HPEC Poster Session 2021

Permanent URI for this collectionhttps://hdl.handle.net/10125/72053

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Addressing Microaggressions in Healthcare
(2021-02-13) Burrell, Patricia; Smitten, Jayne; Higgins-Mahe, Michelle
Microaggressions in the classroom and workplace have a long history. Their occurrences interfere with an engaging, inclusive, and respectful work environment. Utilizing a Trauma-Informed Care approach helps to address some of these issues. It acknowledges the possibility that people may have already experienced trauma and addresses the additional trauma from the microaggressions. Microaggressions will specifically be addressed by: 1) Creating an ethical environment in the healthcare workplace 2) Expand upon a culture of civility and kindness 3) Treat students, faculty, and others with dignity and respect 4) Expand upon healthcare workplace and classroom efforts to identify and address microaggressions, bullying, and incivility We will be expanding upon workplace efforts to address the perpetrator and the victim of microaggressions, bullying and incivility. Utilizing a trauma-informed care approach, we are identifying and intervening and thus preventing the person from re-experiencing the trauma or being re-traumatized. An example is preventing repeated experiences of microaggression resulting in ‘radical battle fatigue’ (JAMA Reference). Trust is a major issue that is destroyed through microaggressions. The trauma-informed care approach reestablishes trust in the educational environment. Leveraging increased awareness and understanding will help reduce the expressions of microaggression resulting in more effective interactions with faculty, students, and colleagues. Addressing microaggressions is one step toward reestablishing a safe and trusting healthcare environment. The issues of Safety, Choice, Collaboration, Trustworthiness and Empowerment are all part of the Trauma-Informed Care approach. The intent of this presentation is an introduction to the pre and post ‘diversity engagement’ survey we will be conducting for our healthcare academic environment, College of Health and Society.
Identifying and Filling the Need for a Social Justice Interdisciplinary Elective
(2021-02-13) Gorenflo, Rachel; Ines, Eden; Schiff, Teresa
Racially motivated homicides, fights over land and water rights, and the disproportionate way COVID-19 has affected marginalized communities, has awakened our nation to the prevalence of social inequality and sparked a revolution for social justice. To achieve health equity solutions, professionals across disciplines must collaborate. Current attempts at JABSOM and the University of Hawaiʻi (UH) to promote interdisciplinary education among Hawaiʻi’s future physicians, nurses, social workers, public health workers, and lawyers have been stunted due to conflicting schedules and geographic distance between campuses. Now, with the prevalence of online learning, students may find more opportunities for schedule overlap and geography will no longer be an issue. This course will be an important first step toward integrative and collaborative solutions to improve the health of our communities.
The Effectiveness of a Virtual Interprofessional Teamwork Simulation Exercise for Nursing, Pharmacy, Social Work and Medical Students at the University of Hawaiʻi
(2021-02-13) Wen, Aida; Wong, Lorrie; Arndt, Robin; Tokumaru, Sheri; Katz, Alan; Esquivel, Monica; Miyasaki, Alison; Kawakami, Chad; Masaki, Kamal
Introduction: The University of Hawaiʻi Health Sciences Schools has been conducting the Hawaiʻi Inter-Professional Team Collaboration Simulation (HIPTCS) exercise since 2014. It was originally designed to have most students work together at one site, and collaborate with students from one discipline (pharmacy) at a distant site. Due to the COVID-19 pandemic, this exercise was converted to an entirely virtual format. Objective: To compare the efficacy of the entirely virtual format of HIPTCS to the original format, and to determine its impact on interprofessional core competencies.
