JGIM
LEARNING OBJECTIVES 2: Review the benefits and limitations of an
online tracker for measuring resident utilization of ALAs
SETTING AND PARTICIPANTS: Responding to disruptions to the resi-
dent learning environment during the COVID-19 pandemic (Redinger 2020),
IM residency programs have expanded the use of asynchronous learning
activities(ALAs). While providing residents with flexibility in how and when
they review content, resident ALA preferences and utilization remains
understudied. At our institution, the Asynchronous Conference Tracker(ACT)
was developed to measure several components of resident utilization of ALAs.
The ACT was introduced to 76 PG1-PGY3 IM residents in July 2020 and
collected entries over a 6-month period.
DESCRIPTION: The ACT was developed by the authors using open-source
Google Forms/Sheets software. The ACT was accessed by residents after
completing an ALA, either via the program website or QR code posters. Three
types of ALAs were counted towards semester conference targets— recorded
core content lectures, interactive cases, and podcasts—with a list of pre-vetted
activities posted on the program website. Residents’ progress towards their
conference targets was presented in real-time on the program website in an
anonymized table.
EVALUATION: ALA utilization was assessed via entries in the ACT. Means
and ranges were calculated for total utilization of recorded lectures, interactive
cases, and podcasts, as well as utilization by class. Mean time between the
posting of recorded core lectures and resident submission to the tracker was
also evaluated.
DISCUSSION / REFLECTION / LESSONS LEARNED: Utilization of
ALAs was high across all PGY classes, with nearly 12 activities completed per
resident over a 6 month period. Residents engaged with recorded core lectures
most frequently, completing a mean 7.4 lectures over the evaluation period
(range 0–33). Podcasts (mean 3.8 activities, range 0–20) and interactive cases
(mean 0.3 activities, range 0–2) were less utilized. PGY2s were most likely to
complete ALAs. The mean time between the content being posted and com-
pletion by residents was 18.6 days.
These findings reflect a shift in resident learning preferences that was present
prior to the COVID-19 pandemic (Cardall 2008), but has accelerated this
academic year: When offered the opportunity, residents will engage with
ALAs–often on busy rotations and both before and after their clinical duties,
as evidenced by time stamps from the ACT. The range of utilization captured
by the ACT points to a need for creative interventions to meet the needs of
residents who do not place as much educational value on ALAs. While other
tools are needed to better assess engagement with the content and knowledge
retention following ALAs, the ACT represents an easily-deployable solution
for capturing resident asynchronous learning preferences.
ONLINE RESOURCE URL (OPTIONAL): https://forms.gle/
17BCCre4oG4PkFV88 https://docs.google.com/spreadsheets/d/
1AATfNoGuR- zMlDbg3FgN72ZifZr0Q8bhLF0wEBqHodc/edit#gid=0
THE CARDIONERDS ACADEMY: A NOVEL DIGITAL MEDIA AND
MEDICAL EDUCATION FELLOWSHIP
Thomas M. Das1; Colin Blumenthal1; Eunice Dugan1; Richard Ferraro1;
Evelyn J. Song1; Karan Desai2; Daniel Ambinder3; Carine E. Hamo3;
Amit Goyal4; Justin Berk5
1
Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
2
Cardiology, University of Maryland School of Medicine, Baltimore, MD
3
Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
4
Cardiology, Cleveland Clinic, Cleveland, OH
5
Internal Medicine/Pediatrics, Brown University Warren Alpert Medical
School, Providence, RI. (Control ID #3544797)
LEARNING OBJECTIVES 1: Fellows in the CardioNerds Academy will
learn to create high-quality asynchronous medical education content, including
producing the CardioNerds podcast and creating virtual journal clubs,
tweetorials, infographics, videos, and blog posts.
LEARNING OBJECTIVES 2: Fellows will collaborate with leaders within
cardiology to develop their professional network and complete a capstone
project.
SETTING AND PARTICIPANTS: 13 Fellows (comprised of IM residents,
cardiology fellows, and hospitalists) divided into 4 houses have been selected
S459
for the inaugural class of the CardioNerds Academy. Video conferencing is
used for most activities.
