Narrative Writing and Emerging Clinical Practice

Purpose: We used a narrative technique with volunteer medical students immersed in early clinical experiences in order to 1) offer students a pathway to self-reflection, and 2) offer program directors insight into issues that arise for students. Methodology: Our medical students between their first and second years spend nine summer weeks working in a clinical practice somewhere in the state. Self-selected students (9 in 2005, 22 in 2006), wrote reflectively once a week, via e-mail, to volunteer physician mentors on campus, sharing observations, feelings, and ideas. Mentors responded in kind to the content of these experiential writings. At the end of the summer, students gathered together to read from their work. Each student turned in one piece of writing to the program. Both students and mentors filled out evaluation forms that assessed the program. One program director identified themes in the students\u27 narratives. Summary of Results: Students and mentors overwhelmingly reported that the narrative time was well spent. Students commented that this writing helped them to perceive their clinical work in a thoughtful way, become more observant and analytical, look for recurrent patterns, and respond better to patients. Mentors found the correspondence rewarding and felt refreshed by it. Themes emerging from student writing addressed life events and professional socialization. Most mentors volunteered to participate again. Conclusions: Program directors found the program to be feasible and useful for students and mentors, filling an unmeet needs for first year medical students to consider, question, and reflect about their early clinical experiences

Evaluating Medical Student Communication/Professionalism Skills from a Patient’s Perspective

Objective: Evaluate medical students’ communication and professionalism skills from the perspective of the ambulatory patient and later compare these skills in their first year of residency. Methods: Students in third year neurology clerkship clinics see patients alone followed by a revisit with an attending neurologist. The patient is then asked to complete a voluntary, anonymous, Likert scale questionnaire rating the student on friendliness, listening to the patient, respecting the patient, using understandable language, and grooming. For students who had completed 1 year of residency these professionalism ratings were compared with those from their residency director. Results: Seven hundred forty-two questionnaires for 165 clerkship students from 2007 to 2009 were analyzed. Eighty-three percent of forms were returned with an average of 5 per student. In 64% of questionnaires, patients rated students very good in all five categories; in 35% patients selected either very good or good ratings; and <1% rated any student fair. No students were rated poor or very poor. Sixty-two percent of patients wrote complimentary comments about the students. From the Class of 2008, 52% of students received “better than their peers” professionalism ratings from their PGY1 residency directors and only one student was rated “below their peers.” Conclusion: This questionnaire allowed patient perceptions of their students’ communication/professionalism skills to be evaluated in a systematic manner. Residency director ratings of professionalism of the same students at the end of their first year of residency confirms continued professional behavior

Using Calibrated Peer Review⢠to Assess and Improve the Quality of Student Documentation of Clinical Encounters at the University of New Mexico School of Medicine (UNMSOM).

The UNMSOM adapted Calibrated Peer Review™, an internet based writing tool, to assist medical students in assessing the structure and content of their clinical notes. Students watch videotaped clinical encounters and write notes based on these patient visits. Students then apply faculty-established standards to assess three calibration notes, the notes of three peers, and their own note. CRR will be demonstrated and student satisfaction described

Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce.

BACKGROUND: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. METHODS: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. RESULTS: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. CONCLUSIONS: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation

Treating hepatitis C in American Indians/Alaskan Natives: A survey of Project ECHO (Extension for Community Healthcare Outcomes) utilization by Indian Health Service providers

Background: American Indians/Alaskan Natives have a high mortality associated with hepatitis C virus, yet treatment rates are low. The ECHO (Extension for Community Healthcare Outcomes) model ™ , a videoconferencing technology for primary care providers, is underutilized at Indian Health Service facilities. Purpose: To ascertain Indian Health Service providers’ benefit of and barriers to utilizing hepatitis C virus TeleECHO clinics. Methods: We electronically sent an Active Participant Survey to Indian Health Service providers utilizing hepatitis C virus TeleECHO clinic and a Non-Participant Survey to other Indian Health Service providers interested in this clinic. Results: In total, 100% of Active Participant Survey respondents perceive moderate to major benefit of hepatitis C virus TeleECHO clinic in managing hepatitis C virus, and 67% of Non-Participant Survey respondents reported lack of administrative time as the major barrier to utilizing this resource. Conclusion: Indian Health Service providers participating in hepatitis C virus TeleECHO clinic perceive this resource as highly beneficial, but widespread utilization may be impractical without allocating time for participation

