in their medical education. Action must be taken to monitor and address family medicine’s negative stereotype, as it has a clear presence in medical education and may have a negative influence on residency selection.

Enhancing patient-centered care for limited English proficiency patients through Tell Me More®: A student-driven initiative to explore the patient as a person and develop students’ communication skills

Tell Me More® (TMM) is a medical student-driven initiative to build rapport between patients, students, and the healthcare team through patient interviews and collaboratively created posters. Patients with limited English proficiency (LEP) often experience impaired communication with providers. TMM has the potential to address the loss of patient-centered dialogue in interpreter-mediated communications. In this exploratory pilot study, we aimed to include LEP patients in TMM by using medical interpreter phones (MIPs) at Long Island Jewish Medical Center, Northwell Health. Our objectives were to: (1) evaluate the feasibility of this approach, (2) compare TMM engagement between LEP and English-speaking (ES) patients, and (3) document the impact of this initiative on the medical student. Following the standardized TMM interview structure, the student used the MIP to interview LEP patients about who they are as people beyond their illnesses. This expanded social history was transcribed to bedside posters to enhance patient connection with the healthcare team. At the end of interviews, patients rated TMM’s impact on their hospital stay. Additionally, medical student reflections were recorded weekly. Our quantitative results from 12 LEP and 49 ES patients support significantly higher TMM participation for LEP compared to ES patients. Qualitative examination of student reflections suggests that TMM enriches medical education by promoting understanding of the LEP patient experience. Our results demonstrate that MIP-supported TMM is a feasible approach to enhance patient-centered care for LEP populations. Further research is needed to explore inclusion of LEP patients in patient-centered care initiatives such as TMM. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Tell Me More: Promoting compassionate patient care through conversations with medical students

Tell Me More® (TMM) is a medical student driven project that represents a movement amongst the rising generation of physicians to practice humanistic, patient-centered medicine through a collaborative approach. Students interviewed patients to create individualized posters designed to build rapport and trust between patients and clinicians, remind patients of their special strengths by highlighting their unique interests and qualities, and encourage more personal and compassionate patient-clinician interactions in order to enhance the patient experience. Students asked each patient three questions: 1. “How would your friends describe you?” 2. “What are your strengths?” 3. “What has been most meaningful to you?” and answers were recorded on a large poster, which was displayed prominently in the patient’s room for clinicians and staff to acknowledge. TMM engaged 5 students and 302 patients over 4 hospital settings throughout Northwell Health. Data collection included daily written reflections by students on their experiences, exit interviews with patients to assess the impact of the project on their stay, and staff surveys that addressed provider perception of the program. Descriptive outcomes supported a positive impact on students, patients, staff and clinicians. TMM succeeded in providing a bridge between patients and clinicians and is a cost-effective practice that lends to more personal patient-provider interactions. Bedside posters positively influenced the culture of a hospital organization and reminded providers of the meaning in their work, which literature shows can reduce provider burnout and improve quality of care

A Collaborative Distance Approach Using the Evidence to Build a Model for Medical Education Mentorship

Background/Purpose: Medical education scholarship (MES) is meaningful work that not only benefits the faculty but also the learners and their institutions. Clinical teaching faculty who engage in Medical Education Research can ensure that their scholarship is directly applied to practice.3 While clinical research skills may be taught directly the adaptation of clinical research skills to MES is limited, lacking in fundamental skills related to terminology, measurement, and literature.1, 2 Inevitably, success depends on good mentorship. Negotiating the terrain of medical education scholarship requires consistent and effective mentorship.3 Unfortunately, effective mentorship for medical education scholarship is lacking.3 Our aim was to conduct a systematized review of the literature as the first part of an award funded by the NEGEA designed to identify the elements of a model for effective MES mentorship. What is unique about this process is that we conducted this review by collaboration among 6 different medical institutions and 9 individuals. Methods: To develop and further refine an interview protocol that will be used with medical education mentors and mentees, we identified, with the assistance of the two reference librarians on our team, articles focused on basic and clinical science research mentorship in medicine. All meetings were held via conference call. Technologies used included EndNote, Dropbox, Excel, and Qualtrics. Article inclusion criteria were: 1) English language articles published between 1990 and the present, and 2) articles focused on mentorship for scholarship in medicine. Studies were excluded if they focus on other mentorship domains (clinical leadership, career development not related to scholarship). We planned to include research studies, reviews, and opinion pieces/perspectives. Results/Educational Outcomes: In the initial meeting, team members were asked to identify relevant terms and phrases, such as mentoring, mentorship, role modeling, research, scholarship, medicine, medical education). The librarians used the suggested terms to identify additional synonyms and categories and created a table of possible search terms. The table prompted a rich discussion at the next team meeting, which included both a common definition of mentorship, and a narrowing of the focus of the literature search. As a result, the team revised the criteria to exclude articles about biomedical research. The librarians developed search strategies for PubMed, PsycINFO, ERIC, CINAHL, Web of Science, and the Cochrane Database of Systematic Reviews. Next the librarians assigned sets of articles to pairs of researchers to review based on titles, or on titles and abstracts when necessary. All articles deemed relevant by the pairs were retained and groups were assigned of articles for identification of factors that mentors and mentees use to positively impact mentorship in scholarship/research. These key factors will then be used to modify the interview protocol for mentor and mentee interviews. Conclusions/Strength of Innovation: This process was successful in using an evidence based process for developing the mentorship in medical education scholarship themes which will be further validated as the project continues. Elements of the process that were critical to the success of a geographically 31 dispersed interdisciplinary team included regularly scheduled phone meetings with agenda items sent well in advance of the meetings, minutes and action items sent following the meeting, discussion time at each meeting to resolve questions, raise new issues, good use of technology available at participating institutions, common understanding of the goals of the project. Having a diverse group of professionals (clinicians, librarians, and medical educators) brought forth the complementary skill sets to the process with different experts leading the process as needed. Issues arose largely regarding understanding and agreement of terminology, including, what is considered “scholarship” and “mentorship.” References: 1. Scott K, Caldwell P, Schuwirth L. Ten steps to conducting health professional education research. Clin Teach. 2015; 12:272-276. 2. Blanchard RD, Artino AR, Visintainer PF. Applying clinical research skills to education research: Important recommendations for success. J Grad Med Educ. 2014;6(4):619-622. 3. Blanchard RD, Visintainer PF, La Rochelle J. Cultivating medical education research mentorship as a pathway towards high quality medical education research. JGIM. 2015; 30(9): 1359-62