Browsing by Author "Wallach, Paul M."
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Item A shared point of care ultrasound curriculum for graduate medical education(Springer Nature, 2024-08-06) Ferre, Robinson M.; Kaine, Joshua C.; Lobo, Daniela; Peterson, Dina; Sarmiento, Elisa; Adame, John; Herbert, Audrey; Wallach, Paul M.; Russell, Frances M.; Emergency Medicine, School of MedicineBackground: Point of care ultrasound (POCUS) education has grown significantly over the past two decades. Like most curricular items, POCUS education is siloed within individual graduate medical education (GME) programs. The purpose of this study was to evaluate the effectiveness of a shared GME POCUS curriculum between five GME programs at a single institution. Methods: Post-graduate-year-1 (PGY-1) residents from emergency medicine (EM), family medicine (FM), internal medicine (IM), combined internal medicine-pediatrics (IM-Peds) and combined emergency medicine-pediatrics (EM-Peds) residency programs were enrolled in a core POCUS curriculum. The curriculum included eleven asynchronous online learning modules and ten hands-on training sessions proctored by sonographers and faculty physicians with POCUS expertise. Data was gathered about the curriculum's effectiveness including participation, pre- and post-curricular surveys, pre- and post-knowledge assessments, and an objective skills assessment. Results: Of the 85 residents enrolled, 61 (72%) participated in the curriculum. Engagement varied between programs, with attendance at hands-on sessions varying the most (EM 100%, EM-Peds 100%, FM 40%, IM 22%, Med-Peds 11%). Pre- and post-knowledge assessment scores improved for all components of the curriculum. Participants felt significantly more confident with image acquisition, anatomy recognition, interpreting images and incorporating POCUS findings into clinical practice (p < 0.001) after completing the curriculum. Conclusion: In this shared GME POCUS curriculum, we found significant improvement in POCUS knowledge, attitudes, and psychomotor skills. This shared approach may be a viable way for other institutions to provide POCUS education broadly to their GME programs.Item Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention(Springer Nature, 2022-07-31) Russell, Frances M.; Herbert, Audrey; Peterson, Dina; Wallach, Paul M.; Ferre, Robinson M.; Emergency Medicine, School of MedicineIntroduction: While a large amount of point-of-care ultrasound (POCUS) undergraduate medical education research exists, very little assesses the effectiveness of teaching on the student's ability to utilize POCUS within a clinical context. We set out to assess the ability of pre-clinical (second year) medical students to perform and interpret a parasternal long axis (PSLA) cardiac ultrasound view, and to diagnose a pericardial effusion on POCUS in a simulated patient with hypotension. Methods: This was a prospective study assessing second-year medical students before and after focused cardiac POCUS instruction. Pre-instruction, students completed a pre-assessment and test. They then watched a short video on cardiac ultrasound technique, anatomy, and pathology. Students then participated in 10 minutes of one-on-one hands-on instruction using a simulated patient. Immediately after didactics and hands-on instruction, students in groups of two to four completed a case simulation where they performed a PSLA view, identified pathology, and made a diagnosis. Differences between pre- and post-workshop responses were analyzed using the Chi-square test. Results: We analyzed data on 132 pre-clinical second-year medical students; 126 (95%) had limited to no POCUS experience prior to the workshop. Comparing pre- to post-workshop responses, we found significant improvement in students' ability to identify a pericardial effusion (46% to 69%) (p=0.002) on a PSLA cardiac view. Of the 57 student groups (132 students), 41 (72%) groups were able to adequately obtain a PSLA view on a mannequin using an ultrasound simulator without needing guidance with probe placement or maneuvering. Thirty-five (61%) student groups were able to identify a pericardial effusion and diagnose cardiac tamponade in a simulated patient with hypotension. Conclusion: After short, structured training, pre-clinical medical students, novice to cardiac POCUS, showed improved knowledge with identifying a pericardial effusion on an ultrasound image. The majority of students were able to obtain a PSLA view and diagnose cardiac tamponade in a hypotensive patient during a during a case-based simulation.Item Incidence of Resident Mistreatment in the Learning Environment Across Three Institutions(Taylor and Francis, 2021) Hammoud, Maya H.; Appelbaum, Nital P.; Wallach, Paul M.; Burrows, Heather L.; Kochhar, Komal; Hemphill, Robin R.; Daniel, Michelle; Clery, Michael J.; Santen, Sally A.Introduction: Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective of this study is to explore the prevalence of resident experiences with mistreatment. Methods: Residents at three academic institutions were surveyed using questions similar to the GQ in 2018. Quantitative data were analyzed based on frequency and Mann-Whitney U tests to detect gender differences. Results: Nine hundred ninety-six of 2682 residents (37.1%) responded to the survey. Thirty-nine percent of residents reported experiencing at least one incident of mistreatment. The highest reported incidents were public humiliation (23.7%) and subject to offensive sexist remarks/comments (16.0%). Female