Student Pharmacists Develop and Implement a Virtual Diabetes/Pre-Diabetes Education Program
(2021-02-13) Luna, Brittany; Quach, Henry; Okamoto, Kimo; Carlisle, Robert; Masuda, Camlyn
Due to the recommendations for social distancing to prevent the spread of COVID-19, in person office visits were cancelled or transitioned to telehealth services to patients without urgent medical issues and all healthcare students had limited opportunities for direct patient care. To improve access to care for patients with diabetes (DM) and pre-diabetes (pre-DM) and to increase opportunities for direct patient care, the pharmacy students at the University of Hawaiʻi at Hilo Daniel K. Inouye College of Pharmacy (DKICP) created a Diabetes Education Webinar (DEW) It program to provide free virtual diabetes education classes. The program consisted of four weekly 30-minute classes offered to patients with DM or pre-DM and their family/friends using a virtual platform called Zoom. In collaboration with the University Health Partners of Hawaiʻi -Family Medicine Clinic, patients were also offered individual appointments with a family medicine resident prior to or immediately after the class to develop individual care plans for managing their diabetes. The topic of the classes included: 1) Overview of diabetes, 2) Managing diet, 3) The importance of and examples of different exercises, 4) Medications and adherence techniques. The program was held twice from Oct-Dec 2020 to allow participants flexibility in attending different classes. The class content was created and presented by different student pharmacists completing their advanced pharmacy practice experience (APPE) rotations. A clinical pharmacist, Dr. Camlyn Masuda, reviewed the content of and supervised each class. Advertising of the DEW IT program consisted of electronic messages and letters to patients with DM or pre-DM. As an incentive to attend, participants who attended all four classes in the program were eligible for a certificate of completion and a free pillbox.
Trends in Opthalmologists’ Recommendations to Patients for Prevention of Age-Related Macular Degeneration
(2021-02-13) Card, Kevin; Golez, Jamie; Ing, Malcolm R.
Age-related-macular degeneration (AMD) is the most common cause of visual loss in the western world. One major emphasis in ophthalmologists’ practice has been on methods to prevent or mitigate the development of AMD. Several factors have been shown to oppose the development of AMD, including: not smoking, maintaining a normal BMI, AREDS2 vitamin supplementation, and consuming a Mediterranean diet. Although significant associations between AMD and the aforementioned risk factors have been reported and cited in the literature, it is not known what impact this information has exerted in clinical practice and to what degree each of these interventions are actually recommended to patients.
Knowledge of Business Practices in Healthcare: The Overlooked Non-Technical Skill in General Surgery Residency Training
(2021-02-13) Camacho, Matthew R.; Chun, Maria B.J.; Murayama, Kenric M.
General surgery training has undergone significant change over the past few decades. Technical innovation has prompted residency programs to accommodate with adjustments to curricula (e.g., laparoscopic and endovascular training). Similarly, the non-technical aspects of surgery practice have been increasing in complexity with stricter coding compliance, growing liability concerns, and decreased reimbursements (1). The lack of a formal training curriculum places general surgery graduates at a disadvantage for success in future practice, translating to difficulty in transitioning from residency to the attending role (2). Despite this, a majority of general surgery residents and attendings do not receive adequate training in these areas; however, there clearly is interest. A recent survey found that 87% of surveyed program directors believed that general surgery residents should be trained in business and practice management (3). Additionally, a survey of all general surgery graduates in the United States, from 2009-2013, indicated a desire for more training in all areas of practice management, particularly, medical coding, contract negotiations, practice management, and insurance billing (4). In the past decade, there has been an increase in the incorporation of business and practice management curricula in general surgery residency. This is less the case for other aspects of the business of healthcare. There are, however, some examples of curricula in various general surgery residency programs across the country as well as other related specialties (e.g., plastic surgery, orthopedics, obstetrics and gynecology, and radiology). By conducting a literature review, we intend to identify and emulate best practices and incorporate novel experiences for general surgery residents at the University of Hawaiʻi (UH). References: 1. Fakhry SM, Robinson L, Hendershot K, Reines HD. Surgical residents' knowledge of documentation and coding for professional services: an opportunity for a focused educational offering. Am J Surg. 2007;194:263–7. 2. Napolitano LM, Savarise M, Paramo JC, et al. Are general surgery residents ready to practice? A survey of the American College of Surgeons Board of Governors and Young Fellows Association. J Am Coll Surg. 2014;218:1063–72. 3. Lusco VC, Martinez SA, Polk HC Jr. Program directors in surgery agree that residents should be formally trained in business and practice management. Am J Surg. 2005;189:11–3. 4. Klingensmith ME, Cogbill TH, Samonte K, Jones A, Malangoni MA. Practice administration training needs of recent general surgery graduates. Surgery. 2015;158:773–6.
