Please note the list below contains proposals that have been peer-reviewed and accepted for presentation at Medicine X | Ed 2018.
For a preliminary schedule, please click here. Updated Wednesday 3/21.
- Instructional Technologies and Engagement Learning Design
- Gaps in Medical Education
- PCOR and CER
- Everyone Included
Instructional Technologies and Engagement Learning Design Presentations (18)
Simplifying Complex Information: Empowering Mental Health Providers and Patients with Physiological Data
Christopher Molaro and Eash Aggarwal
With the popularity of big data being used for health care, it is important to include mental health and present information in a way both the patient and provider can understand together. Integrating data in real time from everyday life will lead to a better understanding of the subtle nuances that make up certain mental health conditions. Providers can add another category to their decision support toolkit to better understand their patients, without having to go through extra training or schooling. Most important, when patients are involved in their treatment and can track their own progress they can become empowered and engaged.
Virtual reality to empower theoretical dental education
Methods: This study included 21 preclinical dental students from Paris Descartes University aged 21-23 years old. Participants were given a virtual reality headset (Google Card Board) enhanced with a motion sensor (Leap Motion). An anatomy application was run on an Android smartphone where participants could interact with their hands with a 3D tooth model and its structures (ie enamel, dentin, cementum, pulp). A survey was then distributed in order to assess participants’ impressions.
Results: Participants found that virtual reality could have a beneficial impact on comprehension of complex or abstract concepts and on knowledge retention. They considered virtual reality as a valuable complement to traditional theoretical learning (eg books, drawings, non-RV videos) although it could not replace it entirely.
Students would also be interested in seeing this technology implemented in their curriculum especially in anatomy, physiology, and surgery.
Conclusions: Virtual reality was reported by students to be, if not disruptive yet, an opportunity to improve their learning process and the university curriculum. Further research is needed to assess its efficacy in dental education compared to traditional methods.
Managing Clinical Rotations: The Source of the Pain
quality and quantity from lagging information technology. A unified platform for schools,
students, and clinical sites to manage clinical rotations can help remedy the problem. We
discuss the outcomes of….
A Single Platform that
– Saves time
– Simplifies onboarding
– Provides better matches
– Increases the number of open rotations
– Provides accurate tracking of all educational experiences
– Improves communication between health systems, schools, and students
Young adults’ attitudes and knowledge for sharing whole-genome sequencing information: University based survey and interview
112 University-based 18 to 25 year olds were surveyed with a structured questionnaire and 11 of the participants undertook structured interviews. Survey questionnaires collected quantitative data through a basic genetic knowledge test, attitudinal questions regarding key aspects related to genomic information sharing on a 0 – 10 scale and demographic information, including gender, educational attainment, field of study or work, any prior genetic education through school or university. Two tailed hypotheses were tested using non-parametric methods to indicate relationships between genetic knowledge, demographics and attitudes to sharing preferences for personal whole-genome sequencing (WGS) information. The interviews further explored preferences for receiving and sharing results. Interview transcripts were analysed using content-based thematic analysis with frequency counts for tick-box selections.
From the survey’s significant results, several novel insights into the attitudes of young adults regarding sharing WGS information were found. Females were more likely to want to share with parents and siblings than males. Females were also more likely to want to know results of relatives. These preferences were also exhibited by those who had undertaken a genetics course at university. Participants who had undertaken a genetics course at school reported lower intention to consult with a HCP (healthcare professional) than either those who had not studied genetics at all or had studied it at university. Those who had a science, technology, engineering or mathematics (STEM) background were more in favour of buying WGS services online. STEM participants and those with more knowledge of genetics were more willing to receive WGS results reports. As educational attainment levels increased concerns about the effect WGS results might have on insurance policies decreased. In contrast, concerns increased among those who had specifically studied genetics as part of a biology course. Quiz scores were highest for participants who had studied genetics in a biology course or had undertaken a genetics course at university and among those within a STEM field.
From the interview data, 240 themes emerged, this included 170 raw data themes from which 52 intermediate order themes were derived, and in turn 18 higher order themes were identified. The five most prevalent higher-order themes that emerged, in descending order, were perceived utility, autonomy vs dependency, belonging, HCP interventions after WGS, impact on self, HCP interventions before WGS, then impact on relatives. The 10 most prevalent intermediate themes were health planning, life planning, discovery with relatives, access to professional care, impact on self, personal health insurance plans, self-discovery, support research, untreatable conditions and relatives’ shared interest. All 11 interviewees were interested in results about treatable conditions, both present and future, as well as pharmacogenetics results. Nine out of 11 wanted results pertaining to variants of unknown significance (VUS). When offered a long list of diseases and conditions, eight participants wanted results about all conditions on the list with only three discriminating among the options. All interviewees preferred to receive their WGS results in-person, primarily from doctors, closely followed by genetic counsellors. Family members were the least popular choice for interviewees to receive their results from. Participants were most willing to share their results with HCPs, researchers, family members and friends. They were least willing to share with insurers and employers.
Our studies offer new insights into how education interplays with attitudes people have towards managing and sharing their genomic results and sets out educational and information considerations for medical professionals. Our findings can be organised as a model to facilitate categorising and meeting the educational needs of patients and DTC service users and are of particular interest to clinicians, whether they are the providers of information and support throughout the genomics process, or only become involved when results have already been received by an individual. The manner in which educational material and results information is delivered to meet genomic service users’ developing knowledge will play a large part in how well individuals receive, manage and share the information to benefit health outcomes.
Developing virtual reality training to improve trauma care
Background: High-level trauma activations require rapid, multidisciplinary team collaboration; however, the current medical training model does not adequately prepare our diverse group of learners to understand each other’s needs. Trauma teams are ad hoc, containing a range of learners from MS3s to PGY9 fellows across multiple departments including surgery, emergency medicine, anesthesia, radiology, nursing and pharmacy. As a result, these learners have little insight into the knowledge, skills, goals and objectives of their teammates – leading to interpersonal challenges and delays in patient care. We will be developing VR educational modules to help improve professionalism, perspective taking of fellow team members, empathy for the patient and situational awareness in the trauma bay.
Methods: We will film 360 video of a trauma resuscitation room from three different perspectives: that of an anesthesiologist at the head of the bed, that of a provider (surgery or EM) at the side of the bed, and that of a patient, from the gurney. These videos will be overlaid with motion graphics and animations to tell the story of the trauma through the perspective of each key player’s role. We will use a human-centered design methodology to determine learning goals for the curriculum. Specifically, we will conduct in-depth, in-context interviews with key stakeholders.
We will evaluate the training tool by measuring empathy, knowledge of provider roles and performance during live traumas. Empathy will be measured using the Jefferson Scale for Empathy. These learners will be tested for their knowledge regarding roles of general surgery, anesthesia and emergency medicine physicians during a high-level trauma. Performance will be evaluated by gathering the number of errors made during video reviews of live traumas. All measurement activities will be performed pre- and post-intervention in order to measure improvement attributed to the training tool.
Results: The VR modules are currently in development, with an expected completion by the date of the conference. We are also presenting this work at SXSW, so the modules will be completed by mid-March in preparation for SXSW. By the time of the conference, we will have results, and at that point, would be happy to submit an updated abstract. Our results will focus on the development of this educational module and the methodologies used.
Conclusions: Simulation in medical education is a well-established training technique; however, the graphic nature of traumas and high stress environment is impossible to replicate in a mock setting. VR is a new and exciting technology that captures the high-stakes nature of the trauma, but allows trainees to practice in a safe setting. We aim to showcase how to use VR in a way that is an effective in creating world-class educational experience for trauma training.
Revolutionizing Medical Education using Adult Learning Theory
Mary Ellen Beliveau
Medical Device Design Education: Identifying Problems Through Observation and Hands-On Training
Narrative medicine as a vehicle for end-of life communication-skills training in residency: a pilot program
Jules Vieaux, Eilann Santo, Jessica Zitter and Miranda Weintraub
All physician trainees can and should practice navigating end-of-life conversations with patients and their families, regardless of intended specialty. However, training in communication and self-reflective skills is not a routine or standardized part of graduate medical education. As a result, many physicians entering the work force have limited experience and lack of confidence in counseling patients regarding end-of-life issues. The purpose of this project was to 1) pilot the use of multimodal narrative medicine in graduate communications training and 2) identify themes that most effectively motivate and engage medical residents in developing these skills.
A pilot workshop was developed and led by senior internal medicine residents and Palliative Care physician, Dr. Jessica Zitter, for an experiential conference series for graduate medical trainees. Participants, which included internal medicine and Ob-Gyn residents, medical students, hospitalist and critical care faculty, as well as pharmacy and nutrition staff, were asked to watch a 25-minute documentary, Extremis, which followed terminally ill patients receiving care in the intensive care unit at Highland Hospital in Oakland, CA. Participants additionally read four selected excerpts from Dr. Zitter’s book Extreme Measures, detailing real cases of terminally ill patients and were asked to reflect on the content prior to attending an interdisciplinary discussion session. The one-hour workshop involved an initial semi-structured discussion focused on identifying ethical and emotional struggles present in each of the four selected excerpts, followed by senior faculty sharing their perspectives on Extremis and Extreme Measures, and concluded with an open group discussion. The senior internal medicine residents identified themes relevant to resident communication-skills training that emerged throughout the workshop and residents provided feedback on the workshop itself.
Four key themes important to the resident learning experience emerged from this pilot workshop: (1) normalization of emotional/moral distress; (2) discomfort surrounding ambiguity; (3) importance of self-compassion in the development of empathy; and (4) the need for structured approaches to developing communication skills with seriously ill patients. Residents provided positive feedback, indicating that this interactive learning approach was useful in introducing nuanced communication skill topics to help them better navigate end-of-life conversations with patients.
While communication-skills training for all physicians is key to providing patient-centered care for patients with life threatening illness, educational methods for teaching these skills are not well established. This pilot workshop, which integrated palliative care faculty expertise with written and visual media, engaged residents in open and self-reflective discussion regarding challenging end of life issues. The workshop provided residents with communication skills to better care for patients facing serious illness while also identifying topics relevant to resident communication-skill training.
Novel Learning Strategies for Students in Basic Sciences
Aaron Brown and Emeka Ajufo
Extremis: Using story to change our patterns of care.
Our current model of caring for patients with advanced illness begs for change. Too many receive default, high-technology treatments at the end of life, often without understanding the full implications of this approach. When people do know more, they almost always choose lower levels of intervention. There is a crisis of poor information transfer in our medical system, and until physicians begin to change their behavior, this crisis will endure. There are ongoing attempts to reform medical education with skill-building, but until healthcare providers themselves believe in the need to change, they are less likely to implement these new tools.
