From Silos to Systems: Leveraging Visualization Tools to Map and Navigate the Complex Terrain of Health Professions Education

Rationale: Health Professions Education (HPE) programs are diverse and founded with varied goals, missions, and pedagogical approaches. Navigation of this complex system requires an understanding of the components and connections that form HPE programs. Educators need shared maps that match this system to facilitate communication, progress, and efficiency. Systems maps are useful for describing shared mental models and delineating educational processes and goals; they are particularly effective for revealing unproductive tendencies toward siloing. In ‘The Seven Silos of Accountability,’ Joshua Brown presents a model of accountability silos in higher education that is applicable to HPE. The seven silos are assessment, accreditation, institutional research, institutional effectiveness, program evaluation, educational measurement, and higher education public policy. Specialized stakeholders may lack understanding of this broad network, leaving leadership in the difficult position of ‘pulling it all together’ with limited backup and support. One approach for enhancing integration, communication, and efficiency across silos is visualizing components of systems as a mechanism for identifying and solving system-level challenges. These visualizations result in a process map that reflects the terrain of an organization called an Organigraph. Organigraphs are practical tools that can be used to orient those new to HPE, facilitate systems-level improvements, and identify opportunities to streamline effort and innovation. In this panel, members of four institutions will present an emerging collaborative effort to support HPE programs. We have designed an organigraph of the common organizational silos in UME as well as a user-sourced, interactive visualization of organizational silos to aid in orientation to HPE programs. Learning Objectives: 61 words At the end of this session, participants will be able to: Identify three advantages of visualizing an organizational process map of the Health Professions education. Describe three examples of how a systems approach can address silo-driven challenges in the academic program environment. Demonstrate how systems visualization tools can be used to map accreditation needs across silos. Discuss pain points of silos in a Health Professions education context and reflect on systems-based solutions. Session Methods and Format: 109 words Introduction and definition of 1) Silos in medical education, and 2) Organigraphs, followed by a presentation of current silos in UME, including examples of use cases from multiple institutions. (25 minutes) Interactive reflection on silos in HPE: Structured large group discussion. (15 minutes) Presentation of 1) an Organigraph that maps the silos and shows how they interact in the functional landscape of UME, 2) an interactive dashboard on these silos, and 3) how this visualization can be sourced by stakeholders. (25 minutes) Interactive reflection on Organigraphs and visualization of silos in HPE: Structured large group discussion. (15 minutes) Concluding remarks and Q&A session with the audience. (10 minutes

Evaluating the Effectiveness of Undergraduate Clinical Education Programs

Medical schools should use a variety of measures to evaluate the effectiveness of their clinical curricula. Both outcome measures and process measures should be included, and these can be organized according to the four-level training evaluation model developed by Donald Kirkpatrick. Managing evaluation data requires the institution to employ deliberate strategies to monitor signals in real-time and aggregate data so that informed decisions can be made. Future steps in program evaluation includes increased emphasis on patient outcomes and multi-source feedback, as well as better integration of existing data sources

A Study of a Cultural Competence and Humility Intervention for Third-Year Medical Students.

ObjectiveThis study evaluates the effectiveness of a cultural competence and humility intervention for third-year medical students by assessing changes in clinical evaluation assessments in patient encounters.MethodsThis study examines the effect of a 1-h educational intervention on cultural competence and cultural humility for third-year medical students. Clinical assessments during observed patient encounters are compared in the clerkship before and after the intervention. The intervention adapts a previously studied cultural competence didactic and emphasizes cultural humility practices. Change in scores from the intervention cohort (clinical year 2019-2020) is compared to a pre-intervention cohort (2018-2019).ResultsStudents who completed the intervention demonstrate greater clinical competency in "relating to patients in a respectful, caring, empathetic manner" as assessed by supervising physicians compared with pre-intervention cohort students (2.7% difference in earning top two scores in subsequent clerkship, P value 0.05, Cramer's V 0.04). Greater clinical competencies were also found in the intervention students compared with pre-intervention students in the domains "demonstrates accountability, contribution and commitment to patient care" and "develops insightful, focused, pertinent questions based on clinical scenarios" (3.8% difference in earning top two scores in subsequent clerkship, P value 0.01 and 5.1% difference, P-value 0.003 with Cramer's V of 0.05 and 0.06, respectively).ConclusionsEducational interventions to improve cultural competence and cultural humility are important during clinical years to shape future physicians. Our study suggests that brief interventions may improve medical students' clinical competencies. A future study with a more robust intervention is expected to yield more substantial results

Development of an expert derived ICD-AIS map for serious AIS3+ injury identification

