Komal Kochhar
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What Factors Influence the Choice of Residency Graduates to Serve in Medically Underserved Areas or Health Professional Shortage Areas?
Dr. Komal Kochhar is the Director of Educational Affairs Data Analytics and the Director of Research in Medical Education in the Dean’s Office of Educational Affairs. She is an Assistant Research Professor in the Department of Family Medicine and an Assistant Research Professor in the Department of Anatomy, Cell Biology and Physiology at the Indiana University School of Medicine.
In order to plan effective healthcare workforce development initiatives, it is important to understand the reasons why the Indiana University School of Medicine (IUSM) residency and fellowship graduates choose to practice in specific locations. Understanding where the IUSM residents and fellows go after completing their training, and understanding the factors that affect those decisions has become very important, especially due to the shortage and mal-distribution of physicians in Indiana. Dr. Kochhar’s research has been used by institutional officials and state policymakers for strategic planning to improve residency training programs and to develop incentives for the resident physicians to remain in Indiana and to practice in medically underserved areas.
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Item An Online Resident-as-Teacher Curriculum Improves First-Year Residents’ Self-Confidence Teaching in the Clinical Learning Environment(Springer, 2023-07-05) Kochhar, Komal; Cico, Stephen J; Whitaker, Nash P; Pettit, Katie E; Brokaw, James J; Nabhan, Zeina MWe implemented an online Resident-as-Teacher curriculum for all incoming residents (PGY1s) to provide them with a basic foundation for effective teaching in the clinical learning environment. The curriculum consisted of 5 asynchronous modules delivered via the web from 2017-2021. Prior to starting the course, the PGY1s completed a self-assessment of their teaching ability (pre-test) and then again 7-8 months after completing the course (post-test). Analysis of the paired data from 421 PGY1s showed a statistically significant improvement in the self-ratings of their teaching from pre-test to post-test (p < 0.001). Our findings suggest that an online Resident-as-Teacher curriculum can produce lasting benefits in new residents’ self-confidence as educators.Item Pilot Study Evaluating a Post Hospital Follow-Up Curriculum for Internal Medicine Interns(2023-04-19) Frontera, Eric D; Ho, Monling; Kochhar, KomalObjective or purpose of innovation Successful hospital follow-up visits can prevent medication errors and mitigate readmissions. Medical education curricula typically focus on how transitions of care are forwarded to providers within an inpatient setting, or from inpatient to outpatient; however, there is little formal training among Internal Medicine (IM) residents in performing ambulatory hospital follow-up visits. Innovation Design A novel curriculum was created whereby IM interns (PGY1) attended a one hour-long interactive lecture that was offered virtually and in-person. The interns observed patient scenarios that highlighted hospital follow-up tasks, which were then used to create a checklist for the learner to apply to their clinic patients. Evaluation Plan: methods and measures Before and after attending the interactive lecture, the interns were asked to complete a pre-test (n=14) and post-test (n=12) regarding their knowledge and attitudes about hospital follow-up visits. PGY2&3 IM residents (n=26) were also asked to complete the pre-test, but were not asked to attend the interactive lecture. This was done to establish a baseline of clinical competence that might be expected in more experienced residents. Outcomes Chi-square analysis revealed no significant differences between the pre-test and post-test results of the PGY1 interns. In comparison to the more senior residents (PGY2&3), the interns remained significantly less likely (p< 0.05) to be confident in their ability to conduct hospital follow-up visits; to identify ways that hospital follow-up visits can help them understand inpatient care and management strategies; to consider social determinants of health as barriers and as possible triggers for readmission; and to be confident identifying next steps in patient care management following hospital discharge. Innovation’s strengths and limitations Our biggest limitation was the small sample size which may have obscured any impact of the intervention. There are ongoing efforts to replicate this intervention with larger sample size.Item Implementation of an Annual Education Day to Foster Medical Education Scholarship in a Regional Campus System(2023-04-19) Kochhar, Komal; Soleimani, Leila A; Byrne, Bobbi J; Stefanidis, Dimitrios; Pettit, Katie E; Zakeri, Bita H; Denny, Kim; Brokaw, James J; Wallach, Paul MPurpose/Background The Indiana University School of Medicine (IUSM) employs a large geographically distributed system of medical education comprised of 8 regional medical campuses statewide and the main medical campus in Indianapolis. An inherent challenge of operating such a large multi-campus educational system is being able to provide professional development opportunities for all our medical educators across the state. Design/Methods To address the professional development challenge in a large multi-campus system, our steering committee planned an inaugural “Education Day” in 2020, which attracted proposals of educational innovations and scholarship from across the statewide system. After a peer-review process, the accepted proposals were scheduled for oral and poster presentations, workshops and small groups sessions, and themed sessions. A keynote address was given by a nationally recognized medical educator. The day ended with an awards ceremony for “best” faculty, staff, and student presentations. The Education Days were held in-person on the Indianapolis campus in 2020 and 2022; and it was held virtually in 2021. Outcomes/Results Across the 3 Education Days: ~250 registrants participated each year ~130 proposals