A Web-based, Searchable Database of Orthodontic Case Files for Patient Care, Education, and Research

In 2005, the Maxwell Museum of Anthropology accepted a donation of 5650 unique orthodontic patient records (treatment records, dental X-rays, dental casts, intra-oral and full facial photographs) from an orthodontists practice in Albuquerque, New Mexico from 1972 through 1999. This collection includes large samples of Hispanic and Native American populations, two groups not often encountered in orthodontic training in the United States or elsewhere. While investigators can use the collection on site at the Museum for approved research, a Web-based, de-identified version of the collection is being developed with input from orthodontics students and faculty from multiple institutions, so the collection can be freely accessed the world over. The database\u27s unique design allows users to search for cases with particular characteristics of interest (e.g., patient ancestry, extraction patterns, diagnoses, and cephalometric parameters) and then review the sequenced intra-oral and X-ray images to observe variations of outcomes from treatments applied to patients with racial and other factors not often encountered in training or practice before.\u27https://digitalrepository.unm.edu/hslic-posters-presentations/1021/thumbnail.jp

Ancestry Estimation in a Web-based, Searchable Database of Orthodontic Case Files for Patient Care, Education, and Research

In 2005, the Maxwell Museum of Anthropology accepted a donation of orthodontic patient records from an orthodontist who has been practicing in the Albuquerque area since the early 1970s. This collection represents a diversity of patients not often encountered in orthodontic training in the United States. A virtual, de-identified, web-based version of a subset of the collection is now being developed. Users can search for cases with particular characteristics of interest (e.g., patient ancestry, extraction patterns, diagnoses, and cephalometric parameters), then review sequential intra-oral and Xray images to observe treatment outcomes. An innovative feature of the database is that it records multiple ancestry estimations, made at multiple points in time by multiple raters, along with a list of ancestry indicators on which the estimations are made (e.g., skin color, hair form and color, facial shape, name, and locality). This poster describes how the database can be used to overcome the limited diversity in the patient populations available to most orthodontics trainees. When this project concludes, the database will contain approximately 400,000 digitized images from 5650 individual cases.\u27https://digitalrepository.unm.edu/hslic-posters-presentations/1018/thumbnail.jp

Creative Education

Background: Physicians will need increased skills in the areas of public health, equity based interventions and patient safety skills to address the medical needs of patients in the 21 st century. Premedical education and experiences is one strategy to address these areas. Methods: A one month rural summer practicum was developed for all BA/MD students. Key components include: 1) physician shadowing; 2) tutorials; 3) narrative writings; and 4) group community projects. Students attend a preparatory community service course prior to the practicum. Pre/post practicum surveys assessed students&apos; attitudes and skills with respect to community interventions. Post practicum surveys evaluate the elements of the practicum. Results: Survey results demonstrated no significant change in opinions or skills and activities with respect to community interventions. Highly rated items in the post practicum evaluations included physician shadowing, community activities, and opportunities to learn from others. Conclusions: A pre-medical practicum experience can help students define their roles as future physicians and increase their interactions within communities around public health issues. Whether this translates into improved involvement of physicians using public health equity based interventions is an area of ongoing study

Ethics of Health Research in Communities: Perspectives From the Southwestern United States

PURPOSE The increasing attention paid to community-based research highlights the question of whether human research protections focused on the individual are adequate to safeguard communities. We conducted a study to explore how community members perceive low-risk health research, the adequacy of human research protection processes, and the ethical conduct of community-based research