2022 IUSM Education Day

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Enhancing resident scholarship with a library partnership.
(2022-04-28) Stumpff, Julia C.; Delbridge, Emilee J.; Vetter, Cecelia J.
Introduction: The ACGME requires that residents understand and participate in scholarly activities in order to meet graduation requirements. Although library support had historically been available to residents, there was no evidence that this resource was utilized in the past. The Family Medicine residency utilizes the library partnership in order to educate residents about the most effective methods to search for relevant literature and provide residents with an overview of pertinent library resources, including how to access full-text articles. A couple of years ago, the presenters developed a curriculum to provide residents with education on library resources, so that residents could effectively complete their scholarly activities by utilizing evidence-based literature. Study Objective: The study objective was to gather data from residents who have received education on IUSM library resources in order to describe what residents learned and what they identify are future educational needs. Methods: During 2 academic years, 23 second-year residents attended a one-hour library instruction session while on their scholarship rotation. Thirteen residents attended a session during October – February of the first academic year, and 10 residents attended a session during August – November of the second academic year. The goals for the session were that residents would: learn the basics of searching for literature on a topic, become familiar with library resources, and begin searching for literature related to their individual scholarly projects. This cross-sectional study used an 8-question survey given to all second and third-year residents at the end of the second year that the library instruction sessions were implemented. Results: Thirteen of the 23 residents responded to the survey (57%). Five of the respondents (38%) were second-year residents, and 8 of the respondents (62%) were third-year residents. All 13 residents responded that they learned about library resources during the session, and 11 residents said they learned the basics of searching for literature on a topic. Eight residents responded that they learned how to get access to full-text articles. Seven residents also responded that having a second session after the project is further along would be useful to them, and 6 residents responded that citation information would be useful for the librarians to cover. Conclusions: Results of the cross-sectional survey indicated that the goal of increasing residents' knowledge about library resources was met. As a result of the library instruction, residents used what they learned when searching for articles and when accessing the full-text of articles. Feedback from the survey suggested that an additional session and more instruction on citation information would be helpful. Future scholarship sessions will be modified to include an introduction to citation management software, and an additional session will be scheduled during the third core to focus more in-depth on citation management software, keyword searching, and any other questions residents may have. Pre-& post-tests to evaluate residents' change in confidence when literature searching and managing citations during their scholarly project will be implemented.
Predictors of publication rate from 2018 and 2019 IMPRS abstracts: an exploratory analysis
(2022-04-28) Ramirez, Mirian; Nguyen, Anne T.; Herbert, Brittney-Shea; Whipple, Elizabeth C.
INTRODUCTION/BACKGROUND: Since 2017 the IU School of Medicine has offered the opportunity to medical students to participate in the Indiana University Medical Student Program for Research and Scholarship (IMPRS). For many students, this is the first opportunity to conduct research in clinical medicine and have their research abstract available in the Proceedings of IMPRS journal, enhancing the visibility of their research and later publishing in a peer-reviewed journal. We determined and analyzed which abstracts from the IMPRS 2018 and 2019 program were then published as peer-reviewed articles. STUDY OBJECTIVE: Our purpose was to determine the proportion of abstracts presented at the IMPRS Summer Program Oral Presentation Symposium during 2018 and 2019 that were further published as full articles in peer-reviewed publications, the time lag to publication, and the factors associated with successful publication. We will identify potential trends or predictors of publication by comparing the years of presentation and publication, the journals where the abstract was published, the IMPRS research track, financial support received, IMPRS program award winning status, and research topics of the published abstracts. METHODS: A total of 241 abstracts were presented at the IMPRS oral Presentation Symposium during 2018 and 2019 (abstracts were identified from the records uploaded in the Proceedings of IMPRS website http://journals.iupui.edu/index.php/IMPRS). We used Pubmed, Google Scholar, Dimensions database, and Citation Finder app to search and find accurate citations of the final version of the published abstract. We combined the author names of the students and mentors with keywords from the abstracts. We used PubMed to gather the articles' medical subject heading (MeSH) terms to perform a co-occurrence analysis. We used Excel to aggregate, clean up and analyze the data and VOSviewer software to generate the topic analysis and visualization map. RESULTS AND CONCLUSION: Overall, 52 of the abstracts (publication rate of 21.6%) have been published in 49 peer-reviewed scholarly publications, by January 2022, with an average and median time between the oral presentation and the official date of publication of 21 months (IQR=9, 26-17). The articles identified were published in 44 journals and one book series; the journal Journal Impact Factor (JIF) ranged from 1.276 to 21.198 (mean 5.62). The journal with the most published articles (≥ 4) was the Journal of Surgical Research. The majority of papers presented at IMPRS 2018 and 2019 that end up with a publication belong to the “Laboratory and translational research” IMPRS research track (66.7%). This approach aims to contribute to a better understanding of the characteristics of the abstracts presented in the context of the IMPRS program that continues the process of publishing manuscripts in peer-reviewed scholarly publications. The findings provide relevant insight to the librarians concerning their involvement and support with the IMPRS program in advising students about initial steps toward scholarly publishing.