“Extremis” is an Academy Award and Emmy-nominated short documentary by filmmaker Dan Krauss, currently streaming on Netflix. In it, we follow Dr. Zitter into the heart of the ICU. We watch as patients, families, and healthcare providers grapple with the complexities of urgent medical decision-making in serious illness. And we witness both the beauty of saving life and the beauty of a good death.
Since its release in early 2016, Dr. Zitter has been overwhelmed by requests to bring the film to healthcare audiences across the country. It has proven to be an excellent tool for engaging healthcare workers on the issue of improving medical care for patients with advanced illness.
This Learning Lab will use “Extremis” as a platform for emotional engagement, and the discussion following as a means to enable learners with a deeper understanding of the issues at hand, as well as a broader skillset with which to address them. After showing the 24-minute film, Dr. Zitter will address “taboo” subjects such as dealing with uncertainty, shame at perceived failure, moral distress, and the challenges of breaking bad news. Where the movie primes the learner to engage emotionally and reflect, Dr. Zitter’s presentation offers strategies for a new approach, one that acknowledges the importance of the whole patient, rather than just her organs.
Transforming Clinical and Patient Education with Virtual Reality
As an MD Candidate and Clinical Fellow in Healthcare Innovation at Jefferson, I lead one of the first studies in the country examining how VR can impact treatment and education for patients in outpatient cardiac rehabilitation. I am also the architect behind the initiative’s first venture into product development, exploring how VR can be used to simulate and better prepare providers to address high-acuity clinical situations.
If chosen as an oral presentation, this talk will focus on either patient education or clinical education, using examples predominantly from the research study or product development effort I lead. If accepted as a learning lab, it will discuss examples from both. This talk would not be effective as a poster presentation.
Accessible and engaging multimedia patient education: the secrets to success
Through the creation of educational hubs, personalized teaching tools have been liberated allowing highly individualized, learner paced education with rich educational content. Each hub can include video, audio, quizzes and downloadable content which learners can access and digest in a self-paced, empowering manner. Smart phones are a readily accessible and widely used technology, and can also be powerful creative tools. Highly engaging educational content can be easily created, edited, and shared in just minutes with simple (and in many cases free) web design and hosting.
This workshop is designed to provide an overview of the creation of educational hubs
for patients, doctors and peers.
Topics covered include:
Researching the hidden needs of your market.
Understanding the “questions behind the questions” in doctor patient interactions.
Creating simple, accessible and engaging videos – quickly and cheaply.
The best video length for engagement and a key skeleton format for educational video.
Using videos as an introduction, to help patients prepare for appointments, for patient education, encourage patients to take ownership and direction in their medical care.
Use of video for consent, reinforcing key educational points and reducing medico-legal risk.
The distribution process – how to make videos available to patients to create engagement, trust and understanding in a patient centred environment.
Using social media and other free tools to identify further needs and hone your message to meet your learners needs.
This workshop will draw upon successful examples of the model including my own practice in the highly specialized area of HIV care and prevention, gay men’s health and peer to peer education of family practitioners in Australia and how this can be done across the world even when internet may not be available.
This workshop is aimed at clinicians in all fields of medicine, educators at all levels, patients and carers.
Learning Lab: Jefferson Design’s Workflow for Manipulating CT Datasets for 3D Printing
Dominick Gadaleta, Victor Hsue, Nicholas Rankin, Denis Huang and Robert Pugliese
Our main project involves reducing operating room times and costs associated with mandibular reconstruction surgeries. In these procedures, titanium plates are manipulated to stabilize the reconstruction site while preserving cosmetic outcomes. ENT surgeons bend these plates intra-operatively, using the patient’s resected mandible as a guide. Using CT scans, our team has been printing anatomically accurate models of patient mandibles. This allows surgeons to better visualize the patient’s anatomy for surgical planning; in addition, the titanium plates can be bent prior to the operation using the 3D print as a guide. Though this technology is currently offered by companies like Stryker, the cost is prohibitive. Our models are produced from relatively affordable consumer 3D printers and cost around 5 dollars.
We are also working on two other projects that involve 3D printed models. The second project involves 3D printing mid-faces from patient CT scans for ENT surgeons, mainly for use as a surgical planning tool. Our third project involves 3D printing temporal bones for ENT residents to use as temporal bone drilling practice for mastoidectomies, which traditionally uses cadaveric bone. The material used to make the models, poly-lactic acid (PLA), provides similar feedback to bone when drilled. Furthermore, our models are inexpensive to print and can be sustainably mass-produced. We aim to show that they can be suitable replacements for cadaveric bone.
The key to success for all three of these projects involves utilizing a consistent workflow going from Computed Tomography (CT) Digital Imaging and Communications in Medicine (DICOM) files to the StereoLithography (STL) format used by 3D printers. Developing the proper workflow is critical to properly rendering a 3D model for printing. Our Jefferson workflow utilizes two open-source platforms: 3D Slicer (3D Slicer 4.8, The Slicer Community, Boston, MA) for segmentation and Meshmixer (Meshmixer 3.3, Autodesk Inc, San Rafael, California) for error reconciliation. In our learning lab, we would like to guide participants through our workflow. Each participant would have 3D Slicer and Meshmixer downloaded on their personal laptop. They would then follow along with us as we all start with an example CT DICOM dataset. Members of our team will also walk around the room for additional 1-on-1 teaching. If time remains at the end of the session, we can work individually with participants to tailor the workflow for any ideas and projects they have.
Our main goal for the learning lab is to have participants leave feeling confident about processing CT DICOM data sets for 3D printing. We believe that our workflow is easy to learn and user-friendly to those with minimal exposure to 3D printing. Our hope is that participants will be able to leverage this workflow and technology to innovate in other fields of medicine and healthcare.
Designing tangible exercises as a means of translating digital concepts for medical students
The seminar «Iconic Turn – How Images Govern Our Actions» combines the findings and topics from the different research areas involved in the project. Hence, the seminar links humanistic-critical, designerly-applied, neurosurgical-medical, and e-patient and patient-centred approaches in order to reflect on changing practices and potentials of medical imaging in neurosurgery.
The proposed session focuses on the concept and development of the design-driven parts of the seminar. It outlines the relevant results of my design research in the neurosurgical clinic, the identified needs and the resulting approaches. My design research (observational field research) was conducted during relevant stages of imaging and image interactions in the context of neurosurgery, which included neuroradiology, ambulances, board meetings, functional examinations and image applications in the operating rooms during different procedures. Each of the resulting insights and each of the goals/needs defined for the class will be depicted with a related exercise to demonstrate the suggested tangible and material-based approach in detail.
The tangible and material-based approach aims at offering a more applied and embodied understanding of mostly abstract digital interaction concepts (in software interactions). For that reason, the hands-on exercises involve material-based explorations of cutting a geometric hard foam model into layers to investigate the concept of sectional images, sketching tasks to explore the projection of 3D objects on a 2D screen and others. Additionally, the teaching concept includes another more subtle ability: the involvement of the hands and tactile stimuli and experiences to anticipate and introduce the necessary tactile and implicit knowledge and reliability of those abilities at the surgical table. The training of these important abilities starts usually with the residency but in this way first material explorations and experiences of their potential differences could already be integrated in med school.
Overall, the session shows my design approach on an abstract and difficult learning level, which is important for the patient’s benefit: the interaction and connection between the physical body and its digital (virtual) models appearing as medical images on a screen.
Virtual Reality as a Teaching Tool
Aaron Lewis and Jennifer Riebli
In our presentation, we would be pleased to offer a brief instructor-led overview starting with a 2D viewing of both a participant experiencing VR alongside the VR environment they are experiencing. We will discuss the benefits of CGI versus a real 360 degree video experience and the explore where different audiences might benefit—physicians, medical students, patients, Tele-ICUs, hospital administrators and medical HR. We will have VR headset and gear available and can discuss best practices for VR equipment, 360 video and the design and development process based on the fundamentals of adult learning and video production.
We will also discuss how VR might be best applied to drive patient centered outcomes, including improvements to prevention, diagnosis, care and connection.
Life Grows Awry — A storytelling activity to quickly build empathy and gain context
Seamus Harte and Emilie Wagner
But if our brains are wired for story—then we don’t need to “learn” storytelling—we simply need to “activate” it.
Our workshop helps people “activate” their storytelling ability through a tool called “Life Grows Awry.” It helps patients discover and succinctly share personal stories of struggle and triumph from their own lives. In turn, healthcare providers can quickly gain empathy for patients while simultaneously learning critical information about their medical and personal history.
“Life Grows Awry” was developed at the Hasso Plattner Institute of Design at Stanford by Seamus Yu Harte. Originally, it was a quick storytelling activity to help build empathy in any context, but through serendipitous collaborations at Stanford with Emilie Wagner, Dr. Henry Lee, and Jules Sherman, the activity has proven to be especially helpful in healthcare, specifically for developing empathy in provider/patient relationships.
One set of students used the tool while meeting with Crohn’s disease patients in their homes to quickly get stories out and gain empathy. This was through their curriculum experiments in “The Empathy Project,” an Oral Presentation at MedX 2017. Its simple framework was approachable for students of all abilities and backgrounds. Another set of students used the tool to refine their tone, content, and flow when presenting to hospital administrators at Stanford Health Care and the Palo Alto VA. They were able to elevate their audience’s empathy for the patients whose experiences they were bringing to life.
“Life Grows Awry” has potential for many use cases in healthcare. While a few have been explored, we intend to examine more prior to MedX 2018 and during the workshop. For example, how might we help patients empathize with busy nurses and doctors? How might we help providers gather critical information prior to patients’ visits?
The benefits of “Life Grows Awry” include quick collection of meaningful information and engaging dissemination of that information so that it has impact. Still, there are more benefits to uncover with the unique mix of participants in MedX 2018 and beyond. Ultimately, it has potential to improve patient experience and outcomes.
Participants of the workshop will be immersed into the hands-on activity and will be provided additional materials to incorporate the activity into their own practice immediately.
Teaching design thinking to physicians of the future
David Janka, Bon Ku and Matt Trowbridge
Attendees will learn the following:
1. An introduction to design thinking as a process, mindset and ability
2. Examples of pioneering efforts to teach design thinking as part of undergraduate medical curricula
3. Challenges to introducing human-centered design in medical school
4. Tips and tricks for implementation from current design thinking programs
Engaging students in online learning – new approaches using design thinking
Juliette Piot, Nirupan Vipulananthan and Rémi Wolf
There are currently significant transformations occurring in anesthesia, critical care and general medical education. Adult Resident learners find themselves at the intersection between new pedagogy paradigms and an ever enlarging literature of knowledge.
The emerging constructivist theory implies that learning should be contextual, active (engaging student in the building of their own knowledge) and social (direct interaction with peers). This integration can be enhanced by two processes: 1) the repetition of information and evaluation, known as retrieval practice effect and 2) contextualization, to transform theoretical knowledge to clinical application.
