Browsing by Author "Dilly, Christen K."
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Item Accommodating patients with obesity in ambulatory care: A clinical environment checklist(Wiley, 2024-09-04) Boland, Wesley; Li, Wendy S.; Dilly, Christen K.; Surgery, School of MedicineObjective: Individuals with obesity face unique challenges when visiting healthcare providers, including inadequate equipment. These negative care experiences, often exacerbated by weight stigma, frequently lead to mistrust and reluctance to seek future care. Currently, few instruments exist to ensure that an ambulatory clinic is welcoming to patients with obesity. The following clinical environment checklist was created with an aim to identify weaknesses in accommodating individuals of size. Methods: A checklist of equipment considered ideal for the care of patients with obesity was developed through a comprehensive review of the literature and feedback from office staff. Eight ambulatory clinics within an urban Midwest setting were assessed, focusing on their accommodations for patients with obesity. Feedback from clinic staff was incorporated to further refine the checklist. Results: Common equipment deficiencies included extra-large blood pressure cuffs, wheelchair-accessible scales, 2XL gowns, and adequate seat dimensions in the waiting area. Healthcare workers reported moral distress for their patients when unable to provide proper care due to these limitations. Newly constructed clinics exhibited better-equipped facilities for patients with obesity. Conclusions: Many clinics lack proper equipment to accommodate patients with obesity, resulting in negative care experiences. This clinical environment checklist can identify problem areas and provide solutions to create more welcoming environments, encouraging future care-seeking behaviors.Item Bridging the gap for future clinician‐educators(Wiley, 2018-12) Dilly, Christen K.; Carlos, W. Graham; Hoffmann-Longtin, Krista; Buckley, John; Burgner, Anna; Medicine, School of MedicineBackground In contrast to the training required in the UK, opportunities for medical education training in the USA are limited. Resident‐as‐teacher programmes are typically insufficient to prepare trainees to be successful clinician‐educators, but few pursue formal education degrees. We sought to assess the need for, and feasibility of, a training pathway for subspecialty fellows in a large Department of Medicine that would prepare our trainees to become effective educators. Methods Quantitative and qualitative methods were used. Previous fellowship applicants and current programme directors were surveyed to determine the potential benefits of the programme. A pilot programme was conducted with fellows interested in education to determine the feasibility of the programme. Pilot participants were interviewed regarding the benefits that they gained from the pilot and the logistical challenges that they experienced. In contrast to the training required in the UK, opportunities for medical education training in the USA are limited Results Five highly ranked fellows would have scored our programmes higher if we offered this training pathway. Pilot participants and fellowship programme directors agreed that there is a compelling need for such a training pathway. A number of themes arose from the interviews that enabled us to build the framework for a strong programme. Discussion Our findings suggest that a clinician‐educator training pathway that draws from multiple subspecialties has the potential to improve recruitment, provide needed career counselling and skills development to trainees, and to build a community of educators that will benefit the institution. Important insights from pilot participant interviews will inform the programme design, in order to keep trainees engaged and overcome logistical challenges.Item Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?(Springer, 2019-03) Dilly, Christen K.; Kahi, Charles J.; Medicine, School of MedicinePurpose of Review Colorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians’ performance. Recent Findings Recent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs, patients are less likely to have advanced adenomas on surveillance and less likely to develop or die from PCCRC. Finally, there is at least some evidence that higher ADRs do not lead to more cumulative surveillance exams. Summary The ADR is a useful outcome measure that can provide individual endoscopists and their patients with information about the likelihood of developing PCCRC. To achieve the lowest possible PCCRC rate, we should be striving for higher ADRs. While strategies and innovations may help a bit in improving ADRs, our efforts should focus on ensuring a complete mucosal exam for each patient. Behavioral psychology theories may provide useful frameworks for studying motivating factors that drive a careful exam.Item Drug-Induced Liver Injury Module for Medical Students(Association of American Medical Colleges, 2020-07-15) Dilly, Christen K.; Craven, Hannah J.; Molleston, Jean P.; Medicine, School of MedicineIntroduction No published curricula exist to introduce medical students to drug-induced liver injury (DILI). However, DILI is the most common cause of acute liver failure in the US, and drug-drug interactions are tested on the USMLE Step 1. Methods We developed an independent study module to introduce students to DILI. This module consisted of a narrated PowerPoint introduction, a journal article, and four example cases. Students completed the module independently. To evaluate the effectiveness of the activity, exam data and responses to the cases were reviewed, and end-of-course survey data were used. These responses were used to modify questions for clarity and to develop a feedback rubric. Results Mean scores on case-related questions in the module ranged from 44% to 73%. However, mean scores on test questions related to DILI ranged from 61% to 98%. It is possible that students learned from receiving feedback in the form of correct answers to the cases. On course evaluations, 52.4% of