Building Bridges in Medical Education: 3rd Annual Indiana University School of Medicine Education Day Program
(2022-04-28) Indiana University School of Medicine
Program for the 3rd annual Indiana University School of Medicine Education Day held at Hine Hall Conference Center on the IUPUI campus on April 28, 2022. The IUSM Education Day is an event for faculty, staff, students, residents, and fellows from all departments and campuses to showcase their medical education research through oral presentations, workshops, poster sessions, and small group discussions.
Method Development Involving Modeling Bacterial Metabolite Regulation of Vaginal Epithelial Cell Signaling in Bacterial Vaginosis
(2022-04-28) Trinh, Alan; Brubaker, Douglas
BACKGROUND Bacterial vaginosis, which is the imbalance of normal vaginal microbiota, contributes to preterm delivery, vaginitis, and decreased drug efficacy. Despite metronidazole efficacy in reducing BV contributing organisms, BV continues to recur in 50% of patients. Previous studies showing imidazole propionate’s role in the pathogenesis of type II diabetes suggest that similar metabolite-regulated pathways in vaginal microbiomes may be the key in pathogenesis of uterine diseases such as BV. Thus, the purpose of this study was to observe the relationship between vaginal metabolites, host or microbiome-derived, and transcriptomic responses in vaginal epithelial tissues stratified by vaginal microbiome composition (“microbiome group”). The hypothesis was that differences in vaginal microbiome composition result in differential regulation of metabolite-host pathway functional relationships. METHODS Transcript levels and metabolite concentrations precollected from 23 East African women were processed and analyzed via R. Transcriptomic data were converted into KEGG pathway enrichment scores via ssGSEA2.0, a package within R. Enrichment scores were correlated (Spearman) with metabolite levels by microbiome group and lactobacillus dominant phenotypes, and relationships were visualized via Heatmap3 and Cytoscape. RESULTS The results showed varying strengths in correlation among metabolites and KEGG pathway enrichment scores after filtering for strong correlations (R > |0.5|) and significance (p< 0.05). Nonlactobacillus dominant microbiomes showed fewer strongly associated metabolite-KEGG pathway relationships compared to the lactobacillus dominant microbiome group, specifically the imidazole-related networks. CONCLUSIONS In this study, variations in significant correlations among metabolites and KEGG pathways suggests that microbiome diversity may contribute to how metabolites regulate host pathways in vaginal epithelial cells. The reduced pathway interactions observed in imidazole compounds suggests that dysregulation may contribute to recurrence of bacterial vaginosis. This method of modelling could be used to characterize the regulation of critical pathways associated with the pathogenesis of bacterial vaginosis.
Formula Mixing Knowledge of Pediatric Residents at a Quaternary Care Center
(2022-04-28) Andrewski, Erik
Pediatric residents receive a paucity of training in regards to best practices for formula mixing and storage leading to decreased comfort and discussion regarding formula at well-child checks. 18% of infants are never offered breast milk and over half of infants are receiving formula by 3 months of age. A large majority of parents report they received no guidance about formula mixing from healthcare providers and may be afraid to ask questions related to formula due to a significant culture of “formula shaming”. Complications of improper mixing include electrolyte abnormalities, hypo or hyperglycemia and failure to thrive. Resident knowledge regarding formula best practices was assessed and found to be deficient for both storage and mixing. A self-paced educational module was created to help residents improve their knowledge of infant formula use.
Developing Cross-Cultural Empathy through Mindfulness
(2022-04-28) Blazin, Lindsay J.; LaMotte, Julia E.