The ideal learning environment involves a mentor, to guide the learner through all stages of Bloom’s taxonomy of cognitive levels, from knowledge to synthesis and application. However, with increasing loads on professor-physicians, the current setting limits the teacher from delivering all cognitive levels. Traditional models focus on teachers spending time and energy on low grade abilities (knowledge and comprehension), but abandon the learner during the most critical phase of acquiring high grade abilities (synthesis and application).
The theoretical solution is the flipped-classroom model that delivers low grade concepts through e-learning in an attempt to optimize mentor time for higher level learning.
E-learning and flipped-classroom – what is the future?
An online learning curriculum has several advantages including: customized lecture progression based on previous knowledge, quizzes to promote active learning, space-repetition of quizzes to help identify knowledge gaps and re-watch video content according to personalized feedback,. A large limitation to most massive open online courses however is engagement and retention of users to course completion. We therefore are concerned with creating a platform that is focused on engagement.
The LearnerLab project
Learnly is an established anesthesia resident platform that is currently used by 40% of Anesthesia programs in the United States. We are launching LearnerLab as a sister platform that will offer beta-testing of new contents and platform designs. Residency education offers the opportunity to have a large curriculum spanning multiple years and can therefore heavily apply cognitive load theory and spiral learning. Learning contents will include blackboard videos and structured skeleton notes, and use formative quizzes to promote active learning and retention. This platform has the unique ability to implement design thinking, evolving with rapid and iterative A/B testing. More specifically, it offers the ability to collect and analyze a large amount of data in order to identify cognitive learning profiles with the ultimate goal of an adaptive, personalized learning tool.
Design Thinking Workshop – Imagining New Approaches
Personalization of learning content requires both identifying domains that may influence cognitive learning profiles, and A/B testing concepts. Our workshop will discuss potential avenues for A/B testing including: curriculum structure and pathway; drip-feed vs. full-release; behavior modification for engagement; structure, delivery, and timing of quizzes; UX and UI design.
Gaps in Medical Education Presentations (31)
Integration of a Simulated Interprofessional Clinical Skills Curriculum: A Prospective Investigation for Standardized Performance
The American Board of Internal Medicine (ABIM) has recognized thoracentesis, paracentesis, lumbar puncture, and airway management as recommended clinical procedures for resident education1. Additionally, several other medical specialties utilize these procedures, but employ different training methodologies. To investigate human performance, which provides safe and effective patient care, one standardized interprofessional training methodology was created. The simulated interprofessional clinical procedural curriculum’s goal is to enhance human performance and reduce error for required clinical procedural which are utilized across a range medical specialties and providers. Simulated clinical training can assist in the enhancement of both clinical knowledge and performance for basic competence2. Employing validated checklists across a large medical continuum may provide insights to further standardize additional basic clinical procedure competencies, which may reduce errors, enhance technical performance, and lead to positive patient outcomes3,4,5.
Recent changes in medical education and practice now limit basic procedural instruction time and patient availability2. Thus, expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technical curriculums in medical education2. Several medical specialties including; Emergency Medicine, Internal Medicine, Med-Peds, General Surgery, Pediatrics, and both masters and doctoral level nursing providers utilize the aforementioned procedures for patient care and management. In large academic medical centers, it is common for basic procedures to be taught by several different faculty members, which may provide various levels of performance and assessment data points. Through the use of validated procedural checklists, it becomes possible to standardize training protocols that mutually benefit several separate providers and patients. Creating a singular simulated procedural skills curriculum provides standardization across the healthcare system and in turn reinforces the commitment to provider training and patient care.
Integration of a simulated procedural skills curriculum allows senior administrators and faculty to investigate the transfer of technical skills to the operational environment. Further, this curriculum aims to standardize training protocols, enhance human performance, reduce clinical errors, and provide better patient outcomes through validated metrics. The primary objectives are:
1. Ensure standardization of procedural skills across medical specialties; specifically, for thoracentesis, paracentesis, airway management, and lumbar puncture utilizing validated procedural checklists.
2. Demonstration of clinical knowledge, relevant to procedures, through the explanation of indications, contraindications, patient preparation methods, sterile techniques, pain management, proper techniques for handling specimens and fluids obtained, and test results.
3. Ability to clearly explain to the patient all facets of the procedure necessary to obtain informed consent, then subsequently competently perform each basic procedural skill according to validated checklist.
4. Provide a safe environment for novice providers to rehearse, then enhance performance through simulated procedures.
5. Augment simulated procedural training toward mastery level learning.
The simulated procedural skills session in which learners will have the opportunity to participate in various basic procedures. Participants rotate through the four stations, with a maximum of 4 people per table. The session begins with a flipped classroom style deployment of training videos for each procedure. Next, learners must demonstrate clinical knowledge by role play assessment for informed procedural consent, utilizing a three-level approach; indications, contraindications, and troubleshooting. Finally, each learner will rotate through the four stations, which provides an overview and demonstration, first person orientation and skill rehearsal, then direct observational assessment of simulated procedure.
The goal of this program is to standardize the education and training of thoracentesis, paracentesis, lumbar puncture, and airway management across multiple residencies and specialties. In our institution, we successfully implemented a similar program in central venous catheter (CVC) training that led to a significant reduction in mechanical complications as well as central line acquired blood stream infection (CLABSI). Barzuk7 translational study concluded that rigorous simulation-based mastery training could be used to improve patient safety and clinical outcomes at community hospitals. One of the limitations of the study was that they only included Internal Medicine and Emergency Medicine residents. Further, the Barzuk7 study aided in holistic cooperation from all residency programs and hospital administrators. This interprofessional curriculum includes, not simply residents from the Internal Medicine and Emergency Medicine, but also residents from Surgery and Pediatrics, fellows from Cardiology and Pulmonary/Critical Care and Advanced Nurse Practitioners. CVC training sessions are held monthly and can accommodates up to 20 learners simultaneously.
This new curriculum is designed to fill existent gaps in resident medical education regarding procedural skill performance, while additionally enhancing communication skills, clinical knowledge and overall provider confidence, all while keeping patient safety a priority with consistent longitudinal training throughout multiple specialties.
Stigmatizing Attitudes and Approach/Avoidance Responses Toward Obese Patients Among Exercise Science Students.
Ahuitz Rojas-Sánchez, Philippe Sarrazin and Aïna Chalabaev
How Technology-Forward Medical Education Can Solve our Greatest Health Care Problem: Access
David Lenihan and Daniel Pianko
It’s no secret that we face a massive shortage of medical professionals worldwide. But what’s most disturbing is the fact that the shortage does not impact everyone equally – underrepresented minorities are disproportionately affected by a lack of physicians. Disparities are built into our healthcare system in the United States and around the world.
For example – unequal access to healthcare is the #1 killer for mothers and children in Latin America. In Latin America and the Caribbean, children from low income homes are five times more likely to die before their 5th birthday. In the United States, life expectancy can be correlated to race and ethnicity and income level. Underrepresented minorities have more ailments and get worse care.
Patients, especially minority patients, are being cared for by doctors who don’t have first hand experience with their unique context, their pressures, their family dynamics or their community norms. Few health professionals today are trained in cultural competencies, although it’s widely understood that health workers with bicultural skill sets improve quality of care and are critical in communities where there is a shortage of health workers.
Any solution to solving the doctor shortage must attack the supply problem, but also the underlying socioeconomic issues. This starts with medical education. Healthcare delivery has changed, but how we train our professionals has not. A new model for health care requires a new model for health education.
Technology has an important role to play in cultivating high-quality doctors affordably, while also graduating health care workers who are culturally competent, empathetic, and service-minded.
In this talk, Dr. David Lenihan will introduce a new model for medical education that leverages predictive analytics, real-time monitoring, and adaptive learning to deliver rigorous education that makes room for culturally competent and patient-centered training.
Measurement of Cultural Competence in Dentistry
Objective: To assess the status of cultural competence of dental students through a validated questionnaire, the “Health Provider Cultural Competence instrument” (HPCCI) (3) which measures five primary dimensions: a.) awareness/sensitivity b.) behaviors c.) patient-centered communications d.) practice orientation e.) self-assessment.
Methods: An online HPCCI questionnaire will be sent electronically to students and faculty members. They will also be asked to report their involvement in community outreach activities. Student subjects will be pre-doctoral Doctor of Dental Surgery (DDS) students, during pre-clinical (first-year DDS) and clinical years (2nd and 3rd). This project will be submitted for IRB exemption or approval as required. Comparisons will be made across the five dimensions between students with respect to their advancement in the program; and between the faculty and the students. Feedback will be provided to participants when data analysis is complete. Suggestions for enhancing cultural competence training will be presented in several venues. Inferential statistical tests will include: a.) Independent t-tests (overall scores) for comparison of responses amongst dental students based on their advancement in the program and with the faculty; b.) one-way ANOVA with post hoc analysis for domain-wise comparisons across the five listed above; and c.) chi-square testing for distribution.
Implications on Educational Practices in Healthcare Faculties: The methods used here can be replicated and used as a model to assess cultural competence for other health care educators and providers. HPCCI is a universal tool that can be used across all disciplines of healthcare. Gaps identified in such surveys and studies can be addressed universally through courses and experiences to enhance cultural competence.
Timeline of the project: January 2018 – March 2018.
1. Kassebaum NJ, Smith AGC, Bernabé E, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017;96(4):380-387.
2. Williamson M, Harrison L. Providing culturally appropriate care: a literature review. Int J Nurs Stud. 2010;47(6):761-9.
3. Schwarz JL, Witte R, Sellers SL, et al. Development and psychometric assessment of the healthcare provider cultural competence instrument. Inquiry. 2015;52.
Digital Nursing: Bridging the gap between health care and innovation
Theofanis Fotis and Anand Sundaralingam
In the current, rapidly changing environment due to technology innovation, healthcare practitioners and patients are bombarded and introduced continuously to new developments of digital technologies. As a result, the divide between humans and digital technologies is widening. The current academic curricula globally, are missing out on following the fast pace of these developments.
A proposed solution for filling this gap in education is the development of an educational programme with a content focused on the development of specific digital skills for healthcare practitioners and especially nurses at the bedside. Through education and research engagement, we will manage to develop a workforce with those digital skills that will enable nurses to use digital technologies, identify risks, protect patients and furthermore engage in the research and development of these new technologies.
The presentation among others will refer to the project for the development of a community based digital health living lab. According to the European Network of Living Labs (ENoLL), whilst to date there exists no agreed upon definition of the concept, they define Living Labs as both an environment (milieu, arena) and an approach (methodology, innovation approach).
Our approach of the living lab is to utilise it as an educational centre where undergraduate students will practice within their clinical placements programme and post graduate students will carry out their research. Benefits for both the citizens and students will be discussed.