Qualitative Assessment of Anki as a Tool for Medical Education
(2021-02-13) Koshi, Elliott J.; Nielsen, Torbjoern N.; Fujiuchi, Bradley L.; Walter, Mattia J.N.; Kuniyoshi, Chaz C.; Sakai, Damon H.
Research has shown that active recall testing and spaced repetition improve long-term retention of information (1). Anki is a free, open-source platform that applies these in the form of user-created flashcards. Anki flashcards have been a favored method of studying for medical students across the nation. Anki flashcards were developed for the first-year medical students at the John A. Burns School of Medicine (JABSOM) by second-year medical students. Anki flashcards were based on topics covered in the cardiology and pulmonology unit, and organized into “decks” based on each problem-based learning (PBL) session. “Decks” were sent out once all first-year medical students had completed the respective PBL sessions. After each “deck” was sent out, a follow-up survey asked for the perceived usefulness of the “deck” using the Likert scale. To assess the project’s impact on students’ overall learning, 16 questions were included on their final exams [based on our Anki decks]. Finally, an end-of-unit survey was sent out regarding the efficacy, relevance, and practicality of the flashcards using the Likert scale. Reference: 1. Deng, Francis et al. “Student-directed retrieval practice is a predictor of medical licensing examination performance.” Perspectives on medical education vol. 4,6 (2015): 308-313. doi:10.1007/s40037-015-0220-x
Learning Immunology: Using Free Medical Education Video Platforms to Supplement Medical Student Understanding
(2021-02-13) Baniqued, Alyssandra; Murayama, Sarah; Sakai, Damon H.
After administering a curriculum needs assessment to our peers, we observed that most students relied on supplemental videos to further their understanding of difficult concepts, particularly in immunology. Due to the self-directed learning curriculum at JABSOM, students seek resources outside of the classroom to improve learning. Utilizing modules pre-approved by faculty ensures the information is accurate and clinically-relevant. We assigned videos associated with the immunology concepts highlighted during the MD2 unit, including Type I-IV hypersensitivity, rheumatic heart disease, allergic rhinitis, and eczema. Videos were found on YouTube via a channel called Osmosis, a medical education video platform that students have recommended in verbal and written feedback to course directors in the past. Students were asked to watch videos, answer post-video questions, and create case maps related to the videos. Questions pertaining to the immunology video content appeared on the final exam and a survey was completed to identify student impressions of the modules.
Student-Created Video Supplements to the Cardiovascular Curriculum
(2021-02-13) Lee, Gunnar A.
Within a problem-based learning medical curriculum, a challenge is posed to lecturers who must cover a wide variety of material in a limited time. Using the cardiovascular and pulmonology subunit at the John A Burns School of Medicine as an example, discussion of cardiac electrophysiology, cardiac contractility, and the cardiac cycle may be covered within a single, one-hour lecture. Although the material posed in the lecture is sufficient for learning core concepts, anecdotal accounts among JABSOM students suggests that there is a demand for additional learning modalities, particularly in the interactive and visual domains. This is particularly important in the era of COVID when the demand for remote learning has never been higher.