Objective: The objective of the mapping project was to develop an expert derived map between the International Statistical Classification of Diseases and Related Health Problems (ICD) clinical modifications (CM) and the Abbreviated Injury Scale (AIS) to be able to relate AIS severity to ICD coded data road traffic collision data in EU datasets. The maps were developed to enable the identification of serious AIS3+ injury and provide details of the mapping process for assumptions to be made about injury severity from mass datasets. This article describes in detail the mapping process of the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) and the International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10-CM) codes to the Abbreviated Injury Scale 2005, Update 2008 (AIS08) codes to identify injury with an AIS severity of 3 or more (AIS3+ severity) to determine ‘serious’ (MAIS3+) road traffic injuries.Methods: Over 19,000 ICD codes were mapped from the following injury categories; injury ICD-9-CM (Chapter 17) codes between ‘800 and 999.9’ and injury ICD-10-CM (Chapter 19) ‘S’ and ‘T’ prefixed codes were reviewed and mapped to an AIS08 category and then relate the severity to three groups; AIS3+, AIS Results: In total 2,504 ICD-9-CM codes were mapped to the AIS, of which 780 (31%) were assigned an AIS3+ severity. For the16,508 ICD-10-CM mapped codes a total of 2,323 (14%) were assigned an AIS3+ severity. Some 17% (n=426) and 27% (n=4,485) of ICD-9-CM and ICD-10-CM codes respectively were assigned to AIS9 (no-map) following the mapping process. It was evident there were ‘problem’ codes that could not be easily mapped to an AIS code to reflect severity. Problem maps affect the specificity of the map and severity when used to translate historical data in large datasets.Conclusions: The Association for the Advancement in Automotive Medicine, AAAM-endorsed expert-derived map offers a unique tool to road safety researchers to establish the number of MAIS3+ serious injuries occurring on the roads. The detailed process offered in this paper will enable researchers to understand the decision making and identify limitations when using the AIS08/ICD map on country-specific data. The results could inform protocols for dealing with problem codes to enable country comparisons of MAIS3+ serious injury rates.</div

Whole-exome sequencing identifies rare variants in STAB2 associated with venous thromboembolic disease

Deep vein thrombosis and pulmonary embolism, collectively defined as venous thromboembolism (VTE), are the third leading cause of cardiovascular death in the United States. Common genetic variants conferring increased varying degrees of VTE risk have been identified by genome-wide association studies (GWAS). Rare mutations in the anticoagulant genes PROC, PROS1 and SERPINC1 result in perinatal lethal thrombosis in homozygotes and markedly increased VTE risk in heterozygotes. However, currently described VTE variants account for an insufficient portion of risk to be routinely used for clinical decision making. To identify new rare VTE risk variants, we performed a whole-exome study of 393 individuals with unprovoked VTE and 6114 controls. This study identified 4 genes harboring an excess number of rare damaging variants in patients with VTE: PROS1, STAB2, PROC, and SERPINC1. At STAB2, 7.8% of VTE cases and 2.4% of controls had a qualifying rare variant. In cell culture, VTE-associated variants of STAB2 had a reduced surface expression compared with reference STAB2. Common variants in STAB2 have been previously associated with plasma von Willebrand factor and coagulation factor VIII levels in GWAS, suggesting that haploinsufficiency of stabilin-2 may increase VTE risk through elevated levels of these procoagulants. In an independent cohort, we found higher von Willebrand factor levels and equivalent propeptide levels in individuals with rare STAB2 variants compared with controls. Taken together, this study demonstrates the utility of gene-based collapsing analyses to identify loci harboring an excess of rare variants with functional connections to a complex thrombotic disease

Expert-developed ICD-AIS map for measuring serious road traffic injuries

Expert-developed ICD-AIS map for measuring serious road traffic injurie

Protective T cell immunity in mice following protein-TLR7/8 agonist-conjugate immunization requires aggregation, type I IFN, and multiple DC subsets

The success of a non-live vaccine requires improved formulation and adjuvant selection to generate robust T cell immunity following immunization. Here, using protein linked to a TLR7/8 agonist (conjugate vaccine), we investigated the functional properties of vaccine formulation, the cytokines, and the DC subsets required to induce protective multifunctional T cell immunity in vivo. The conjugate vaccine required aggregation of the protein to elicit potent Th1 CD4+ and CD8+ T cell responses. Remarkably, the conjugate vaccine, through aggregation of the protein and activation of TLR7 in vivo, led to an influx of migratory DCs to the LN and increased antigen uptake by several resident and migratory DC subsets, with the latter effect strongly influenced by vaccine-induced type I IFN. Ex vivo migratory CD8–DEC205+CD103–CD326– langerin-negative dermal DCs were as potent in cross-presenting antigen to naive CD8+ T cells as CD11c+CD8+ DCs. Moreover, these cells also influenced Th1 CD4+ T cell priming. In summary, we propose a model in which broad-based T cell–mediated responses upon vaccination can be maximized by codelivery of aggregated protein and TLR7/8 agonist, which together promote optimal antigen acquisition and presentation by multiple DC subsets in the context of critical proinflammatory cytokines