A Few Things Every Med Student (and Doctor) Should Know About Designing Products and Experiences – Thoughts From The World Of Consumer Electronics
Robin Diane Goldstein
After more than 22 years at Apple helping to launch some of its most iconic consumer products (iPod, iMac, Apple Watch), I took a detour about 3 years ago to focus on the company’s efforts in the health and medical space, and was part of the team that brought HealthKit, ResearchKit, and CareKit to life, as well as the recently launched Apple Heart Study taking place in collaboration with Stanford Medicine.
Coming to the space with an engineering background (EE/CS undergrad at MIT), a public policy background (Masters Degree in City Planning from MIT), and a law degree, but having spent a career working on consumer electronic products (Apple, Sony), I’ve developed some insights I believe are worth sharing/exploring with those looking to innovate in the medical space, especially those interested in the space of digital health, including:
1. Engineers focus on the What and How but rarely consider the Why (or So What?) of a product or solution.
2. Physicians are trained to quickly filter information to exclude anything that isn’t actionable and this can lead to a false equivalence between the concepts: “This data isn’t useful” and “I don’t know what to do with this data”… which, in turn, can unintentionally stifle innovation and slow the development of both new insights and new types of insights.
3. Both groups fall prey to the common trap of building products and experiences for themselves. The appeal of “N=1” is understandable, especially in the health and medical space, but leads to a number of rhetoricological fallacies that can result in the design of products and experiences without a clearly defined vision of either the “Why” or “Who” (outside of the developer) the product/experience is intended to help (notwithstanding the often heard, “we want to help people – this will save lives”).
For example, a consumer device capable of detecting and distinguishing between multiple types of arrhythmia may present an interesting engineering challenge, and may provide a level of signal granularity valuable to a physician, but from the patient (consumer) perspective the value proposition is often simply the binary: “Do I have to see my doctor? Do I not have to see my doctor?” This can then lead to scenarios where an instrument may become more sensitive and intelligent over time, but from the patient’s perspective has no additional intrinsic value. Both perspectives are reasonable but lead to different considerations during the design process.
I have been developing (ongoing) a model for thinking about the design of health and medical tools (digital apps and devices) marketed into the consumer space and believe some simple concepts would be valuable for anyone looking to innovate in the space to remember:
1. Recognize that unlike traditional consumer products, medical products (apps/devices) are generally only valuable once the customer ‘closes the loop’ with a health care professional. This means that products/solutions should identify the intended ‘direct’ customer and an ‘indirect’ customer, and address (or at least acknowledge) both of their interests and needs (which may not be the same).
2. Understand that developing solutions under current research and regulatory paradigms can be limiting, and that the future should not simply be the present with fewer bugs. This means looking beyond the traditional buckets of “diagnosis” and “screening” to a new/third class of “potentially actionable inklings”… Information (or bits of data) that taken alone may not be actionable, but when combined over time (possible years) and/or with other data may lead to actionable diagnostic or screening information.
3. Steal (or more politely, ‘adopt’) the insights of Steve Jobs who said,
“You’ve gotta start with the customer experience and work backwards to the technology… You can’t start with the technology and try to figure out where you’re gonna try and sell it. I’ve made this mistake probably more than anyone else in this room. And as we have tried to come up with a strategy and a vision for Apple it started with ‘what incredible benefits can we give to the customer’, ‘where can we take the customer’, not starting with lets sit down with the engineers and figure out what awesome technology we have and figure out how to market that.”
This leads to a definition of a compelling consumer product/experience (“I didn’t know I needed it, and now I can’t live without it”) – Think smart phone, DVR, microwave, etc. And the challenges of translating this to the medical space, which is fraught (for traditional ‘consumers’) with emotional & ethical elements not found when selecting an iPhone over a Samsung Galaxy.
In working with those already practicing medicine, and talking with colleagues, I recognize that while education is possible at any point in one’s career, real change can take place when med students are exposed to concepts of product design as part of their education while they are first forming their ideas about the future and practice of digital medicine. I would love the opportunity to share some of the insights I’ve developed during a career in consumer products and would welcome the chance to give a short talk to those engaged in defining the future of medical education.
The single best undergraduate major and field of medicine to pursue for the future of healthcare
I would strongly argue that Landscape Architecture is the single highest yield major to prepare anyone for the future of healthcare. Landscape Architecture is about systems oriented design thinking across all scales. It prepares one to understand data and design in order to tell a story of what an existing system could transform into if desired. More so than architecture or city planning, landscape architecture is more connected to healthcare because of its strong roots in the life sciences. Designing any system in the field requires an intimate understanding of biology and environment and how the two are inexorably linked. Human health depends on the health of the environment and being able to understand those complex systems and design for that is what landscape architecture is fundamentally about. Whether you are concerned about mental health, obesity, or pharmacology the knowledge of landscape architecture is incredibly insightful and practically useful.
In this talk I want to share my story and journey of how landscape architecture prepared me for my role as a pediatrician who practices clinical informatics. At first these may seem like disparate entities but it is really landscape architecture that ties everything together. For anyone interested in going into healthcare they should study landscape architecture.
What do Millennials want?
Consumerism, digitalization, social consciousness – just to name a few things millennials care about. But most importantly, at the core of the future that is emerging is a transition toward asymmetrical information, the very foundation of what we are calling millennialism.
Being a millennial myself who happened to have lived in both Asia and the U.S. for an equal amount of time, I have experienced this shift globally. And having studied and worked in healthcare in the last four years, I truly gained a knowledge of how this shift will change the way medicine is practiced and how medical education will evolve.
In this presentation, I will present my thesis of the impact of millennialism in healthcare, exploring the dynamics of the new market, the relationship of millennial physicians, patients, and management.
Let me tell you about yesterday’s catastrophe: the power of concrete stories of failure
Failure is a key component of learning and improving, and medicine is a field in which everyone should always be learning. Every patient is different, which means there isn’t ever one “right” answer. Medicine should encourage creativity and novel ideas, but to do so, we must become comfortable with the fact that sometimes we will fail.
Becoming comfortable with the fact that we sometimes fail requires talking about it. It requires explicitly, uncomfortably, and sometimes publicly telling stories of failure. I do this all the time. It makes some people uncomfortable, because this is not something that we’ve been socialized to do, but mostly it makes it possible for other people to share their stories about failure, to feel less alone in that experience, and to aim higher on their next attempt.
Each story of failure is the story of something that was tried. When we all share these stories, we make group success possible. We make it possible to build and advance. This is true in all fields, but medicine is particularly uncomfortable with the idea of failure. Real change–in culture, in care, in humanity–requires becoming comfortable with failure.
We’ve all failed at something and been too embarrassed to talk to other people about it. And we’ve all identified with someone else who has failed, and been comforted by stories of how others managed similar challenges. But we have not yet regularly begun to tell each other about our failures, which will allow us to harness the power of these experiences at a group level and normalize the experience of failure. Normalization of failure has huge implications on our astronomical rates of burnout and isolation.
This talk is a call to action: talk about your failures with your friends and colleagues. Find your way to greater confidence, creativity, and professional success through concrete stories of failure.
The Taboo of the Entrepreneur in Medicine
The Coach Approach in Medical Education
In 2015, the University of British Columbia designed and implemented a program coach position to assist and support faculty development in their Abbotsford Mission Family Practice Residency Program. Coaching is a term that has recently emerged in the medical education literature and often applied in the context of working with medical students and residents (Deiorio, Carney, Kahl, Bonura, & Juve, 2016; George, Reis, Dobson, & Nothnagle, 2013). Early results of the coach approach include lower resident burnout rates (Palamara, Kauffman, Stone, Bazari, & Donelan, 2015); residents’ perceived ability to improve patient care via adopting a coaching relationship (Polak, Finkelstein, Axelrod, Dacey, Cohen, Muscato, Shariv, Constantini, & Brezis, 2017); and residents’ increased awareness regarding the importance of physician-patient communication (Wagner, Jester, & Moseley, 2002). Furthermore, when implemented in faculty development, coaches were key in promoting preceptors’ understanding of a safe learning environment; in assisting the preceptors with goal setting; and in resident reflection (Kopechek, et al, 2017).
In this session, participants will learn how coaching is employed within the Abbotsford Mission Family Practice Residency Program faculty development and resident education as well as the challenges and opportunities experienced in addressing our site’s gaps.
Tele-education: From Classroom to the “Virtual” Bedside
The Pediatric ICU Bedside Medicine Course at Michigan State University College of Human Medicine increases medical student exposure to patients at Helen DeVos Children’s Hospital during pre-clinical years. The curriculum emphasizes critical thinking and “hands-on” experience at the bedside to ease transition into clinical training.
Walking into the room of a critically ill child can be overwhelming to a medical student. Despite their passion to learn, their knowledge is limited. Emotions from seeing a sick child who is dependent on mechanical ventilation and multiple catheters to sustain basic physiologic functions can distract a naïve learner from getting the most from their education. Duty hour limitations have imposed additional constraints on the number of bedside experiences a trainee can receive.
To address students’ knowledge gaps, emotional discomfort, and limited experiences at the bedside, we incorporated tele-education into a bedside medicine curriculum. Through secure video-conferencing technology, students were able to “virtually” observe, assess, and discuss an ICU patient within the confines of a classroom. Classroom discussion was facilitated by an intensivist and parents were consented to allow the participation of their child during these virtual sessions. Following the virtual experiences, students were surveyed to better understand the benefits and drawbacks of tele-education within a bedside medicine curriculum.
Most students felt that tele-education prepared (emotionally and intellectually) them better for actual encounters at the bedside. They also acknowledged that tele-education can provide opportunities for increased patient exposures and clinical scenarios they may otherwise miss due to work-hour restrictions.
Not surprisingly, students voiced concerns regarding the lack of physical contact during tele-education. Learning was primarily observational and they were denied a more complete sensory experience – including palpation during a physical exam.
More surprising, however, was students’ acknowledgement of how their own empathy limited their education at the actual bedside. During tele-education, they felt free to learn without concerns for agitating patients, disturbing nursing staff, and unsettling family members. Students appreciated the “low-stress” and “less distracted” learning environment that was offered via tele-education in comparison to the actual bedside.
Students additionally demonstrated empathy when bringing up the de-humanizing aspects of projecting a 2-D image of a patient onto the classroom screen. These impersonal tele-education experiences that excluded personal interactions with the patient, family, and staff could hurt the development of effective communication skills on the part of our future physicians.
In an era of rapidly evolving technologies, we need objectively assess newer modes of education as we revise antiquated teaching models. Our student feedback suggests that tele-education offers significant enhancements to the traditional bedside medicine curriculum and warrants further study.
Medicine in the digitale age – Do it by the book but be the author!
Digital Patient-Doctor Communication, Smart Devices and Apps, Telemedicine, VR/AR and Big Data are modules of the curriculum – Frontal Teaching and Instruction NOT. The curriculum is a blended learning concept that makes “Learning through experience” and a “Digital Makerspace” the central parts of the course. An engaging eLearning supplements the course before and afterwards. Testimonials, self-experiments, video recordings and collaborative drawing are the products during the course, which lead to a collaborative e-book.