Cross-Cultural Classroom: Assessing Student Opinion of Online, Case-Based Learning Modules Utilizing MRI and XR Technology, in American and Turkish Medical Students
(2021-02-13) Nakamatsu, Nicole A.; Torigoe, Trevor; Mikami, Brandi; Thompson, Jesse D.; Rettenmeier, Christoph; Lozanoff, Beth K.; Kaya, Brock; Smith, Alice; Lee, U-Young; Aytaç, Güneş; Lozanoff, Scott
With the increase of distance learning during the COVID-19 pandemic, there is a need to provide effective medical education remotely. Anatomy education is confronted with unique obstacles due to the complex spatial arrangements that must be mastered to achieve effective understanding. Cultural competency also represents a significant obstacle for achieving academic success when presented to ethnically diverse student populations. The objective of this study was to develop online, case-based anatomy learning modules and assess student perceptions of their educational effectiveness. To achieve this objective, MRI scans of selected cadaveric cases were subjected to a workflow that enabled the development and delivery of online, extended reality (XR) case presentations. It was hypothesized that students will positively perceive online, case-based anatomy presentations, which will enhance learning experiences and encourage medical student exploration and engagement when delivered cross culturally. This hypothesis was tested through a survey, consisting of six questions, directed at assessing student opinion of online, case-based anatomy learning by cross-cultural cohorts represented by American and Turkish medical students.
Ten Years Experiences of Evidence-Based Simulation Education from International Journal Club
(2021-02-13) Oh, Sanghoon; Lee-Jayaram, Jannet; Hara, Kristine; Park, Hyunsoo; Rhee, Jiyoung; O'Donnell, John; Phrampus, Paul; Lutz, John W.; Henker, Hiroko
Since November 2011, monthly International Journal Club (IJC) has been a unique, online faculty-moderated forum for international simulation fellows to present and discuss peer reviewed simulation-based healthcare education articles. Non-native English fellows at the SimTiki Simulation Center University of Hawaiʻi and the Peter M. Winter Institute for Simulation Education and Research (WISER) University of Pittsburgh selected and reviewed articles for presentation and discussion with participants in an English language academic setting, and a safe space for moderated discussion. Simulation educators from around the Pacific Rim joined as participants and discussants. Monthly IJC agenda, presenting fellows and selected journal articles were recorded in the online data management system, Simulation Information Management System (SIMS® UPMC), used by the two fellowship simulation centers. IJC initially used the GoToMeeting webinar platform (LogMeIn Inc., Boston, MA) and transitioned to Zoom online conference software (Zoom Video Communications, Inc., San Jose, CA). Presenters provide a 15 minutes slide presentation followed by 30 minutes of discussion. The PICO framework of the presented articles guides discussion. Facilitated discussion following presentation is open to all online attendees.
Medical Student Long-Term Skill Retention Following Cardiac Point-of-Care Ultrasound Training Based on the American Society of Echocardiography Curriculum Framework
(2021-02-13) Jujo, Satoshi; Sakka, Brandan I.; Lee-Jayaram, Jannet; Kataoka, Akihisa; Izumo, Masaki; Kusunose, Kenya; Nakahira, Atsushi; Oikawa-Miyoshi, Sayaka; Kataoka, Yuki; Berg, Benjamin W.
Cardiac point-of-care ultrasound (POCUS) training has been integrated into medical school curricula. However, there is no standardized cardiac POCUS training method for medical students. To address this issue, the American Society of Echocardiography (ASE) proposed a basic cardiac POCUS curriculum framework for medical students.
