7 research outputs found
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Sailing on the '7 Cs': teaching junior doctors how to redirect patients during difficult consultations in primary care
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'Wargaming with the chiefs': A novel pre-mortem exercise to enhance communication and well-being among 'top gun' chief residents
Pilots who complete the 'TOPGUN' program return to their squadrons as elite leaders and instructors. Physicians from all specialties who are selected to become Chief residents can also be viewed as 'Top Guns', as they are the 'cream of the crop'; having been chosen to be the leaders and role-models for all the other residents in their programs. Yet, unlike Top Gun pilots, Chief residents are arguably only minimally prepared for this new role. Wargaming involves generating every possible bad outcome and brainstorming contingencies for these possible outcomes. We developed an exercise for the incoming Chiefs (ICs) and outgoing Chiefs (OCs) in four specialties: Family Medicine, Internal Medicine, Neurosurgery, and Neurology. Following this exercise, 100% of the Chiefs in all four programs indicated that this activity was beneficial and the majority agreed that wargaming improved communication and their own feelings of well-being. Based on our trainees' feedback, it appears that wargaming is a simple, fun, and highly-interactive exercise which increases perceived control among ICs and allows OCs the chance to reflect and share their knowledge and experience with the new Chiefs. This activity also seems to enhance communication and feelings of well-being among both incoming and outgoing Chief residents
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Using Show-and-Tell Rounds to Enhance Camaraderie Among Residents
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Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers
Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening.
We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses.
There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers.
Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed
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Abstract B002: Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees
Abstract Background: Hepatitis B (HBV), a leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the United States. Undiagnosed HBV infection precludes HCC screening and contributes to late-stage presentation and decreased survival. Previously, we reported low HBV screening rates in persons from endemic countries. Barriers to screening include lack of insurance, limited diffusion of guidelines, and provider uncertainty. We aimed to assess knowledge about HBV and HCC screening and to explore barriers to HCC screening among trainees from three unique institutions. Methods: We administered a survey to trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We used univariate, bivariate, and Pearson's chi-squared analyses to assess knowledge and barriers using clinical vignettes. Results: There were 183 respondents born in 36 countries. Median age was 31 years. The sample was 35% Hispanic, 29% White, 18% Asian, 9% Black, 7% other, 2% multiracial and 52% male. Training department was Internal Medicine, 71%, Family Medicine, 11%, Infectious Diseases (ID), 6%, or Gastroenterology (GI), 7%. The perceived burden of HBV was low; 2/3 stated HBV affects <5% of the patient population, 59% correctly estimated national HBV prevalence and 25% correctly estimated global prevalence. In vignettes with behavioral risk factors (e.g., intravenous drug use), trainees correctly advised screening, 63-96%. However, when birthplace was the only risk factor, correct responses ranged from 33-53%. Overall, 48% chose an incorrect combination of HBV screening tests. Respondents from HBV-endemic countries were no more likely to screen for HBV. Knowledge of HBV treatment indications was poor. More fellows (ID/GI) correctly recommended treatment than residents, p <0.01. Barriers to HBV screening were lack of education among health care workers, limited expertise in screening of immigrants, and limited patient education. Barriers to treatment were cost, knowledge about HBV regimens, and provider comfort. Respondents were more likely to recommend HCC screening in cirrhotic patients vs. noncirrhotic HBV patients, even when indicated. Only 43% of participants recognized that HCC screening is unnecessary in patients with acute HBV and 53% either recommended HCC screening or indicated uncertainty in noncirrhotic patients with resolved HBV infection. Respondents indicated they would screen for HCC if strong evidence suggested a mortality benefit or if recommended by a national organization. Key barriers to screening were uncertainty or lack of awareness about HCC guidelines and patient financial barriers. Conclusions: In a diverse sample of trainees, knowledge of HBV and HCC screening recommendations is suboptimal. Efforts to broadly disseminate guidelines through targeted educational interventions are needed as responses confirm that HCC screening indications, especially in HBV, are not universally known. Citation Format: Patricia D. Jones, Mahmoud Mahfouz, Harry Nguyen, Jonathan Tu, Carlos R. Diaz, Shweta Anjan, Stefanie Brown, Kassandra Bosire, Paul M. Martin, Olveen Carrasquillo. Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B002