2022 IUSM Education Day

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Fostering Cultural Humility in Caring for a Returning Traveler: A Pediatric Resident Simulation
(2022) Hecht, Shaina; Westwater, Molly; Sui, Htayni; Byrne, Bobbi
Introduction: International travel has become more frequent outside of the current worldwide pandemic. With increased international travel, there is also more opportunity for physicians to encounter illness associated with this travel, including in pediatric patients. Pediatric residents should be well versed in obtaining a detailed travel history, creating a differential diagnosis and launching a treatment plan with the family for management of illness after international travel. Additionally, the concepts of cultural humility and avoiding judgement while caring for families with different cultural backgrounds is an important skill for residents to foster during training. Study Design/Hypothesis: A simulated patient encounter focusing on a pediatric patient with recent international travel was designed as part of a large multi-scenario simulation education event that is held annually for all pediatric residents. We hypothesized that this simulation would increase pediatric resident knowledge in obtaining a travel history as well as improve the residents’ self-perceived cultural humility when caring for international travelers. Methods: We designed a simulation scenario for second year pediatric residents focused on a febrile child who recently returned from international travel. The child’s family originally presented to a local religious leader prior to having the medical assessment. Pre and post simulation, a survey with questions regarding medical knowledge in the preparation of a pediatric patient for international travel as well as assessment of these patients upon return from international travel were included. Additionally, the Multidimensional Cultural Humility Scale (MCHS) was administered to residents to assess their cultural humility pre- and post- simulation. Results: Twenty- seven residents participated in the simulation. Overall, the mean score of the MCHS did not significantly increase after the simulation. After completing the scenario, all participants did agree that they felt more comfortable caring for immigrant children, more prepared to take a travel history, and more comfortable caring for a child who has traveled or will travel internationally. Conclusions: While we did not find statistical significance in overall self- perceived cultural humility after completing the simulation, pediatric residents felt more prepared to care for children after international travel as a result of participating in this educational intervention. Further data is required to determine if statistical significance would be achieved with increased numbers of participants. Based on post-scenario feedback and observations from scenario facilitators, minor adjustments will be made in future iterations of the scenario to better meet the educational objectives outlined for the participating pediatric residents.
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.
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.
Career Mentors & 5-Year Data on the IUSM Anesthesiology Match
(2022-04-28) Yu, Corinna; Ye, Jian; Boyer, Tanna; Mitchell, Sally
Introduction: The IU Department of Anesthesia provides Anesthesiology Career Mentors to 3rd and 4th year medical students. We have approximately 47 requests per class year. In the past 5 years, we have matched 181 students into Anesthesiology, averaging 36 students per year (range 30-46). Where do these students match into Anesthesiology? How many of them use the Career Mentorship program? If they don’t choose Anesthesiology, which other specialties appeal to them? Objective: The purpose of this presentation is to examine the pipeline of students interested in anesthesiology who request a career mentor and match into anesthesiology. Methods: Match data from publicly obtained IUSM Graduation Booklets for the Class of 2017 through 2021 was filtered for those students matching into Anesthesiology Residency Programs. These programs were mapped and cross-referenced for medical school rankings based on the 2022 US News & World Report Medical School Rankings for Research. Anesthesiology career mentorship requests were tracked starting in 2019 for the class of 2020 onwards, so students who matched into Anesthesiology were cross-referenced with students who had formally requested Anesthesiology Career Mentors in 2020 and 2021. Students who had formally requested Anesthesiology Career Mentors in 2020 and 2021 were also cross-referenced with the IUSM Graduation Booklet data to see how many of these students matched into Anesthesiology or other fields. Results: Of the 181 students that have matched into Anesthesiology from 2017-2021, 63 students matched at IU (35%). The rest are distributed across the regions of the US, including residency programs at the top 25 medical schools including Harvard, NYU, Duke, Stanford, and UCSF. The majority of students matching into Anesthesiology request Anesthesiology Career Mentors, with 73% (48/66) of students assigned to mentors in the graduating class of 2020 and 2021. 96 mentors were requested in the class of 2020 and 2021, with 29 students (30%) not matching into Anesthesiology. These students may have changed careers and not applied to Anesthesiology. Many of these students choose to pursue other specialties, including Internal Medicine, Radiology, Pediatrics, Family Medicine, General Surgery, Obstetrics-Gynecology, Orthopedic Surgery, and Psychiatry. Some students were not listed in the IUSM Graduation Booklet or did not have a residency listed. Conclusion: Limitations of this analysis include students’ choice to publish their Match data in the IUSM Graduation Booklet and the possibility of some students being lost to follow up due to not graduating yet or changing their name. No direct link can be made between formally assigned Anesthesiology Career Mentors and the Match, especially since some students may have sought out informal mentorship. Anesthesiology continues to be a competitive field with high student interest. More research can be done to understand factors that influence student decisions for specialty and to track student alumni and follow their career progression into fellowship and the physician workforce. Additional data collection on the usefulness of the career mentorship program and ways to improve and further support student career choice and Match success will be especially helpful as Step 1 changes to pass/fail.