Effectiveness of Just-In-Time Training for Video Laryngoscopy in Emergency Pediatric Intubations
(2021-02-13) Lum, Evan; Aeby, Kagen; Sommer-Candelario, Sheri; Delos Santos, Stephanie; Choi, So Yung; Lee-Jayaram, Jannet
During the SARS-CoV-2 pandemic, use of video laryngoscopy (VL) over direct laryngoscopy (DL) for intubation is recommended to minimize risk by increasing first attempt success and distance from the patient’s airway during this potentially aerosol-generating procedure (1). Additionally, VL may augment emergency pediatric intubations, particularly for providers with less experience (2). Training methods for skill development vary. Just-in-time training (JITT) is an on-the-job, directed training method involving short, step-by-step practice under instructor guidance. JITT decreases procedural skill decay for high-risk procedures and has demonstrated similar intubation times for VL and direct laryngoscopy in experienced providers (3). References: 1. Miller L, Luković E, Wagener G. Guiding airway management and personal protective equipment for COVID-19 intubation teams. Br J Anaesth. 2020;125(3):e288-e290. doi:10.1016/j.bja.2020.06.001 2. Baek MS, Han M, Huh JW, Lim CM, Koh Y, Hong SB. Video laryngoscopy versus direct laryngoscopy for first-attempt tracheal intubation in the general ward. Ann Intensive Care. 2018;8(1):83. Published 2018 Aug 13. doi:10.1186/s13613-018-0428-0 3. Branzetti JB, Adedipe AA, Gittinger MJ, et al. Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay. BMJ Qual Saf. 2017;26(11):881-891. doi:10.1136/bmjqs-2017-006656
Impact of Rater Training on Pediatric Simulation Assessment of Medical Students
(2021-02-13) Mizuo, Barry; Sutton, Cori X.Y.; Kuniyoshi, Chaz; Hong, Travis K.F.; Lee-Jayaram, Jannet
The role of simulation in high-stakes assessments continues to demonstrate increased demand for assessing behavioral outcomes and adoption of competency-based assessment.1 However, without rigorous processes for rater training, high-stakes assessments of student performance in simulation may be open to bias, inconsistency, and lack of fairness.2 Our pediatric simulation session was developed in 2017 to evaluate for medical student entrustability of Entrustable Professional Activity (EPA) #10 - Recognize a patient needing urgent or emergent care and initiate evaluation and management. Incorporation of rater training is essential to ensure better accuracy and reliability of student assessment by our simulation session if it is eventually utilized as a high-stakes assessment by the medical school.
Preparing for the Pediatric Clerkship: MSPREP (Medical Student Preparatory Resource to Excel in Pediatrics)
(2021-02-13) Taum, Courtney K.; Ishida, Lauren; Mizuo, Barry; Len, Kyra
Background: The transition to clinical clerkships brings many new experiences that cause anxiety for third-year medical students. During the pediatric inpatient rotation, medical students describe challenges preparing for family-centered rounds (FCR) and oral presentations. Students have reported feelings of self-doubt, unpreparedness, and anxiety while rotating through the pediatric inpatient rotation. Objectives: Through the implementation of this resource in multiple phases, the primary objective is to decrease medical students’ anxiety regarding rounding and FCR presentations, and to increase preparedness for FCR, each by at least 1 point. Secondary objectives include improving efficiency during rounds and for residents.
Medical Student Knowledge of Native Hawaiian Obstetrics
(2021-02-13) Seamon, Elisabeth; Carpenter, Dee-Ann; Soon, Reni
Indigenous people across the world face large health disparities. Research indicates that cultural insensitivity may contribute to negative health outcomes. Culturally competent care in the health field is needed to help address the disparities. Since the medical school accrediting body, Liaison Committee on Medical Education (LCME), mandated the inclusion of cross-cultural training into the curriculum, much research has been published on the efficacy of teaching methods. Programs that trained students in cultural competency showed increases in knowledge, patient skills, and awareness of factors involved in the patient-provider relationship (Jernigan, et al., 2016). Trainings are usually generalized to more than one culture and some are done in the pre-clinical years. However, students are not able to apply the content to practice or understand specific aspects of a culture in context to a specialty until their clinical 3rd year rotations.