Instructors not only include doctors from various specialties but also psychologists, big data analysists, app developers, medical ethicists and most important patients. Everyone is included is the core principle, which offers different views on the digital transformation of medicine to enable students to reflect on this fundamental change in our profession.
Healing and Wellbeing: The forgotten phases of the patient journey
Prevention, Diagnosis and Treatment are taught in medical school and practiced in the US. Then patients are drop kicked into a “new normal” with little to no support and left to fend for themselves during the Healing and Wellbeing phases. The fact that providers can’t bill for a healthy patient is not a good enough reason why.
– Prevention – It is unquestionably the best tool to utilize in battling a medical condition.
– Diagnosis – Here in the US the tools for early diagnosis continue to get better and better.
– Treatment – Though costs seem to skyrocket year-after-year for medicines and medical procedures, the US still does a world-class job of saving patients lives, even after a chronic diagnosis.
“When I completed my cancer treatment I was given about half a dozen different sized sheets of photocopy paper, some of which had website URLs typed on them, and a few handwritten, barely decipherable notes from my physicians. I was wheeled through the front doors of the hospital, congratulated, and drop kicked into the backseat of a car.”
– Healing – When entering this phase patients generally thumb through their paperwork end review a few paragraphs of information about diet, nutrition and lifestyle. They feel orphaned in the world of their “new normal”. If they have an emergency, or relapse, then they can go back and see their healthcare team. If not, they’re on their own.
– Wellbeing – In the US there is no mechanism for compensating a physician to keep a patient healthy unless it’s a wealthy patient who can afford to do so out of their own pocket.
This session will look at the Healing and Wellbeing parts of the patient journey from two different points of view. They are:
– Foreign hospitals – In Thailand one of the very successful hospital systems there has three hospitals in Bangkok. One of those hospitals is dedicated exclusively to Wellness.Yearly physicals deliver the kinds of blood work and imaging that you would expect from a major US Hospital, but they also deliver a battery of tests that paint an ongoing picture of the way the patient is aging. For example, if a seniors hand eye coordination and grip strength is beginning to fall behind on one side of their body, they can walk out of the hospital with a prescription to bounce and squeeze a tennis ball in one hand for a certain number of times each morning and each evening. Hand eye coordination is then retested. The outcome of this prescription is to enable that senior, in the event that they slip, to grasp a nearby handrail with enough speed and strength to hold their body weight up.
– Evidence-based tips for life – There are US based organizations that enable patients in the Healing and Wellbeing phases of the patient journey to share best practices that have been reviewed and blessed by medical professions and serve to pave the way for patients following in their footsteps. In many cases these tips for life are the kinds of everyday logical pieces of wisdom that only a patient would think of. Things like recommending the brand of workout pants that have snaps on the outside seam so that a prostate cancer patient who has just returned home can sneak his catheter line out between the snaps and hide the bag in the gym bag that he’s carrying while taking a walk around the neighborhood to clear the post-surgery cobwebs.
The session will conclude with the proposal of an architecture designed to enable the original health care team to guide the patient via the setting of achievable health goals during each and every phase of the patient journey so that the patient feels empowered in the process and motivated to succeed, especially in Healing and Wellbeing.
This session will be hosted by Roger Holzberg, creator of the Infusionarium system and education platform, a former award winning VP creative director at Walt Disney Imagineering, and the first (consulting) creative director for the National Cancer Inst. Infusionariums education / support network is in use on over 6200 patient/family smart devices. He is a 14 year cancer survivor and age category elite triathlete, using the sport to raise money and awareness for medical research he supports.
Bridging the gap – innovating at the edge
The author, an award-winning nurse innovator in the United Kingdom completed an exploratory qualitative research study to identify the development and support needs of healthcare innovators. Due to the scope of the study and timeframes the participants interviewed were clinical innovators. Utilising the research findings and her personal journey the author will build an international platform that could bridge the gap for innovators, where everyone included. Previous experience within NHS England Innovation Team and London South Bank University as a knowledge broker provided understanding of the dimensions of digital technology that could be harnessed for innovators.
Co-design and co-production will be used at each layer of beta testing of platform development with previous presenters at MedX Michael Seres and Alison Cameron acting as sense makers and participants in the research study involved in development. The platform will build on established networks in the UK, USA, Canada and New Zealand and will be launched in 2018 to provide blended learning, coaching and a peer support network.
A way to bridge the gap, inspire co-production and support innovating at the edge!
Perioperative smoking cessation counselling: A missed opportunity?
Viji Kurup and Danielle McGlynn
This session will focus on a review of current literature to look at effects of this intervention, who the stakeholders are, how to get buy-in from your institution and effective counseling techniques. These techniques will focus on motivational interviewing with gain-framed messages (shown to increase short-term abstinence).
Update from the Wards: On Using EHRs as a Third Year
Vanderbilt/Lipscomb University Student Hotspotting: A Case Study in Interprofessional Student Patient Advocacy
Adverse drug event Reporting
A Multi-Tiered Approach to Educating on the Hidden Epidemic of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
In order to address this underserved area of medicine, the Blue Ribbon Foundation listened to the stakeholders, including patients, doctors, scientists, and public policymakers. Because the problem we sought to solve was so multi-faceted, we created a multi-tiered approach to attack it from different angles. Our approach exhibits a “bottom-up” and “top-down” strategy simultaneously.
From a bottom-up perspective, created a fellowship program for medical students, starting with one medical school, Nova Southeastern University, which houses one of the world’s leading labs in this field. Our fellowship program resulted in the Dean of the medical school promising to add ME/CFS to the curriculum, and we’re now branching out to replicate this success at other schools. Similarly, from the top-down perspective, we’ve worked closely with powerful institutions including the U.S. Congress, Centers for Disease Control, and the General Assembly for the State of Georgia to address educational standards at a systemic level. Recently, we passed HR 170 in the Georgia General Assembly, urging state agencies to do more to combat this scourge. We’re now working with state agencies on a letter to all physicians in Georgia explaining how to diagnose and treat the disease.
In this presentation we’ll show how to address a difficult educational gap at the level of a single school, at the state level, as well as at the state level in engaging with Congress and the CDC.
Creating Design-Based Learning Opportunities for Medical Students: Early-stage Experiences from the University of Virginia Medical Design Program
Matthew Trowbridge, David Chen and Alex Gregor
Trainees in the ICU: Moving Beyond the Academic Objectives to Address Psychosocial Needs
In order to address these concerns, we designed a multi-dimensional program throughout the month, encompassing engagement of families, orientation to equipment and alarms and early participation in care conferences. We conduct debriefing sessions after critical events and arrange. round tables with experienced attending physicians and advanced practice providers to discuss coping skills and perspectives on the psychologic aspects of the care for critically ill patients. Trainees participate in code blue training that focuses on teamwork during CPR and sudden changes in patient condition.
At the end of the rotation, students and residents report not only meeting their educational goals but achieving a comfort in the ICU during interactions with patients, families and members of the care team. They feel equipped to actively participate in, if not lead, patient presentations, family meetings and CPR. They also feel comfortable discussing concerns and fears in patient care with supervising physicians, social workers and ethicists in order to alleviate anxiety regarding ethical or medical concerns and develop coping skills related to care of difficult patients. Trainees are also asked to identify areas outside the ICU in which they would be able to translate these skills and have provided a variety of examples.
Supporting students in need as they transition to residency: medical coaching for academically vulnerable students
It’s Not Brain Surgery! Best Practices for Using Question Banks in Residency Programs Using Neuroscience of Learning Principles
Gustaf Axelsson, Praelada Wongsirimeteekul, Michael Healy and Roy Phitayakorn
There is little practical research about how resident physicians should best prepare for in-training examinations and board certifying/qualifying examinations. Therefore, resident physicians are often forced to develop their own examination preparation techniques as there are few best practices on how to use question banks effectively and efficiently. However, the non-medical education literature has many examples of how to apply neuroscience of learning principles to help resident physicians maximize their performance on high-stakes examinations.
This workshop is widely applicable to all involved in residency education, but also applicable to undergraduate medical education. Attendees (residents, medical students, and educators) will complete the workshop with a greater understanding of how to apply best neuroscience of learning practices to the use of question banks in the preparation for high-stakes examinations. Attendees will also practice using PeerWise© (http://peerwise.cs.auckland.ac.nz/), a free online collaborative question writing tool.
This workshop will be highly interactive and feature active lecturing, small group discussions, and practice opportunities. The outline for the workshop and time allocated to each component is as follows:
-Introductions (5 minutes): Facilitator introductions, workshop overview, and participant introductions
-Discussion of best neuroscience of learning practices for using question banks (15 minutes): Review of concepts including retrieval practice, spaced education, and collaborative question-writing
-Introduction of PeerWise© and participant practice with PeerWise© in small groups (30 minutes): Creation of three multiple choice questions followed by peer discussion/review
-Wrap-up (10 minutes): Brief take-away points discussion and answering any final questions
-Participants will leave the workshop with a greater understanding of the neuroscience principles that underlie best practices when using question banks for resident physicians.
-Participants will also have a chance to practice using collaborative question writing software to subsequently lead a workshop at their own institution to allow resident physicians to generate question banks.
Lessons From a Transgender Patient
OpenNotes for Medical Education: Medical students partner with patients as patient note navigators
OpenNotes is a critical part of the movement toward transparency in information between physicians and patients. This level of transparency allows for a number of new initiatives that can help drive the future of medical care. One such idea is to connect new medical students and patients around OpenNotes as ‘Note Navigators.’ The idea is that patients who have access to OpenNotes at Academic Medical Centers would be partnered with medical students in a way that is beneficial for both parties. Patients would have a dedicated medical student who could help them navigate their clinical note. In addition, they would have the opportunity to directly educate future physicians on how to better think about patients as true partners in the documentation experience. There are numerous benefits for medical students as well. Early in their training–also known as preclinical years–students are looking for experiences with actual clinical contact and this would provide that contact in a format that is scalable, flexible, and adaptable to multiple situations. It would also be a way for medical students to learn about clinical documentation in a real world context.
Have a dedicated medical student who can help them navigate their notes
Can educate future physicians on how to write notes that work for patients as well as physicians
Learn good and poor documentation practices from real world examples and settings
Have clinical experiences early in their training when these opportunities are usually limited
In this workshop we will share ideas around how medical students and patients can form partnerships around OpenNotes, but this is just the tip of the iceberg–there could be many more ideas to expand on this collaboration. The workshop will start with a brief overview of OpenNotes, followed by Liz Salmi sharing the patient perspective with clinical notes. After that, Chethan Sarabu will share his experiences in medical education highlighting opportunities for OpenNotes. These short presentations will be followed by interactive exercises to develop a novel curriculum for incorporating OpenNotes into medical education.