DESCRIPTION: The CardioNerds Academy is a medical education fellow-
ship, whose primary focus is educating physicians in the use of digital media
for cardiology education. The fellowship is free and not directly affiliated with
any singular medical institution. IM residents and cardiology fellows who have
completed at least 1 year of post-graduate training are eligible to apply. The
Fellows are mentored by a group of Chiefs, who are IM residents with
experience in digital content creation. The Academy is led by creators of the
CardioNerds podcast.
The fellowship lasts 12 months, during which fellows will complete 3-month
rotations in “Videos and Blog Posts”, “Tweetorials”, “Virtual Journal Clubs”,
and “Infographics”. During each rotation, Chiefs mentor Fellows in creating
their own digital education content within the rotation domain, that will be
disseminated by the CardioNerds platform. Chiefs organize didactic sessions to
discuss best-practices at the beginning of the rotation.
In addition to the core rotations, each Fellow is tasked with completing a digital
cardiovascular education capstone project. To assist in this goal, Fellows are
connected with the larger CardioNerds network, which includes cardiovascular
fellows and faculty throughout the country.
EVALUATION: Each Fellow will complete a pre-fellowship survey at the
beginning of the program (see “Online Resources”). This survey will assess:
(1) attitudes and beliefs regarding digital media and medical education; (2)
reported comfort with the digital media modalities and with ACGME’s listed
“Competencies for Medical Educators”; and (3) a formal Needs Assessment,
asking Fellows to identify content creation skills and medical education core
competencies most important to improve their teaching. At the end of the
fellowship, each Fellow will complete the same survey to assess for changes.
DISCUSSION / REFLECTION / LESSONS LEARNED: As more learners
turn to the internet to augment the traditional medical education experience,
there is a need to provide physicians with the tools necessary to create and
effectively leverage digital content for medical education. Digital media pro-
vides the opportunity to connect individuals despite geographical distance and
decrease educational hierarchies. The CardioNerds Academy is the first digital
media medical education fellowship to focus on the field of cardiology.
ONLINE RESOURCE URL (OPTIONAL):
https://docs.google.com/forms/d/1qxRw1Gg9bwGypfgFjvpooia-
Vf9V70baTvT6riswKE8/prefill
THE EVOLUTION OF OPHTHALMOSCOPY: USING A
SMARTPHONE FOR TEACHING THE FUNDOSCOPIC EXAM
Akaanksh Shetty2; Patricia Nelson1; Thwe Htay3
1
Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX;
2
Medical Education, Texas Tech University Health Sciences Center El Paso
Paul L Foster School of Medicine, El Paso, TX
3
Medical Education, Texas Tech University Health Sciences Center El Paso
Paul L Foster School of Medicine, El Paso, TX. (Control ID #3540662)
LEARNING OBJECTIVES 1: To evaluate student preference and confidence
in identifying anatomic landmarks using two smartphone imaging devices.
LEARNING OBJECTIVES 2: To determine if there is room for improve-
ment in the direct ophthalmoscopic exam using smartphone imaging devices.
SETTING AND PARTICIPANTS: Ninety-seven second year medical stu-
dents were asked to complete an IRB approved anonymous survey pre- and
post-training comparing their perceived confidence, proficiency, and ease of
use of a traditional direct ophthalmoscope versus a novel smartphone enabled
imaging device. Ninety-three students completed the survey in its entirety and
were included in the study while incomplete surveys were excluded. Both the
direct ophthalmoscope and smartphone training sessions were performed on
Kyoto head models that had one eye displaying pathology and one control eye
displaying a normal retina. No human patients were used in this study.