were received each year; in 2022, we included an additional 40 proposals from medical students statewide regarding their Scholarly Concentration projects1 80% of the post-event respondents rated Education Day as excellent/very good 87% strongly agreed/agreed (SA/A) they were better able to collaborate with other IUSM medical educators 79% SA/A they were better able to identify best practices in medical education 72% SA/A they were better able to publish educational outcomes data To facilitate statewide dissemination, the presentations were archived in the University’s ScholarWorks Digital Repository.2 Strengths/Limitations IUSM’s Annual Education Day has established itself as a successful venue to share educational best practices and to forge new collaborations. Feasibility/Transferability Although the time and resources required for a successful Education Day are substantial, this event can be replicated elsewhere.Item Implementation of a Foundational Online Resident-as-Teacher Program for All First-Year Residents(2023-04-20) Kochhar, Komal; Dilly, Christen K; Cico, Stephen J; Whitaker, Nash P; Pettit, Katie E; Brokaw, James J; Nabhan, Zeina MPurpose/Background Residents are expected to teach medical students, and yet few enter post-graduate training programs prepared to do so. Each year at the Indiana University School of Medicine, 400 first-year residents (PGY1s) from multiple specialties begin their post-graduate training. Our goal was to implement a school-wide Resident-as-Teacher (RasT) curriculum for all incoming PGY1s to provide them with the requisite pedagogical skills and self-confidence to teach effectively.1 Design/Methods We required that our curriculum be delivered asynchronously and on-demand to avoid having to schedule numerous in-person training activities across multiple teaching hospitals. We used the A3 problem-solving process2 to create a series of online training modules delivered via Canvas from 2017 to 2021. These modules focused on our institutional and clerkship learning objectives and incorporated videos of best practices for teaching in the clinical environment. Prior to the start of the course, the PGY1s completed a self-assessment of their teaching ability (pre-test) and again 7-8 months after completing the course (post-test). Outcomes/Results Of the 1,091 residents who completed the pre-test, 421 also completed the post-test (38.6%). Analysis was limited to 421 respondents who completed both the pre-test and post-test (paired data). According to the McNemar-Bowker Test, there was a statistically significant improvement in the teaching self-ratings from pre-test to post-test, e.g., 31% self-rated above average/excellent versus 53% self-rated above average/excellent (p < 0.0001). Moreover, the PGY1s self-reported significant improvements in 3 teaching skills: Teaching Strategies, Individualized Teaching, and Providing Feedback (p < 0.01). Strengths/Limitations Our findings suggest that an online RasT curriculum can produce lasting benefits in PGY1’s self-confidence as teachers (Kirkpatrick levels 1 and 2a) but is limited by the inability to assess higher-order benefits like behavioral change (Kirkpatrick levels 2b, 3, 4).3 This online approach to RasT training is feasible to administer, fulfils LCME requirements, and can easily be replicated.Item Program Brochure - 4th Annual IUSM Education Day(IUSM, 2023-04-28) Kochhar, KomalAn inherent challenge of operating a large multi-campus educational system is being able to provide professional development opportunities for all our medical educators across the state. To address this need, we implemented an annual “Education Day” at Indiana University School of Medicine to promote educational scholarship across our nine-campus system. Held each spring, Education Day showcased the educational scholarship of our faculty, staff, and learners, and provided a forum to share best educational practices and forge new collaborations in educational research.Item Program Brochure - 3rd Annual IUSM Education Day(IUSM, 2022-04-28) Kochhar, KomalAn inherent challenge of operating a large multi-campus educational system is being able to provide professional development opportunities for all our medical educators across the state. To address this need, we implemented an annual “Education Day” at Indiana University School of Medicine to promote educational scholarship across our nine-campus system. Held each spring, Education Day showcased the educational scholarship of our faculty, staff, and learners, and provided a forum to share best educational practices and forge new collaborations in educational research.Item Program Brochure - 1st Annual IUSM Education Day(IUSM, 2020-03-06) Kochhar, KomalAn inherent challenge of operating a large multi-campus educational system is being able to provide professional development opportunities for all our medical educators across the state. To address this need, we implemented an annual “Education Day” at Indiana University School of Medicine to promote educational scholarship across our nine-campus system. Held each spring, Education Day showcased the educational scholarship of our faculty, staff, and learners, and provided a forum to share best educational practices and forge new collaborations in educational research.Item Adaptability in Medical Education: 2nd Annual Indiana University School of Medicine Education Day Program(IUSM, 2021-04-22) Kochhar, KomalProgram for the 5th annual Indiana University School of Medicine Education Day held virtually on April 22, 2021. An inherent challenge of operating a large multi-campus educational system is being able to provide professional development opportunities for all our medical educators across the state. To address this need, we implemented an annual “Education Day” at Indiana University School of Medicine to promote educational scholarship across our nine-campus system. Held each spring, Education Day showcased the educational scholarship of our faculty, staff, and learners, and provided a forum to share best educational practices and forge new collaborations in educational research.Item Asian American Experience in