A Deficiency of Lifestyle Medicine Education for Professionals Fuels Persistence and Increasing Prevalence of Chronic Diseases
This talk will briefly introduce the power of lifestyle medicine to prevent and treat chronic disease before reviewing the literature to demonstrate the gaps in medical education that exist. The work of the American College of Lifestyle Medicine (ACLM), partnering organizations such as the Lifestyle Medicine Education Collaborative (LMEd), and the emergence of medical school professional-in training Lifestyle Medicine Interest Groups (LMIGs) will be highlighted. It will serve as a call to action for advanced curriculum development in evidence-based lifestyle medicine and effective counseling methods across the scope of medical school, residency, and fellowship training.
Participants in the conference will be engaged to help design innovative solutions to help address this gap in medical educational.
Mindfulness: Theory, Practice and Technology Embedded in a Graduate Seminar
Pamela Ressler and Maureen Strafford
The course, Mindfulness and its Application to the Experience of Pain, was developed by an interdisciplinary faculty team of a physician and nurse, Maureen Strafford and Pamela Ressler, both skilled educators and experienced mindfulness practitioners. The course (the only one of its kind of which we are aware) embeds experiential components of mindfulness meditation within the didactic framework of a rigorous graduate level seminar. Students are introduced to and study the history of meditative practice, medical research, specifically the neuroscience of meditation for those with chronic pain conditions, at the same time as they are guided in beginning a personal practice of mindfulness meditation using a variation of a validated framework of MBSR (mindfulness based stress reduction). Using a collaborative approach with students, digital tools, such as apps, Muse® and virtual reality, to enhance behavior change (daily mindfulness practice) were tested, compared and evaluated. The combination of rigorous graduate level learning embedded with daily meditation practice and judicious use of technology to promote behavior change have been the unique features of this course. Additionally, we have integrated digital tools of connection and community via the technology platform, Voice Thread, for students to share and interact with classmates throughout the week related to their insights and challenges of a beginning practice of meditation and comments and reviews of academic readings.
Since we first offered this 7 week elective course in 2014, student demand has been high (with wait lists for the past 2 years) and stellar evaluations from the students. The majority of students have recommended the course and its content to fellow graduate students both within the school of medicine and within other departments. We hope to introduce the MedX Ed audience to our course methods through a learning lab or workshop format, using experiential exercises as well as sharing lessons learned in the development, approval and implementation of non-traditional, interdisciplinary graduate learning.
Transgender Generations: Diversity of Trans Patient Experiences in Health Care Inclusion
By gradually introducing facets of complexity relevant to transgender patient care, we will explore different “generations” of trans health care. This workshop and session will address specific variables such as: disclosure of gender status, nomenclature with respect to gender identity, gender expression, pronoun usage, health care conversations, stage of transition, media visibility of trans people, medical privacy from provider to provider, and individual patient expectations.
As presenters paint a more nuanced picture, participants can prepare to encounter these complexities and ultimately navigate them in more optimal ways for their patients or practices and communities as a whole. Each workshop attendee has seen but one slice of a transgender patient story, thus everyone is both a listener and participant. All attendees will be encouraged to share their own experience so as to complete the picture of our diverse trans patient generations.
Charlie Blotner, an MSW student studying medical social work, and Micah Rajunov, pursuing an MS in Organizational Development, have a breadth of professional training experience that grant them a big-picture view of gender: culture, identity, bias, and reframing. By acknowledging the fears of others, these two trans-identified individuals meet others where they are, putting them at ease while leading with storytelling. This workshop is meant to share the challenges, provide tools, and pull together insights from presents’ own experiences personally and professionally, as well as participants’.
Addressing burnout in Healthcare: How mindfulness training can help
Upon completion of this activity, learners will:
Describe the symptoms of burnout and recognize signs in self and others (Change in knowledge)
Able to use mindfulness to handle negativity bias on a personal and systems level (Change in behavior)
Apply mindfulness in everyday activities and understand the application in their work environment (Change in performance)
What We’ve Forgotten In Healthcare: That People Are Human, Not Machines
Riva Greenberg and Boudewijn Bertsch
Simply, people are not machines. As human beings, literally growing organisms, people do best when they feel safe and trusting, supported and hopeful. Treating people as people, requires a paradigm shift whereby we use the natural sciences to inform practices when healthcare providers meet their patients. Our work is to educate providers on how to create those conditions, how to change the quality of their interaction with patients and how to expand their current treatment repertoire. Our focus is in diabetes, but our work is applicable to any chronic condition that needs to be managed by the individual who has it.
For the past three years we have been sharing a strengths-based, positively framed approach that we call the Flourishing Treatment Approach (FTA) with health professionals around the world. Rather than the conventional Coping Treatment Approach (CTA), that aims to help people with chronic condition like diabetes “cope” with their disease, the FTA has been designed to help people flourish. While the CTA is defined by its focus on the disease (pathogenesis) and problems, recognizes one expert and uses best practices, the FTA is based on what causes health (salutogenesis), recognizes both provider and patient as experts and uses emergent practices and aims to help the patient find a positive narrative for their new redesigned state as someone with a or multiple chronic conditions. The innate potential of resilience that human beings possess is an essential focus of the FTA.
The FTA based finds its origin in almost 200 interviews where we found that a substantial population improved their life after their diagnosis. The Flourishing Treatment Approach is grounded in science and its tools are theory-informed rather than based on case-based reasoning. Theories that inform the FTA include Polyvagal theory, Aaron Antonovsky’s Sense of Coherence theory (Salutogenesis), Complexity and systems theory and Solution Focused Brief Therapy.
The workshop will consist of a 30 minute presentation contrasting the Coping treatment approach (machine based paradigm) and Flourishing Treatment Approaches, (human resilience and growth paradigm) and a 60 minute skills-based training where participants will practice two tools from the Flourishing Treatment Approach that can be put to use immediately.
PCOR and CER Presentations (3)
Derivation and Validation of a Geriatric‐Sensitive Perioperative Cardiac Risk Index
Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric‐sensitive index, derived from geriatric data, will capture this population’s unique response to risk factors.
Methods and Results
The model was developed using the NSQIP (National Surgical Quality Improvement Program) 2013 geriatric cohort (N=584,931) (210,914 age>=65) and validated on the NSQIP 2012 geriatric cohort (N= 485,426) (172,905 age>=65). Least Angle Shrinkage and Selection Operator regression was used for initial variable selection. The Geriatric‐Sensitive Cardiac Risk Index (GSCRI) was then evaluated in the 2012 data set. The area under the curve (AUC) was compared among the GSCRI, RCRI, and Gupta MICA in the 2012 data set. The GSCRI had an AUC of 0.76 in the validation cohort among geriatric patients. When the Gupta MICA was tested on geriatric patients in the validation cohort, a significant deterioration (~17%) was noted, as well as a significant underestimation of the risk. The GSCRI AUC of 0.76 in the geriatric subset was significantly greater (P < 0.001) than those in the RCRI (AUC=0.63) or Gupta MICA (AUC=0.70) models, outperforming the RCRI and Gupta MICA models in geriatric patients by 13% and 6%, respectively, with a ΔAUC and P‐value of 0.13 (P<0.001), and 0.06 (P<0.001).
The GSCRI is a significantly better predictor of cardiac risk in geriatric patients undergoing noncardiac surgery.
Understanding Arthritis Patient Preferences via Smart Phone Technology – An Update on the ArthritisPower Research Registry and its Applications
In March 2017, CJ launched version 2 of AP. By September 2017, the organization enrolled over 11,000 consented arthritis patients (8,500 between Mar. 2017 and Sept. 2017), fulfilling one of its primary milestone requirements with PCORI 12 months ahead of schedule. To date, the patient population has recorded nearly 100,000 Patient Reported Outcomes (PROs) and there are more than a dozen different patient-centered studies originating in or being deployed through AP.
As data capture shifts from paper to computer or mobile technologies, a recent study aimed to better understand if patients might have limited interest in contributing data over time or that they may only record new data when there has been a change in their clinical status if the data was solely being collected via smart phone. AP users were asked to voluntarily complete Patient Reported Outcomes (PROs) including the RAPID3 and four NIH-developed PROMIS instruments, plus disease-specific information. Researchers evaluated the average time it took the patient to record each instrument and the total number of unique days that users recorded PROs. It was theorized that patients would contribute longitudinal data only when at least one of their scores exceeded a minimally important difference (MID).
The study found that of 1,946 patients who registered with AP more than 3 months prior to analysis, 20.6% did not contribute any PRO data, 53.3% entered it once, and 26.1% entered at least twice without prompting from a health care provider or reminder email. Only 23.1% of patients contributing longitudinal data had a change greater than the MID in any of the 5 PRO measures. Patients with RA, biologic use, and Twitter accounts were more likely to contribute longitudinal PRO data.
This study, and others, demonstrate that people living with arthritis are willing to participate in research. If doctors have confidence in certain PRO measures, then they can use them to better understand their patients’ experience of disease.
An approach to scaling evidence backed Digital Vaccines based on Neuropsychology to impact Global Health
Bhargav Sri Prakash
The first pre-clinical studies involving fooya!, was undertaken by behavioral researchers at Baylor College of Medicine’s Children’s Nutrition Research Center, showed a significant increase in awareness levels among middle school children and self-reported inclination to follow MyPlate guidelines. Results from the Phase-1 randomized controlled clinical trial results were published at ObesityWeek-2014 and the Childhood Obesity Conference-2015 and showed statistically significant outcomes in terms of healthy food choices and consumption among middle school children. Phase-2 studies undertaken during the 2014 ExxonMobil Summer Science Camp showed statistically significant results in terms of healthier food consumption over a two-week camp, which was published at the 2015 MedicineX conference at Stanford Medical School. Another phase-2 randomized-controlled field-experiment by researchers from the Center for Communication & Change India, an affiliate of the Center for Communication programs at the Bloomberg School of Public Health, Johns Hopkins University, was undertaken in partnership with Prof Rema Padman and her team at Carnegie Mellon University. A paper based on the machine learning applied to the analysis of the results and game telemetry was published at the MedInfo-2017 – 16th World Congress on Medical Informatics and Precision Healthcare, along with presentations about the ongoing project at the Stanford MedX|ED-2017, POMS-2017, SCECR-2017 and INFORMS-2017 conferences. Ongoing studies at Children’s Hospital of Pittsburgh-UPMC harnesses adaptation of fooya! for diabetes management, along with neuroscience imaging studies at Children’s Mercy Hospital at Kansas Medical Center.
The talk is structured to offer a case study of science and evidence in defining a field of digital vaccines since 2011, along with the underlying science and engineering in developing consumer-grade entertainment experiences, which are backed by evidence of outcomes. The talk will also shed light on the design philosophies and triggers for innovation in this field.
