Presentation 1 - IMPROVING STUDENT TEAMWORK IN THE PRECLINICAL CURRICULUM
Best Oral Presentation Award Nominee

Henrike Besche

Harvard Medical School

 

PURPOSE Recently we changed our preclinical curriculum to case-based collaborative learning (CBCL). In CBCL students apply what they learn at home to a new case in class. Classroom discussions alternate between students working in small teams and group discussions. Classes are designed to foster critical thinking and students find CBCL classes stimulating and engaging. However, students reported problems in working as a team. Based on this feedback we set out to: 1) Understand the experiences student were having; 2) Test an intervention to see if team dynamics could be improved.  METHODS A validated team performance scale was combined with two-open-ended questions. This survey was administered to all teams in the course at several time points, including before and after an intervention. Mixed methods were used to categorize team effectiveness and identify common characteristics.  RESULTS Without intervention about half of the teams showed signs of dysfunction. The most successful teams had a process in place in how they went about their work and succeeded at creating a safe learning environment. When given a structured activity to set team norms, team function improved significantly. Importantly, both dysfunctional teams and teams that reported great interpersonal relationships struggled with creating respectful discourse.  CONCLUSIONS Interpersonal and communication skills are essential to the medical profession and traditionally taught in context of clinical care. The CBCL curriculum provides rich opportunities for students to hone interpersonal and teamwork skills in the preclinical curriculum if given appropriate resources. Supporting students in creating psychologically safe teams and raising awareness on "group think" is essential for students to form effective teams and engage higher order critical thinking.

 

Presentation 2 - Facing uncertainty in the GME learning environment: perceptions and experiences of internal medicine residents and attending physicians at a US academic medical center
Best Oral Presentation Award Nominee

Galina Gheihman

Harvard Medical School

 

PURPOSE Clinical uncertainty is pervasive in medicine, yet many clinicians are uncomfortable with uncertainty and unwilling to acknowledge it. Studies link intolerance of uncertainty to burnout, ineffective communication strategies, cognitive biases, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical setting and the perceptions of physicians and trainees facing uncertainty. Understanding clinicians' experiences may help improve how physicians and patients acknowledge, manage, and cope with uncertainty, as well as identify educational strategies for promoting tolerance of uncertainty among trainees. METHODS This mixed-methods study investigated perceptions and experiences of uncertainty in the clinical environment among internal medicine residents and attending physicians at a single US academic medical center. A survey, semi-structured interviews, and in-person observations were conducted. RESULTS Regression analysis of validated survey instruments assessing stress, burnout, and tolerance of uncertainty demonstrated resident physicians (n=35) have more perceived stress from uncertainty than attending physicians (n=14) (15.6 [5.0] vs. 19.0 [3.6], p<0.05), and significantly higher symptoms of burnout (7.1 [2.9] vs. 4.9 [2.0], p<0.05). Perceiving the learning environment as more competitive and/or stressful strongly correlates with an increased reluctance to disclose uncertainty (r= -0.44, p<0.01). Qualitative analysis revealed four themes: (1) a desire to communicate uncertainty to patients; (2) the influence of authority; (3) role modeling to promote tolerance of uncertainty; and (4) embracing uncertainty is not part of formal medical curricula. CONCLUSIONS Uncertainty is inherent to medicine; yet strategies to tolerate and manage uncertainty in the clinical setting and teach residents such skills are lacking. We found that level of training and role impacts how uncertainty is emotionally perceived and its impact on stress and burnout. Attending physicians can play an important educational role by modeling explicit language and management strategies for uncertainty in clinical encounters. Medical curricula should include formal strategies to acknowledge, embrace, and manage clinical uncertainty.

 

Presentation 3 - LESSONS LEARNED IN CLERKSHIP INNOVATION: A QUALITATIVE STUDY OF THE DESIGN AND IMPLEMENTATION OF LONGITUDINAL INTEGRATED CLERKSHIPS
Michael J. Chilazi

Harvard Medical School

 

PURPOSE Longitudinal Integrated Clerkships (LICs) are growing internationally as an alternative to Traditional Block Clerkships. In LICs, medical students participate in the comprehensive care of patients over time, maintain continuing learning relationships with preceptors, and meet the majority of core clinical competencies across disciplines simultaneously. In the process of developing the first multi-year, comprehensive LIC in the United States as its core clerkship model, the Kaiser Permanente School of Medicine recognized an absence in the literature of an empirical study, survey, or review of LIC leaders' perspectives on LIC design. Therefore, we interviewed LIC leadership across the United States, Canada, and the United Kingdom to fill this gap. METHODS Using convenience sampling, we conducted in-depth, semi-structured interviews with leaders (i.e. clerkship directors, discipline directors, or administrative coordinators) of established LIC programs to explore experiences related to designing and implementing LICs at their institution. We performed qualitative thematic analysis on interview transcripts. RESULTS We interviewed 29 participants representing 20 LICs. Major themes identified key challenges in LIC implementation and possible solutions. These included: (1) Administration: facilitating continuous learning relationships with preceptors and patients requires substantial administrative support and technological solutions; (2) Faculty development and support: outpatient education necessitates targeted faculty development and support that acknowledge current practice and productivity demands; (3) Buy-in: appealing to outcomes data and shared professional values promotes engagement of key stakeholders; and (4) Comparability: rigorous program evaluation enables innovators to demonstrate comparable learning outcomes, validate innovations, and contribute to the literature. CONCLUSIONS Program leaders experience similar challenges when designing, implementing, and expanding LICs, highlighting future opportunities for collaboration to identify solutions. Further, this analysis provides  lessons that may be helpful to innovators in clinical education working on approaches other than LICs.

 

Presentation 4 - TEACHING THE "KIND CARE BUNDLE" - A TRANSITION TOWARD COMPASSIONATE CARE
Cynthia Cooper
Harvard Medical School

 

PURPOSE Simple behaviors can have a dramatic impact on patient-clinician relationships. We developed a bundle of concrete verbal and non-verbal behaviors for showing attention, consideration, and compassion in patient interactions. The "Kind Care Bundle" curriculum was taught to medical students immediately prior to the start of their clinical rotations. This abstract describes the curriculum and the students' assessment of the teaching session. METHODS The curriculum was taught over five weekday mornings in three-hour sessions. Students met with an author (CC) in five groups of 8 peers and were asked to reflect on a time they felt cared for or witnessed compassionate care. The "Kind Care Bundle" or the Three Es - was then introduced. The Three Es€“Entrance, Encounter, and Exit- outline compassionate behaviors for each element of a patient interaction. Subsequently, pairs of students interviewed inpatients with an aim to practice the Three Es and solicit patients' perspectives on compassionate care. A de-brief culminated the session. Participants completed a post-session evaluation to assess the curriculum and report their motivations to use the Bundle in clinical rotations. RESULTS 37 of 40 eligible students participated. Students highly rated the curriculum's organization, relevance and their likelihood to use the Bundle again. Qualitative analysis revealed students' valued the Three E's as 'simple ways to make a patient feel valued,' 'very useful and important to keep in mind when facing burnout,' and 'being a kind person is as important as understanding medicine.' CONCLUSION The "Kind Care Bundle" curriculum was well-received by participants, prompting medical students to identify memories and experiences of compassionate care and practice concrete behaviors to improve student-patient interactions. It may have use in other health professions student and clinician populations and at other institutions.