INTRODUCTION: The murder of George Floyd sparked international movements to address racial inequality. These movements have prompted critical conversations about medical racism, bias, and social determinants of health. These events have caused us to turn inwardly and question what we know, the limits of our understanding, and the role of medical training in developing the skills and perspectives needed to address racial inequality in health care systems. The purpose of this session is to share the design and preliminary outcomes of a curricular intervention that aims to train pediatrics residents to use mindful reflective practice to develop cross-cultural empathy and engage with anti-racist ideas. STUDY OBJECTIVE: To develop and implement a curriculum that teaches mindful reflective practice as a tool for developing cross-cultural empathy and advancing diversity, equity, inclusion, and justice in healthcare. METHODS: Pediatrics and combined medicine-pediatrics residents participated in four 90-minute small group sessions: (1) cultivating critical awareness of racism in medicine, (2) unpacking bias, microaggressions, and coded language, (3) exploring personal identity and intersectionality, and (4) committing to action and curriculum reflections/feedback. Each session was co-led by 3 facilitators (LB, JL, FW) and structured to provide opportunities for learners to engage, explore, explain, and elaborate on the content presented. Each session began with a guided mindfulness activity and concluded with individual written reflection. Participants completed the Maslach Burnout Inventory, Mindful Attention Awareness Scale, Empathy Quotient, and Stanford Professional Fulfillment assessments prior to session 1, following session 4, and 3 months after completion of the curriculum. Participants also completed the Social Justice and Empathy Assessment following session 4, and 3 months post-curriculum. Quantitative data was analyzed for pre-post changes using t-tests. Curriculum acceptability, facilitator effectiveness, and perceived benefit of each portion of session content was reviewed. Participants engaged in a brief audio-recorded focus group at the end of session 4. The transcribed focus groups and participants’ written reflections following each session were qualitatively analyzed to identify common themes. RESULTS: Preliminary results from first two cohorts (N=9) indicate that all residents found the course to be sufficiently challenging and that it helped them to pursue growth. The majority of participants expressed increased understanding of curriculum domains; mindfulness (77.8%), medical racism (88.9%), bias/coded language/microaggressions (100%), and identity/oppression/intersectionality (88.9%) and rated the overall course as excellent (88.9%). All residents endorsed agreement for facilitator’s content expertise and excellence in teaching skills. Qualitative analysis of focus groups is ongoing at this time. Preliminary review suggests that participants enjoyed the curriculum, found it to be unique in their residency experience, and desire more opportunities to discuss DEIJ issues in small groups. We expect full quantitative an qualitative analysis of all 6 cohorts in this pilot study will be completed and available for presentation at IU Education Day.
Pre-Clinical Medical Students' Attitudes Towards Psychiatry
(2022-05) Opperman, Michael; Smith, Alyssa; McCann, Joseph; Chastain, Jonathan; Schiller, Brennan; Thomas, Alexander; Jivens, Morgan; Schargorodsky, David; Scofield, David; Grant, Larrilyn; Sweazey, Robert; Richardson, Jenelle; Plawecki, Martin
Scholarly Concentrations Program: A PRIME Approach to Addressing Care for the Medically Underserved and Vulnerable Populations
(2022-04-28) Birnbaum, Deborah R.; Rojas, Michelle; Allen, Bradley L.; Wallach, Paul M.
Examine how well the structure of the Scholarly Concentrations Program and content of each concentration relates to the goals of the federal Health Resources and Services Administration grant received to create more interest and prepare more medical school graduates to care for medically underserved and vulnerable populations. The grant funds the Primary Care Reaffirmation for Indiana Medical Education, or PRIME. project. A review of how concentrations align with the grant was conducted by reviewing program, concentration and course learning objectives and mapping to the grant objectives. Numerous concentrations were found to be an excellent fit, creating a PRIME opportunity to enhance the SC Program and move the needle on the grant objectives.