As this field of digital vaccines is being defined in collaboration with world-renowned scientists and researchers, it represents a significant milestone as a result of collaboration across silos of entertainment technology and clinical research. The goal of this talk is to present the work in progress and generate feedback about ongoing plans to undertake population health studies to establish a global standard for lifestyle disease prevention.
Everyone Included™ Presentations (15)
“Think like a Journalist: Power of Storytelling in Medicine”
The field of medicine can learn much about how writers and journalists transmit a story effectively. Good storytelling can help healthcare providers understand the nuances of the patient’s experience, and the social, emotional, and community factors that may influence a patient’s health condition. Stories can also be a way for physicians to connect with their patients (and vice versa), connect with their colleagues, deal with difficult and heavy emotions, and build resilience to burnout. Great stories can also be a vehicle to advocate for better health policies.
As a resident physician and epidemiologist, and relatively new writer with work featured in The New York Times, New York Magazine, and The Boston Globe (among other places), I will describe how health care providers and patients can use storytelling to advance their ideas, advocate for their field, and connect more authentically with the healthcare team.
Moment of Care: Lifetime of Impact!
Shari Bookstaff and Abby Snitovsky
Widening participation to medical school and objectively improving knowledge of the application process: Impact of a one-day conference
Monica Parker and Jessica Roberts
Widening participation in medicine refers to increasing the number of people from demographic groups with low participation rates applying to, and remaining in medical education.1 Disadvantaged socioeconomic backgrounds are historically under-represented in medicine.2 Reasons include disparity in educational opportunities, leading to lack of guidance on the process of applying to medical school and lack of knowledge of the role of a doctor or medical student.3 Despite endeavours made by universities to widen access to medicine, current data illustrates that just 40% of schools nationwide are engaged with medical school outreach, and ‘cold spots’ remain, many being in the North of England.4
A one day conference was attended by 78 students (ages 16-17 years) from 24 different schools. The students answered an online questionnaire consisting of 21 questions designed try to gauge student awareness of the application process for medical school and the role of a doctor. The aim was to see if the student’s awareness had objectively improved post-conference, irrespective of their subjective improvement in reported confidence scores. At the conference, students attended lectures and workshops on a range of topics and a repeat questionnaire was completed after the event.
Results were available for 74/78 students (4 excluded due to missing data). The data was normally distributed and so a paired samples T Test was performed. The one day widening participation conference elicited a statistically significant improvement in the number of students answering correctly on average across the 21 questions (n = 74, St Dev. = 10.81, p = 0.031).
A free to access, one day widening participation conference was statistically significant in improving student knowledge of the application process to medical school.
1. 1. Selecting for Excellence Group. Selecting for Excellence Final Report. London: Medical Schools Council, 2014
2. Greenhalgh, T. The standardised admission ratio for measuring widening participation in medical schools: analysis of UK medical school admissions by ethnicity, socioeconomic status, and sex. BMJ (2004);328:1545
3. Greenhalgh, T., Seyan, K., Boynton, P.,“Not a university type”: focus group study of social class, ethnic, and sex differences in school pupils’ perceptions about medical school. BMJ (2004). 328 (7455): 1541
4. Selecting for Excellence Group. Implementing Selection for Excellence: An Update. London: Medical Schools Council, 2015
Patient-Centered Support with Music, Dance and Art
Patients like me are often trapped in home, suburbia, isolated and lonely, not only challenged with physical fatigue from disease, aging and treatment; but often depression and stress, which impacts 77% of American physically, and 73% psychologically according to The American Psychological Association (APA). 60-90% of doctor visits are due to stress.
Research shows 45% of seniors and 62% of teenagers feel lonely, which is more damaging than smoking 15 cigarettes a day. 10,000 American turn 65 daily, many more worldwide. 80% of older adults have at least one chronic disease, and 68% have at least two. These statistics show a clear and urgent need to design effective behavior interventions for patients who are facing isolation, regardless of age.
Heart disease, cancer, and stroke are the leading causes of death among the elderly. If no action is taken, our economy may collapse due to higher medical cost and lower spending habits in an aging population. Research says Creative Arts Therapy improves quality of life by 50% and reduces pain by 59% for cancer patients! (78% over 55) Dance reduces the risk of dementia by 76% (Alzheimer’s cost $1 in $5 now, and $1 in $3 by 2050 in Medicare), cardiovascular death by 47% (1 in 3 death). 90% of elders prefer to age at home.
If we can provide more “aging-in-place” technology solution to bring creative arts therapy, exercise, cross-generational connections, and more importantly community support to home. We will ensure a more healthy aging community and more stable economic worldwide. We will discuss these published medical studies and how to design for healthy behavior change, thus provide patient-centered support with music, dance and art.
Dance4Healing is a patient-centered tele-exercise platform to bring creative arts therapy to home care, and use AI to empower healthy behavior change in a fun way. We won Stanford Medicine X Healthcare Design Award in 2016, and Stanford Health++ Hackathon Intel Nervana AI Cluster Grand Prize in 2017. Our mission is to support patients, caregivers and family members, reduce healthcare cost, and spread the cognitive, physical, and socio-emotional health through dance all over the world.
Patient perspectives on health literacy – Learning from ePatient blogs
Hidden in Plain Sight: An interdisciplinary discussion exploring the nature of disclosure and chronic illness in medical education and health care
This panel seeks to: 1) highlight the experiences of and identify barriers faced by prospective students and practicing healthcare providers living with chronic medical conditions, 2) explore the concept of disclosure in the age of social media/online patient engagement and the current cultural climate, 3) discuss creating a diverse and inclusive culture of medicine, with an evidence-based discussion of the admissions and education process, 4) explore the potential for positive impact of inclusivity and diversity on patient care, and 5) create tangible tools for change that both panelists and audience will be able to implement in their own professional and personal lives.
Emily Bradley is a Stanford MedX ePatient, medical assistant, and prospective Physician Assistant student. She will discuss disclosure of chronic pain and invisible illness in the clinical environment as well as throughout the PA admissions process; explore the implications of social media patient engagement and advocacy work, and the implications of disclosure on the patient-provider relationship.
Rachel Crooks is a Stanford MedX ePatient, prospective MD student, and research assistant. She will explore appropriate boundaries when navigating work in the neurology field while living with a chronic neurological disorder, discuss disclosure of a chronic illness when applying to medical school and examining what it means to pursue a medical career with the uncertainty of having a disease in remission.
The Lived Experience of Illness: Artist-Patients Enrich the Medical School Curriculum.
1. Pamela Schaff is Associate Professor and Director of the Keck School of Medicine’s Humanities, Ethics/Economics, Art, and Law (HEAL) Program. Her vision for interdisciplinary and interprofessional education has led to space within the medical school curriculum–and within the university community more broadly–for conversations to take place among visual artists, musicians, filmmakers, theater artists, health care students and practitioners, researchers, patients, and community members.
2. Ted Meyer is an artist with Gauchers Disease who made art about the painful episodes that were the hallmark of the disease. He also didn’t expect to survive past 40. All that changed when the enzyme replacement treatment became available, thanks in part to the research he participated in at the NIH. Meyer found himself with more years than he’d planned for, and soon started making scar art that told a story. This quickly grew into the Scarred for Life series, and a position as artist-in-residence at the UCLA School of Medicine. There he curated artwork by other patient-artists like himself, and found that students connected with this kind of off-book learning about the lived experience of illness. Ted is now Artist-in-Residence at the Keck School of Medicine and curates the art gallery shows.
3. Simi Rahman is a pediatrician, medical educator and storyteller. She applies narrative medicine skills in clinical practice and designs curricula to train residents and medical students in the medical arts and humanities.
Meyer and Schaff have collaborated to create art shows aligned with the content of the medical school curriculum, bringing patient-artists and their art into the medical school to talk about the lived experience of illness. In interviews with the patient-artist and a physician, Meyer is able to bridge the two worlds and allow students to observe a dialogue that is anchored in the art that hangs around them.
Some shows are strictly designed around body systems, for example the respiratory module paired with the work of an artist with Cystic Fibrosis. There is also the innovative Artist-Researcher show format, pairing artists with researchers in creating artwork about the research projects on campus. And the overwhelming response to the mail-in art show about Pain led to entries from over 17 countries and 260 pieces of mail-in art about all manner of pain.
This rich diversity of perspectives allows medical students to connect the material they are learning in class to the experiences of real patients, to innovative ideas in research, and to the global dimensions of the practice of medicine.
A panel discussion describing these experiences will be followed by a demonstration of narrative medicine in action by Rahman and Meyer, an exemplar of the interviews Meyer conducts, with examples of Meyers’s art anchoring the discussion.
Programs such as the Keck School of Medicine Artist-in-Residence/ HEAL Curriculum collaboration can bring a diversity of perspectives to the environment of the medical school and humanize the medical education experience for students. Patient-artists like Meyer have a cumulative lived experience of illness that is not found in textbooks, and is made accessible through the visual medium of art. In making art about illness, the process of meaning-making in medicine is laid bare, and in the process of disseminating this art and speaking about it, the patient and the physician demonstrate the co-creation of narrative that is central to the practice of effective and compassionate medicine.
Project Apollo – A vision for the Co-Created Future of Care
Michael Kurisu Do,
Deaunne Denmark Md Phd,
Gloria Ma Phd,
Co-creation of a multi-disciplinary collaborative team for an “N=1” personalized program of a journey to health incorporating different healing modalities guided by quantified evidence-based data for the individual patient. This will create a crossroads between exceptional patients (Personal Health Pioneers “PHPs”), clinical providers, and research scientists within the field of Integrative Health and Medicine. The outcome of this effort will be to have the collaborative team focus on the journey of health for each patient. Advanced data analytics will be used to quantify several aspects of each patient’s journey to explore and implement a more holistic, integrated, and sustainable approach to health and well-being.
Project Apollo patients will meet on a regular basis not only with their physician, but also with each other, and with research scientists thus co-creating a larger group of medical support where all aspects of health and wellness are explored. Patients will become their own health advocate and be empowered to explore their diagnosis and look for healthy lifestyle interventions to produce change.
Project Apollo has ability to become a role model for N=1 research projects. Participants will collaborate with different research labs and will learn the art of “citizen science” and conduct valid experiments for outcome measures regarding social, economic, community, and environmental variables for integrative health and wellness.
Engaging the under-engaged: Canadian studies in social support for asthma
Kerri MacKay and Dia Sue-Wah-Sing
Research, including the Asthma Canada Severe Asthma Study (2014), indicates a greater need for social support among adults with asthma.
Case studies from a variety of populations supporting the need for social support will be a focus of the presentation. For pediatric populations, we will explore Asthma Canada’s Asthma Pals Spring 2017 pilot program, encouraging children aged 7-11 to connect with other children across Canada and learn about their asthma. The children in the program, led by young peer mentors with asthma, expressed great benefit in having the empathy of other kids with asthma across the country who understood their experience and became friends. We will also explore why other methods of social support for this population have fallen short of patients/families needs, and why a hybrid online-“in person” feel of structured discussion may better transfer to and engage adult populations.
