Going viral: a scoping review of the current state and impact of online research dissemination in emergency medicine

James Gray

Cincinnati Children's Hospital

The use of free, open-access medical education (FOAM) and other online methods for the dissemination of new knowledge and research continues to increase. This scoping review aims to map and synthesize the literature describing the use of novel, online tools for the dissemination of emergency medicine research and create a conceptual model representing a modern understanding of dissemination for researchers. We searched the traditional literature via Pubmed, CINAHL, EMBASE, ERIC, and SCOPUS, and the grey literature via internet search engines. We included 73 out of 874 abstracts and articles identified, 58 of which were from the traditional literature. We identified 7 primary domains represented in the literature: integration with traditional sources, quantitative measurement of novel dissemination methods, online communities of practice, professional development, quality assessment, advantages and disadvantages of FOAM, and a scoping review of FOAM for knowledge translation. Online methods to disseminate new research are reaching new importance for researchers, but significant gaps exist in the understanding and measurement of its potential. Researchers and research networks should leverage their skill and knowledge to help provide better understanding of these novel tools. 

Addressing the Pediatric Rheumatology Workforce Shortage Through a Dedicated Early Exposure Elective in Pediatric Rheumatology

Katherine Schultz

Cincinnati Children's Hospital

Objective

The pediatric rheumatology workforce shortage is worsening as few medical graduates pursue this subspecialty. The root cause remains unclear, but research suggests the lack of early exposure may contribute. We created DEEEPR (Dedicated Early Exposure Elective in Pediatric Rheumatology) and assessed the impact of early exposure on medical student interest in pediatric rheumatology. We hypothesized DEEEPR would generate interest in pursuing pediatric rheumatology. 

Methods

DEEEPR, designed via adult learning-theories, was introduced in 2016 and included a weeklong experience for third-year medical students and 2- or 4-week long experiences for fourth-year medical students. A prospective, survey-based educational study was conducted in 2018-2019 to evaluate the impact of DEEEPR on career discernment. 

Results

In the four years following the implementation of DEEEPR, the number of third-year medical students rotating on pediatric rheumatology ranged from 24-43 students. This was a notable increase from 8 students the year prior to DEEEPR implementation. The number of fourth-year medical students rotating in pediatric rheumatology did not change as a result of DEEEPR. 

Following elective participation, 38/59 (60%) of all students indicated they had increased interest in pursuing pediatric rheumatology. On a follow up survey assessing long-term impact of the curriculum, 13/34 (38%) participated, and none of the 13 indicated they still wanted to pursue pediatric rheumatology. 

Conclusion: 

DEEEPR was successful in increasing the number of third-year medical students exposed to pediatric rheumatology and increased initial interest in a career in pediatric rheumatology, although this interest was not maintained long-term. 

CHANGE-Asthma: A Mixed Methods Evaluation of a Novel Educational App for Asthma

David Swetland

Cincinnati Children's Hospital

Background: Asthma education is an important component of asthma management and control. With the COVID-19 pandemic, standard asthma education was affected by a transition to telehealth visits, preventing hands-on education experiences for pediatric patients and their caregivers.

Aims: The goal of this study was to evaluate the effects and utility of the CHANGE-Asthma app, an educational bundle of augmented reality-based smart games, educational videos, and an asthma action plan, on caregivers of pediatric patients with asthma who have been seen in subspecialty telehealth clinics.

Methods: This was an explanatory, sequential mixed methods study. Quantitative data consisted of a childhood Asthma Control Test (cACT), a knowledge assessment, and time spent within the app. Qualitative data consisted of semi-structured interviews and evaluation by thematic analysis to develop recurring themes related to their experience. 

Results: There was no statistically significant change in the cACT or knowledge assessment scores when evaluating pre- and post-intervention scores. Time spent within the app significantly decreased after the first week; the mean total time spent within the app was 8.6 minutes over an average of 14 weeks (range 9-19 weeks). Several themes regarding the app developed from thematic analysis: usability, real-world application, who might benefit the most, saturation of knowledge, response to augmented reality, and novel ideas for future iterations. Caregivers stated how they utilized augmented reality as deliberate practice to improve their skills. 

Conclusion: With this mixed methods approach, we evaluated caregivers’ real-world usage of a mobile health app and obtained personal insight into the utility of novel technologies for patient education. 

Validation and use of an Induction of General Endotracheal Anesthesia Checklist Assessment for Medicals Students in a Clinical Setting during their Introductory Anesthesiology Clerkship

Wendy Nguyen
University of Minnesota Medical School

Background:

The American Association of Medical Colleges deemed performing lifesaving procedures such as airway management a medical student competency for transitioning to residency. Anesthesiology clerkships provide the unique opportunity for medical students to practice these procedures in the safe and controlled operating room environment. Given limitation of practicing procedures in simulation centers, we aim to validate a Checklist we developed for use in the clinical setting where medical students perform the steps of safely inducing general anesthesia with endotracheal intubation. 

Methods:

We validated the Checklist by aligning the Checklist with our clerkship objectives, modified it based on feedback and after trialing it. Using paired t-tests, we calculated pre- and post-clerkship Checklist scores to determine curriculum efficacy. The baseline Checklist was done at a simulation center, whereas the post-clerkship Checklist was performed in the clinical setting. The P value of <0.05 was determined to be statistically significant. We examined agreement between overall scores with intraclass correlation coefficients (ICC).