Medical Student Concerns for Respiratory Protection on Anesthesiology Elective
(2022-04-28) Yu, Corinna; Webb, Timothy; Guillaud, Daniel; Mitchell, Sally
Introduction: Anesthesiologists perform aerosolizing procedures including endotracheal intubation, necessitating the use of personal protective equipment (PPE) such as N95 masks during the Coronavirus Pandemic. Medical students rotating on anesthesiology electives are similarly exposed to potential viral transmission during these procedures. Objective: This study compares student responses to concerns about their respiratory protection in 2020 vs. 2021. Methods: Medical students rotating on the Adult Anesthesia Elective (2020) and the Anesthesiology & Perioperative Medicine Elective (2021) were assigned to read, “Respiratory Protection for Healthcare Workers” and answer “Do you have any concerns about your respiratory protection?” 61 students completed the assignment in 2020, and 74 students in 2021. These responses were analyzed and coded for themes. 10 themes emerged for students who were concerned with their respiratory protection, and 4 themes emerged for students who were not concerned. Basic percentages were calculated and the number of students expressing various themes in their responses was summed and compared between 2020 vs. 2021. Results: In 2020, 35% of students were concerned about their respiratory protection, decreasing to 28% in 2021. Reasons for students not being concerned include the availability of PPE, vaccination status, testing patients for COVID pre-operatively, and the option to avoid the risk. Reasons for concern included the aerosol-generating nature of intubation, N95 masks should be single use, patients not being tested for COVID properly and failed fit tests and mask seals (only in 2020), availability of PPE, fear of being a vector, and not doffing properly. Long-term COVID complications and ability to socially distance at work were also concerns in 2020. Conclusion: Student concern with respiratory protection decreased from 35% to 28% from 2020 to 2021. One of the primary differences is that students were vaccinated in 2021. Students not concerned displayed confidence in PPE availability and patients testing negative for COVID-19 prior to OR procedures. In addition, some students commented on their ability to avoid risk by not caring for COVID-positive patients, although one student commented this hindered their education. Student concerns included viral transmission during aerosolizing procedures and the observation of N95 mask reuse, which is not advised. Some students were not able to get a fit test due to PPE shortages or had failed their fit test in 2020. Facial hair and having a beard was a concern in both 2020 and 2021 for proper mask fit. Other students feared being an asymptomatic carrier and acting as a vector to their patients and loved ones. Similarly, they worried that the testing window for patients was too wide. Students in both 2020 and 2021 expressed concern about self-contamination from not doffing their PPE properly. A few students commented on the unknown long-term effects of COVID-19 and the inability to socially distance at work. Generally, students were not concerned with PPE availability and their personal safety in the clinical environment on their anesthesiology elective. As the pandemic continues to evolve, time will tell if we can continue to maintain PPE supplies, effective vaccines, and work to decrease student concerns.
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.
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.
Investigating the Effectiveness of Case-Based Learning Sessions for Integrating Anatomy Content
(2022-04-28) Merritt, Emily R.; McNulty, Margaret A.; Neal, Chemen M.; Deane, Andrew S.; Haywood, Antwion A.; Byram, Jessica N.
Introduction: Adjusting to medical school can be challenging as students learn to adapt to the curriculum’s fast pace and content volume. Gross anatomy, embryology, and histology are increasingly integrated into medical curricula, with the responsibility placed on students to find and understand the relationships between these content areas. Case-based learning (CBL) is an effective and commonly used means of teaching in medical education, and its application of problem-solving skills to clinical cases make it a useful method for integrating content. Study Objective: Therefore, the goal of this research was to assess the effectiveness and value of CBL sessions in integrating gross anatomy, embryology, and histology and promoting effective study techniques. Methods: In 2021, Indiana University School of Medicine implemented a pre-matriculation program (termed “Leadership and Academic Development”, or LEAD, Scholars) targeted toward under-represented students in medicine. The program included content from the first block of the medical anatomy course and four fully integrated CBL sessions that each included anatomy, embryology, and histology content from the upper extremity and thorax. LEAD Scholars (n = 25) were divided into groups of six or seven; for each session, they completed an individual pre- and post-quiz and worked as a group to answer case questions. Cases consisted of one or more clinical scenarios and questions that required students to interpret images, complete matching exercises, and make diagrams or flow charts. Students completed a post-session survey with Likert-style questions and free responses about preparation and session effectiveness. Pre- and post-quiz scores were compared using Wilcoxon signed rank tests. Free responses were analyzed using thematic analysis. Results: Analyses revealed a significant improvement on post-quiz scores for all CBLs (p≤0.002). In the post-session survey, students strongly agreed the sessions were effective at improving their understanding of course content and appropriately connecting anatomy, embryology, and histology content. Students commented that they enjoyed the real-life application of the material, found the sessions helpful for making connections between the topic areas, and encouraged them to keep up with the material. They noted that adding more cases and providing more pre-work to guide preparations would improve the sessions. Students also discussed needing to change their study habits as the sessions progressed and noted difficulty in keeping up with the embryology and histology content in light of the volume of gross anatomy material. Conclusion: These results suggest that CBL sessions are a viable means for delivering integrated medical anatomy content to medical students and providing opportunities to practice and adapt study techniques. Session modifications will focus on expanding the sessions to provide more opportunities to practice the content and study techniques and including specific pre-work activities to guide preparation.
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.
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.

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