DESCRIPTION: Direct ophthalmoscopy is a basic and essential physical
examination skill taught in all medical schools. Multiple studies have shown
that medical students, residents, and even physicians have limited confidence
and skill proficiency in performing an ocular fundus exam using an ophthal-
moscope. We used two smartphone retinal imaging devices, the Ophthalmic
oDocs Fundus and the oDocs Nun, to effectively image the retina. The oDocs
S460
Fundus is a 3D printable adapter that converts any smartphone and 20 diopter
lens into a retinal fundus camera. The oDocs Nun is a wide field ophthalmo-
scope that can be utilized with or without a smartphone. We hypothesized that
the smartphone retinal imaging devices would be preferred by trainees as they
enable instructors to provide real-time feedback for our students, which is not
possible currently with the direct ophthalmoscope alone.
EVALUATION: Paired sample t-test showed there was a significant differ-
ence t(92)=-32.3 (P < .001) in pre- and post-test scores for confidence follow-
ing training overall. The direct ophthalmoscope was only preferred by 18% of
students when compared to other smartphone imaging devices. The other 82%
of students preferred the smartphone imaging devices due to ease of use and
view of the retina.
DISCUSSION / REFLECTION / LESSONS LEARNED: 70% of the
students preferred the oDocs Nun, to the direct ophthalmoscope. Device
preference is primarily determined by ease of use as selected by 82.8% of
respondents and view of the image by 81.7% of respondents. Ease of use and
view were more important than the ability to capture the image or educate the
patient. This device is a novel, effective education tool, with a potential for
retinal imaging and telemedicine consults. This study demonstrated that sim-
ulation training is an effective method to increase medical students’ confidence
in performing a fundus examination. It also shows that innovation in traditional
instruments and teaching can improve learner confidence in performing a vital
exam. With the rapid development of technology, we must adapt our instru-
ments and teaching styles to best improve medical education and patient care.
THE IMPACT OF THE CORONAVIRUS PANDEMIC ON LEARN-
ING AND USING POINT-OF- CARE ULTRASOUND BY INTERNAL
MEDICINE RESIDENTS
Nalinee C. Srisarajivakul, Michael Janjigian, Anne Dembitzer,
Khemraj Hardowar, Deborah Cooke, Harald Sauthoff
Internal Medicine, New York University School of Medicine, New York, NY.
(Control ID #3546047)
LEARNING OBJECTIVES 1: Describe a longitudinal curriculum to train
internal medicine (IM) residents in point-of-care ultrasound (POCUS).
LEARNING OBJECTIVES 2: Recognize the impact of decreased patient
contact on residents’ retention of POCUS skills.
SETTING AND PARTICIPANTS: Despite the well-documented benefits of
POCUS, internal medicine residents receive little formal training. We imple-
mented a curriculum in the 2019 academic year to train 55 PGY-2 IM residents
in POCUS across four urban teaching hospitals and a method to evaluate its
efficacy. As the COVID pandemic hit, we additionally sought to understand
the impact of COVID on the efficacy of our curriculum and to ascertain from
IM residents their barriers to using POCUS during the COVID pandemic.
DESCRIPTION: The curriculum was composed of three workshops,
consisting of lectures and hands-on practice covering lung, cardiac, abdominal,
and lower extremity vascular views. Following the workshops, we sought to
consolidate learners’ knowledge with a subsequent year-long skill building
phase. The skill-building phase was truncated due to the pandemic. A hands-on
assessment was performed prior to the course and not repeated at course
conclusion due to social distancing concerns. An online knowledge test was
administered before the course, immediately following the course, and at one
year. A survey assessing attitudes and barriers to POCUS was administered
before the course and at one year.
EVALUATION: No resident passed the pre-course hands-on assessment.
Prior to the course, the average resident score was 54% on the online knowl-
edge quiz; directly after the workshop series, the average rose to 78%. At one
year, the average score on the online knowledge quiz was 74%, a statistically
significant decrease (p=0.04). Ninety-one percent of residents reported
performing POCUS at least once/month prior to the pandemic. During the
pandemic, scanning activity decreased; 67% residents reported they scanned
rarely or never.