Results:

Fourteen medical students participated in the study.  The ICC for agreement was 0.881 (95% CI: 0.357, 0.969) and ICC for consistency was 0.934 (95% CI: 0.807, 0.978). There was a statistically significant improvement in the score from baseline to final evaluation of 3.9 points (95% CI: 2.5, 5.2; p<0.001).

Conclusions:

We validated our Checklist. The statically significant change in Checklist scores suggests that our medical students gained knowledge and experience performing procedures during the clerkship and were able to demonstrate it during the Checklist assessment in a clinical environment.  The Checklist may be used as an objective measure for medical students to achieve competency.

A Collaborative Qualitative Research Study to Develop a Content-Valid Rubric for Distance Vision Subjective Manifest Refractometry

Amy Jost
Cincinnati Eye Institute

Background: Refractometry a skill that is difficult for beginners to learn and challenging for the evaluators to assess. A well-constructed rubric can provide guidance as a training tool to the novice refractionist and as an assessment tool to the instructor. 

Purpose: A new rubric was created to provide clinical educators with a content-valid, internationally-standardized rubric to teach and assess competency in subjective refractometry. 

Methods: A panel of seven international content experts participated in a qualitative research study to create a distance vision subjective manifest refractometry rubric by identifying the key steps of the procedure, determining performance levels of competency, and creating behavioral descriptors for each procedural step and level of competency. The rubric was reviewed by a total of 32 international subject-matter experts from 18 countries and from various roles, to ensure content validity. 

Results: This internationally-standardized rubric is a content-valid competency assessment tool that could be applied globally to teach and assess distance vision manifest subjective refractions.

Conclusions: It was important to collaborate with international subject-matter experts to develop a rubric that was specific enough to ensure proper steps are being followed, yet flexible enough in the wording that is can be adapted to regional/local methods. 

Additional rubrics for near vision refraction, cycloplegic refraction, and other ophthalmic skills are being considered.

“Having Your Back While Keeping Your Gaze Forward”: Longitudinal Coaching Relationships and Their Effect on Feedback Processes - A Grounded Theory Study

Priya Jain
Ann & Robert H. Lurie Children's Hospital


Purpose: Health professions educators have begun shifting their views of feedback from one-directional giving of information to bi-directional dialogue that also incorporates how learners receive and process that information. This shift foregrounds the role of educational alliances. This study explores how longitudinal relationships between trainees and faculty coaches influence feedback processes and what factors help or hinder these relationships and processes.

Methods: The authors used constructivist grounded theory methodology and performed semi-structured interviews of pediatric fellowship trainees, faculty coaches and program directors from two pediatric subspecialty fellowship training programs. Both programs had previously implemented longitudinal Clinical Coaching Programs. Interviews were conducted between 2019 and 2020.

Results: The authors identified significant positive influences of effective longitudinal relationships between faculty coaches and trainees. These influences shaped both enactments of the coaching role and feedback processes that fostered their success in key ways, A primary success factor was reflected in the individualized tailoring of feedback and coaching processes based on a growth mindset, trainee feedback preferences, and knowledge of prior coaching conversations. In addition, multiple factors hindered successful coaching relationships. These barriers included (a) inadequate preparation for coaching conversations, (b) lack of specific feedback provided by the coach, and (c) coaches’ failure to encourage trainees to develop individualized improvement goals.

Conclusions: Simply providing feedback to trainees no longer suffices in today’s health professions education landscape. Feedback processes embedded within coaching programs enable faculty coaches to develop strong longitudinal relationships with trainees and to implement individualized coaching techniques. These growth-oriented educational alliances support trainees in fundamental ways, namely in processing feedback and guiding development of personalized learning goals. Clinical training programs can help their trainees foster invaluable skills that promote life-long learning and continuous self-improvement.

Camp for Children with Diabetes: A Multi-Disciplinary Medical Staff Simulation Training Curriculum

Erin Atwood

Cincinnati Children's Hospital

Appropriately trained medical staff and a medically safe environment are critical at diabetes camps. We designed a simulation-based curriculum for training medical staff to manage common diabetes scenarios in a camp environment. Camp medical staff from a variety of disciplines participated in three simulation scenarios focused on responding to diabetes emergencies (hypoglycemia and hyperglycemia with ketosis) and addressing use of insulin pumps. Scenarios were developed utilizing the conceptual framework of cognitive load theory and purposefully included background distractions to mimic a camp environment. Participants completed demographic surveys (including profession, prior experience in diabetes) and workload assessments. Twenty-five medical staff completed the surveys; most were female, aged 25-34 years, and physician trainees (residents, fellows). The majority of medical staff (N=16) had some diabetes training prior to camp orientation. However, very few had experience with or training in diabetes technology or emergencies that required the administration of insulin or glucagon. Workload assessments, completed at the beginning and end of camp by the simulation participants revealed a statistically significant decrease in temporal demand (p = 0.03) felt by the medical staff. Our simulation curriculum addressed a knowledge gap related to emergency management of diabetes and understanding of diabetes technology. It also was successful in demonstrating a decrease in temporal load or time demands reported by the participants. Next steps include comparative studies of simulation vs. standard orientation on medical staff knowledge and cognitive load, and evaluation of camper outcomes.