A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed
(2022-04-28) Yu, Corinna; Rigueiro, Frank; Backfish-White, Kevin; Boyer, Tanna
Introduction: Although difficult airway management is an expected skill of anesthesiologists, there is no mandatory training focused on this skill set in anesthesiology residency programs. Difficult airways are taught when the clinical situation arises, leading to variable resident expertise. Formal instruction in cricothyrotomy is lacking and the procedure is clinically rare. This lack of training has led to a rise in fellowship programs in airway management, demonstrating the need for greater attention to this skill set. Procedural times for cricothyrotomy improve after educational interventions, providing further evidence to support formal instruction in invasive airway management training. Patients presenting for upper endoscopies are considered full stomach due to the bleeding, and endotracheal intubation is preferred over sedation to prevent aspiration. These airways can be challenging to manage and may require surgical intervention as a last resort. We created a difficult airway simulation scenario to teach residents cricothyrotomy. Objective: To teach anesthesiology residents how to perform a cricothyrotomy and improve their confidence in difficult airway management. Methods: A patient presents with an acute gastrointestinal bleed for an upper endoscopy. A pressurized bag of red fluid was hidden out of view with tubing placed into the SimMan’s posterior oropharynx. Anesthesiology residents obtain the history from the patient when the patient coughs vigorously and its mouth fills with simulated blood. Residents attempt intubation, which is difficult if not impossible on this SimMan. When they communicate their decision for surgical intervention, a secondary mannequin was provided to perform the actual cricothyrotomy. At the end of the simulation, a behavior checklist is used for evaluation and the residents are asked to complete a simulation feedback form. Results: 26 PGY-4 anesthesiology residents completed the simulation from April-May in 2019 with 25 residents providing feedback with a 5-point Likert scale of agreement. Most residents quickly recognized the patient’s need for emergency intubation. 16 residents had prior experience managing the airway in an acute upper GI bleed (average 3 patients) whereas 9 residents reported no prior experience. 88% of participants strongly agreed that the simulation was a valuable learning experience with 92% stating it increased their confidence and clinical decision making in handling similar scenarios in the future. In addition, there were no negative scores to any of the survey questions. Discussion: Difficult airway skills include management of a patient with an upper gastrointestinal bleed requiring surgical cricothyrotomy. This is a valuable skill that can be taught with simulation. Our simulation led to an increase in resident confidence in the procedure, but it would be useful to follow up with the cohort and see if these skills prepared them for patient encounters afterwards and if the learning was sustainable. Conclusion: Our simulation case was a valuable learning experience for residents and provided critical surgical skills for future anesthesiologists in difficult airway management. It is worthwhile to include this simulation in the anesthesiology resident curriculum.
Parental Leave During Anesthesiology Fellowship
(2022-04-28) Rigueiro, Frank; Yu, Corinna
Introduction: Parental leave is an important consideration for many residents and fellows as they choose programs balancing their career goals with their goals for family planning. Benefits of parental leave are decreased infant mortality and increased breastfeeding, which has health benefits for infants and mothers. In 2018, one study found only 7 of 15 residency training institutions in the local area had an institutional GME policy providing paid designated childbearing leave. A study at Mayo Clinic at 269 programs found that 40% of residents and fellows planned to have children during training. 89% of fathers rated parental leave as an important benefit, and pregnancy and childbirth plans altered choice of GME program in women more often than in men. The ACGME encourages allowances for parental leave but does not provide specific recommendations on how to manage the leave, giving programs institutional control over their own policy. Leave policies can be complicated by requirements from Centers for Medicare and Medicaid Services, Health Resources and Services Administration, the Veterans Health Administration, and the National Institutes of Health, depending on allocations for resident/fellow salary. Objective: As prospective anesthesiology fellows research programs with family planning in mind, how accessible are these local GME policies on parental leave? Methods: We compiled a list of all 140 ACGME-approved anesthesiology fellowship programs including 60 pediatric, 74 adult cardiothoracic, 63 critical care, 39 regional and acute pain medicine, 41 obstetric, 111 chronic pain medicine & 1 clinical informatic program. We performed online searches of each program’s website to look for institutional GME policies on parental leave. If we could not find the results within 10 minutes, it was considered not easily accessible. Results: Out of 140 anesthesiology ACGME-approved fellowship programs, 99 programs had parental leave policies easily accessible online (71%) whereas 41 programs did not have policies easily accessible online (29%). Of these 41 programs, 6 of them required a log-in for access to their parental leave policies. Discussion: Anesthesiology fellowship programs should consider having a generous parental leave policy and making this policy easily accessible online to demonstrate support for physician well-being and work-life balance. We found that many anesthesiology fellowship programs do not have parental leave policies easily accessible online for interested applicants. Reasons many trainees don’t use parental leave include the sense of being a burden to colleagues, anticipation of a heavier workload later, delayed program completion, not needing the time, or not being the primary caregiver. Additional research should pursue opportunities for competency-based training, flexible scheduling of work hours or start dates, part-time options, and childcare benefits to meet the rising demands of the current workforce. Conclusion: Parental leave is an important public health priority and an important aspect to physician well-being. Residency and fellowship programs should ensure they have established institutional GME policies and share them publicly in an easily accessible format online with interested applicants to remain competitive and guarantee a diverse applicant pool.

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