DISCUSSION / REFLECTION / LESSONS LEARNED: Our course led to
significant improvement of knowledge regarding ultrasound technology and
image interpretation, however this decayed at one year, likely due to lack of
skill reinforcement. Though POCUS was widely used prior to the pandemic,
usage dropped at the pandemic’s peak, despite its utility as both a diagnostic
JGIM
and therapeutic tool. The most commonly cited reason for lack of use was
concern regarding contamination and infectious exposure. While the COVID
pandemic disrupted our curriculum, it also highlighted opportunities to incor-
porate POCUS into clinical practice and reinforced the importance of contin-
ued longitudinal practice to retain learned skills.
THE PRE-MEDICAL HEALTH COACHING (PHC) PROGRAM:
PRE-MEDICAL STUDENTS AS VOLUNTEER HEALTH COACHES
AT A SAFETY-NET HOSPITAL IN CALIFORNIA, 2016-2020
Emma B. Shak1,3; Davida Flattery2; Bryant Chow2; Kala Mehta2,3
1
Medicine, San Francisco VA Health Care System, San Francisco, CA
2
Medicine, Highland Hospital, Oakland, CA
3
Medicine, University of California San Francisco, San Francisco, CA.
(Control ID #3535717)
LEARNING OBJECTIVES 1: Explore how to engage pre-medical students
as health coaches to contribute to a more diverse primary care workforce.
LEARNING OBJECTIVES 2: Discuss the benefits of racially- and
culturally-concordant health coaching on patient outcomes.
SETTING AND PARTICIPANTS: The setting for this program is the Adult
Medicine Clinic at Highland Hospital, within Alameda Health System (AHS)
in Oakland, California. Highland is a public safety net hospital serving a
culturally diverse and predominantly low-income Medicaid and uninsured
patient population. Although this project began in 2008, the current review
encompasses the years 2016-2020, during which 22 pre-medical students
participated. These data represent an update to an oral presentation at the
2017 SGIM national meeting.
DESCRIPTION: Pre-medical students who self-identified as belonging to
groups historically underrepresented in medicine (URM) served as volunteer
pre-medical health coaches (PHCs) in outpatient primary care. This study
assessed the impact of the PHC program on PHC outcomes and patient level
outcomes. PHCs were recruited from local pre-medical post-baccalaureate and
undergraduate programs. Selected PHCs were trained in motivational
interviewing and evidence- based chronic disease self-management support.
PHCs spent 5 hours weekly, for 1-3 academic years, working alongside
primary care residents and faculty in a public safety-net adult medicine outpa-
tient clinic. During each clinic session, they: 1) observed the doctor-patient
interview, 2) provided on-site health coaching to patients, and 3) provided
telephone follow-up after the visit.
EVALUATION: The 21 PHCs were diverse - 36% were from URM groups
and 9% were first generation individuals. Preliminary results show that the
PHC experience had a positive impact on career trajectory: 91% stayed in
science, 50% applied to medical school, and 20% have entered medical
training. Qualitative impacts on coaches included significant clinical exposure,
meaningful connection with patients, overcoming career barriers, and having a
more holistic view on health. Patient level impacts varied: hemoglobin A1c
level decreased by 1 percentage point in patients with diabetes-focused action
plans; 89% of smoking-focused action plans led to smoking decrease or
cessation. In contrast, action plans focused on weight loss did not yield a
significant change in BMI over time.
DISCUSSION / REFLECTION / LESSONS LEARNED: The Pre-medical
Health Coach (PHC) program is an innovative model with potential benefit for
both PHCs and patients. PHCs were often from URM backgrounds, providing
culturally-concordant chronic disease self-management support to patients in a
safety-net health care system. This program could be readily adapted in health
care systems across the country to increase racially and ethnically diverse
entrants to the healthcare workforce, tackle chronic disease inequities, and
reduce primary care provider workloads. Future directions include evaluating
the impact the PHC program on career paths over time, as well as long- term
effects on patient outcomes and patient satisfaction.
THE PRICE IS RIGHT: USING CLINICAL REASONING TO TEACH
HIGH VALUE CARE
Natalie Farha, Muhammad Zarrar Khan, Lola Di Vincenzo, Anira Iqbal,
Nayan Agarwal, Megan McGervey
Internal Medicine, Cleveland Clinic, Cleveland, OH. (Control ID #3544792)