residents indicated experiencing significantly more incidents of: public embarrassment, public humiliation, offensive sexist remarks, lower evaluations based on gender, denied opportunities for training or rewards, and unwanted sexual advances. Faculty were the most frequent instigators of mistreatment (66.4%). Of trainees who reported experiencing mistreatment, less than one-quarter reported the behavior. Conclusion: Mistreatment in the academic learning environment is a concern in residency programs. There is increased frequency among female residents.Item Indiana University School of Medicine Scholarly Concentrations Program Annual Report 2021(Indiana University School of Medicine, 2021) Indiana University School of Medicine; Wallach, Paul M.The Indiana University School of Medicine is confident that the curriculum prepares all future healers to transform health across the state and beyond. Many students come into medical school with varied interests related to medicine. Maybe they worked in an underserved rural clinic or still reflect on bioethics discussions from one of their favorite undergraduate courses. The Scholarly Concentrations Program offers medical students the opportunity to pursue their passions through coursework and scholarship in an academic setting that runs throughout medical school yet doesnot extend the time it takes to complete a medical degree.Item Indiana University School of Medicine Scholarly Concentrations Program Annual Report 2022-2023(Indiana University School of Medicine, 2022) Indiana University School of Medicine; Wallach, Paul M.The Scholarly Concentrations Program offers students a longitudinal extracurricular program, designed to enhance their medical school experience through a parallel curriculum without incurring additional time or tuition. Students complete topic-specific coursework, engage in scholarly pursuits, benefit from mentorship to become better prepared leaders in their chosen field, and develop professional identity beyond medical knowledge. The topics are of broad interest and the program leverages the unique expertise, strengths, interests and needs of the school's diverse campuses and communities.Item Indiana University School of Medicine Scholarly Concentrations Program Annual Report 2023-2024(2024) Indiana University School of Medicine; Wallach, Paul M.The Scholarly Concentrations Program offers students a longitudinal extracurricular program, designed to enhance their medical school experience through a parallel curriculum without incurring additional time or tuition. Students complete topic-specific coursework, engage in scholarly pursuits, benefit from mentorship to become better prepared leaders in their chosen field, and develop professional identity beyond medical knowledge. The topics are of broad interest and the program leverages the unique expertise, strengths, interests and needs of the school's diverse campuses and communities.Item The IUSM Scholarly Concentrations Program: Strategic Collaborative Education Across Schools and Departments(2020-03-06) Birnbaum, Deborah R.; Rojas, Michelle; Corson-Knowles, Daniel; Wallach, Paul M.A changing healthcare landscape calls for innovation and expansion of expertise in medical education. How does a medical school better prepare medical students to thrive in a changing profession? Through its Scholarly Concentrations Program, Indiana University School of Medicine is collaborating with non-physician experts from schools with expertise in topics that are medically relevant and of interest to medical students. Scholarly Concentrations are longitudinal experiences that enhance the medical education program through coursework and scholarly work. In addition to enhancing students’ education, it offers the opportunity to enhance campus reputation and develop research focus for students and faculty. Partnerships were created in both directions. IU School of Medicine sought out schools and departments with unique expertise on different medical campuses. Schools and departments also approached IU School of Medicine about its Scholarly Concentrations program as momentum built. These partnerships are creating mutual benefits for IUSM, partners, faculty and students. Benefits for partner organizations include mentoring opportunities, reputational enhancement, having an impact on healthcare system, and pathways to certificates and advanced degrees. For IUSM and its students, the partnerships enhance professional development through Scholarly Concentrations in areas of clinical, teaching, research, advocacy and administration.Item Medical School Without Walls: 50 Years of Regional Campuses at Indiana University School of Medicine(Wolters Kluwer, 2022-12) Wallach, Paul M.; Birnbaum, Deborah R.; Ryan, Elizabeth R.; Pieczko, Brandon T.; Hess, Jay L.The history of Indiana University School of Medicine (IUSM) dates to 1871, when Indiana Medical College entered into an affiliation with Indiana University in Bloomington to offer medical education. In 1971, the Indiana General Assembly passed a bill to create and fund a distributed model for medical education for which IUSM was responsible, an innovative approach to implementing a statewide medical education program. IUSM became one of the first U.S. medical schools to implement what is today known as a regional medical campus model. This regional medical campus system has permitted IUSM to expand enrollment based on national and local concerns about physician shortages, increase access to care locally, support expansion of graduate