students agreed or strongly agreed that the online modules as a group (which included the DILI module) were an effective teaching method. Discussion This module introduces students to DILI and enables them to interact with valuable resources. We hope that modifications will improve the learning experience and effectiveness of the module. Going forward, we plan to collect validity evidence for the feedback rubric and develop an advanced version of the module for gastroenterology fellows.Item Genetic Testing and Counseling in Metabolic Liver Disease: An Interactive Lecture for Medical Students(Association of American Medical Colleges, 2020-10-19) McPheron, Molly A.; Craven, Hannah J.; Molleston, Jean P.; Dilly, Christen K.; Medical and Molecular Genetics, School of MedicineIntroduction Medical students have limited opportunities to learn about current genetic testing. This session provided exposure to different types of testing and the complex issues that physicians may encounter when counseling patients on proper testing and interpreting results. Methods We designed a 1-hour interactive lecture for second-year medical students. We presented an overview of the topic, then applied the concepts to specific disorders and cases. Students were asked to answer questions regarding cases using an audience response system, and we used their responses as the basis for our in-class discussion. This session has been held twice, with 25 students attending in 2018 and 31 students in 2019. The session was also recorded so that additional students not in attendance could watch, and was available to 151 students in 2018 and 333 students in 2019. Results Students answered questions via audience response system. There was a range of 47%–100% of students giving the correct answers in 2018, and 55%–93% in 2019. Exam questions covering genetic counseling issues were answered correctly by 66% and 77% of students in 2018, and 70% and 68% of students in 2019. Discussion This session provided an opportunity for medical students to be exposed to some of the complex ethical and psychosocial issues that may arise with genetic testing for liver disease and to consider how to navigate them. Using an audience response system during the lecture made the session more interactive and allowed the teacher to correct errors and teach based on the responses.Item How to Become a Leader as a Fellow(Elsevier, 2023-08) Bhavsar-Burke, Indira; Dilly, Christen K.; Medicine, School of MedicineLeadership skills are vital for gastroenterology fellows to cultivate to adapt to advancing practice environments and promote lifelong personal and professional development. Although leadership is a key component of the physician’s role, leadership skills are not always formally taught. Fellows in gastroenterology should recognize opportunities to build these skills. Through this article, we aim first to argue that all doctors are leaders. We then describe ways that fellows can develop self-leadership. Finally, we highlight pathways for trainees to take on roles to lead others. As a supplement, we provide examples of fellows’ leadership journeys.Item New Causes for the Old Problem of Bile Reflux Gastritis(Elsevier, 2018) McCabe, Marshall E., IV; Dilly, Christen K.; Medicine, School of MedicineItem Perspectives on Colon Cancer Screening—A Physician Panel Discussion for Preclinical Medical Students(Association of American Medical Colleges, 2020-10) Dilly, Christen K.; Craven, Hannah J.; Molleston, Jean P.; Medicine, School of MedicineIntroduction Colon cancer is the third most common cancer in the US, and the survival rate improves drastically with early detection. It is important for medical students to understand screening options, and to be able to effectively discuss these options with their patients. While basic information about colon cancer screening is ubiquitous in US medical school curricula, no published curricula describe teaching students the nuances of negotiating this discussion with patients and tailoring screening to individual patients' needs. Methods We developed a 90-minute session for second-year medical students as part of a gastroenterology and nutrition course. We provided a short lecture on colon cancer screening. We then had a panel of practicing gastroenterologists and a primary care physician discuss their approaches to six hypothetical cases. The students reflected in writing on what they learned from the session and on their opinions of the session format. Results Of second-year medical students, 139 attended the session and 110 submitted written reflections on the session (79% response rate). The students perceived significant gains in knowledge, communication skills, and attitudes around the discussions. Discussion This expert panel session taught medical students knowledge and communication skills related to colon cancer screening. The session could be easily implemented at any medical school, either at the preclinical or clinical level.Item Reframing Academic Productivity, Promotion and Tenure As a Result of the COVID-19 Pandemic(Magna, 2021-01-01) Sotto-Santiago, Sylk; Dilly, Christen K.; O'Leary, Heather A.; Craven, Hannah J.; Kara, Areeba; Brown, Cynthia; Kressel, Amy B.; Rohr-Kirchgraber, TheresaFaculty members have been impacted in a multitude of ways by the COVID-19 pandemic. In particular, faculty seeking promotion and tenure have been impacted by the disruption and inconsistent levels of productivity. In this article, we consider academic productivity in the context of clinical, research, education and service missions within higher education and the academic medicine professoriate. We offer a series of recommendations to faculty members, to institutions, and to professional societies in hopes we can challenge pre-existing deficits in promotion and tenure processes, and academic worth.Item Reimagining Gastroenterology Fellowship Training – The Third Year of the Future(Elsevier, 2023) Bhavsar-Burke, Indira; Shah, Brijen J.; Carethers, John M.; Whitson, Matthew J.; Kaul, Vivek; David, Yakira; Dilly, Christen K.; Medicine, School of Medicine