Medical Students for Mental Health: Curriculum Development for JABSOM’s Community Health Program
(2021-02-13) Tamamoto, Kasey; Peric, Alyssa; Taniguchi, Evan
Community Health Programs offered at JABSOM allow students to improve their communication and professionalism while building a sense of cultural humility and social responsibility. These programs are mandatory for all first-year JABSOM students. Through partnerships with community organizations, students learn to promote health and improve the quality of life for individuals in their community. Although JABSOM offers a wide range of Community Health electives, one focused on serving patients with mental health needs was not available in the curriculum. The ‘Medical Students for Mental Health’ (MSMH) elective was developed in June 2018, with goals of increasing student interest in mental health, developing student competence in serving individuals with mental illness, reducing stigmas associated with mental health, and expanding JABSOM’s range of community outreach. The project originally partnered with the Hawaiʻi State Hospital (HSH), a psychiatric forensic hospital. However, in March 2020, due to the COVID-19 pandemic and related precautions to in-person service activities, volunteering with HSH became restricted. In response, project leaders formed a partnership with the United Self Help (USH), a local self-help group that had traditionally offered support groups for individuals suffering from a mental illness. Students helped USH transition their support groups to a virtual interface, and served as support group facilitators.
Curriculum Development for JABSOM’s Learning Communities: Medical Ethics
(2021-02-13) Tamamoto, Kasey; Rousslang, Nikki; Nakashima, Eryn N.; Morihara, Clarke; Peric, Alyssa; Murayama, Sarah; Wong, Vanessa S.; Len, Kyra
In Fall 2020, the John A Burns School of Medicine (JABSOM) implemented Learning Communities for medical students. Learning Communities are intentionally developed, student focused, longitudinal groups of faculty and students that aim to enhance a student’s medical school experience and maximize learning. During a summer elective, second-year medical students designed and implemented a curriculum module to complement an existing Problem-Based Learning module at JABSOM. The module, implemented in December 2020, focused on the ethics of medical aid in dying. This module featured a presentation led by a local physician in Hawaiʻi who has experience with the recently passed “Our Care, Our Choice Act,” which allows terminally ill patients with the capacity to make medical decisions to determine their own medical treatment at the end of their lives. After the presentation, small-group discussions within first-year Learning Community groups took place.
The Creation of a Wellness Panel for JABSOM’s Learning Communities
(2021-02-13) Tamamoto, Kasey; Nakashima, Eryn N.; Rousslang, Nikki; Morihara, Clarke; Peric, Alyssa; Murayama, Sarah; Wong, Vanessa S.; Len, Kyra
In 2020, the John A Burns School of Medicine (JABSOM) implemented Learning Communities for medical students. Learning Communities are intentionally developed, student focused, longitudinal groups of faculty and students that aim to enhance a student’s medical school experience and maximize learning. The curriculum of Learning Communities addresses topics that are difficult to address effectively through classroom lectures but are essential to the development of an effective physician (i.e. wellness/resilience, ethics, professionalism and cultural awareness).
Professionalism at JABSOM: A Professionalism Philosophy to Live By
(2021-02-13) Carpenter, Dee-Ann; Buenconsejo-Lum, Lee; Omori, Jill; Kasuya, Richard
“Professionalism in Medicine” has been an institution-wide initiative to include students, residents, faculty, and staff at the John A. Burns School of Medicine (JABSOM). Professionalism is not well defined at JABSOM, nor is there a clear definition at many other schools. Specific Task Forces over many years contributed to the values and expectations of professionalism at JABSOM which are stated in Graduation Objectives, course handbooks, and several policies including social media use and guidelines for appropriate appearance and attire. Most recently, there have been further professionalism issues, prompting the JABSOM Curriculum Committee to create a Professionalism Task Force in 2020 to: 1) Discuss ways to promote professionalism amongst the student body and the faculty 2) Determine which professionalism issues should be tracked by the Office of Student Affairs 3) Recommend which degrees of infraction should be in the JABSOM students’ permanent record, and which could also be notated in the Medical Student Performance Evaluation (MSPE), which is a summary letter of evaluation intended to provide residency program directors an honest and objective summary of a student's salient experiences, attributes, and academic performance. 4) Establish guidelines for the JABSOM professionalism board, including purpose and membership of the board as well as which professionalism issues should be heard by this professionalism board

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