medical education, and provide opportunities for research and scholarship by faculty and students statewide. This effort was made possible by partnerships with other universities and health care systems across the state and the support of local community and state leaders. The model is a forward-thinking and cost-effective way to educate physicians for service in the state of Indiana and is applicable to others. This article highlights milestones in IUSM’s 50-year history of regional medical education, describes the development of the regional medical campus model, recognizes significant achievements over the years, shares lessons learned, and discusses considerations for the future of medical education.Item Medical Student Experiences With Accessing and Entering Patient Information in Electronic Health Records During the Ob/Gyn Clerkship(Elsevier, 2020-02) Hammoud, Maya M.; Foster, Lauren M.; Cuddy, Monica M.; Swanson, David B.; Wallach, Paul M.; School of EducationBackground Medical school graduates should be able to enter information from patient encounters and to write orders and prescriptions in the electronic health record. Studies have shown that, although students often can access electronic health records, some students may receive inadequate preparation for these skills. Greater understanding of student exposure to electronic health records during their obstetrics and gynecology clerkships can help to determine the extent to which students receive the educational experiences that may best prepare them for their future training and practice. Objective The purpose of this study was to examine medical student reporting of electronic health record use during the obstetrics and gynecology clerkship. Study Design A Step 2 Clinical Knowledge End-of-Examination Survey about electronic health record use was administered to medical students after they completed the Step 2 Clinical Knowledge component of the United States Medical Licensing Examination. For inpatient and outpatient rotations, students were asked if they accessed a record and if they entered notes or orders into it. Descriptive statistics for a sample of 16,366 medical students who graduated from Liaison Committee on Medical Education–accredited schools from 2012–2016 summarize student interactions with electronic health records by rotation type and graduation year. Chi-square techniques were used to examine mean differences in access and entry. Results The survey had an overall response rate of 70%. In 2016, most survey respondents (94%) accessed electronic health records during their obstetrics and gynecology clerkship, but 26% of them reported “read-only” access. On the inpatient service, <10% of students reported any order entry; 58% of them reported entering progress notes, and 47% of them reported entering an admitting history and physical. Conclusion Medical school graduates who are entering obstetrics and gynecology residencies are expected to be competent in documenting clinical encounters and entering orders, including those that are unique to obstetrics and gynecology. This study shows that some students may receive less experience with entering information into electronic health records during their obstetrics and gynecology clerkships than others, which could result in unequal levels of preparedness for graduate medical education.Item Piloting a Graduate Medical Education Point-of-Care Ultrasound Curriculum(Springer Nature, 2022-07-23) Ferre, Robinson M.; Russell, Frances M.; Peterson, Dina; Zakeri, Bita; Herbert, Audrey; Nti, Benjamin; Goldman, Mitchell; Wilcox, James G.; Wallach, Paul M.; Emergency Medicine, School of MedicineObjective: As point-of-care ultrasound (POCUS) use grows, training in graduate medical education (GME) is increasingly needed. We piloted a multispecialty GME POCUS curriculum and assessed feasibility, knowledge, and comfort with performing POCUS exams. Methods: Residents were selected from the following residency programs: internal medicine, family medicine, emergency medicine, and a combined internal medicine/pediatrics program. Didactics occurred through an online curriculum that consisted of five modules: physics and machine operation, cardiac, lung, soft tissue, and extended focused sonography in trauma applications. Residents completed a pre- and post-curriculum questionnaire, as well as knowledge assessments before and after each module. One-hour hands-on training sessions were held for each module. Differences between pre- and post-participation questionnaire responses were analyzed using the Wilcoxon rank sum. Results: Of the 24 residents selected, 21 (86%) were post-graduate year two or three, and 16 (65%) were from the internal medicine program. Eighteen (67%) residents reported limited prior POCUS experience. All pre- to post-knowledge assessment scores increased (p<0.05). Statistically significant increases pre- to post-curriculum were found for frequency of POCUS use (p = 0.003), comfort in using POCUS for assessing for abdominal aortic aneurysm, soft tissue abscess detection, undifferentiated hypotension and dyspnea, cardiac arrest and heart failure (p<0.025); and competency in machine use, acquiring and interpreting images and incorporating POCUS into clinical practice (p<0.001). All participants felt the skills learned during this curriculum were essential to their future practice. Conclusions: In this pilot, we found using a combination of online and hands-on training to be feasible, with improvement in residents’ knowledge, comfort, and use of POCUS.