Through the case study and related University of Alberta Social Support Research Program/Sustainable Online Support studies (Stewart et al, 2011; Stewart et al, 2012) combined with research from the Severe Asthma Study and other works, we will explore if the application of a modified version of the “Asthma Pals” format might be successfully implemented in an adult population to provide greater social support and feelings of competence to adults newly diagnosed with asthma, or adults with severe asthma.
Social media in undergraduate medical education: A window into the patient experience
The use of social media is nearly ubiquitous across the population and increasingly so in healthcare, with over 90% of medical students and physicians maintaining a social media presence. Stakeholders from the healthcare continuum engage with social media in unique ways which may reflect their individual or professional interests. One growing example is the population of patients with rare and/or chronic conditions, who maintain active connections on both public and private digital platforms. These forums provide patients an avenue to access medical information, connect with fellow patients and caregivers, and share experiences navigating their conditions in the context of a complex healthcare system. Broad platforms such as Facebook, Patients Like Me, and The Mighty host a myriad of patient-centered communities while focused sites such as NeuroTalk, Children with Diabetes, BabyCenter have curated more patient and disease-specific spaces.
A growing body of literature is considering the dangers and opportunities of social media in medicine. Topics such as professional networking and education, privacy, patient communication, and patient education have garnered rich discussion. However there exists a dearth of literature on the utility of these patient-centered communities in educational programming. Pre-clinical students learn about disease processes through educational methods such as lectures and case-based learning. Increasingly, students are provided early clinical experiences, however all physicians lack access to the daily lived-experience of patients and families.
The digital world offers opportunity for engagement with open-access patient-centered communities. These spaces provide insight into the patient experience, the lived-experience of battling disease, and the shortcomings of our healthcare system in addressing the complex needs of these patients at home, in the clinic, and in the inpatient setting. Thoughtful integration of these networks in the undergraduate medical curriculum may serve to expose students to diverse patient narratives and challenge them to consider the manifestations of disease in everyday life. Could interaction with patient-centered digital communities foster empathy?
Increasing Engagement for end-users with Digital Health Tools and Data
Srihari Yamanoor and Narasimha Sai Yamanoor
Engagement methods include gamification, team activities, visual and auditory coaching for individuals. Gamification, contests, prizes and team engagement are typically presented through heatlhcare organizations and employers.
There are many compelling reasons to create tools for individuals such as privacy and lack of an employer/insurer support system. As current users of physical activity monitors, the authors experienced a drop in engagement with devices over an extended period of use.
To bridge the engagement gaps, a series of projects were initiated, to use physical activity data from wearable devices and improve engagement as well as motivation. The goals are simplicity, cost effectiveness and open source development.
The first generation product is a visual, non-numeric dashboard, that can be installed in various home/work environments. The dashboard displays daily step-goal progress as a series of LEDs. A second project, was created to be a highly-visible, large scale display, as a Step-Down counter, which counts backwards from the user’s daily step goal, and displays that number, updating every 15 minutes, and attempting to count down to zero every day.
Wearable data is gathered from the device database using an API at 15-minute intervals, and the Raspberry Pi Zero computer is used for control. The projects were displayed at four different public events, to potential end-users and the general public. Based on the feedback, newer projects are underway.
A third project under progress, uses the Google AIY toolkit, to provide auditory engagement to the end-user. The project will use the wearable device data and a series of programmed IF-THEN-THAT rules through an auditory output dashboard to engage the user.
The authors will demonstrate projects to exemplify open, inexpensive end-user engagement tools that will improve the engagement effectiveness of physical activity monitoring devices. This can help with weight loss and lifestyle changes as well as management for many groups of individuals including the healthy, as well as those recognized as pre-diabetic and diabetic patients.
Enabling IT to Coproduce CF Care
Personalized health records (PHRs) are a patient’s own version of an EHR. However, many existing PHRs do not meet the needs of people with chronic health conditions. The Cystic Fibrosis Foundation’s Patient Registry (CFFPR) for example is one of the leading clinical data registries and captures several hundred data points collected during clinic visits. Many of these data points are not discretely captured in EHRs currently. The data must be manually reviewed and entered by a staff member. Another potential problem with PHRs from a provider point of view is collecting too much data, making it hard to identify signal from noise.
Our goal is to revolutionize the relationships between these seemingly disparate technologies by offering a mechanism to bridge this gap. By optimizing the EHR in a way that mirrors the data collected by the CFFPR we can more easily extract and deliver the data to the registry. From here, the registry can supply this data to a PHR for CF patients. With this new technology, patients will be able to see their care in a way that has previously on print outs or in disparate pieces of patient portals.
Writing Lab: Co-creating Great Stories with Patients and Clinicians
Bon Ku, Amitha Kalaichandran and Adam Hayden
The workshop will first present a 20-minute overview of how to approach storytelling in medicine, which includes two samples of stories presented in popular media (e.g. The New York Times) and journals (e.g. Journal of the American Medical Association “Piece of My Mind” section). A general structure will be proposed, for participants to follow when creating their story. As well, the pitfalls (for instance, respecting autonomy, informed consent and HIPAA guidelines) will be described. Then, for the following 45 minutes, participants will be separated into small groups which will include at least one clinician and one patient, to come up with a story as a group, following the structure suggested (or building upon the structure in a new way). The remaining 25 minutes will allow groups to share the story and receive reflective feedback.
Workshops leaders will include: Amitha Kalaichandran (Resident doctor, University of Ottawa; Health journalist); Bon Ku (Assistant Dean for Health and Design, Thomas Jefferson University); Affiliation); and Adam Hayden (Patient storyteller and recurring speaker, Medical Humanities and Health Studies Program, Indiana University at IUPUI).
In this workshop, attendees will learn the following:
Grounding the shared experience to receive medical care (all clinicians are patients but not all patients are clinicians)
How to rapidly prototype a story from the point of view of patient or clinician
Learn a step-by-step approach to developing a story
Recognize the pitfalls to writing stories in medicine
Promoting Active Student Participation in Medical School Curriculum Design and Development
Tao Le, Yunxiang Chu, Amol Utrankar and Jason Batten
Since 1969, Rogers and Freiberg have argued for active engagement of students in the learning and teaching process so that students take on more responsibility for their own education. Calls to action for student involvement in curriculum design can be traced back to Dewey (1916), continuing to the 1960s with the active student movement in the USA and Europe and today. The traditional view has been that curriculum planning is the territory of academic staff and faculty, with students taking a more passive role in learning. However, by encouraging medical students to become active co-creators, producers, designers and evaluators of their own learning, they become engaged in an experience to improve the structure and content of a medical school course. This collaboration works to enhance students’ and educators’ experiences of learning by producing a dynamic and interactive process of teaching.
This workshop will feature interactive presentations with case studies of medical school curriculum programs where students are actively involved in the course design process, followed by facilitated small group activities to help participants identify strategies through which medical students and faculty can work together to design and implement curricular changes. Such a workshop is desirable as it provides medical educators with approaches to empowering their students to take an active role in improving their educational experience.
1. Describe the opportunities and challenges of active student participation in medical school curriculum design.
2. Discuss different models of active student participation with faculty guidance in curriculum design.
3. Examine practical case scenarios for growing the next generation of student-led and faculty-guided curriculum designers and educators.
4. Extrapolate and generalize lessons learned to existing and growing curriculum design strategies with student and faculty involvement at medical schools.
Activities and Schedule:
This 90 minute workshop includes the following components:
Introduction (10 min): In the large group setting, we will introduce the panel and list participants’ goals for attending the session on a flip chart.
Principles (15 min): In the large group setting, we will discuss the evolution of student involvement in medical school curriculum design, its benefits and challenges, and the learning science supporting active student participation in the curriculum creation process. Example models of active student participation will be presented from different schools including scholarly concentrations and formal education course electives followed by a discussion of common themes among the successful approaches.
In small groups, participants identify current student involvement in curriculum design, implementation, and evaluation at their home institutions and where opportunities exist for better participation. Each small group will present their findings back to the main group (25 min).
In small groups setting, participants identify strategies to improve active student participation in curriculum development at their home institutions. Participants will also discuss the potential benefits and challenges of implementation. Each small group will present their recommendations back to the main group (25 min).
Revisiting of workshop goals and a brief summary of key takeaways that can be applied at the home institution (15 min).
This workshop will examine the models, opportunities, challenges, and strategies of student involvement in medical school curriculum design. Stanford Medicine X | ED is an ideal venue for sharing, exchanging, and documenting ideas for promoting active student participation in curriculum design at medical schools. Medical schools are moving towards a change where students are encouraged to take control of their own learning. As a result of this session, we expect participants to 1) be able to discuss and describe learning models where active student participation in medical curriculum improves learning, 2) be able to identify how student-led changes may be implemented at their own institutions, and 3) be able to identify specific strategies for implementing student-led and faculty-guided approached for creating course content.
Dewey J. Democracy and education. New York, NY: Macmillan; 1916.
Rogers C. Freedom to learn. Princeton, NC: Merrill; 1969.
What do I say when….? Working towards greater LGBTQIA awareness
Rachel Lewin and Madin Lopez
Studies show that providers are ill equipped to work with LGBTQIA patients, and that training programs spend little time on the topic (James, Herman, Rankin et al, 206). This workshop will be a space to ask the complicated questions you have about these topics.
This workshop will cover questions like:
What does it mean to be queer? agender? Genderfluid?
What is the difference between gender and sex? How do I use these terms appropriately?
What is the gender spectrum?
What is a PGP?
What do I do if I make a mistake and misgender someone?
What are some appropriate ways to discuss someone’s transition?
How to approach talks about hormone replacement therapy
How to broach sensitive topics specific to this community, like increased HIV risks, drug use, etc.
Pregnancy and pap smears for trans men
HIV and Prep for trans women
During the first half of this workshop, we will cover important definitions and answers to these audience generated questions. In the second half of the workshop, we will break into groups by the population you serve (I.e. Medical students, patients, etc) and discuss the challenges that emerge in daily practice. We encourage participants to come prepared to talk about any & all related situations they are concerned about managing. Facilitators will rotate and help debrief throughout second half. Finally, we will debrief as a group and cover any final questions that arose.
Participants will increase their understanding of how to interact sensitively with the LGBTQIA community, and will consider how to develop educational initiatives that uphold and model these values. They will have the opportunity to address specific questions and concerns in a space where they will not be mocked for or cause harm with their lack of knowledge. Participants will also be directed toward resources to help them continue their efforts to engage this community sensitively.
We as a people fear what we do not know. Fear turns to hatred. Developing an understanding of a community that allows you to communicate with patients, students, employees, etc. in ways that promote inclusion is a critical step toward unity, and our participants will be taking this step.