the Largest Allopathic Medical School(2023-04-28) Chen, Steven X.; Wang, Manda Y.; Padgett, Craig M.; Kochhar, Komal; Ko, PaulAsians generally comprise around 20% of medical professionals but make up about 7% of the United States population. They are considered an overrepresented minority within the field of medicine. We studied the Pan- Asian diaspora at the only allopathic medical school in Indiana by identifying relationships and trends of medical students. The percentage of the Asian population in the state of Indiana is approximately 2.7%. The Indiana University School of Medicine possesses two unique qualities that make it stand out among its counterparts and suitable for a study regarding representation across Indiana and comparable midwestern schools: 1) It has nine statewide campuses covering the entire state, and 2) it is largest medical school in the nation. In this cross-sectional study, we obtained matriculation and graduation data from classes entering IUSM between 2013-2022. Data were de-identified per protocols within IUSM’s Business Intelligence office. IRB review not required due to a determination of not human research. The racial category of Asian was determined by self- identification on one or more application and/or onboarding forms. It includes, but is not limited to, Chinese, Filipino, Indian, Korea, Indian, Japanese, Vietnamese. The category may also include those who identify as two or more races. Excluded are American Indian, Alaska Native, Native Hawaiian, Pacific Islander. Asian representation at IUSM were comparable to the overall representation of Asians in medicine. While regional variation differed among each of the nine statewide campuses, the population of Asian students were overrepresented compared to their respective campus’s county population. There was also no significant difference between Asians and non-Asians matching outside of Indiana for residency nor was there any selection for a specific specialty (e.g. primary care, surgery). Our work stands to highlight the importance of quantifying the Asian experience and to benefit future work in diversity, equity, and inclusion. The Asian experience is unique when considering the group’s underrepresentation in society but overrepresentation in the medical field. Given the “model minority” myth surrounding Asians at large, more data and studies are needed to examine and understand the experience of medical students as they interface with the hidden curriculum and patient care.Item Inspired to Learn: Integrating Pre-Clinical Respiratory Educational Principles into Clinical Clerkship Practice(2023-04-28) Sharpe, Shannen; Friel, Rylee; Barron, Emily; Shockley, Emily; Thamba, Aish; Bontrager, Erin; Ganapaneni, Sruthri; Stoll, Kennedy; Vellutini, Natalie; Roy, Lynn; Cooper, Shannon; Kochhar, Komal; Carlos, GrahamIntroduction: IUSM students have reported on the Graduation Questionnaire (GQ) that there is a lack of pre-clinical content incorporated into clinical rotations. Student performance on respiratory/pulmonology questions on the USMLE Step 1 and 2 exams is similar to other medical disciplines at IUSM, despite feedback from students that the Pulmonary Grand Rounds (PGR) teaching method is very effective. Rather than presenting content via recorded didactic lectures, the PGR team, composed of a multidisciplinary physician panel, presents clinical vignettes in an interactive setting. Furthermore, according to student feedback, the current model lacks a sufficient content review of relevant Phase I material. Students have requested additional support with pre-clerkship study/review materials content. Through this study, we aim to empirically evaluate the impact of designing interactive pre-clerkship modules reviewing relevant Phase 1 PGR material on the medical knowledge and clinical competencies of Phase II students. Background: The American Medical Women’s Association organization called for scholarship pertaining to educational innovation. The PGR curriculum provides us with a unique opportunity to evaluate the impact of undergraduate medical education on student knowledge retention and engagement from a metacognition perspective. A diverse group of students and faculty was pulled together with the IUSM Research in Medical Education unit to creatively address the ability to quantify engagement and knowledge retention above in a scholarly project. PGR is a unique multi-modal teaching design built at a large medical school with nine campuses to increase student engagement via zoom, Top Hat, and a case-based teaching approach with a multidisciplinary panel. Study objective: Evaluate student engagement and knowledge retention through clerkship standardized examination performance, Step 2 performance, and GQ with the implementation of a spaced repetition learning model comprised of interactive pre-clerkship modules which reinforce session objectives introduced in pre-clinical education. Methods: In Phase I, PGR includes over 200 board-style questions throughout nine sessions. Students engage with the medical content by answering these questions on TopHat and discussing the reasoning for correct vs. Incorrect answers with the expert panel. Students are again tested over similar content during their local and NBME exams. We proposed the creation of an optional module for each clerkship for students to use prior to Phase II. The modules would include a question bank supplemented with videos to foster preparation and enhance performance on clinical clerkships and Step 2. This question bank would utilize the same questions students had originally seen in PGR months earlier to improve concept retention and memory. The instructional videos would connect physiology to the clinical scenarios the students expect to encounter during their clerkship. We would anonymously track student engagement through a pilot-tested survey and performance on the modules along with clerkship National Board of Medical Examiners exams, Step 2, and the GQ. Finally, we plan to assess knowledge gaps to supplement future grand rounds curriculum while providing clinically relevant information to improve patient care.